Mandated insurance coverage of birth control is a controversial subject. But now, a new study, published in the Journal of the American Medical Association, finds that 69 percent of Americans believe that health insurance plans should be required to cover birth control.
The findings come just as the U.S. Supreme Court is weighing its decision in a high-profile legal challenge to provisions of the Affordable Care Act (ACA) that mandate health insurance coverage of contraception.
More than 2,000 adults, across all 50 states and the District of Columbia, completed the survey, which asked participants their opinions on birth control, as well as a broad range of healthcare topics.
Lead study author Michelle Moniz, M.D., an OB/GYN and researcher at the University of Michigan Medical School, said, “Our findings suggest that a clear majority, about seven out of 10 adults actually support requirements for coverage of birth control in all health insurance plans.”
Women, Parents, and Minority Groups Support Mandate
“We tried to ask this question in as unbiased a way as possible,” said Moniz, adding that the survey was unique because the researchers were able to characterize individuals who were likely to be in favor of the policy.
“Women, racial and ethnic minority groups, and parents were actually more likely than other adults to support the requirement for contraceptive coverage,” Moniz said. Blacks and Hispanics were the minority groups that were most in favor of the mandate.
Participant support for mandatory coverage of other medical services was even higher, with 75 percent of respondents indicating that they support coverage for mental healthcare services.
Noting that most U.S. adults support coverage of a variety of health services, including birth control, Dr. Moniz said, “My personal belief is that health policies across the United States may have a better chance of improving health when those policies reflect the preferences of the majority of Americans.”
Supreme Court to Decide Coverage Case
The ACA requires employers of a certain size to provide their full-time workforce with health insurance, including coverage for all Food and Drug Administration (FDA) approved contraceptives. If they don’t provide this coverage, they are subject to a fine.
In 2012, when this part of the ACA took effect, some religious organizations objected and negotiated rules that allowed certain religious employers, such as church-run hospitals and universities, to have a third-party insurer cover the costs of birth control. For-profit businesses can’t apply for this exception, and at least 48 separate cases have been brought by companies challenging the law for religious reasons.
In June, the Supreme Court is expected to decide on the first of these cases, which is Sebelius v. Hobby Lobby Stores. The Christian owners of the arts-and-crafts chain store argue that their religious beliefs prevent them from paying for certain types of FDA-approved birth control, such as intrauterine devices (IUDs) and the morning-after pill.
When an IUD Is the Choice
Courtney Everette shared her reasons for supporting mandated coverage of birth control. As a teenager, she started taking hormonal birth control to treat endometriosis, a painful condition that causes heavy bleeding and may lead to infertility if not properly managed. In 2008, she was diagnosed with a blood clotting disorder called antiphospholipid syndrome (APS) and could no longer use hormonal birth control.
“The option that my doctor felt was most appropriate given all of my health concerns was to use a copper IUD, which is incredibly expensive,” said Everette. Prior to the ACA, Everette’s insurance covered part of her costs, but she had to pay several hundred dollars out-of-pocket.
“I still use copper IUDs as my method of birth control and it’s really nice that it’s covered now,” says Everette, who decided to have kids not long after being diagnosed with APS. “As a family with two children, medical expenses can really make or break your month.”
High Costs Can Be a Barrier
Long-term forms of birth control, such as the IUD, that don’t require patients to remember to do something every day, are among the most effective types of contraception, said Daniel Grossman, an OB/GYN and vice president for research at Ibis Reproductive Health.
However, these birth control methods often have greater upfront costs and can be prohibitively expensive for patients who don’t have coverage through a health insurance plan.
Grossman went on to say that very often when women are asked what method they want to be using, or when they are making a choice, cost is an essential component of that decision.
“Conversely, when the issue of cost is removed, and women receive evidence-based counseling about contraception options, there tends to be a high uptake of more effective types of birth control,” said Grossman.
“There’s no question that cost is an important barrier to accessing the most effective methods of contraception. At the same time, from a societal and health systems perspective, it is incredibly cost-effective to offer these methods. They may have a higher upfront cost, but they can help to reduce unintended pregnancy and help women achieve their life goals,” said Grossman.