In the wake of the Supreme Court’s Hobby Lobby decision, a new commentary in the journal Women’s Health Issues emphasizes the importance of making the most of the contraceptive coverage mandate under the Affordable Care Act (ACA). The commentary focuses on challenges beyond employer objections that could slow privately insured women’s full use of contraceptive benefits, and offers suggestions for “making the most of first-dollar contraceptive coverage.”
The commentary was coauthored by Carol S. Weisman, PhD, distinguished professor of public health sciences and obstetrics and gynecology, and Cynthia H. Chuang, MD, MSc, associate professor of medicine and public health sciences, at the Penn State College of Medicine. It appears online and in the September/October print edition of Women’s Health Issues, the peer-reviewed journal of the Jacobs Institute of Women’s Health of the Milken Institute School of Public Health at George Washington University.
The ACA requires that private insurance plans (except those grandfathered in or exempted due to employers’ religious beliefs) provide women with access to all FDA-approved contraceptive methods without cost-sharing. This first-dollar coverage “has the potential to dramatically shift contraceptive use patterns, to reduce the U.S. unintended pregnancy rate…and to improve the health of women and families,” Weisman and Chuang say. In particular, evidence suggests more women will choose highly effective long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs), that previously would have been too expensive.
However, cost is not the only barrier women face when considering their contraceptive options. Many women may be uncertain about what their plans cover or unaware of the attributes of various methods now within their financial reach. Their primary care providers may not be trained in the provision of LARCs, and insertion of IUDs and implants may require referrals to obstetrician/gynecologists.
To address these challenges, Weisman and Chuang recommend clear communication to the public about the ACA contraceptive coverage mandate and to private plan enrollees about their plans’ contraceptive coverage, as well as training of primary care providers and seamless referral arrangements between primary care providers and those who can provide LARCs. In addition, they call for the “design, assessment, and dissemination of woman-centered information and decision tools to help women make optimal contraceptive choices in the context of their own life circumstances and preferences.” The commentary offers examples of current initiatives in Massachusetts and Pennsylvania to develop and disseminate such decision tools.
“Following the Hobby Lobby decision, many women’s health advocates are focusing—very appropriately—on the ACA’s employer requirements,” said Chloe Bird, editor-in-chief of Women’s Health Issues and senior sociologist at RAND. “At the same time, this commentary reminds us we must also consider how best to ensure that women whose plans entitle them to first-dollar contraceptive coverage are able to learn about and access the forms of contraception that best suit their needs.”
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