Hey President Obama, Where's My Free Birth Control?
Remember last summer when it was announced that, thanks to the Obama Administration’s Affordable Care Act (ACA), women across the U.S. would have access to free birth control? Did you run into the streets armed with buckets and nets hoping to catch birth control pills, Nuva-Rings, and IUDs raining from the cargo-hold of government planes? Did you head to your nearest pharmacy expecting sample Depo shots to be handed out like bourbon chicken at the mall food court? Or did you, like many more sane women, call your insurance provider to find out what this truly meant for your pocketbook and your health? Turns out no matter which avenue you chose you likely found that birth control is not free today and won’t be free anytime soon.
Perhaps a little background to get you all caught up? President Obama signed the ACA (also known as “Obamacare”) into law in 2010. The Act’s birth control mandate went into effect on August 1, 2012, stating that new or renewing health insurance plans are now required to provide birth control to women at no out-of-pocket cost — that’s co-pays or deductibles. The announcement was met with much celebration by women’s health advocates on one side and “The End is Near” sign-making parties on the other most notably with a Republican congressman going so far as to compare the mandate with the bombing of Pearl Harbor and the attacks of 9/11. Seriously. Religious institutions put forth the loudest objections even though the mandate exempts places of worship, offers a compromise for religion-affiliated schools and hospitals, and gave a year-long reprieve to religion-based nonprofits and other employers.
Two main issues stand to prevent you from setting up a bottomless birth control goodie jar on your nightstand (wouldn’t that be cool?): insurance companies and the religious exemptions.
Health InsuranceIn order to get birth control with no additional cost you first need to have an insurance policy, which of course is not free. You pay for it directly with your wallet or your labor (and your employer pays for it on your behalf). No insurance means you pay out of pocket as always, just like it was before the ACA. So step one: get insurance or re-enroll in your plan. Otherwise, you’ll have to wait until 2014 when the ACA will require everyone to have insurance or pay a penalty. Step two: make sure your health plan is compliant with the ACA. Some don’t have to comply as quickly as others and if your plan is one of the lollygaggers, then you’ll still have to fork over some cash to the pharmacist. Step three: check to see if your preferred method of birth control has a generic equivalent. If it does but your fancy ladyparts insist on the branded version, insurers can still charge a co-pay. For certain brands that don't have a generic equivalent like the NuvaRing or the patch (Ortho-Evra), insurers can refuse coverage outright, forcing you to choose another brand even though you were 30 years old before you finally figured out the best birth control method for your health and lifestyle.
Religious InstitutionsWomen who work for religious institutions may find another barrier to accessing no co-pay/deductible birth control – lawsuits and moral objections against making the birth control benefit available to employees of religion-based nonprofits like schools and hospitals. In February, President Obama proposed new rules that clarify the rules around religious exemptions from having to offer the benefit for their employees and offers a compromise to keep religious employers from having to use their funds to support your sexy time (aka your private business. According to the compromise, employees of religion-based organizations that opt out will still have access to birth-control benefits through separate individual insurance policies for contraceptive coverage, with costs offset by the federal government. Basically the Obama Administration did an end-run around the religious objectors to ensure that women, not their employers, get to make their healthcare decisions. Of course, the religious institutions are not happy with this compromise at all. The U.S. Conference of Catholic Bishops wants a full exemption for affiliated organizations and religious leaders suspect that their holy money will somehow get mixed with your birth control money and that just can’t happen. Expect more lawsuits and more confusion as the government seeks ways to accommodate religious freedoms and women’s access to affordable health care.
Maybe one day birth control and even all types of healthcare will be truly free. For now, the ACA is helping to make it a little more affordable through health insurance access and no additional cost for preventive services. There’s still a lot of red tape to cut through as insurers, health providers, and employers understand how and when the Act’s provisions apply. We have a few years yet before the full benefits of the ACA become apparent. In the meantime, check out this fact sheet from the National Women’s Law Center to find out if your health insurance plan now covers birth control and other preventive services with no co-pay or deductible.