This expansion of contraception coverage is important in light of steep declines in prescriptions for birth control and emergency contraception in states banning abortion.
The Biden-Harris administration last week announced a new proposed rule that would significantly expand access to no-cost birth control under the Affordable Care Act. The rule would require private health insurance to cover all forms of contraception without co-pays, including over-the-counter contraceptives.
“President Biden and Vice President Harris believe that women in every state must have the freedom to make deeply personal health care decisions, including the right to decide if and when to start or grow their family,” said the White House.
Building on the Affordable Care Act’s requirement that most private health plans must cover contraception without cost sharing, the proposed rule would expand coverage to over-the-counter (OTC) contraception without cost sharing, make it easier to learn about coverage for OTC contraception and strengthen coverage of prescribed contraception without cost sharing.
“The Biden-Harris administration has taken an extraordinary step to ensure all women can access the birth control that works best for them by requiring health plans to cover, without cost-sharing, every unique FDA-approved contraceptive product or its generic equivalent both over the counter and with a prescription,” said Rep. Lois Frankel (D-Fla.), chair of the Democratic Women’s Caucus, which led the charge in Congress pushing for legislation and executive action to expand and protect access to birth control.
This change is particularly important in light of steep declines in prescriptions for birth control and emergency contraception in states banning abortion after the Supreme Court overturned Roe v. Wade.
With access to abortion under attack by extreme MAGA Republicans, it is more important than ever that birth control is accessible and affordable.
Rep. Lois Frankel (D-Fla.)
According to a new study published in the top-ranked journal Obstetrics & Gynecology, states enacting the most restrictive laws on abortion experienced about a 5 percent total decline in oral contraceptive prescriptions filled by pharmacies in the first year after Roe’s reversal. In Texas, the rate dropped 28 percent. The declines were particularly dramatic for the emergency contraception pills Plan B and Ella, which dropped 65 percent more in the most restrictive states compared to less restrictive states.
The study authors attribute the decline to the closure of abortion clinics, where many women access prescriptions for contraception. Post-Dobbs, 63 brick-and-mortar abortion clinics in 14 states closed, including 24 in Texas.
Another crucial cause of the decreasing prescriptions for contraceptives is states’ restrictive policies, which include allowances for pharmacists to refuse to provide contraceptives based on their own particular religious, ethical or moral beliefs, dropping ECs from insurance coverage mandates and a lack of over-the-counter coverage for emergency contraceptives for those on Medicaid.
“With access to abortion under attack by extreme MAGA Republicans, it is more important than ever that birth control is accessible and affordable,” said Frankel.
In July 2023, the FDA approved the first nonprescription birth control pill in the U.S.—the daily oral contraceptive Opill, now widely available over-the-counter, but many insurance plans do not cover Opill. The emergency contraceptive Plan B is also available over the counter, but is often not covered by insurance without a prescription. The Biden-Harris rule would require health insurance plans to cover both of these medications without co-pays.
The Obama administration first required coverage of contraception without co-pays under the Affordable Care Act in 2012.
In addition to requiring health insurance to cover birth control without co-pays, the proposed Biden-Harris policy would make it easier to learn about coverage for over-the-counter contraception. To help ensure that women understand this new benefit, most private health plans would be required to disclose that over-the-counter contraception is covered without cost sharing and without a prescription—and take steps to help women learn more about their contraception coverage.
“Today’s proposal to require plans and issuers to cover contraceptive services—without a prescription and at no cost to the individual—is a long overdue step in increasing access to basic, reproductive healthcare to millions of women,” said acting Secretary of Labor Julie Su.
While the Biden-Harris administration is working hard to increase access to contraception, Republicans are trying to restrict access. Last June, all but two Republican Senators voted against the Right to Contraception Act, which would have codified the right to contraception in federal law and guaranteed the right for healthcare providers to prescribe contraceptives and provide information, free from government interference. Republicans in the U.S. House have introduced legislation to defund the Title X Family Planning Program. At the state level, Republican elected officials are trying to ban or restrict birth control. Many falsely claim that emergency contraception and birth-control pills cause abortion.
Meanwhile, Project 2025 would reverse the Affordable Care Act’s requirement that health insurance cover contraception without copays, and would revive the Trump administration’s broad “religious and moral” exemptions to the contraceptive mandate—which allowed employers to deny health insurance coverage for any form of contraception. Project 2025 would also eliminate insurance coverage for the morning-after pill Ella (which, unlike Plan B, requires a prescription).
By contrast, the Biden-Harris administration’s new proposed rule would greatly expand access to contraception at a time when an increasing number of abortion bans and restrictions in Republican-dominated states make avoiding unwanted pregnancies harder and continuing pregnancies more dangerous.
“The proposed rule we announce today would expand access to birth control at no additional cost for millions of consumers,” said U.S. Department of Health and Human Services Secretary Xavier Becerra. “Bottom line: Women should have control over their personal healthcare decisions. And issuers and providers have an obligation to comply with the law.”
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