In 2012, the birth control pill accounted for an average of 44 percent of American women’s out-of-pocket health spending. Now, the average has dropped to 22 percent. For many women, it’s dropped to zero.
This dramatic transformation is thanks to the Affordable Care Act’s contraceptive mandate, according to a new study in the journal Health Affairs. Researchers at the University of Pennsylvania surveyed the spending habits of nearly 800,000 women between the ages of 13 and 45 from January 2008 to June 2013.
The numbers they report are striking: Since 2012, women have saved $1.4 billion on birth control pills alone. That’s almost three times the only other estimate researchers could locate, a report by IMS Health that found savings of $483 million back in 2013. The average savings per user was $255; the average prescription cost fell from $32.74 to $20.37.
Researchers also found dramatic savings for other forms of contraception. For instance, a woman with an intrauterine device, which can cost upward of $1,000, saved about $248. “$1,000 might not blow you away, but a drop of 25 percent is likely to be significant for that woman,” says Nora Becker, a Ph.D. candidate at the Perelman School of Medicine at the University of Pennsylvania and lead author on the study. “For many of these women, contraception is their No. 1 health need.”
“It turns out the law is doing exactly what the law said would happen,” Becker adds. “We are seeing a dramatic and immediate drop in out-of-pocket spending.”
Next, Becker hopes to examine how the new birth control coverage impacts which type of birth control women choose. For instance, if cost isn’t a factor, many women may opt for a longer-lasting and potentially more effective method, such as an IUD. That choice could in turn have an impact on the birth rate down the road.
Post-Obamacare, private insurance now covers a range of preventive women’s health services, including Pap smears, cancer screenings, diabetes screenings, and prenatal care. Many argue that women in the U.S. shouldn’t have any out-of-pocket expenses for their birth control services and education in the Affordable Care Act era. So why isn’t the number zero instead of 22 percent?
One reason is that the mandate is required to cover at least one brand of birth control in every category, but certainly not all. Another is that the ACA is still being implemented. Right now, any health plan that hasn’t changed its cost-sharing benefits since 2010 is considered “grandfathered,” or exempt, from the mandate; about a third of the women in the study were on grandfathered plans. “A significant minority of women are still paying a lot for their contraception,” Becker says. Fortunately, grandfathered plans are phasing out over the next few years, meaning affordable contraception will be accessible to all in the near future.