The proportion of privately insured U.S. women who paid $0 out of pocket for oral contraceptive pills increased sharply, from 15% to 40%, after the Affordable Care Act's (ACA) contraceptive coverage guarantee went into wide effect, according to a new Guttmacher study in the journal Contraception. A similar increase, from 23% to 52%, was seen among vaginal ring users with private insurance.
"Our analysis provides the first quantitative evidence that the cost-sharing protection under the ACA is indeed working as intended," says Lawrence B. Finer, director of domestic research at the Guttmacher Institute and lead author of the study. "Large numbers of women who couldn't previously do so are now obtaining birth control without co-pays or deductibles, which allows them to more easily attain contraception's well-documented health, social and economic benefits."
The Guttmacher study draws on data from an ongoing, nationally representative survey of women aged 18–39, comparing women's responses in fall 2012 (before the contraceptive coverage requirement took effect for most women) and spring 2013 (after the requirement came into force for millions).
"That the benefits for pill and ring users have accrued so rapidly is remarkable, showing that the contraceptive coverage guarantee is meeting a real demand," says Adam Sonfield, senior public policy associate at Guttmacher and study co-author. "And the ACA's impact is certain to grow significantly as its protections, including for contraceptive coverage without out-of-pocket costs, are phased in across the country. The number of covered workers enrolled in 'grandfathered' plans—existing plans given a temporary reprieve from many of the ACA's new rules—has been declining rapidly, as Congress intended, from 48% in 2012 to 36% in 2013."
However, despite the very positive progress for pill and ring users, the study found no significant change over time among privately insured injectable users or IUD users in the proportion who paid nothing out of pocket. According to the authors, this could indicate that some private health plans are not, as required, applying the ACA's cost-sharing protections to "the full range" of female contraceptive methods approved by the Food and Drug Administration.
"Unfortunately, anecdotal evidence from media reports and from health insurance companies' own publicly available documents suggests that some plans are improperly requiring patient cost-sharing in circumstances where they shouldn't," says Sonfield, who also authored a related policy analysis. "This is unacceptable, and state and federal policymakers should step up enforcement as needed."
The extent to which the federal contraceptive coverage requirement will help U.S. women also hinges in part on the U.S. Supreme Court. The Court in late November agreed to decide whether owners of for-profit companies can assert religious objections in order to deny their employees insurance coverage of contraceptive services and supplies in employer-sponsored health plans. If the Court were to grant for-profit corporations such an exemption, its decision could potentially deny the benefits of contraceptive coverage to significant numbers of employees and their dependents.
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Research: "Changes in Out-of-Pocket Payments for Contraception by Privately Insured Women During Implementation of the Federal Contraceptive Coverage Requirement," by Lawrence B. Finer, Adam Sonfield and Rachel K. Jones, has been published online in the journal Contraception.
Policy analysis: "Implementing the Federal Contraceptive Coverage Guarantee: Progress and Prospects," by Adam Sonfield, appears in the Fall 2013 issue of the Guttmacher Policy Review.
The survey on which this study is based was conducted using GfK’s web-enabled KnowledgePanel®, a probability-based panel designed to be representative of the U.S. population. Initially, participants are chosen scientifically by a random selection of telephone numbers and residential addresses. Persons in selected households are then invited by telephone or by mail to participate in the web-enabled KnowledgePanel®. For those who agree to participate, but do not already have Internet access, GfK provides at no cost a laptop and ISP connection. People who already have computers and Internet service are permitted to participate using their own equipment. Panelists then receive unique log-in information for accessing surveys online, and then are sent emails throughout each month inviting them to participate in research.