The ACA Revolutionized Contraceptive Access, but It’s Not Enough — Yet

Safe and effective contraceptives are one of the most significant achievements of modern medicine. Contraceptives help prevent unwanted pregnancies, reduce the risk of diseases and help women manage the sometimes debilitating side effects of menstruation. Access to contraceptives increases bodily autonomy, allowing people to decide on their terms if and when they want to have children. As a practicing nurse in maternal child health, I’ve seen that mothers and babies benefit when families are prepared financially, emotionally and medically for a pregnancy.

But having spent over 25 years in the health care industry, I can say that, despite the tremendous and welcome changes in contraceptive access brought about by the Affordable Care Act, women still face too many barriers in obtaining the birth control they need.

The ACA completely transformed the world of contraceptive access. By defining contraceptives as an essential health benefit, the ACA made it so that contraceptives must be covered at no cost to the patient. This has led to a decrease in costs for most contraceptives and an increase in contraceptive use.

However, we have not yet entered the Golden Age of contraceptive access. While the letter and the spirit of the ACA made it clear that contraceptives are essential care, there remain loopholes to contraceptive coverage. And whenever there are loopholes, there are insurance companies eager to exploit them.

The ACA was thorough in ensuring that all 17 categories of Food and Drug Administration-approved contraceptives — including pills, IUDs, patches, injections and more — must be covered cost-free. But while insurance companies must comply with this mandate, they are not required to cover more than one specific product within each of those categories. That means that a patient may be denied coverage for the contraceptive method, such as a specific birth control pill, that works best for them.

Fortunately, the solution is simple: Issue new guidance and implement enforcement measures. The administration must work across agencies to further clarify the guidance: All FDA-approved forms of contraception without generic equivalents should be covered without cost-sharing. In addition, there needs to be a standardized exception process for waiving the copay for any product that is determined to be the most medically appropriate based on the determination of the attending provider. That process must be easily accessible, transparent and sufficiently expedient and must defer to the attending provider’s determination of medical necessity. A plan or pharmacy benefit managers’ medical management practices cannot supersede the attending provider’s determination.

Determining the right method of contraception for an individual can involve a lengthy trial-and-error process. The same contraceptive may affect women differently based on their unique physiology, medications and underlying conditions. Going through that process only to learn that the product they need is not covered by their insurance and is out of their budget is heartbreaking and leads to suboptimal care. And while it’s true that patients can seek medical exemptions from their insurance, for many women the claims process is an insurmountable barrier and, too often, claims are denied.

The federal government has classified contraceptives as essential health care, which it absolutely is. Women shouldn’t have to choose between paying high out-of-pocket costs for their preferred contraceptive or being forced to settle for a contraceptive that doesn’t work well for them. Insurance companies have far too much power to limit contraceptive choices, and it’s damaging to women’s health, particularly for low-income women who can’t afford to pay additional costs. Unequal access to preferred contraceptives perpetuates disparate health outcomes for lower-income communities.

Thanks to the ACA, we have taken huge strides forward in making contraceptives accessible to women. However, as long as the loopholes that currently exist remain open, insurance companies will continue to prevent women from having full access to the contraceptives they need. Women and their healthcare providers — not insurance companies — are the experts when it comes to knowing what contraceptives work for them. By mandating coverage of the full range of FDA-approved contraceptive products, we can put the power of choice back where it belongs: in the hands of women and medical professionals.

No more exorbitant out-of-pocket costs or daunting claims processes or settling for substandard care. It’s time to fulfill the intent of the ACA and give women the agency to choose the contraceptives they need.


Beth Battaglino, RN-C, is the CEO of HealthyWomen and a practicing nurse in maternal child health at Riverview Medical Center-Hackensack Meridian Health in Red Bank, N.J.

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