Commentary Contraception

Why Contraceptive Coverage Is Critical: Lessons from Massachusetts

Amanda Dennis

In Massachusetts, we have already learned some lessons about why it is important to include contraception at no additional cost.

All articles included in Rewire’s coverage of the IOM Report can be found here.

The Institute of Medicine has just released a report advising HHS to cover contraception with no additional costs under national health care reform.  We are thrilled about the report’s recommendations and are hopeful that Secretary Sebelius will make sure contraception is covered without a co-pay so that the millions of women who will be insured under national health reform will not have to go without contraception because they can’t afford their co-pays.

In Massachusetts, we have already learned some lessons about why it is important to include contraception at no additional cost.  Massachusetts passed state-level health care reform legislation in 2006. Reform has already led to a number of improvements in access to health care for Massachusetts residents, however women insured by the subsidized health care plans must pay anywhere from $1 to $50 monthly co-pays for their contraception.

A collaborative study conducted by Ibis Reproductive Health and the Massachusetts Department of Public Health Family Planning Program investigated how Massachusetts health care reform impacted low-income women’s access to contraception.  We conducted interviews with women and family planning providers throughout Massachusetts and found that reform has led to improvements in access to contraception for many, but not all women. 

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First, the good news.  Many women in the study said they had “wicked easy” access to contraception after health care reform.  A small number of women even said they began taking contraception for the first time after reform because the small co-pays made contraception more affordable than it was before reform when they did not have insurance.  One woman explained:

“I know a big factor for a lot of my friends—like the pill is just too expensive so they fore-go it, and they rely on other questionable methods.  And I think health care reform will help bring unplanned pregnancies and stuff like that down.”

However, we also found some women continue to have a hard time accessing contraception because of cost.  Family planning providers reported that some of the women they see don’t fill their contraception prescriptions because they can’t afford their co-pays.  One family planning provider explained that some women cannot afford to pay any co-pay for contraception because they are simply struggling to survive.  She said, “If you have a choice between getting your medications or your prescriptions and paying for food, or paying for your bills, which would you choose?  They choose not to get their prescriptions.” Another family planning provider explained that even small co-pays are barriers to contraception for some women.  She said:

“They’re trying to pay the rent, they’re trying to go to school, they’re trying to work, and keep their kids in daycare…Sometimes paying $1 or $2 can be difficult.” 

The stories of women in Massachusetts highlight why it is so important to include contraception with no additional costs under national health care reform.  We look forward to the day when all women can say accessing their contraception is “wicked easy” and affordable.  We hope the recommendations released from the IOM are the first step to reaching that goal for women in Massachusetts and throughout the US.

**Many thanks to Kelly Blanchard for her excellent comments on this piece.

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