The XX Factor

New York May Force Insurers to Fully Cover Birth Control Even If Obamacare Gets Repealed

In New York, no matter what happens at the federal level, these could be free.

New York’s attorney general is making moves to protect no-cost access to contraception in the event that a Republican-controlled Congress and a Trump-controlled executive branch roll back the current contraception mandate of the Affordable Care Act.

Under the ACA, all health insurance plans must cover birth control with no out-of-pocket cost to the patient. If congressional Republicans get their way and repeal the ACA, the piece of legislation Eric T. Schneiderman introduced on Wednesday will ensure that people covered by state-regulated insurance companies will still get free birth control.

The bill would also expand the ACA’s contraceptive benefits. It would apply to all FDA-approved birth control, including emergency contraception. (The ACA allows insurance companies to limit coverage to a single kind of any given class of contraceptive, meaning an insurer could hypothetically cover the Mirena IUD, but not the smaller, lower-dose Skyla. Since Mirena and Skyla are not therapeutically equivalent, the New York law would require an insurer to provide either one at no cost.) Schneiderman’s proposed legislation would also make insurers pay for vasectomies for men and let women get a year’s worth of contraception at one time.

This kind of state regulation could prove essential for low-income women in coming years, as no-cost contraception is losing its friends in high places. In addition to a Congress that’s hostile to the ACA and has voted repeatedly to defund one of the nation’s most visible providers of contraception, Trump’s pick to head the Department of Health and Human Services, Rep. Tom Price, is a staunch opponent of birth-control access. Price has spoken out against the ACA’s contraceptive mandate, claiming laughably that not a single woman in the U.S. has trouble affording birth control. He has called the mandate, which has saved 55 million women billions of dollars, “a trampling of religious freedom and religious liberty in this country.” If Congress somehow stalls on ending mandatory contraceptive coverage, Price is likely to do everything he can (and he can do a lot) to make it happen. Planned Parenthood is reporting that demand for IUDs has risen 900 percent since the election as women rush to get their contraceptive ducks in a row before Trump’s inauguration.

Some states have previously experimented with funding contraception on their own, with remarkable results. Colorado’s pilot program gave free long-acting reversible contraception (LARC) to any teenager or low-income woman who wanted it. Over about four years, it nearly cut the teen pregnancy rate and the teen abortion rate in half, saving taxpayers millions of dollars. Inspired by Colorado’s success, Delaware launched a similar program last year.

The past year has also seen a handful of states pass bills like the one New York’s legislature will consider: legislation that codifies and expands the ACA’s contraceptive mandate at the state level. A California law that went into effect a year ago now requires state-governed insurers to cover all FDA-approved contraception. Last year, Vermont passed a similar bill that also expands mandatory coverage to vasectomies and a year’s worth of oral contraceptives at a time. Maryland went a step further and included emergency contraception in its contraceptive mandate, which will go into effect at the beginning of 2018. The proposed New York legislation seems to include the best and most comprehensive coverage of these earlier laws. Schneiderman filed a similar bill in 2015, but it stalled in a state Senate committee.

Schneiderman’s legislation can also be understood in the context of recent attempts by state and municipal political leaders to protect their residents from the havoc Trump and Congress may wreak down the line. Earlier this week, for instance, Washington, D.C. Mayor Muriel Bowser announced the formation of a new $500,000 legal defense fund for undocumented D.C. residents who may be vulnerable under Trump’s presidency. American cities could be the country’s best hope for thwarting Trump’s mass deportation plans. And states—the blue ones, anyway—may be an effective safeguard against attacks on contraception.