Unintended Consequences of Health Reform in Massachusetts: New Barriers to Contraception

Kelly Blanchard

One unintended consequence of Massachusetts’ innovative 2007 reform legislation is reduced contraceptive access for low-income women. We can't repeat this mistake nationally.

Clearly the US health care system needs reform.  Massachusetts’ innovative reform legislation
in effect since 2007 provides many lessons that federal policymakers should
heed as they consider models to reform health care across the nation.

Ibis Reproductive Health and the Massachusetts Department of Public
Health Family Planning Program are particularly interested in the impact of
health care reform on contraceptive access for low-income women in
Massachusetts.  The two
organizations embarked on a collaborative research project in late 2008.  Findings from the project highlight the
critical need to pay attention to the architecture of reform to protect access
to contraception for low-income women. 
Focus group discussions with women and interviews with family planning providers
reveal new challenges to accessing and providing care under a health care
system that includes individual insurance mandates and expands access to private
health insurance.

Even with expanded access to health insurance, new barriers to
contraception access have developed. 
Prescription requirements are confusing and inconvenient for some women
who previously accessed their contraception from a family planning clinic.  Providers women like and trust, like
family planning or community health centers, may not be covered under private
insurance plans, and it is difficult for women to identify what contraceptives
are covered and what providers offer covered services. 

Insurance plan information is often confusing and not
user-friendly.  The plan websites
we reviewed did not allow a search for contraception based on common terms like
“the pill” or “the ring” but required the user to know either the brand or
generic name of the method. 

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Women in Massachusetts rely on their family planning providers to
help them understand their insurance, translate plan information and mailings,
and complete eligibility paperwork. 
Family planning providers described challenges contracting with the
plans that took part in the state-subsidized scheme, and also faced
administrative burdens with billing and helping their clients understand what
is covered under the new plans.

Women’s health advocates, women themselves, and family planning and
sexual and reproductive health service providers need to pay close attention to
exactly how contraception will be covered and how preventive care in general
will be managed in any national reform plan.  In Massachusetts some new barriers were specific to
contraception services—like some plans not covering services provided by family
planning providers—but others were more about the logistics of the plans and
the eligibility requirements. 
Confusing formularies and women moving on and off the plans due to
erratic employment or life changes like moving or having a baby will affect
more than contraceptive services.   

As Congress continues to debate health care reform, we should ask
whether family planning providers and community health centers are included as
key providers of preventive health care services to ensure women can continue
to access health care with the providers they know and trust.  We should also demand that
contraception be covered at low cost, and that information about the full range
of methods and how they are covered be easily available and
understandable.  We should also
argue for prescription coverage that provides more than one month of medication
at a time—more cycles of hormonal contraception have been show to increase use—as
well as consider innovative strategies for covering the cost of
non-prescriptive contraception methods like condoms.  Another possibility for policymakers to consider is
legislating low copays for contraception in subsidized plans.

Contraception is not only cost-effective but is critical for women to
live the lives they want and protect their health and the health of their
families.  Providing complete
coverage of preventive and women’s health services like contraception should be
part of any national health reform package.

Roundups Politics

Campaign Week in Review: Trump Selects Indiana Gov. Mike Pence to Join His Ticket

Ally Boguhn

And in other news, Donald Trump suggested that he can relate to Black people who are discriminated against because the system has been rigged against him, too. But he stopped short of saying he understood the experiences of Black Americans.

Donald Trump announced this week that he had selected Indiana Gov. Mike Pence (R) to join him as his vice presidential candidate on the Republican ticket, and earlier in the week, the presumptive presidential nominee suggested to Fox News that he could relate to Black Americans because the “system is rigged” against him too.

Pence Selected to Join the GOP Ticket 

After weeks of speculation over who the presumptive nominee would chose as his vice presidential candidate, Trump announced Friday that he had chosen Pence.

“I am pleased to announce that I have chosen Governor Mike Pence as my Vice Presidential running mate,” Trump tweeted Friday morning, adding that he will make the official announcement on Saturday during a news conference.

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The presumptive Republican nominee was originally slated to host the news conference Friday, but postponed in response to Thursday’s terrorist attack in Nice, France. As late as Thursday evening, Trump told Fox News that he had not made a final decision on who would join his ticket—even as news reports came in that he had already selected Pence for the position.

As Rewire Editor in Chief Jodi Jacobson explained in a Thursday commentary, Pence “has problems with the truth, isn’t inclined to rely on facts, has little to no concern for the health and welfare of the poorest, doesn’t understand health care, and bases his decisions on discriminatory beliefs.” Jacobson further explained: 

He has, for example, eagerly signed laws aimed at criminalizing abortion, forcing women to undergo unnecessary ultrasounds, banning coverage for abortion care in private insurance plans, and forcing doctors performing abortions to seek admitting privileges at hospitals (a requirement the Supreme Court recently struck down as medically unnecessary in the Whole Woman’s Health v. Hellerstedt case). He signed a ‘religious freedom’ law that would have legalized discrimination against LGBTQ persons and only ‘amended’ it after a national outcry. Because Pence has guided public health policy based on his ‘conservative values,’ rather than on evidence and best practices in public health, he presided over one of the fastest growing outbreaks of HIV infection in rural areas in the United States.

Trump Suggests He Can Relate to Black Americans Because “Even Against Me the System Is Rigged”

Trump suggested to Fox News’ Bill O’Reilly that he could relate to the discrimination Black Americans face since “the system [was] rigged” against him when he began his run for president.

When asked during a Tuesday appearance on The O’Reilly Factor what he would say to those “who believe that the system is biased against them” because they are Black, Trump leaped to highlight what he deemed to be discrimination he had faced. “I have been saying even against me the system is rigged. When I ran … for president, I mean, I could see what was going on with the system, and the system is rigged,” Trump responded.

“What I’m saying [is] they are not necessarily wrong,” Trump went on. “I mean, there are certain people where unfortunately that comes into play,” he said, concluding that he could “relate it, really, very much to myself.”

When O’Reilly asked Trump to specify whether he truly understood the “experience” of Black Americans, Trump said that he couldn’t, necessarily. 

“I would like to say yes, but you really can’t unless you are African American,” said Trump. “I would like to say yes, however.”

Trump has consistently struggled to connect with Black voters during his 2016 presidential run. Despite claiming to have “a great relationship with the blacks,” the presumptive Republican nominee has come under intense scrutiny for using inflammatory rhetoric and initially failing to condemn white supremacists who offered him their support.

According to a recent NBC News/Wall Street Journal/Marist poll released Tuesday, Trump is polling at 0 percent among Black voters in the key swing states of Ohio and Pennsylvania.

What Else We’re Reading

Newt Gingrich, who was one of Trump’s finalists for the vice presidential spot, reacted to the terrorist attack in Nice, France, by calling for all those in the United States with a “Muslim background” to face a test to determine if they “believe in sharia” and should be deported.

Presumptive Democratic nominee Hillary Clinton threw her support behind a public option for health insurance.

Bloomberg Politics’ Greg Stohr reports that election-related cases—including those involving voter-identification requirements and Ohio’s early-voting period—are moving toward the Supreme Court, where they are “risking deadlocks.”

According to a Reuters review of GOP-backed changes to North Carolina’s voting rules, “as many as 29,000 votes might not be counted in this year’s Nov. 8 presidential election if a federal appeals court upholds” a 2013 law that bans voters from casting ballots outside of their assigned precincts.

The Wall Street Journal reported on the election goals and strategies of anti-choice organization Susan B. Anthony List, explaining that the organization plans to work to ensure that policy goals such as a 20-week abortion ban and defunding Planned Parenthood “are the key issues that it will use to rally support for its congressional and White House candidates this fall, following recent setbacks in the courts.”

Multiple “dark money” nonprofits once connected to the Koch brothers’ network were fined by the Federal Election Commission (FEC) this week after hiding funding sources for 2010 political ads. They will now be required to “amend past FEC filings to disclose who provided their funding,” according to the Center for Responsive Politics. 

Politico’s Matthew Nussbaum and Ben Weyl explain how Trump’s budget would end up “making the deficit great again.”

“The 2016 Democratic platform has the strongest language on voting rights in the party’s history,” according to the Nation’s Ari Berman.

Roundups Politics

Campaign Week in Review: Trump Weighs in on Supreme Court Decision, After Pressure From Anti-Choice Leaders

Ally Boguhn

The presumptive Republican nominee’s confirmation that he opposed the decision in Whole Woman’s Health v. Hellerstedt came after several days of silence from Trump on the matter—much to the lamentation of anti-choice advocates.

Donald Trump commented on the U.S. Supreme Court’s abortion decision this week—but only after days of pressure from anti-choice advocates—and Hillary Clinton wrote an op-ed explaining how one state’s then-pending decision on whether to fund Planned Parenthood illustrates the high stakes of the election for reproductive rights and health.

Following Anti-Choice Pressure, Trump Weighs in on Supreme Court’s Abortion Decision

Trump finally broke his silence Thursday about the Supreme Court’s decision earlier this week, which struck down two provisions of Texas’ HB 2 in Whole Woman’s Health v. Hellerstedt.

“Now if we had Scalia was living, or if Scalia was replaced by me, you wouldn’t have had that,” Trump claimed of the Court’s decision, evidently not realizing that the Monday ruling was 5 to 3 and one vote would not have made a numerical difference, during an appearance on conservative radio program The Mike Gallagher Show. “It would have been the opposite.” 

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“So just to confirm, under a President Donald Trump-appointed Supreme Court, you wouldn’t see a majority ruling like the one we had with the Texas abortion law this week?” asked host Mike Gallagher.

“No…you wouldn’t see that,” replied Trump, who also noted that the case demonstrated the important role the next president will play in steering the direction of the Court through judicial nominations.

The presumptive Republican nominee’s confirmation that he opposed the decision in Whole Woman’s Health came after several days of silence from Trump on the matter—prompting much lamentation from anti-choice advocates. Despite having promised to nominate anti-choice Supreme Court justices and pass anti-abortion restrictions if elected during a meeting with more than 1,000 faith and anti-choice leaders in New York City last week, Trump made waves among those who oppose abortion when he did not immediately comment on the Court’s Monday decision.

“I think [Trump’s silence] gives all pro-life leaders pause,” said the president of the anti-choice conservative organization The Family Leader, Bob Vander Plaats, prior to Trump’s comments Thursday, according to the Daily Beast. Vander Plaats, who attended last week’s meeting with Trump, went on suggest that Trump’s hesitation to weigh in on the matter “gives all people that are looking for life as their issue, who are looking to support a presidential candidate—it gives them an unnecessary pause. There shouldn’t have to be a pause here.”

“This is the biggest abortion decision that has come down in years and Hillary Clinton was quick to comment—was all over Twitter—and yet we heard crickets from Donald Trump,” Penny Young Nance, president of Concerned Women for America, said in a Tuesday statement to the Daily Beast.

Kristan Hawkins, president of Students for Life of America, expressed similar dismay on Wednesday that Trump hadn’t addressed the Court’s ruling. “So where was Mr. Trump, the candidate the pro-life movement is depending upon, when this blow hit?” wrote Hawkins, in an opinion piece for the Washington Post. “He was on Twitter, making fun of Elizabeth Warren and lamenting how CNN has gone negative on him. That’s it. Nothing else.”

“Right now in the pro-life movement people are wondering if Mr. Trump’s staff is uninformed or frankly, if he just doesn’t care about the topic of life,” added Hawkins. “Was that meeting last week just a farce, just another one of his shows?”

Anti-choice leaders, however, were not the only ones to criticize Trump’s response to the ruling. After Trump broke his silence, reproductive rights leaders were quick to condemn the Republican’s comments.

“Donald Trump has been clear from the beginning—he wants to overturn Roe v. Wade, and said he believes a woman should be ‘punished’ if she has an abortion,” said Dawn Laguens, executive vice president of Planned Parenthood Action Fund, which has already endorsed Clinton for the presidency, in a statement on Trump’s comments. 

“Trump’s remarks today should send a shiver down the spine of anyone who believes women should have access to safe, legal abortion. Electing Trump means he will fight to take away the very rights the Supreme Court just ruled this week are constitutional and necessary health care,” continued Laguens.

In contrast to Trump’s delayed reaction, presumptive Democratic nominee Clinton tweeted within minutes of the landmark abortion rights decision, “This fight isn’t over: The next president has to protect women’s health. Women won’t be ‘punished’ for exercising their basic rights.”

Clinton Pens Op-Ed Defending Planned Parenthood in New Hampshire

Clinton penned an op-ed for the Concord Monitor Wednesday explaining that New Hampshire’s pending vote on Planned Parenthood funding highlighted “what’s at stake this election.”

“For half a century, Planned Parenthood has been there for people in New Hampshire, no matter what. Every year, it provides care to almost 13,000 people who need access to services like counseling, contraception, and family planning,” wrote Clinton. “Many of these patients cannot afford to go anywhere else. Others choose the organization because it’s the provider they know and trust.”

The former secretary of state went on to contend that New Hampshire’s Executive Council’s discussion of denying funds to the organization was more than “just playing politics—they’re playing with their constituents’ health and well-being.” The council voted later that day to restore Planned Parenthood’s contract.

Praising the Supreme Court’s Monday decision in Whole Woman’s Health, Clinton cautioned in the piece that although it was a “critical victory,” there is still “work to do as long as obstacles” remained to reproductive health-care access.

Vowing to “make sure that a woman’s right to make her own health decisions remains as permanent as all of the other values we hold dear” if elected, Clinton promised to work to protect Planned Parenthood, safeguard legal abortion, and support comprehensive and inclusive sexual education programs.

Reiterating her opposition to the Hyde Amendment, which bans most federal funding for abortion care, Clinton wrote that she would “fight laws on the books” like it that “make it harder for low-income women to get the care they deserve.”

Clinton’s campaign noted the candidate’s support for repealing Hyde while answering a 2008 questionnaire provided by Rewire. During the 2016 election season, the federal ban on abortion funding became a more visible issue, and Clinton noted in a January forum that the ban “is just hard to justify” given that restrictions such as Hyde inhibit many low-income and rural women from accessing care.

What Else We’re Reading

Politico Magazine’s Bill Scher highlighted some of the potential problems Clinton could face should she choose former Virginia governor Tim Kaine as her vice presidential pickincluding his beliefs about abortion.

Foster Friess, a GOP mega-donor who once notoriously said that contraception is “inexpensive … you know, back in my days, they used Bayer aspirin for contraception. The gals put it between their knees, and it wasn’t that costly,” is throwing his support behind Trump, comparing the presumptive Republican nominee to biblical figures.

Clinton dropped by the Toast on the publication’s last day, urging readers to follow the site’s example and “look forward and consider how you might make your voice heard in whatever arenas matter most to you.”

Irin Carmon joined the New Republic’s “Primary Concerns” podcast this week to discuss the implications of the Supreme Court’s decision in Whole Woman’s Health v. Hellerstedt on the election.

According to analysis from the Wall Street Journal, the popularity of the Libertarian Party in this year’s election could affect the presidential race, and the most likely outcome is “upsetting a close race—most likely Florida, where the margin of victory is traditionally narrow.”

The Center for Responsive Politics’ Alec Goodwin gave an autopsy of Jeb Bush’s massive Right to Rise super PAC.

Katie McGinty (D), who is running against incumbent Sen. Pat Toomey (R) in Pennsylvania, wrote an op-ed this week for the Philly Voice calling to “fight efforts in Pa. to restrict women’s access to health care.”

The Iowa Supreme Court ruled against an attempt to restore voting rights to more than 20,000 residents affected by the state’s law disenfranchising those who previously served time for felonies, ThinkProgress reports.

An organization in Louisiana filed a lawsuit against the state on behalf of the almost 70,000 people there who have previously served time for felonies and are now on probation or parole, alleging that they are being “wrongfully excluded from registering to vote and voting.”