For many women, it began as a simple question of gender equity. But it's evolved into a constitutional standoff over religious freedom that could go all the way to the Supreme Court.

The issue is whether health-insurance plans that provide prescription-drug coverage must also include coverage for prescription contraceptives.

This week, courts in New York and California wrestled with the question of whether religious organizations opposed to contraceptive use on moral grounds should be exempt from those requirements when insuring their employees. The outcomes of both cases could determine the direction of national trends, which for the last decade have been steadily moving toward required coverage for contraceptives.

"There's a growing consensus in this country that all women should have access to contraceptives because it's a basic healthcare need," says Eve Gartner, a senior staff attorney at Planned Parenthood Federation of America. "But there have usually been fairly vitriolic battles in the state legislatures around this."

The idea of what's come to be called "contraceptive equity" wasn't even on the national agenda until 1996, when Viagra came along. Within seven weeks of that drug's approval by the FDA, more than 90 percent of insurance plans covered it. The birth- control pill, in comparison, had been around for more than 40 years - but was not included in most American insurance plans.

That disparity sparked indignation and sent women's groups on the legislative offensive.

Since then, 20 states have passed "contraceptive-equity" laws - requiring employers who offer prescription-drug coverage to include coverage for prescription contraceptives, including the pill and intrauterine devices (IUDs). Most states, though not all, also have exemptions for churches and other purely religious organizations. In New York and California those exemptions are narrowly defined - and that's what is at issue in the courts.

In New York, the legislation is called the Women's Health and Wellness Act (WHWA). It went into effect in January 2003 and defines a religious employer as, essentially, an entity with the chief purpose of spreading its religious values, and one that primarily employs and serves people who share its religious beliefs.

That was the result of a compromise that settled an acrimonious battle. The state Assembly originally passed a bill with no exemption for religious groups. (Currently, five states have no exemption: Georgia, Iowa, New Hampshire, Vermont, and Washington State.)

The New York Senate's version contained a broad exemption, which would have included any organization "operated, supervised, or controlled by or in connection with a religious organization, denominational group or entity." If that had been approved, the current litigants - among them Catholic Charities - would be covered. But since those litigants lost in the legislature, they went to the courts for relief.

Page: 1 | 2