A New Survey Indicates ACA Increased Birth-Control Options but COVID-19 Threatens Gains

By Kelly Folkers (March 16, 2021)

Since President Obama signed the Affordable Care Act (ACA) into law almost ten years ago, increasing numbers of patients have been able to use their desired form of contraception, according to the results of a recent national survey of OBGYNs. One of the law's most popular provisions requires insurers and employer-sponsored plans to cover most FDA-approved contraceptive methods without charging a co-pay or co-insurance. But with the COVID-19 pandemic continuing into its second year and the future of the ACA pending in the Supreme Court, these important gains furthering reproductive autonomy hang in a precarious balance. 

The Kaiser Family Foundation reports that 63 percent of providers have seen contraceptive use significantly or somewhat increase after the implementation of the ACA's birth-control coverage mandate in 2012. Importantly, 69 percent of OBGYNs surveyed reported that the number of their patients able to select their desired method of contraception significantly or somewhat increased subsequent to the provision's implementation. 

Historically, access to contraception has led to a number of beneficial outcomes for women and people with uteruses. Since oral birth control pills became legal in 1965, more women have enrolled in college and earned higher wages. But like any type of health care, birth control is not a one-size-fits-all approach. Patients need a menu of birth control options available as some may cause unwanted side effects. 

Despite the ACA's important gains, the survey also revealed that lower-income patients, particularly those on Medicaid, face significant difficulty in affording and accessing sexual and reproductive healthcare. Though 78 percent of the OBGYNs surveyed accepted Medicaid, many noted barriers to enabling contraceptive choice like the need to get prior authorization or being limited to prescribing an initial contraceptive supply for only 30 days. While the survey provides important context to suggest that the ACA has significantly improved access to contraception nationwide, the survey respondents included, primarily, providers who practice in states with Medicaid expansion, in urban settings, and in private clinics.

At the same time, the ongoing COVID-19 pandemic has created new barriers to accessing care. According to the Guttmacher Institute, one third of women reported delays or cancellations in contraceptive or other sexual and reproductive healthcare. While physician accessibility has increased with the use of telemedicine, at least five states require that providers prescribe birth control in person. 

Without guaranteed, affordable access to one's desired birth control method, many patients may need emergency contraception or abortion. But several states have essentially used the pandemic as a pretext for almost completely curtailing abortion access. For example, early in the pandemic Texas banned all abortions that were not "necessary to preserve the life and health of the mother," essentially requiring any person seeking an abortion in Texas to travel out of state. In many red states, patients have had to rely on the support of community organizations to provide transport for an abortion, risking their life and health to exercise their constitutionally protected right to reproductive autonomy. 

While the ACA laid the foundation for increased access to reproductive health care, the Kaiser Family Foundation survey signals that access to the full array of FDA-approved birth-control options remains inequitable. Further, the pandemic has revealed the need for states to ensure reproductive autonomy and justice by guaranteeing coverage for the full array of contraceptive options for all and removing unnecessary barriers to accessing reproductive health care.