More American women are getting free birth control in the wake of the Affordable Care Act, which requires most private insurance plans to pay for contraception with no co-pay or other out-of-pocket costs.
The percentage of women with private insurance coverage getting free oral contraception, or the pill, rose from 15 percent in the fall of 2012 to 67 percent this spring. The ACA’s free birth control mandate went into effect January 2013. Free access to other forms of pregnancy prevention also rose, according to research conducted by the Guttmacher Institute and published online Thursday in the journal Contraception.
“This analysis shows that the contraceptive coverage guarantee under the ACA is working as intended,” says Adam Sonfield, senior public policy associate at Guttmacher and lead author of the study, in a press release. The institute is a nonprofit organization focused on reproductive and sexual health rights, policy and research.
The study found that the proportion of women paying nothing for the vaginal ring rose from 20 percent to 74 percent; those using injectable contraceptives with no out-of-pocket costs increased from 27 percent to 59 percent; and those using the IUD free rose from 45 percent to 62 percent.
So if free contraception is required by the ACA, why haven’t those numbers hit 100 percent?
The paper in Contraception offers a few explanations. The ACA allowed insurance carriers to continue offering grandfathered plans that predated the act, and some do not offer free contraception. Over time, those plans are being discontinued.
But there are lasting exceptions to the rule. If women choose name-brand drugs when generics are available or if they use out-of-network services, they can be charged for it. Also, there are contraception-coverage exemptions for religious institutions and, following the U.S. Supreme Court decision in Burwell vs. Hobby Lobby, for certain closely held businesses.
Additionally, Guttmacher researchers have found that in some cases insurance companies are improperly charging women for birth control.
The data were collected from an online survey of women age 18 to 39 who were questioned multiple times over an 18-month period. More than 4,600 were surveyed initially, but the final analysis was limited to 892 women who responded to four surveys, had private insurance and were using prescription contraception.
The study concludes:
“By guaranteeing that women have coverage for a wide range of contraceptive choices without cost sharing, the federal requirement may help them overcome financial barriers to choosing a contraceptive method they will be able to use consistently and effectively, thus increasing their likelihood of avoiding unplanned pregnancies.”