U.S. states mull contraception coverage as Obamacare repeal looms

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By Jilian Mincer

<span class="articleLocation”>Growing numbers of U.S. states are seeking to
ensure that women have continued access to free birth control in
case the insurance benefit is dropped as part of President-elect
Donald Trump’s vow to repeal and replace the Affordable Care
Act.

The 2010 law, popularly called Obamacare, requires most
health insurance plans to provide coverage for birth control
without a patient co-payment, which can be as much as $50 per
month for birth control pills or $1,000 for long-acting
contraceptives such as intrauterine devices.

California, Maryland, Vermont and Illinois since 2014 have
enacted statutes codifying the Affordable Care Act’s
contraception mandate in state law and expanding on the federal
law’s requirements. Democratic lawmakers in New York, Minnesota,
Colorado and Massachusetts said they are pursuing similar
measures this year, with Obamacare under mortal threat in
Washington.

New York’s Democratic attorney general, Eric Schneiderman,
on Wednesday introduced such a measure in his state’s
legislature that would expand on the Obamacare contraception
mandate.

“Women across New York are very concerned that Republican
efforts to repeal the ACA will mean the loss of the
contraception on which they rely,” Schneiderman said.

“I won’t hesitate to act to protect New Yorkers’ rights –
including the right to choose, and the right to birth control –
no matter what a Trump administration does,” Schneiderman added,
referring to abortion rights.

Trump, who succeeds Democratic President Barack Obama on
Jan. 20, and his fellow Republicans in Congress have made
dismantling Obamacare their “first order of business,” as Vice
President-elect Mike Pence put it on Jan. 4.

Republicans in Congress have not presented a detailed
proposal for repealing and replacing the law but many
Republicans and religious conservatives have opposed the
Obamacare contraception mandate.

Twenty-eight of the 50 states currently have laws requiring
private insurers to provide coverage for birth control. But not
all the laws affect all insurance plans, and only a few mandate
cost-free birth control.

OUT-OF-POCKET EXPENSES

The Obamacare contraception mandate has applied since 2012
to most new insurance plans including employer-provided
coverage.

In 2013, for example, the mandate saved U.S. women more than
$1.4 billion in out-of-pocket expenses for birth control pills,
according to a report by University of Pennsylvania researchers.
Almost 6.9 million privately insured U.S. women used the pill
that year.

The legislative move by some states, most of them Democratic
governed, is designed to clear up uncertainty for some of the 55
million women who now have access to free contraceptives and
related treatments under the Affordable Care Act.

Conservatives also have chipped away at the Obamacare
mandate in court. The U.S. Supreme Court ruled in 2014 that
forcing family-owned businesses to pay for employee insurance
coverage for birth control ran afoul of another federal law
safeguarding religious freedom.

The Supreme Court last May sent another legal challenge by
nonprofit Christian employers back to lower courts to reconsider
the matter after tossing out their rulings favoring the Obama
administration.

“I think it is even more important now,” said Colorado state
Representative Susan Lontine, who last year co-sponsored a
contraception coverage bill in her state’s legislature that did
not get passed but she expects to be resurrected in 2017. “We
don’t know what will happen on the federal level.”

California in 2014 became the first state to pass a
contraception mandate that went further than the Obamacare
language. Maryland, Vermont and Illinois last year passed laws
that also eliminated co-pays for vasectomies and allowed women
to fill a birth control prescription for at least six months
rather than one to three.

The New York legislation would allow women to fill multiple
months of a birth control prescription, prohibit private
insurers from “medical management” reviews that could limit or
delay contraception coverage, and provide coverage for
vasectomies without a co-pay.

Within a matter of months, the Trump administration even
without congressional action could drop contraception from
Obamacare’s list of preventive services that health insurance
plans must cover without out-of-pocket costs, said Laurie Sobel,
senior policy analyst at the nonprofit Kaiser Family Foundation.

If repealed, some employers might choose to maintain the
coverage without a co-pay because it is a relatively inexpensive
benefit popular with employees.

The proportion of privately insured women who paid nothing
out of pocket for birth control pills increased from 15 percent
in the fall of 2012 to 67 percent in the spring of 2014 during
the time when the coverage went into wide effect, according to
the Guttmacher Institute research organization.

The no-cost contraceptives coverage also spurred women to
switch to long-acting methods such as the IUD, which is offered
in the United States by Bayer, Teva,
Allergan and Medicines360, studies have found.

More than 77 percent of women and 64 percent of men support
the no-cost contraceptives coverage, according to a 2015
Washington Post/Kaiser Family Foundation survey.



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