Monday, August 16, 2021
Accessing contraceptives is a health necessity for many women. Contraceptives help prevent unwanted pregnancy while reducing the risk of diseases including endometrial, ovarian, and colorectal cancers. However, finding and obtaining the right contraceptive method often places an undue financial burden on women, particularly low-income women.
One of the many achievements for patients in the Affordable Care Act was defining contraceptive as an essential health benefit that could be covered at no cost under the bill. This has led to a dramatic decrease in costs for most contraceptives and a dramatic increase in contraceptive use.
Unfortunately, while the Affordable Care Act mandates coverage across the full range of contraceptive methods, it does not mandate coverage across the full range of FDA-approved contraceptive products, and, despite the intent of the bill, contains loopholes that allow insurance companies to deny coverage of certain products to women who need them and shift costs onto patients.
Why does this matter? Not every contraceptive product is right for every woman. Different products have different side effects interactions with other medications and conditions that impact women to varying extents, and some products that are effective for one woman may not work at all for another.
Working with a doctor to find the right product can often be a challenging and lengthy process, and too many women come out of that process only to find that the product their doctor has recommended is not covered by their insurance and out of their budget.
Federal guidance around the Affordable Care Act attempts to protect patients whose provider recommends a contraceptive product out of medical necessity, but the claims process is complicated and many women find their claims denied. Insurance companies have far too much discretion to violate the law as written and intended, and women are suffering as a result.
Far too many women are faced with a choice between paying high out-of-pocket costs for contraceptives on top of their regular care and forgoing contraception that works for them entirely. This issue disproportionately impacts low-income women who can’t afford to make up the difference and contributes to disproportionate health outcomes among lower-income communities.
The Affordable Care Act was one of the greatest legislative wins for women and for patients everywhere in recent memory. It has made great strides towards its stated goals on so many fronts, including by increasing access to contraceptives and decreasing unwanted pregnancy. But the loopholes that exist currently are preventing the Affordable Care Act from reaching its goals for contraceptive access entirely.
Insurance companies have shown that when given discretion, they will fail to cover contraceptive products deemed medically necessary by doctors. We must instead put the power of choice into the hands of the women who need contraceptive products most by mandating the coverage of the full range of FDA-approved contraceptive products.
Thankfully, the fix is straightforward: Congress must act to pass legislation to bolster the goals of the Affordable Care Act by mandating the full coverage of all FDA-approved contraceptive products without making women go through lengthy claims processes for approval.