In the age of Obamacare, birth control is supposed to be free for everyone. It's part of the deal. Unfortunately, that hasn't played out in practice: In response to a number of insurance companies deciding to flout the Affordable Care Act's contraceptive coverage mandate, the Obama administration recently had to remind insurers that they are required to provide full coverage for all forms of female contraception, without co-pays or cost-sharing, and not just some types of birth control. Because when they don't, women get pregnant.
It makes sense, right? When women can't access contraception, they face higher rates of unintended pregnancies (and, subsequently, the need for abortion care increases too). But the issue of "access" is more complicated than whether a woman has insurance coverage or not: Even minimal cost-sharing can affect the type of birth control a woman chooses, which can in turn affect her likelihood of becoming pregnant.
As University of Michigan scholars Vanessa K. Dalton and Lauren MacAfee detail for The Conversation, the most effective forms of birth control are also the most expensive. When insurance companies fail to comply with ACA guidelines, they make women less likely to choose contraceptive methods such as intrauterine devices, which have significantly higher rates of efficacy at a much greater cost. Via The Conversation:
Relative to other forms of health care, the low cost of so many contraceptive methods may make the individual out-of-pocket expense seem unimportant. But to many women, these costs are real. Cost is a big factor in choosing to use one form of contraception over another, using it consistently or even the likelihood of using contraception at all. [...]
We studied the relationship between out-of-pocket costs and contraception use among almost 1.7 million women enrolled in the types of plans regulated by the ACA rules between January 1 and December 31, 2011. Women in plans with the highest level of cost-sharing were 35% less likely to have an IUD placed than women with the lowest level of cost-sharing – suggesting that even higher income women are sensitive to the price of contraceptives.
The Contraceptive Choice study, which offered almost 10,000 women free birth control, demonstrated that low-income and uninsured women will select the most effective (and most expensive) birth control methods at high rates when cost is not a factor.
Dalton and MacAfee note that many insurers have taken an approach of offering full coverage for just one "type" of birth control from different categories -- hormonal, barrier, emergency and implants -- without regard for the overlap between categories or for women's individual needs. But with the Obama administration putting insurers on notice, the accessibility of low-to-no-cost birth control should increase -- and the rates of unintended pregnancy and abortion should go down.
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