American women should have access to safe contraceptives

Eleven years ago, Congress passed the Affordable Care Act and began the largest expansion of access to health care in this country in five decades. This landmark law gave 20 million previously uninsured Americans access to health care. But that was not all. In addition to providing coverage for our most vulnerable, it assisted women by defining contraception as an essential health benefit covered under the law.

Contraceptive methods and counseling services are covered at no cost to patients. The Affordable Care Act transformed into law a goal that experts in reproductive health have long understood to be critical, which is that access to covered or low cost contraception is one of the most effective mechanisms to prevent unwanted pregnancies.

To a remarkable extent, the law succeeded in delivering on its promise of access to low cost contraception. The use of contraceptive methods, like intrauterine devices and other implants, quadrupled from 2002 and 2017. At the same time, costs declined greatly. These wins are worth celebrating and signal the importance of the Affordable Care Act as an instrument for expansion of affordable health care to Americans. The shifts it generated point to a sea change with how women access and utilize contraception, which has been a true policy success of the law.

Yet this success also highlights the work that is yet to be done to achieve the reality in which there is universal access to affordable contraception. The challenges faced by women of low income backgrounds is certainly acute. While many contraceptive drugs are covered or available at low cost, courts and insurance firms have created new barriers that further hinder access to critical medications for women.

Although the Food and Drug Administration has approved new drugs and technology in the years since the law was enacted, insurance firms and pharmacy benefit managers will often refuse to cover all of them. When such coverage is denied, these approved contraceptives are unaffordable and out of reach for patients. As a result, these women may be unable to access the contraception that works best for them.

A lack of choice and unaffordability of contraceptive methods are not just abstract concerns. Every woman reacts differently to numerous available contraceptive options. A medication that works well for one woman might not work at all for another. When insurance firms pick and choose to cover certain contraceptives over others, they are functionally barring women from access to health care needed to stay healthy.

When the Affordable Care Act was drafted, language was inserted to limit the ability of insurance firms to restrict which contraception options are available. But some have been ignoring the spirit and letter of the law by continuing to obstruct access, resulting in greater health disparities and worsened outcomes. Women who do not have access to such approved contraceptives also stand at an elevated risk of ovarian and endometrial cancer. Contraception is an essential part of health care, and so much is lost when women cannot access what they need.

Despite the scale of the problem, the solution is simple and feasible. We need legislation to ensure that every woman has access to all approved contraceptives and can work with her doctor to discover one that is best for her. This means the array of approved contraceptives should be fully covered by insurance, which would reinforce the spirit and letter of the Affordable Care Act and continue the trend it started with the dramatic reduction in unwanted pregnancies. Congress must make all approved contraceptives a reality for women in our country.

Sally Greenberg is executive director of the National Consumers League.