Private and Public Insurance Coverage for Contraception
Private and Public Insurance Coverage
The Affordable Care Act (ACA) strengthened affordable access to contraception by expanding the number of Americans with public or private health insurance and eliminating cost sharing for contraception. Scroll down for more background on Medicaid and the ACA's provision on no co-pay birth control.
WHY IS CONTRACEPTIVE ACCESS IMPORTANT?
Women who decide to become pregnant, rather than having it “just happen,” are better prepared emotionally and financially for the demands of parenting. But they can’t make that decision if they lack access to contraception.
Forty-five percent of pregnancies among all women are described by the women themselves as unplanned. Women under age 30 account for the majority of these (nearly 2 million of the 2.8 million unplanned pregnancies in the US). We have seen progress in recent years—as unplanned pregnancies have begun to decline—but more work remains to ensure that everyone has the power to decide.
Unlike many other health issues, unplanned pregnancy is completely preventable. Only 5% of unplanned pregnancies occurred in women using birth control carefully and consistently. The other 95% of unplanned pregnancies occur among women who don’t contraception or who use it inconsistently.
The reasons for this are complex, but it often comes down to a lack of access to the full range of contraceptive options. This is particularly important for people who face the greatest disparities in unplanned pregnancy. For example, the unplanned pregnancy rate remains higher for Black and Hispanic women than for white women, and these disparities remain even when controlling for income.
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 61.4 million women benefit from the Women’s Preventive Services provision. In 2013 alone, women saved at least $1.4 billion in out-of-pocket costs for birth control pills, 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 to choose not to cover some or all methods of birth control. While it is unclear how quickly women (or how many women) may be impacted by this, employers are now permitted to exclude contraception from their plans as the fight will continue in the lower court.
In October 2017, the Trump Administration released two rules that significantly expanded the number of employers eligible for exemptions from covering contraception based on religious or moral objections. Many women could be left without access to no co-pay coverage for some or all methods of birth control if the rules are allowed to go into effect. In December 2017, two federal court judges issued preliminary injunctions to put a stop, for the time being, to the rules. In January and February 2018, the Trump Administration appealed those rulings.
Despite the ongoing cases and preliminary injunctions, the Administration decided to finalize the rules in November 2018. In January 2019, a federal court in Pennsylvania issued a preliminary nationwide injunction.
On January 17, 2020, the U.S. Supreme Court agreed to hear both cases, and consolidated them into one, with the decision handed down on July 8, 2020 (see above).
Current Status: There have been numerous efforts to weaken or dismantle Medicaid, and it is likely to face other challenges in the future. We’ll continue to monitor this and let you know about challenges that could reduce access to high quality contraceptive care through Medicaid.
About Medicaid: 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, 36 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.
Birth control access maps. More than nineteen million women in need of public funding for contraception live in contraceptive deserts (meaning they lack “reasonable access” to a public clinic with the full range of methods). See how your state compares.
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.
Polling on the popularity of birth control:
- Everyone Loves Birth Control
- Survey Says: Power to Decide
- Survey Says: Thanks, Birth Control
- Survey Says: Support for Birth Control
Key Messages on Birth Control Coverage and Access
- 75% of adults favor continuing the Title X Program, including 66% of Republicans and 84% of Democrats.
- 78% of adults agree that birth control is a basic part of women’s health care.
- More than 90% of all Americans (across political parties, race, and ethnicity) agree that for those trying not to get pregnant, using birth control is taking personal responsibility.