Pass bill to broaden birth control access

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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After the U.S. Supreme Court recklessly overruled Roe v. Wade last year, Minnesota lawmakers are laudably focused on protecting abortion access within the state.

But legislators ought to seize this session as an opportunity to strengthen reproductive health care on multiple fronts. There's more to do in addition to passing the high-profile Protect Reproductive Options (PRO) Act, which has already cleared the Minnesota House and is expected to be taken up by the Minnesota Senate on Friday.

A sensible next step, one that ought to garner bipartisan support, is HF 210/SF 164, a bill that would improve access to long-acting reversible contraception, or LARC, for women served by the state's medical assistance programs. This contraception includes intrauterine devices as well as implants (such as Nexplanon). Both methods provide long-term birth control that doesn't require taking a daily pill and can be reversed later if desired, and both are far more effective than other alternatives, such as condoms.

The bill is championed by DFLers Rep. Kristin Bahner in the House and Sen. Kelly Morrison, a physician, in the Senate. The legislation would fix an administrative snag and make it easier for women on medical assistance to get LARC at a crucial time: in the hospital shortly after giving birth.

The bill has the backing of respected health care organizations in the state. Among them: the Minnesota Medical Association, which represents more than 10,000 physicians, residents and medical students. And, the Minnesota section of the American College of Obstetricians and Gynecologists (ACOG).

An ACOG letter signed by Dr. Siri Fiebiger, a Minnesota physician, to legislators makes it clear why the immediate postpartum time window is so important. "The hospital setting offers convenience for the patient and the health care provider ... . In addition, women are at risk of an unintended pregnancy in the period immediately after delivery as resumption of ovulation may occur shortly after delivery. Studies show between 40% and 57% of women report having unprotected intercourse before the routine six-week postpartum visit."

Another important stat: A 2016 study suggests that up to one-third of new moms may miss their first checkup, illustrating why waiting until then to get LARC is not ideal.

In Minnesota, public medical assistance programs have a monthly enrollment averaging over 1 million, meaning the legislative fix could benefit thousands of women and their families across the state. Public health coverage policy can also influence private health insurance, so there may be a beneficial ripple effect as well if women who have private health plans face the same barrier.

LARC, which is often provided in an outpatient setting, is currently covered for all Medicaid enrollees. So is removal of these reversible contraceptive methods if a woman decides to have another child.

But current policy creates an unfortunate bureaucratic hurdle if a woman wants LARC in the hospital after delivery. The issue involves how hospitals are reimbursed for medical assistance enrollees' labor and delivery. The current method of "bundling" payment for labor and delivery doesn't appear to adequately cover the cost of the LARC device nor the cost to administer it.

HF 210 would sensibly remedy this by requiring separate reimbursement for LARC in addition to labor and delivery costs. This should spur medical providers to offer it shortly after birth, helping more women access it if they want it.

Since 2016, federal officials have strongly urged states to adjust their policies to "optimize" LARC access, with calls to specifically fix the bundled-payment problem. Dozens of other states have heeded this and implemented reform. It's an embarrassment that Minnesota is one of six states that have yet to enact the separate reimbursement or another fix. HF 210 is good policy and long overdue.