By Agata Pelka
The ability to plan, time, and space children is inextricably linked with economic opportunity, stability, and security for women and families. This is no surprise to the majority of women who report using contraception as a means to complete their education, keep or get a job, and to support themselves and their families financially. In addition, voters intuitively recognize the connection between control over one’s reproductive decision-making, financial stability, and equal access to opportunities.
Access to contraception is widely documented as an important factor in increasing female engagement in the work force and for narrowing the gender wage gap. Today, working mothers are the breadwinners in four out of 10 American families, and working women’s income is integral to the economic security of most families. The impact of one’s ability to decide whether and when to have a child on women’s economic outcomes is even more stark when examining long-term outcomes for women who were denied a wanted abortion: they were almost three times more likely to be unemployed and almost four times more likely to be below the Federal Poverty Level than women who were able to successfully access the abortion care they wanted.
It is important to note that the economic benefits of contraceptive use have not been distributed equally: low-income women and women of color have not benefited as much as their higher-income and white counterparts. We still have a lot of work to do to ensure that all women have meaningful access to comprehensive reproductive health care. One of the major barriers to consistent contraceptive use is high out-of-pocket cost, and women in particular are likely to defer medical care because of cost. Even with insurance, cost-sharing in the form of co-pays can be prohibitive to accessing the most effective – and in turn often the most expensive – contraceptive methods. Cost-sharing for health services is specifically intended to discourage the use of non-essential services, which is inappropriate when applied to ongoing contraceptive use.
The Affordable Care Act (ACA) acknowledged this fact and removed this obstacle by extending a no co-pay requirement to contraceptive coverage. As a result, women saved approximately $483 million on contraception in 2013. State legislators have also increasingly taken steps to protect and expand coverage for contraceptives and abortion care in their states. Six states currently prohibit cost-sharing for contraception and three have provisions that will be effective in 2018 and 2019 – most of which cover even more methods than under the ACA. California and New York require certain plans to cover abortion care. Last session, Oregon passed ground-breaking legislation requiring health insurers to cover the full spectrum of reproductive health services – including contraception, abortion, prenatal and postpartum care – without co-pay. Since state legislative sessions kicked off in January, legislators have continued the momentum to improve coverage for reproductive health care by introducing bills in several states:
- Omnibus no-co pay coverage bills for reproductive health care services (Virginia, Washington). The bill in Washington provides coverage that is accessible regardless of an individual’s citizenship status.
- Bills to expand access to no-copay contraception (Michigan, Florida, Arizona, Virginia, Indiana, New York, Massachusetts, Indiana, Mississippi, Missouri, Washington). In their contraceptive coverage bills, several states are including coverage of vasectomy, either through gender neutral language or through explicit language covering male sterilization (Arizona). Indiana and Missouri include language that would provide access to no co-pay contraception for individuals working for employers that object to providing the coverage for religious reasons.
- Provisions to allow patients to fill multiple months of a prescription – the majority up to 12 months (New Hampshire, Indiana, Missouri, Mississippi, New York, Rhode Island and Wisconsin). Such provisions improve usage and continuation rates of contraception.
- Measures to expand access to contraception directly at pharmacies by authorizing pharmacists to prescribe and/or dispense contraceptives under certain circumstances (Missouri, New Hampshire, New Jersey).
- Repeal restrictions on abortion coverage (Arizona, Oklahoma) and require that certain plans cover abortion with no co-pay (Washington, Missouri).
All of these measures would make contraception and abortion care more accessible to women. Ensuring that everyone has access to comprehensive reproductive health care coverage – which includes contraception, abortion, prenatal and postnatal care – allows a woman to make the best decisions for her circumstances and her family. As threats to these vital services continue to loom at the federal level, more and more state legislators have been turning their attention to this issue as part of their family economic security agendas. Reproductive health advocates and their constituents around the country eagerly await more bill introductions pushing these protections forward this session and beyond.
Agata Pelka is a State Legislative Counsel at the Center for Reproductive Rights, where she works to advance proactive policy strategies in the states.