ACA Contraception Mandate is a Success

One of the most impactful aspects of the Affordable Care Act (ACA) on public health is the mandate that insurers cover all contraceptive methods. The mandate predictably caused push-back from faith-based corporations, but there has been little discussion in public and legal debates on its benefits to individuals and society.

In this study, authors calculated contraceptive out-of-pocket spending of a large sample of women from January 2012 to June 2013 for prescriptive and in-office methods. June 2012 represented initial mandate application with wide-spread compliance by January 2013. For prescription methods (pill, patch, ring, diaphragm, cervical cap, and emergency contraception) authors used pharmacy claims data and for in-office methods (injection, implant, IUD) they used supply, procedural, and visit cost data. Authors compared mean and median costs per user, as well as change in costs before and after implementation.

For all methods except the ring and the patch, mean and median patient costs declined substantially between the before (January 2012-June 2012) and after (January 2013-June 2013) periods. For the two most popular methods, pill and IUD, mean annual costs per individual declined $255 (44%) and $108 (30%), respectively.  For all methods except the pill and patch, median patient expense was $0, demonstrating the mandate’s effectiveness at achieving no cost-sharing for contraception.

There are many limitations to this study, including the use of calculated estimates from raw data, the exclusion of insurers with religious exemption from the mandate, the change in utilization patterns for different contraception methods, the exclusion of grandfathered insurance plans (36% of all insured workers), the change in individuals’ contraceptive methods during the study periods, and the inclusion of patch and pill data, which reflected lack of compliance practices by insurers.

As the researchers wrote, “It is still too early to predict impact of the mandate on health care use and spending, or on other health and socioeconomic outcomes for women;” however, 75 years of national and international evidence concerning contraception use has repeatedly demonstrated that increased access and affordability results in many benefits for individual women and society at large, indicating the mandate’s potential success in improving the economy and women’s lives.

commentary by Laura Grubb

Abstract

The Affordable Care Act mandates that private health insurance plans cover prescription contraceptives with no consumer cost sharing. Using a large administrative claims data set from a national insurer, we estimated out-of-pocket spending before and after the mandate. We found that mean and median per prescription out-of-pocket expenses have decreased for almost all reversible methods. The average percentages of out-of-pocket spending for pills and intrauterine device insertions by women using those methods both dropped by 20% after implementation of the ACA mandate. We estimated average out-of-pocket savings per user to be $248 for the intrauterine device and $255 annually for the pill. We conclude the mandate has led to large reductions in total contraceptive out-of-pocket spending and that these price changes are likely to be salient for women with private health insurance. PMID: 26153316

Becker, NV and Polsky. D. Health Affairs. 2015; 34 (7): 1204-1211.