Too often, barriers to health care curtail people’s ability to take care of themselves and make critical decisions about their lives, including if and when to have a child. Making decisions about your own body is a fundamental right, and when that ability is curbed, the consequences are far reaching and deeply disruptive. This basic tenant of reproductive freedom has helped usher along decades of progress in gender equity and economic and educational opportunity. After all, when everyone has the ability to plan their own futures, they, their families, and their communities thrive.
Contraception has played a revolutionary role in making this progress possible. With contraception, people are better able to time births and have healthier pregnancies, and fully realize their educational, financial, and professional futures. About one-third of wage gains made by women since the 1960s are the result of access to birth control pills, according to a study by researchers at the University of Michigan. This ultimately improves their lives, the stability of their families, and the well-being of children. It’s no wonder the Centers for Disease Control and Prevention named contraception one of the top ten public health achievements of the past century.
Despite the dramatic positive role contraception has played in this country, it remained out of reach for many who could not afford expensive co-pays or out-of-pocket costs. As a primary care physician for more than twenty years, I saw patients cut their pills in half or skip pills to stretch their prescription a little longer. Others had to settle for a less effective contraception method because they could not afford the out-of-pocket costs for the method that would work best for them. All this changed when the Affordable Care Act (ACA) declared what doctors and women and have long known: contraception is basic, preventive health care . By declaring contraceptives preventive care, the ACA required insurers to cover, without co-pay, FDA-approved contraception methods. This guaranteed patients, regardless of their economic status, the ability to shape their own lives.
With all contraception options accessible and affordable, a person can choose the option that’s best for them, empowering them to prevent unintended pregnancy and plan their future.
Now, this guarantee is under serious threat. House Republicans narrowly passed a bill that will throw millions off their insurance and eliminate coverage requirements for Essential Health Benefits like contraception. Meanwhile, the Trump Administration stands ready to strike Health and Human Services (HHS) regulations that established and clarified some of its key provisions, including no-copay coverage of contraception. In fact, HHS Secretary Tom Price is on record opposing the no-copay contraception benefit – he apparently believes “there’s not one” person who doesn’t have access to contraception. This is simply not true and willfully ignores the lived reality of millions of people.
Without the ACA’s protections, birth control pills can cost as much as $600 a year and highly effective long-acting reversible contraceptives, such as IUDs, can cost up to $1,000. Before the ACA, 55 percent of woman between 18 and 34 reported struggling with the cost of birth control at some point. When birth control is difficult to access, it is used inconsistently, increasing the risk of unintended pregnancy. Since the ACA was implemented, more than 55 million women have gained access to no-copay birth control and women have saved a combined $1.4 billion a year on pills alone. The number of Planned Parenthood patients using IUDs has increased by 91 percent over the past five years now that its initial cost is no longer a concern. With all contraception options accessible and affordable, a person can choose the option that’s best for them, empowering them to prevent unintended pregnancy and plan their future.
The current national political climate is downright hostile toward reproductive rights and health care access , making it imperative that states get two steps ahead of the federal government and protect their residents from egregious attacks on their care. California, Maryland, Illinois, and Vermont already require insurers to cover contraception without co-pay, and many other states, including Massachusetts, Minnesota, New York, and Oregon, are considering similar protections. These proposals will not only protect access to no-copay birth control, in many cases they will expand access by eliminating persistent barriers to care. In Massachusetts, for example, the legislation before lawmakers will eliminate cost sharing for vasectomies, establish no-copay coverage for over-the-counter emergency contraceptives, and require coverage of 12-month prescriptions. This is our opportunity to protect basic reproductive rights from constant attack while building on the promise of the ACA.
A person’s zip code should never determine their ability to access care but now is the time for governors and state legislators to step up and protect access to basic health care for everyone they can. We have made great strides in reducing teen pregnancies, unintended pregnancies and even the abortion rate by prioritizing access to birth control and preventive care. We cannot afford to turn back the clock on such progress. Not now, not ever.
Feature image: UNISON – the public service union, L0059976 Model of a contraceptive pill, Europe, c. 1970. Credit: Science Museum, London. Wellcome Images, images@wellcome.ac.uk, wellcomeimages.org
