Colorado legislation to expand reproductive health coverage nears passage


Boram Kim


The Colorado House Health and Insurance Committee approved Senate Bill 189 on Tuesday, which the bill’s sponsors contend would improve access to reproductive healthcare services by removing economic barriers. The bill passed the Senate last week and now heads with amendments to the House Appropriations Committee for consideration.

Provisions in the bill would require state-regulated health plans to cover abortion, STI, and HIV treatments without cost-sharing or out-of-pocket costs. They would prohibit insurers including Medicaid from applying step therapy or standard prior authorization protocols to deny coverage for HIV treatments.

SB 189 also clarifies existing state and federal statutes that cover drugs and procedures associated with HIV prevention and expands the contraception coverage program for undocumented people to include family planning services. 

The bill sponsors say copayments for reproductive healthcare services are often too expensive to afford, disproportionately impacting BIPOC women. According to the Colorado Fiscal Institute, these barriers cause women of color to have higher rates of unintended pregnancies and a greater need for abortion resources than white women.

“Studies show that unplanned births significantly reduce women’s participation in the labor force and the inability to obtain an abortion undermines career aspirations and achievement,” said the bill’s co-sponsor Rep. Lorena Garcia (D-Adams County). “People who are denied an abortion or who are unable to afford one are nearly four times more likely to live below the poverty line. Studies have found that being denied an abortion increases the amount of debt [that is] 30 days or more past due by 78%. Being denied an abortion also increases the rate of negative public records such as bankruptcies and evictions by 81%.”

The bill’s sponsors say addressing the economic barriers to bodily autonomy will improve equity and access to reproductive healthcare. 

Committee members heard testimony both for and against SB 189 during public comment. 

Pro-life advocates were opposed to the provisions expanding access to abortions, while other community members were against the absence of parental consent for minors to receive contraception and services related to their reproductive health. 

Opponents testified against what they view as the bill’s unfair prioritization of reproductive health over other medical conditions, arguing that STI, HIV, and abortion were the result of life choices around sexual activity. 

“An overwhelming majority of those sexual encounters are completely chosen by their participants,” said Erin Meschke, a resident of Boulder. “Why should we shield people from the consequences of their choices? If people don’t learn cause and effect from a young age, you end up with irresponsible or antisocial personality disorders. I don’t want my tax dollars going to pay for someone’s STI treatment when I have worked hard for my money and control my own sexuality to protect myself from unwanted pregnancies and infections.”

SB 189 is part of a group of bills (along with SBs 188 and 190) called the “Safe Access to Protected Health Care” package. All three bills passed the Senate last week. 

SB 188 would prohibit insurers and other entities, including out-of-state officials, from taking legal and punitive actions against healthcare practitioners for services related to reproductive health rendered in Colorado. 

Meanwhile, SB 190 would restrict deceptive trade practices related to the provision of reproductive healthcare, which the Colorado Catholic Conference (CCC) says would prevent crisis pregnancy centers from advertising.

In an interview with Catholic News Agency this week, CCC Executive Director Brittany Vessely said the proposals would create a way to work around a state constitutional amendment that restricts public funding of abortion. 

“If enacted, [SB 189] would circumvent Colorado’s prohibition against public funding of abortion in the Colorado Constitution by requiring large employer insurance plans to provide coverage for the total cost of an abortion and requiring individual [and] small-group plans to provide abortion coverage,” Vessely said. “Insurance funding does contain public funding—it is ridiculous to assume premiums mean it’s private funding, but this is the argument from bill sponsors.”

The Colorado Association of Health Plans (CAHP) took an “opposed unless amended” position on SB 189, expressing concerns about the costs associated with expanding coverage for STI treatments and implementing the one-day prior authorization timeline for HIV medication.

“Because the bill generally refers to treatment, we don’t know if this could allow for a doctor to determine that a patient’s heart failure is due to an STI from years prior,” CAHP Associate Director Brandon Arnold said. “So we’re concerned that all of the care that could follow from an STI diagnosis to some point could become a first-dollar treatment forever.”