Obamacare made contraception free. So why do only 42 percent of sexually active women report having their birth control fully covered?
In part, it's because some women who report using birth control rely on male condoms—which are not covered under the Affordable Care Act's contraception mandate. The health law requires that new insurance policies cover all FDA-approved contraception prescribed for women without cost sharing, meaning that couples using male condoms still have to pay for them.
That's a significant number of women, according to the Kaiser Family Foundation's 2013 Women's Health Survey, released Thursday. Some 63 percent of sexually active women rely on male condoms, and 54 percent rely on one contraceptive method. Compare that with the 48 percent of sexually active women who use oral contraceptives—which include birth-control pills—and the 45 percent who report using two or more contraceptive methods, and it's evident that at least some women are relying on male condoms as their only method of birth control.
Another reason women are reporting that they don't have their birth control fully covered is simply because their insurance plan doesn't have to. According to the survey, 31 percent of sexually active women reported that their insurance covered only part of the costs, which could be because they chose a birth-control method that isn't covered—such as a brand-name drug—or because they went out of their provider network to get it.
Insurers also don't have to provide contraceptive coverage without cost sharing for "grandfathered" plans, the term used to describe older policies that don't (yet) have to meet the Affordable Care Act's coverage requirements. One other exemption is for religious employers who object to contraception—and women on those plans are finding themselves footing the full bill.
Meanwhile, some women simply don't know about the birth-control coverage requirements of the law—and the Centers for Medicare and Medicaid Services is working to fix that. Cara James, director of the CMS Office of Minority Health, said it's drafting an outreach plan to teach the newly insured how to use their coverage, and education about the benefits the law requires is ongoing, especially as the agency gears up for the next open-enrollment period. They're also working to ensure that doctors explain patients' options when they go in for preventive care visits.
And millions of Americans still live without health insurance—which means they've got to figure out how to pay for birth control on their own.
The result is that even with the Affordable Care Act's contraception mandate, 18 percent of sexually active women don't have contraceptive coverage, according to Kaiser's survey.
While nearly half of sexually active women use at least one form of contraception, Kaiser found, one in five aren't using birth control at all. By the time Kaiser conducts its next four-year survey, women's-health experts expect to see the number of women who report having their contraception covered increase.
"I'm holding my biggest smiles for the day when we're much closer to 100," said Amy Allina, deputy director of the National Women's Health Network. "We are certainly aware that cost was and is a barrier to women getting contraceptive care."