Kylie Sparks is a young actress who suffers from a range of medical issues from fibromyalgia to irregular and painful menstrual cycles. Her period was so agonizing that she says, “There were 3 to 5 days a month where I would have to cancel auditions or meetings because not even my strongest prescription pain medication could touch these.” She couldn’t use oral birth control (a common treatment for irregular cycles) because she developed blood clots. Before the implementation of the Affordable Care Act (ACA), and its mandate that private and public health insurance plans cover FDA-approved birth control at no cost, she says she had to put off medical appointments she needed for other conditions just to get treatment for her painful periods, “This was all before the ACA, so these costs, even with health insurance, were ridiculous,” she wrote me in an email.
Kylie told me that her life drastically changed after the ACA passed. Her doctor listened to her medical history and recommended the Mirena IUD, which can act as both a birth control method and remedy for her painful and irregular periods (and lasts 5 years). With the ACA it was free for her. It changed her life, Kylie said.
Now that Congress has taken its first steps to repeal the Affordable Care Act — also known as Obamacare — millions of women across the U.S. are wondering how they are going to pay for their contraception if the provision for birth control disappears, with no adequate replacement.
The ACA requires that a range of preventative women’s health services — including mammograms, screenings for sexually transmitted infections, and HPV vaccinations — are covered in full, with no co-pay. Contraception is a preventative service and so 18 categories of FDA-approved birth control methods are required to be covered by health insurance plans, including Medicaid, as long as they are prescribed by a healthcare provider.
The provision isn’t perfect. It requires that insurance plans make at least one type of birth control available to women, from each of the 18 categories, at no-cost. So, for example, if a particular brand of birth control pill doesn’t work for an individual and her plan only covers that one at no-cost, she may need to cover the cost of a different type that works better for her. There are also exemptions to the law, most notably for religious employer health plans, that have resulted in multiple court battles. But overall the law has worked extraordinarily well, helped to eliminate gender disparities in health care costs, and made it easier for millions of women to access the full range of contraceptive methods.
How well, you ask? At of the end of 2015, more than 55 million women in the U.S. had contraceptive coverage. Since Obamacare was implemented in 2012, women have saved approximately $1.4 billion per year on birth control. The percentage of women with private insurance who pay nothing out of pocket for their birth control skyrocketed from 15% in 2012 to 67% in 2014. It also saves the government billions of dollars, in case you’re wondering.
The rate of unintended pregnancies has also sharply declined over the last four years, as has the rate of abortions. These changes are likely due to women having access to affordable contraception, according to a Guttmacher Institute analysis. And, to be clear, although anti-abortion advocates want to point to increasing abortion restrictions on the state level for the reason abortions have declined –and it is true that restrictions to abortion access contribute to declines — the evidence suggests that improved access to contraception has made the biggest impact on these numbers. The abortion rate has declined in states with more abortion restrictions as well as those without. In fact, according to Guttmacher, over 60 percent of the decline in abortion numbers are in states without new abortion restrictions.
It’s not news that contraception is good for women and their families. When women can decide if and when to have children and have the ability to space their pregnancies, their lives change for the better. In 2016, the Guttmacher Institute asked women about the birth control provision, and a majority reported that birth control has helped them take better care of themselves and their families, extend their education, and support themselves financially.
The birth control provision is also popular with the public. According to the Kaiser Family Foundation, the majority of Americans (71%) support laws that require health plans to cover the full cost of birth control. Even before the ACA was implemented, when the comment period was open for the public to weigh in on Obamacare, the birth control provision received far and away the highest number of comments, with more than 300,000 women’s health advocates in all 50 states supporting the effort.
With all of these positive consequences, there’s a lot on the line if the federal requirement to cover no-cost birth control disappears. It could result in millions of women who can no longer afford to pay for contraception or pay for the most effective long-term methods. One year after Obamacare went into effect, Think Progress noted:
Before Obamacare’s birth control provision went into effect, the high cost of contraception was prohibitive for many women. In fact, research conducted in 2012 found that nearly half of young women said they hadn’t used their birth control as directed in order to cut down on costs. And extremely small numbers of women opted to use the most effective form of contraception — the intrauterine device, or IUD — because it could cost several hundred dollars out of pocket.
If the contraceptive coverage mandate goes away, we’ll once again put women in the U.S. at risk of not being able to afford the tools they need to help prevent unintended pregnancies, space wanted pregnancies, or manage health conditions like endometriosis.
The process of repealing the ACA is in motion and, as of now, President-Elect Trump and the GOP members of Congress who are at the forefront of the repeal push have not put forth a replacement idea. If it’s repealed, the ACA won’t go away until the end of 2017. But that doesn’t leave women feeling much better. Although four states have expanded their coverage of contraception to include no-cost contraception for women with private insurance or Medicaid, if the federal birth control coverage requirement is thrown out, the majority of the 99% of women who rely on birth control at some point in their lives, and the families who depend upon affordable access to contraception for a multitude of reasons, will be left without a critical preventative health service, threatening women’s health and the tremendous public health gains we’ve made in a relatively short period of time.