The XX Factor

Co-Pay-Free Contraception Starts Tomorrow for Many Americans

Woman holding birth control pills.
Starting tomorrow, any new insurance policies must cover contraception without a co-pay

Photograph by Keith Brofsky/Thinkstock Images.

If you were thinking about buying some birth control pills or even getting an IUD inserted today, it might be the wise choice to wait until tomorrow, when the contraception mandate under the Affordable Care Act starts its big rollout. Starting tomorrow, any new insurance policies sold to individuals or employers must cover contraception without a co-pay as part of a larger package of mandatory co-pay-free women’s preventive care benefits. After tomorrow, insurance plans that have already been purchased will have to start offering no-co-pay contraception when they renew. Since Aug. 1 is a favorite day for many employers to renew their insurance plans, that means the free contraception we’ve been hearing so much about is finally coming into fruition for a huge chunk of American women.

As the above video from the Guttmacher Institute demonstrates, making contraception so much easier to afford is noncontroversial from a public health and even cost savings perspective. The one-third of women who use contraception inconsistently or not at all in any given year account for 95 percent of unintended pregnancies, and around four in 10 of those end in abortion. (If anti-choicers were in this for “life” instead of punishing sex, they would have therefore ferociously and unequivocally demanded free contraception for all women years ago. After all, it’s a much smaller ask than their favorite one, the termination of a woman’s right to control her own body.) Inability to afford contraception is a major reason that women are inconsistent contraception users. The Center for American Progress found that 55 percent of women ages 18 to 34 reported struggling to pay for birth control, which led to inconsistent use. It seems like contraception should be a spending priority, but in a culture where contraception use is frequently linked with being a “slut” or written off as a luxury item like it was an expensive sex toy, no wonder women try to cut costs by skipping contraception. When people are routinely told they don’t deserve basic necessities, we shouldn’t be shocked if they actually are influenced by the argument.

Indeed, this notion that contraception is a luxury item is why this common sense policy has been so controversial. The phrase “free contraception” might as well be crafted in a lab that specializes in pushing conservative buttons. The lethal combination of invoking pleasure plus women plus money could only get worse if you brought race into it. But that’s not really the best way to understand this policy. For one thing, the people receiving no-co-pay contraception have paid for it themselves, with a combination of insurance premiums and labor. This is why the claim that denying already-earned benefits is an employer’s “religious” right is ludicrous, as it’s the equivalent of claiming that since an employer signs your paychecks, he can require you to tithe to the church of his choosing. Nor is there any real reason to think that paying for contraception is the same thing as paying for sex; sex can and does happen without contraception (thus our high unintended pregnancy rate). This is prevention of pregnancy. If you remove sexual hysteria from the equation, it’s the equivalent of the government requiring seatbelts in cars, even if that does technically mean all car purchasers are on the hook for covering this car feature whether they want it or not.  

Of course, just as people who resisted mandatory seatbelts have benefited along with the rest of us from lower rates of traffic fatalities, they will also benefit from the reduced social and health care costs that stem from reducing unplanned pregnancies. Luckily, public health advocates have learned not to hold their breath waiting for a thank you. It’s hard on the lungs, you know.