The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) is breaking down financial barriers to birth control, at least when it comes to making long-acting reversible methods such as intrauterine devices (IUDs) accessible and affordable. A new study by the Guttmacher Institute, published in the journal “Contraception,” found that, of the 39 million women at risk for unintended pregnancies, 90 percent of them use contraception, and the number of them who now have access to affordable contraception has substantially increased since the passage of the ACA. Although coverage has expanded significantly, the study also found that cost factors still stand in the way of getting the patients the most appropriate form of birth control for them.
A provision of the ACA requires that patients have the ability to obtain contraception coverage without out-of-pocket expenses. This requirement started being phased in during August 2012, and took effect for many health insurance plans in January 2013. Not all entities have to provide this coverage, as some grandfathered insurance plans remain, as well as religious-based organizations that do not have to provide coverage for their employees.
Researchers reviewed administrative data for 417,221 women whose physicians queried their insurance plans between January 2012 and March 2014 to determine whether they had coverage for a hormonal IUD and the extent of that coverage. The researchers found that in January 2012, 58 percent of women would have incurred out-of-pocket costs for an IUD, compared to only 13 percent of women in March 2014. The study found that differentials by age and region dissolved over the time period of the study, which, they believe, suggests that the ACA successfully reduced inequality among insured women.
The study found that 87 percent of insured women would not have had to pay out of pocket for a hormonal IUD by the spring of 2014, a substantial increase from the 42 percent of women who would not have had to pay out of pocket before the implementation of the ACA provision in 2012. This increase occurred across all age groups and regions of the country.
IUD expenses are not totally covered, the study noted, as many of the associated expenses are not covered, such as visits for insertion and removal.
“This study adds to the growing body of evidence on the ACA’s impact on women’s contraceptive access,” said Megan Kavanaugh, a Senior Research Scientist at the Guttmacher Institute and one of the authors of the article. “Women seeking a hormonal IUD—one of the most effective forms of contraception available—may be dissuaded from obtaining one because of high out-of-pocket costs. As this study documents, the ACA is making these more expensive methods a realistic option for many women. More women can now choose a birth control method based on what works best for them as opposed to what they can afford.”
Researchers also noted that, because they analyzed private insurance queries, as opposed to the number of patients actually requesting the IUD or individuals for whom the IUD would be the best form of coverage, the study had some limitations. The actual number of all IUD inquiries could not be tabulated. This is because doctors would have known the public coverage parameters without having to inquire, and the inquiries were the basis of the study. Additionally, the study also indicated that13 percent of the women studied in March 2014 continued to face out-of-pocket costs to obtain a hormonal IUD, at least among privately insured individuals. Even so, the data suggest that the ACA has made tremendous advances in making this type of contraception more affordable.