The Affordable Care Act (ACA) is supposed to cover out-of-pocket costs for contraception, meaning it should be free for everyone who needs it. But that isn’t always the case. Since the ACA’s introduction in 2012, people have been paying for contraception that should be free because of the mandate’s complex and difficult-to-navigate details. Worse, sometimes it’s because some insurance companies simply don’t comply with the law.
But many of you don’t need this history lesson since you’ve lived it yourself.
At Favor, formerly The Pill Club, we’re committed to helping patients get the care they need, and that often goes beyond medical advice. We regularly hear from patients that navigating the roadblocks put up by insurance companies is too time-consuming, emotionally draining, and burdensome—that it's easier to just pay out of pocket than deal with their insurance companies.
Not everyone can afford this option, and no one should be forced to pay, even if they have the means. Covering contraception gives women and people who can get pregnant control over their lives, and it’s long overdue that our elected officials hold insurers and employers accountable to the law.
More legislation limiting reproductive healthcare options were passed in 2021 than in any year before, and a Supreme Court decision expected this summer could severely limit access to abortion and potentially pave the way for government rollbacks of emergency contraception, other birth control, comprehensive sex education, and more.
Over the past few months, lawmakers have begun taking important steps to protect birth control access and make it harder for insurance companies and employers to circumvent the law. More on what they’re up to below.
It’s not unusual for lawmakers to apply public pressure in situations where businesses disregard the law. In this case, they’re putting safeguards in place to make sure that employers and insurance companies are following the contraceptive mandate. These safeguards have been a long time coming and have never been more important amid an increasingly hostile environment for reproductive rights.
Here’s a Quick Rundown of How Lawmakers Are Stepping Up:
December 2021 → Congress sent a letter to the Biden administration asking them to better enforce the contraceptive mandate, calling attention to the hoops people like you have to jump through just to get their birth control covered.
Why This Matters? This is a direct response to patient and provider experiences, acknowledging people aren’t getting the health care they’re entitled to: free birth control that meets their needs.
January 2022 → The Departments of Labor and Health and Human Services clarified the ACA, stating that insurers must cover all FDA-approved contraceptive methods, making it easier for you to get the birth control you want.
Why This Matters? This should eliminate hurdles you may have experienced, including limited coverage for newer FDA-approved methods such as Phexxi (non-hormonal gel) or a requirement that you try an insurance company’s preferred brand, and document it doesn’t work for you, before moving on to your desired one. This is known as fail first.
February 2022 → 34 senators called on the Departments of Labor, Health and Human Services, and Treasury to develop strong enforcement mechanisms related to the contraceptive mandate, including clearly laying out any exemptions.
Why This Matters? The letter emphasizes the growing attacks on reproductive rights and the public health benefits of the contraceptive mandate. They want action now to make sure people aren’t cheated out of their right to no-cost birth control.
The bottom line: All three of these moves *finally* recognize the barriers too many people still face in accessing convenient and affordable birth control, even in the face of existing law. We’ve said it before, and we’ll say it again: your👏birth👏control👏should👏be👏free.
Can They Do More?
While these are all great first steps, Congress and the Biden administration must prioritize strengthening the contraceptive mandate and move quickly. This includes holding insurance companies accountable and making it harder for employers to opt-out of covering contraception for their employees. Some health plans aren’t required to follow the contraceptive mandate at all.
For example, plans provided by churches and religious nonprofits, as well as employers and schools that object to contraception due to a “sincere religious or moral objection,” can often opt-out. Government action made it easier for employers to claim this “moral objection” in 2018, and the Biden administration has signaled it will take steps to make it more difficult to opt-out on the basis of religion. We encourage you to stay informed and hold your elected officials accountable.
What Can I Do?
Because of the ACA’s contraceptive mandate, most health insurance plans are required to cover birth control and other important reproductive health services at no or low cost. If a doctor or other health care provider determines that you need a particular contraceptive, even if it's not on the list of approved products for your plan, your insurer is required to have an expedient process for you to seek a waiver. If you run into trouble, you can file an appeal with your insurance provider. If you think you’re incorrectly required to pay out-of-pocket for your birth control, you can call the CoverHer hotline at 1-866-745-5487.
You can also call or write to your senator and congressional representative asking them to protect access to free birth control and sign on to this letter if they haven’t already. You can look up your elected official here.