Why is Contraceptive Access Important?
Everyone deserves the power to decide if, when, and under what circumstances to get pregnant and have a child. Contraception, which is available in a wide array of methods, is key for people who don’t want to get pregnant. Unfortunately, there are many barriers to accessing contraception.
For example, more than 19 million women eligible for publicly funded contraception live in what we call a contraceptive desert, meaning they live in a county lacking reasonable access to the full range of contraceptive methods. These barriers put people already struggling to make ends meet at risk of not being able to get the birth control method right for them. They might face additional transportation costs, childcare costs, and unpaid time off of work because of the long distances they need to travel to access care.
To learn more, please see our 2021-22 Federal Policy Agenda and our recommendations on how the Administration can advance reproductive well-being.
Title X Family Planning
About the Title X Family Planning Program
For more than 50 years, the Title X family planning program has played a critical role in preventing unplanned pregnancy by offering high-quality contraceptive services, preventive screenings, and health education to low-income women and men. In addition to Medicaid, Title X is an important part of the health care safety net, and it has widespread support according to polling data.
FY 2024 (October 1, 2023 - September 30, 2024) - Status: In Process
Most recent action: On November 15, the House and Senate passed a continuing resolution (CR)—a stopgap measure to keep the government funded at current levels. The CR funds defense and security related appropriations through January 19, 2024, and domestic appropriations bills—including Labor, Health, and Human Services and Education (LHHS), which funds Title X—through February 2, 2024. It is important to continue to remind members of Congress about the significance of this program for your community and urge them to fully fund it.
What happened previously:
- At the end of September, Congress passed, and President Biden signed, a CR to keep the government funded at current levels through November 17, 2023.
- On June 27, the Senate Appropriations Committee passed its FY 2024 Labor, Health and Human Services and Education (LHHS) Appropriations bill, which maintains level funding ($286.5 million) for Title X. In contrast, the U.S. House LHHS Subcommittee advanced a bill earlier in July, that eliminates funding for the program.
- On Thursday, March 9, President Biden released his budget request for the 2024 fiscal year (FY). It proposes increasing funding for the Title X Family Planning Program from its current level of $286.5 million to $512 million--a 79% increase. The president's budget proposal is just that, a proposal. Congress ultimately has the power of the purse. Read Power to Decide's statement on the president's FY 2024 budget proposal and appropriations request to Congress.
FY 2023 (October 1, 2022 - September 30, 2023) - Status: Complete On December 29, the President signed an Omnibus Appropriations bill into law. The bill funds the federal government through the remainder of fiscal year 2023. Unfortunately, the bill provides flat funding for key programs that provide reproductive health care services and education, including the Title X Program--which is funded at $286.5 million for the 10th year in a row. Please read Power to Decide’s full statement on the Omnibus Appropriations bill.
- FY 2024 Appropriations Request Letter - explains why increased funding for Title X is a priority.
- FY 2022 to FY 2024 Budget Chart.
- NFPRHA’s interactive map contains additional data on Title X.
Title X Domestic Gag Rule
2019 Final Title X Domestic Gag Rule
In 2019, the Trump administration undermined the ability of Title X health centers to provide quality care by enforcing the “domestic gag rule.” To continue receiving Title X funding, clinics were forced to withhold some information regarding abortion services and care and not to provide abortion care at the same physical site where Title X services were provided. Many clinics could not comply with this and roughly 1,000 were forced to leave the Title X program as a result. The loss of this funding meant that these clinics had fewer resources to serve people who depended on them for care. The Department of Health and Human Services (HHS) estimates that between 2018 and 2020 there was a total decrease of 2.4 million people served by Title X clinics. Of that amount, 63% or (1.5 million) was the direct result of the gag rule.
In 2021, the Biden-Harris administration released a new Title X rule that will begin to repair the damage done to the Title X network and help patients to receive equitable, affordable, and client-centered family planning care. The new rule eliminates the gag rule restrictions and paves the way for health centers forced out of the program to rejoin the network of Title X clinics. However, Title X has been chronically underfunded. The program needs a significant increase in federal funding to meet community needs around the country.
Separate from the Appropriations process, in March 2020, the American Rescue Plan (P.L 117-2) included a one-time investment of $50 million in funding for Title X. These funds are not tied to the fiscal year and will be available until expended. (See Power to Decide's statement on the American Rescue Plan.)
The Medicaid program is a partnership between states and the federal government, with several different pathways to eligibility. States have been required to cover family planning services for reproductive age beneficiaries since 1972. States also have the option to provide a more limited set of benefits, such as family planning services, to those with income above the traditional Medicaid eligibility levels. Twenty-six states have federal Medicaid Family Planning expansions. In addition, 39 states (including Washington, DC) have implemented the full Medicaid expansion in order to provide health insurance coverage to low-income, non-disabled adults (a group that was not eligible under traditional Medicaid), as the ACA allows. Medicaid plays a vital role in offering contraception to low-income individuals, accounting for 75% of public spending on family planning.
The Biden-Harris administration has signaled their intent to reverse policies that make it more difficult for people to gain coverage through Medicaid, but Congress must also support policies that expand Medicaid coverage and access to services.
It is important for the federal government not to approve state Medicaid waivers that put up additional barriers to reproductive health care and should also take steps to end existing waivers of that nature. Any cuts or restrictions that reduce access to Medicaid or the contraceptive care it covers undercut contraceptive coverage and access at the same time as states are looking for opportunities to expand that coverage and access.
Read the letter Power to Decide, in conjunction with other reproductive health organizations, sent to CMS on Free Choice of Provider.
No Co-Pay Birth Control
About No Co-Pay Birth Control
Thanks to the Women’s Preventive Services provision of the ACA, women covered by Medicaid expansion, marketplace, and employer-based plans are not required to pay extra out-of-pocket costs for women’s preventive services, which includes birth control. An estimated 62.1 million women benefit from the Women’s Preventive Services provision. Women also saved at least $1.4 billion in out-of-pocket costs for birth control pills in a single year, and there is evidence that the provision is increasing the ability of women to obtain more effective birth control methods for those who want it.
Current Status: In Effect, with Broad Exemptions
On July 8, 2020, the US Supreme Court released its decision in Trump v Pennsylvania. The ruling allows employers and universities to opt out of covering birth control in their insurance plans for just about any reason—leaving people covered by those plans to shoulder the full cost of their birth control without any insurance coverage. While it is unclear how many people may be impacted by this, employers are now permitted to exclude contraception from their plans as the fight will continue in the lower court. The Court ruled that this was within the Trump administration's executive authority to do, and President Biden committed during the campaign to undoing these regulations. The Biden-Harris administration is expected to release new draft rules in 2022.
In addition, as new methods of birth control become available, we know people sometimes struggle to get their insurance plan to cover those methods.
In response to stakeholder feedback about some plans not complying with the Affordable Care Act’s Birth Control Benefit, on January 10, the Biden-Harris administration issued guidance to make sure insurance plans cover the birth control you and your provider decide is right for you, without co-pays or deductibles. Additionally, the guidance directs consumers to report plans that are not covering their birth control as required. If you are facing this issue, please read Power to Decide’s blog post on how to report your plan.
In May 2022, Power to Decide released a new report When Your Birth Control Isn't Covered that reveals troubling new evidence of health insurance companies failing to provide coverage of the full range of birth control options with no out-of-pocket expense, as required under the Affordable Care Act (ACA).
On July 28, the Biden-Harris administration released updated guidance that reaffirms several important standards outlined in the ACA, including the requirement that health insurance companies provide a transparent and easy-to-use exceptions process to help patients get coverage of the contraceptive method that works for them in cases when it is not typically covered by their plan. See Power to Decide's press release on this guidance.
Finally, we know that over-the-counter methods like some forms of emergency contraception and internal condoms are not covered by insurance unless you have a prescription. This is already a problem for people using those methods, and it could become an even bigger problem in the future if some birth control pills become available over the counter.
- Power to Decide: When Your Birth Control Isn't Covered - This report reveals troubling evidence of health insurance companies failing to provide coverage of the full range of birth control options with no out-of-pocket expense, as required under the Affordable Care Act (ACA).
- Kaiser Family Foundation: State and Federal Contraceptive Coverage Requirements—Implications for Women and Employers - This issue brief summarizes the continuing litigation on the federal contraceptive requirement and explains the interplay between the federal and state contraceptive coverage laws.
Over the Counter Birth Control
Latest Action on Over the Counter Birth Control
In July 2022, HRA Pharma submitted the first-ever application to the FDA to make a progestin-only form of daily birth control available over the counter. Power to Decide is a proud member of the Free the Pill coalition, which works to advance reproductive justice and equitable access to birth control pills across the United States.
About Over the Counter Birth Control
Research has shown that when the pill moves over the counter it remains a safe and effective method of birth control. And it’s important to note that over the counter birth control pills wouldn’t remove the need to see a doctor regularly for things such as well woman visits, Pap smears, and IUD placement. By removing the barrier of a prescription, we can increase access not just for the 19 million women in deserts, but for everyone across the country.
Doctors support this effort. The American College of Obstetricians and Gynecologists has stated it believes that the pill should be available over the counter in the US. And the American Academy of Family Physicians supports over-the-counter access to oral contraception without a prescription. The American Medical Association has also recommended that manufacturers of the pill apply to the Food and Drug Administration for permission to switch from prescription to over-the-counter status.
Polling on the popularity of birth control