Valentine’s Day is an annual celebration of romantic love. With love often comes sex. When unprotected, sex can lead to pregnancy and, when unintended, to regret. Unintended pregnancy often leads to family instability, poor educational and labor market outcomes, and lower chances at upward mobility.
The good news is that regulations accompanying the Affordable Care Act (ACA) have made it a little easier to prevent unintended pregnancy. These include a contraceptive coverage provision which requires most private and public insurers to cover all FDA-approved forms of female birth control, with no cost-sharing.
The bad news is that President Trump directed agencies to rescind components of the ACA “to the maximum extent permitted by law” within hours of taking office, placing the future of the contraceptive coverage provision in jeopardy. Repealing this regulation could have devastating impacts on the millions of women (and men) who have benefited from this coverage.
The ACA’s contraceptive coverage has expanded access to millions of women
The portion of women of reproductive age who were uninsured fell by more than one-third in the first two years of the ACA’s implementation. Over 55 million women now have coverage of preventative services (including contraceptives) with no cost-sharing. Prior to the ACA, women using birth control would spend between 30 and 44 percent of their total health care expenditures on contraceptives. For example, an IUD could cost as much as one month’s salary for a woman working full-time at the federal minimum wage. The ACA’s contraceptive coverage has saved contraceptive users an average of $250 annually in out-of-pocket spending—in total, this means about $1.4 billion in savings per year for oral contraceptives alone. Women choosing IUDS and implants—the most expensive yet most effective forms of birth control—experienced an average decline of about 70 percent in out-of-pocket costs.
Improved contraceptive use is one of the major explanations for the decline in unintended pregnancy and abortion in recent years.
Improved contraceptive use is one of the major explanations for the decline in unintended pregnancy and abortion in recent years. Still, 54 percent of unintended pregnancies result from not using contraception, and 41 percent result from inconsistent use. Improving the affordability of and access to contraceptives is critical to further reducing rates of unintended pregnancy in the United States.
With threats to the ACA looming, what can be done?
Repealing the protections in the ACA would put the affordability and consistent use of contraceptives at risk. Millions of women who have been able to access contraceptives with no cost-sharing would again be forced to dedicate non-trivial portions of their paychecks to control their own fertility. Many might be more likely to use contraceptives inconsistently or incorrectly, if they choose to use contraceptives at all.
Thankfully, many states are taking it upon themselves to pass their own laws to retain the contraceptive protections formally guaranteed by the ACA. California, Vermont, Illinois, and Maryland have enacted laws that would effectively preserve contraceptive coverage and, in some cases, expand it by (1) requiring coverage for over-the-counter contraceptives without a prescription, (2) enabling women to get longer-term supplies of oral contraceptives in a single visit, and (3) expanding coverage with no cost-sharing to male sterilization. Legislators in Oregon recently proposed a law that would protect free access to birth control as well as services including prenatal care, well-woman visits, and STI screenings. In January, New York Governor Cuomo announced that his administration would require that insurers cover at least one form of contraception at no cost. Leaders in other states are also pursuing measures to increase information about and access to contraception.
Knowledge is power
It is also essential to improve both knowledge and availability of LARCs (long-acting reversible contraceptives), in order to steepen recent declines in unintended and teen pregnancy rates. Even more importantly, women need good reproductive health care counseling. An Oregon-based initiative that has expanded to nearly 20 states promises to improve the quality of reproductive health care by emphasizing One Key Question on every intake form used by primary care and other physicians: “would you like to become pregnant in the next year?” The answer fundamentally guides what type of care the patient receives, directing women who are not actively seeking to have a child toward the most appropriate forms of birth control, and those who are to good preconception and prenatal care.
The public largely supports birth control as essential to reproductive health care, including 90 percent of Democrats and 70 percent of Republicans. The future of the ACA will have enormous implications on women’s access to contraceptive coverage. Valentine’s Day is all about love, and love without regrets means ensuring access to affordable, effective contraception.