Perhaps among the most notable achievements of the Patient Protection and Affordable Care Act (ACA) is the requirement that private health insurance plans cover contraceptive counseling, services, and Food and Drug Administration (FDA)–approved methods without cost sharing. Since 2013, decreased out-of-pocket medical expenditures for contraceptives have benefited millions of insured women in the U.S. Highly effective long-acting reversible methods (LARCs), including intrauterine devices (IUDs) and implants, have now become more readily accessible options for many more with the ACA’s elimination of high up-front insertion procedure and device costs. In tandem, increased coverage (greater prescription supply, reduced co-pays) of oral contraceptive pills and other refillable forms as a result of the ACA has removed important financial barriers to more commonly used methods. Ultimately, the hope is that the contraceptive mandate will increase access to effective contraception, thereby supporting planned pregnancies and improving outcomes for women, their families, and society.
Unfortunately, ongoing multilevel challenges to the ACA’s implementation continue to preclude many women from receiving their full reproductive healthcare benefits. These challenges may not be widely understood among women or even health professionals and have received little mainstream attention in lieu of other timely, important, and highly sensitive policy debates around Zika virus, religious exemption, congressional fights to end Planned Parenthood funding, and legislation restricting access to abortion. Meanwhile, though, the general public and healthcare workforce is still grappling with the meaning of “contraceptive mandate” and nature of services that comprise preventive family planning care. Additionally, the political and ideological “blurring” of contraception and abortion, which may not reflect women’s views of and priorities for reproductive health policy, has distracted and disserviced women by precluding much needed education on the ACA and perpetuating unfavorable views of it. New results from the Pew Research Center indicate that 54% of Americans disapprove of the ACA. Thus, increasing awareness of several key woman-, healthcare system–, and policy-level issues with the ACA and contraception appears warranted. The following paragraphs summarize these multilevel issues and offer recommendations for how women, health systems players, and health policymakers may fully leverage the ACA’s contraceptive mandate (or expand upon it) to improve the status of women’s reproductive health and health care in the U.S.