Why Women Don’t Think Their Birth Control Is Free

More than half of women are still paying for their contraception despite the Affordable Care Act’s mandate, a new survey shows.

A woman holds prescription contraceptives June 13, 2001 in Seattle, Washington. A federal judge ruled on that Bartell Drug Co., which operates 50 drug stores in the Seattle region must pay for prescription contraceptives, like the birth control pills shown here, for its female employees. The class-action suit was brought against Bartell Drug Co. by Jennifer Erickson, a 27 year-old pharmacist with the company, and may lead employers across the country to do the same.
National Journal
Clara Ritger
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Clara Ritger
May 15, 2014, 12:42 p.m.

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.”

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