Insurance Coverage for Contraception Should be a Health Care Standard

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The Trump administration just issued new federal rules that allow employers or insurance companies to stop offering coverage of birth control with no out-of-pocket costs.  These rules take effect immediately.  The rules create large, new loopholes in existing protections from the Affordable Care Act (ACA or Obamacare) that currently require nearly all insurance plans, with exceptions for religious employers, to cover birth control that’s free from out-of-pocket costs.

Making sure all women have access to the tools they need to plan the timing and size of their families is a critical piece of the puzzle in building equal economic opportunity for Texans who aspire to overcome poverty, join the middle class, and enjoy prosperity.  Birth control is also critical for improving public health. Women’s preventive health care—including birth control—helps women stay healthy, have healthy pregnancies, and avoid unplanned pregnancy. Today, over half of Texas births are unplanned. When women lack the tools to plan and space their pregnancies, babies face higher risks of prematurity and low birth weight.

Polling finds that more than two-thirds of Americans (71 percent) support the ACA’s requirement that insurance plans cover contraception with no out-of-pocket costs.  Birth control is one of the most-used preventive health services among women.  Insurance coverage for it should be standard issue, just as recommended preventive care services for children and men are included in insurance plans.

Despite popular misconceptions that contraception is a lowcost service, many women struggle to afford birth control. The most effective forms of birth control, like IUDs, have up-front costs of up to $1,000 and some birth control pills can cost $60 a month.  Even the more affordable generic birth control pills require regular doctors’ office visits.  The cost of contraceptives prevents many women, especially low-income women, from using birth control consistently or choosing the best and most effective form of contraceptive for them.  The ACA’s guarantees that contraception: (1) will be covered by most health insurance, and (2) will not be subject to a copayment or a deductible, has directly translated into millions of women having financial access to the full range of reliable contraceptive methods available to prevent unintended pregnancies and have healthier pregnancies.

The ACA requires most health insurance to cover a full range of cost-effective and proven preventive health care services, including but not limited to, contraception.  The ACA already exempts religious employers, like churches, from the contraception requirement, and makes an accommodation for religiously-affiliated nonprofits and closely held for-profit corporations, letting them opt out of providing coverage for contraception, while still ensuring that women can access contraception separately.   The newly issued rules create broad exemptions from contraception coverage, but with no guarantee of another route for women to get no-cost contraception. These rules will make it much harder for some women to access contraception or sterilization.

When women lose access to affordable contraception, social mobility and financial security can slip further out of reach.  Health insurance plans should cover basic and essential preventive health care services like contraception with no out-of-pocket costs, period.  Insurance companies, employers, and colleges shouldn’t get to pick and choose what health care women can get at affordable prices.

Stacey Pogue joined the center in 2008. She focuses on health policy issues. Before coming to the center, she did health policy and research work with the Medicaid and CHIP Division of the Health and Human Services Commission and the Texas Department of Insurance. In 2010 and 2011, she was selected to serve as a funded Consumer Representative to the National Association of Insurance Commissioners (NAIC). Pogue earned a Bachelor of Science in Geography, summa cum laude, from Texas A&M University in 1997 and a Master of Public Affairs from the LBJ School of Public Affairs at The University of Texas at Austin in 2005.

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