Barriers to ACA's Contraception Mandate Remain: Part I


For millions of women, the contraceptive coverage guarantee under the Affordable Care Act (ACA) has already had profoundly positive effects. A 2015 report by HHS estimated that more than 55 million women now have preventive services coverage without any cost sharing for contraceptive services and supplies.
 
But even with the promise of expanded contraceptive coverage, millions of American women are facing daunting barriers as they attempt to access those benefits.
 
Obamacare’s impact on access to contraceptives
The impressive gains cited in that HHS report have occurred largely since female contraception was added to a list of preventive services covered by the ACA in 2011. The federal mandate applies to all new health insurance plans with plan years beginning on or after Aug. 1, 2012.
 
Since then, private insurers have been required to pay for birth control methods approved by the FDA, sterilization procedures for women, and patient education without out-of-pocket costs. These benefits must cover the clinical visit and services, follow-up care and management of side effects, counseling for continued compliance, and device insertion and removal at an in-network provider.
 
The contraceptive mandate’s impact on public health has been huge.
 
“The ACA is insistent that we include contraception coverage as regular health care,” said Georges Benjamin, MD, executive director of the American Public Health Association. “It expands the access significantly and normalizes it as part of regular medical care.”
 
During their medical appointments, patients have the opportunity to discuss the full range of contraceptive choices. “It’s not just about pills,” Benjamin added. “It’s about sexual health. It’s about reproductive health and various options. It allows that discussion to occur in a trusted environment.”
 
ACA’s relief from expense of contraception
For decades, the overall cost—including deductibles and co-payments—had posed significant barriers for women to access their preferred contraceptive methods, said Susan Berke Fogel, JD, director of reproductive health at the National Health Law Program in Los Angeles. (NHeLP advocates for the rights of low-income and underserved individuals and families on federal and state levels.) Many of those barriers have been lifted—to a large degree—through the implementation of the law’s contraception mandate.
 
“When women have the contraceptive that works best for them and their lifestyle, they’re more likely to use it consistently,” Fogel said. And consistent usage reduces unintended pregnancies.
 
Empowerment to control their own reproductive lives also contributes greatly to the economic prosperity of women and families. Having a child has implications for a woman’s financial well-being, job security, workforce participation, and education, according to the National Women’s Law Center. “Access to reproductive health care helps to ensure that women and families make that decision for themselves, when they are ready,” the organization has posted on its website.
 
Without insurance coverage, those health care services can be costly. The average cost of a year’s worth of birth control pills amounts to approximately $370—or about 51 hours of work for a woman earning the federal minimum wage of $7.25. An intrauterine device “can cost a month’s salary for a woman working full time at minimum wage,” according to the Guttmacher Institute, a research and policy organization focused on advancing sexual and reproductive health and rights.
 
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