Eroding the Birth Control Mandate

The Trump administration made its boldest move against contraception access on Friday, when it reversed Obama-era policies requiring most employers to include birth control in employee insurance plans. Nonprofit companies, private firms, and publicly traded companies can opt out of providing birth control through employee insurance plans by claiming a “sincerely held religious or moral objection.” This change was made, effective immediately, with no period for public comment.

If you have insurance that still covers contraception, now might be the time to look into IUDs or implants, which can last for at least three years.

Previously, only a small group of religious employers was exempt from the requirement to include birth control in employee insurance plans; the new rule expands the types of businesses that can claim religious exemptions. Furthermore, these employers need not cite any particular religious beliefs, but can simply claim to have moral objections to birth control in order to opt out of including contraception in employee insurance plans.

The ruling drew condemnation from the American Congress of Obstetricians and Gynecologists, Planned Parenthood Federation of America, the American Civil Liberties Union, the National Women’s Law Center, and the Center for Reproductive Rights.

Under the provisions of the Affordable Care Act, contraception is considered a “preventive” service and, therefore, legally must be made available with no out-of-pocket costs to patients. Zero-copay birth control, as this is called, has saved users and their families billions of dollars in the years it has been in effect.

While this rule doesn’t completely roll back zero-copay birth control overnight, thousands or even millions of women with employers purporting religious convictions or moral qualms may have to start paying full price for their birth control if coverage is dropped from their insurance plans. There are many varieties of birth control, and while some can be relatively inexpensive, costs can cut across a wide range. According to Bedsider, birth control can cost anywhere from the tens to the hundreds of dollars:

  • birth control pills: $10 to $113 per month
  • birth control shot: $50 to $120 per three months
  • vaginal ring: $55 per month
  • contraceptive implant: $450 to $848 (three years)
  • copper intrauterine device (IUD): $500 to $739 for ParaGard (10 to 12 years)
  • hormonal IUD: $500 to $858 for Mirena or Kyleena (five years)

Switching to a cheaper form of contraception can cause hardships to users, who may be forced to use formulations that cause more side effects, or that lack desired features. Some users might favor one brand of pill over another, as one might be better for managing conditions like endometriosis, menstrual cramps, or even acne. Some users may prefer the convenience of the patch, ring, or shot, which don’t have to be taken every day like a pill. And, finally, some highly effective birth control methods, like IUDs and implants, are so expensive that many users cannot afford to pay for them out of pocket.

Lately, there has only been one bit of good news in terms of contraception access, which is that Tom Price, a fierce opponent of reproductive rights, resigned as secretary of Health and Human Services last month. The HHS secretary has the power to declare that contraception is not a “preventive” service insurers must make available to their customers with no copay. In one fell swoop, the HHS secretary could undo the enormous progress the Obama administration made in expanding access not just to all forms of contraception, but also to highly effective forms of contraception that had for so long been out of reach to so many.

For now, we can only hope that the next person at the helm of the Department of Health and Human Services will recognize that expanded access to contraception improves the health and wealth of women and their families, decreases incidence of unintended pregnancy — and saves taxpayer money.

To learn about birth control, make an appointment at your local Planned Parenthood, where a health care provider can review your options with you and help find something appropriate for your lifestyle and preferences. If you have health coverage that includes birth control, you should still be able to get it with zero copay — for now. If you’re worried about your access to birth control in the future, now might be the time to look into the implant or an IUD, methods that can last for at least three years and up to 12 years.