In June 2012, the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act of 2010 (ACA). The ACA, drawing upon recommendations developed by the Institute of Medicine and adopted by the U.S. Department of Health and Human Services (DHHS), requires new private health plans written on or after August 1, 2012 to cover contraceptive counseling and services and all U.S. Food and Drug Administration-approved methods without out-of-pocket costs to patients. For many plans, this requirement took effect in January 2013. However, existing plans are exempt from the requirement so long as no significant negative changes, such as cutting benefits or raising cost-sharing, are made to them; DHHS has projected that most of these plans will likely lose this protected status within a few years. The agency has also approved an exemption for some religious employers, similar to the exemption included in several state laws. In addition, DHHS proposed an additional “accommodation” for entities not eligible for the religious exemption. On June 30, 2014, the U.S. Supreme Court issued another decision that allows closely held, for-profit firms to opt out of the contraceptive coverage mandate in the ACA.
Currently, almost all insurance plans cover prescription drugs, but some still do not provide coverage for the full range of FDA–approved prescription contraceptive drugs and devices. More than half of states, however, require insurance policies that cover other prescription drugs to also cover all FDA-approved contraceptive drugs and devices, as well as related medical services. Some of these state policies allow employers or insurers to refuse to cover contraceptives on religious or moral grounds.
Additionally, federal law requires insurance coverage of contraceptives for federal employees and their dependents; it includes a limited but seldom used exception for religious insurers. In December 2000, the U.S. Equal Employment Opportunity Commission made it clear that an employer’s failure to provide coverage of contraception, when it covers other prescription drugs and preventive care, is a violation of protections against sex discrimination under Title VII of the Civil Rights Act; those protections for employees’ benefits include no exemption for religious employers.
- 28 states require insurers that cover prescription drugs to provide coverage of the full range of FDA-approved contraceptive drugs and devices; 17 of these states also require coverage of related outpatient services.
- 2 states exclude emergency contraception from the required coverage.
- 1 state excludes minor dependents from coverage.
20 states allow certain employers and insurers to refuse to comply with the mandate. 8 states do not permit refusal by any employers or insurers.
- 3 states include a “limited” refusal clause that allows only churches and church associations to refuse to provide coverage, and does not permit hospitals or other entities to do so.
- 7 states include a “broader” refusal clause that allows churches, associations of churches, religiously affiliated elementary and secondary schools, and, potentially, some religious charities and universities to refuse, but not hospitals.
- 9 states include an “expansive” refusal clause that allows religious organizations, including at least some hospitals, to refuse to provide coverage; 1 of these states also exempts secular organizations with moral or religious objections. (An additional state, Nevada, does not exempt any employers but allows religious insurers to refuse to provide coverage; one other state exempts insurers in addition to employers.)
- 14 of the 20 states with exemptions require employees to be notified when their health plan does not cover contraceptives.
- 4 states attempt to provide access for employees when their employer refuses to offer contraceptive coverage, generally by allowing employees to purchase the coverage on their own, but at the group rate.
- United States: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
Monthly State Policy Updates
Get an overview of state legislative and policy activity in all topics of sexual and reproductive health.