Guest Blog: The Co-Pay Question—Contraceptive Access Under the ACA

Barbara S. Levy, MD

Barbara S. Levy, MD

If you’ve been to the pharmacy or doctor’s office lately, there’s a good chance that you noticed something different about your bill—there may not have been one. Depending on what type of insurance you have, you may now be eligible to receive all FDA-approved contraception and other preventive health services without a co-pay. This is due to the Affordable Care Act (ACA), a law with a lofty goal: overhauling our current health care system to provide the majority of Americans with affordable access to health care. While the intricacies of the ACA—and health insurance policies—are complex, it’s important for women to understand these most recent changes because they so specifically apply to us.

Whether or not you still have a co-pay for contraceptives depends on where you get your health insurance. More than half of people in the US get their insurance either through their job or by purchasing an individual insurance plan. Currently, the contraceptive coverage provision applies to most of these private plans. Insurance companies that adopted ACA policy changes early on may have already updated their plans to offer free contraception beginning in August 2012. As time passes, more plans will comply. However, there are some exceptions—some plans have grandfathered status that gives them more time to meet the terms of the new requirements, and some religiously affiliated organizations are currently exempt from providing this coverage.

State Medicaid programs already provide no-cost contraception to enrollees. The ACA expands Medicaid’s reach, potentially decreasing the number of uninsured women ages 19–64 from 20% to 8%. Many states are still hammering out exactly how Medicaid provisions will be implemented. ACOG is following this issue closely and supports the adoption of the ACA’s Medicaid expansion in all states.

So how can you find out whether your plan has changed and what new services are covered? You’ll need to ask a few questions and then update your records to be sure your health care team (you, your insurer, pharmacy, and your doctor) is on the same page:

  • Ask your employer or your health insurer whether the ACA has caused any significant changes to your plan. If so, what are they, and specifically, is contraception now covered without a co-pay?
  • If there are updates to your plan, be sure to notify your pharmacy and your doctor’s office and report any problems to your plan administrator or insurance company. It’s up to you to be sure you’re being charged correctly based on what your policy covers.

As an ob-gyn, I am thrilled by the increased availability of no-cost contraception that the ACA provides. Contraception is a basic health necessity for women. More access puts women in the driver’s seat, helping us avoid unintended pregnancy and take control of our reproductive health.

Learn more about contraceptive coverage and the ACA.

Barbara S. Levy, MD, is vice president of health policy at ACOG.

Guest Blog: Why Expanding Medicaid Matters for Women

Gerald F. Joseph Jr, MD

Many women in the United States do not have health insurance. As a result, they don’t get the health care they need and their health suffers. Compared to women with health insurance, uninsured women are:

* Less likely to receive preventive care or treatment for disease.

* More likely to be diagnosed with cervical and other cancers at a late stage and die from the disease or its complications due to a delay in diagnosis.

* Less likely to get prenatal care during pregnancy. The babies of uninsured women are also more likely to be born with a low birthweight and die within the first year of life.

* Less likely to use a prescription contraceptive, which can lead to unintended pregnancy.

The Affordable Care Act (ACA) can help. It expands Medicaid—the state-federal health insurance program for low-income individuals—which is one of the health care reform provisions that ACOG supports. The percentage of uninsured women ages 19–64 could decrease from 20% to 8%, but this will happen only if all 50 state governors decide to expand their Medicaid programs. ACOG encourages all states to accept this expansion offer, under which the federal government will pay all the costs until 2016. After that, the federal contribution gradually drops, but only to 90% in 2020 and beyond.

The ACA also makes it easier for states to provide Medicaid birth control coverage to low-income women by eliminating bureaucratic red tape.

With Election Day approaching rapidly, I encourage you to find out what the candidates in your state support. Use your vote to make it clear to your state lawmakers that expansion of Medicaid is good for women’s health.

For more information:

Protect Medicaid and Women’s Health

What the Medicaid Eligibility Expansion Means for Women

Medicaid Expansion Resources

Gerald F. Joseph Jr, MD, is ACOG vice president for practice activities.

Guest Blog: The Recipe for Preventing Unintended Pregnancy

Erika E. Levi, MD, MPH

Ob-gyns are on the front lines of the effort to decrease the rate of unintended pregnancy, which accounts for half of all pregnancies in the US. Now, we have more information about how we can best accomplish this goal.

Recent findings from the Contraceptive CHOICE Project made news headlines, and for good reason. The project—which included more than 9,000 contraception-seeking adolescents and women in the St. Louis region who were at risk for unintended pregnancy—found that the rate of unintended pregnancy dropped with just two simple interventions. Women were given:

  1. A short contraceptive counseling session that covered all methods of reversible contraception and emphasized the superior effectiveness of long-acting reversible contraception (LARC) methods: intrauterine devices (IUDs) and hormonal implants.
  2. The contraceptive method of their choice for free.

Seventy-five percent of the women selected a LARC method. Among all the women, there were lower rates of abortion, including repeat abortion, and lower rates of teen births. These findings support ACOG’s recommendations on the use of LARC methods as first-line contraceptive options to reduce unintended pregnancy and highlight the benefits of providing women with no-cost access to contraception.

ACOG advises ob-gyns to:

  • Provide counseling on all contraceptive options, including implants and IUDs, even if the patient initially states a preference for a specific contraceptive method
  • Encourage implants and IUDs for all appropriate women, including those who’ve never given birth
  • Adopt same-day insertion protocols. Screening for STIs may also occur on the day of insertion, if indicated
  • Avoid unnecessary delays to LARC initiation, such as waiting for a follow-up visit after an abortion or miscarriage or waiting to time insertion with the menstrual cycle
  • Advocate for coverage of all contraceptive methods by all insurance plans
  • Support local, state, federal, and private programs that provide contraception, including IUDs and implants

The problem of unintended pregnancy in the US is not going away. As ob-gyns, we are uniquely positioned to help women avoid unintended pregnancies. Let’s work with our patients and help them make the best choices for their reproductive health.

Erika E. Levi, MD, MPH, is a Family Planning Fellow at the University of North Carolina at Chapel Hill.

Guest Blog: Prevent Teen Pregnancy on a LARC

Elisabeth J. Woodhams, MD

In my Chicago clinic I see a lot of adolescents, and by extension, I prescribe a lot of contraception. Although, by “prescribe contraception” I actually mean “place IUDs and implants,” which, until recently, had been considered a fairly edgy clinical practice in some circles. Imagine my excitement, then, over ACOG’s latest recommendations from the Committee on Adolescent Health Care and the Long-Acting Contraception Work Group that encourage us to offer these two contraceptive methods as first-line options for sexually active teens.

Family planning specialists have long known that long-acting reversible contraception (LARC) devices are safe for adolescents and are significantly more effective at preventing pregnancy when compared with other forms of short-acting contraception, such as pills, patches, or vaginal rings. In fact, a recent study found that women using a LARC device were 20 times less likely to experience an unplanned pregnancy than women using short-acting methods. This is hugely important considering that:

  • 82% of adolescent pregnancies are unplanned
  • 20% of adolescent mothers will experience a second pregnancy within two years of their first pregnancy
  • Condoms are the most common method of contraception used by adolescents. While still important for preventing sexually transmitted infections (STIs), they are the least effective contraceptive method for preventing pregnancy.

LARC methods work better than short-acting ones because there’s no user error. As I tell my patients, a pack of pills only works if you’re actually taking them. Also, the continuation rates are better—in that same study, 86% of adolescents using a LARC device were still using it a year later, compared with 55% of those using a shorter-acting method.

And LARC methods are very safe for adolescents:

  •  IUD expulsion is uncommon in adolescents
  • There is no increased risk of infertility for IUD users
  • Any increased risk of pelvic inflammatory diseases (PID) is limited to the first 20 days after insertion of an IUD and is related to infection at the time of insertion rather than the IUD itself. This is another important reason ob-gyns should screen all their patients under 25 for chlamydia and gonorrhea annually.
  • IUDs and implants can be placed immediately post-delivery or post-abortion
  • IUDs and implants can decrease menstrual blood loss and decrease anemia, a plus for many teens

So make sure LARC methods are at the top of your list when you’re counseling adolescent patients. For many teens, LARC devices—combined with condoms for STI prevention—are the best way to ensure they get on the right reproductive track early.

Elisabeth J. Woodhams, MD, is a Family Planning Fellow at the University of Chicago in Illinois.

 

A Victory for Healthy Moms

According to a recent New York Times article, maternal deaths have plunged from more than half a million per year in the 1990s to roughly 287,000 in 2010. A report released by the United Nations attributes the decline to better access to and use of contraceptives and of antiretroviral therapies among mothers with AIDS, and more births being attended by doctors, nurses, and medically trained midwives. Though this number is still far too high, the drop in maternal mortality is dramatic and serves as a powerful reminder that we’re heading in the right direction.

Contraceptive access is essential for all women because, according to the World Health Organization, if the 215 million women desiring contraception could get it, each year unintended pregnancies would drop by 71% and maternal deaths would decrease by 67%. In a world of limited resources and 7+ billion people, helping women control their fertility is the right thing to do. By providing women with options that help them make better reproductive choices and protect their health, and by making childbirth safer, women, families, and their communities become stronger and more empowered. The decline is confirmation that inroads can be made and that small changes can make a huge difference.

Maternal mortality remains a major threat to women of all backgrounds. ACOG continues to explore methods of lowering maternal deaths at home and abroad. In the meantime, this good news puts wind in the sails of physicians, women’s health advocates, and communities who tackle this problem from the front lines. And during National Women’s Health Week, it’s an especially fitting time to celebrate.

Access to Contraception Is Every Woman’s Right

You’d have to be living under a rock to have missed the recent political and culture debates about contraceptive access and coverage. Having practiced ob-gyn since the early 1970s, I can tell you that contraception is a fundamental part of women’s health care, just as important as Pap screening, prenatal care, and breast exams. ACOG has long advocated for the right of women to obtain contraception, expanded access to and coverage of it, and a doctor’s ability to prescribe contraception to his or her patients.

More than 80% of reproductive-age women will use contraception for a wide variety of reasons, not just for birth control. Hormonal contraceptives can help with gynecologic problems such as endometriosis, menstrual cycle irregularities, fibroids, and premenstrual syndrome. They also treat acne, improve bone density, help with perimenopausal symptoms, and reduce the risk of certain cancers.

Of course, many women use contraception to avoid pregnancy. However, not enough do, because roughly half of the pregnancies in the US are unintended. Unplanned pregnancies often cause undue strain on women, their families, and society. Lack of access and affordability of contraception deprives a woman of her right to plan a pregnancy at a time that makes most sense for her. Clearly, any campaign to reduce unintended pregnancy must be coupled with a comprehensive program of sex education and easily accessible options for contraceptive health.

I take pride in the fact that my patients turn to me for advice and guidance about medical issues, healthy lifestyle, screenings, immunizations, and their contraceptive needs. I trust that women know what’s best for their lives and their bodies. I also know that contraception is a basic necessity used to protect and improve women’s health. And I am not alone. I stand with ACOG in putting women first. I fully support the right of all women to unimpeded contraceptive access.

Wrong-Headed Decision on Plan B One-Step

For a decade, ACOG has supported making emergency contraception (EC) available over the counter (OTC) without an age restriction. So it was deeply troubling and disappointing to see HHS Secretary Kathleen Sebelius overrule the US Food and Drug Administration’s decision to remove the age restriction and make Plan B® One-Step accessible to all females capable of becoming pregnant.

The argument that 11- and 12-year-olds are not capable of understanding how to use EC isn’t true, based on the data, and it misses the point. The majority of girls this young are not sexually active and do not represent the bulk of adolescents who are at risk of an unwanted pregnancy. According to the Guttmacher Institute, nearly half of all high school students in the US have had sex at least once, and 85% of adolescent pregnancies are unintended. These high school students are the adolescents who would most benefit from OTC access to EC.

The overwhelming scientific evidence shows that EC is safe for teens and women and is highly effective in preventing unintended pregnancy. Ideally, all sexually active teens and women would use effective contraception each and every time they engaged in sexual intercourse to avoid an unplanned pregnancy. But, we don’t live in a perfect world—a condom tears or you miss a pill, for instance. Rapid access to EC is especially important for women that have been raped.

EC products contain the same hormones as oral contraceptives, only in a higher dose. EC works primarily by preventing ovulation, but it can also prevent fertilization or implantation. However, timing is critical: EC is most effective when taken within 72 hours after unprotected intercourse. This is why OTC access is so important. There’s no need to wait for a doctors’ appointment to get a prescription, or to have the prescription filled.

While EC does not replace the consistent use of reliable birth control, making it available without a prescription to all provides an important safety net. For this reason, ACOG will continue to advocate for removing this unnecessary age restriction to OTC EC.

Birth Rates Drop During Recession

Raising a family is an expensive proposition. The estimated cost of raising a child born in 2010 until age 17 is almost $287,000. So it came as no surprise when the Pew Research Center released a recent report showing a decline in birth rates since the recession began in December 2007. Since then, the rate has dropped from 69.7 births per thousand women aged 15 to 44 to 66.7 births in 2009.

The drop was most pronounced among Hispanics. Between 2008 and 2009, the birth rate among Hispanics fell almost 6% compared with African-Americans who experienced a 2.4% decline, and whites who had a 1.6% drop. Experts say people are postponing having children because they don’t have the necessary financial resources. But regardless of the economy—planning a pregnancy always makes sense.

Unintended pregnancies can have significant health consequences for both mother and baby, especially if women don’t get prenatal care early and often. Decisions about family planning are at the core of a woman’s wellbeing and will have lasting repercussions over her entire lifespan. In good times and bad, it’s important to use a method of birth control that’s right for you. Take charge of your health now.