Government Mandates Free Birth Control Pills

Trump Administration Rolls Back Mandate in 2018

Woman holding package of birth control pills
Contraceptives Must Be Covered By Company Health Plans. Tim Matsui / Getty Images

American insurance companies are required to provide birth control pills and other forms of contraception at no cost to women under guidelines announced by the U.S. Department of Health and Human Services in August 2011.

The insurance rules calling for free birth control pills take effect on Aug. 1, 2012, and expand medical coverage under the health care reform law signed by President Barack Obama, The Patient Protection and Affordable Care Act.

"The Affordable Care Act helps stop health problems before they start," said then Health and Human Services Secretary Kathleen Sebelius. "These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need."

At the time the rules were announced 28 states required health insurance companies to pay for birth control pills and other forms of contraception.

Reaction to Free Birth Control Pills

The rule requiring insurers to provide birth control for women at no cost was met with praise from family-planning organizations, and criticism from the health care industry and conservative activists.

Cecile Richards, president of Planned Parenthood Federation of America, described the Obama administration rule as being a "historic victory for women's health and women across the country."

"Covering birth control without co-pays is one of the most important steps we can take to prevent unintended pregnancy and keep women and children healthy," Richards said in a prepared statement.

Conservative activists argued that taxpayer money should not be used to pay for contraception, and the healthcare industry said the move would force them to raise premiums and increase the cost of coverage to consumers.

How Insurers Will Provide Birth Control Pills

The rules give women access to all Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling. The measure does not include abortifacient drugs or emergency contraception.

The coverage rules allow insurers to use "reasonable medical management" to help define their coverage and keep costs down. For example, they will still be allowed to charge copayments for brand-name drugs if a generic version is available and is just as effective and safe for the patient.

Copayments, or copays, are paid by consumers when they purchase prescriptions or go to their doctors. Birth control pills cost as much as $50 a month under many insurance plans.

Religious institutions that offer insurance to their employees have the choice of whether to cover birth control pills and other contraception services.

Reason for Free Birth Control Pills

The Department of Health and Human Services considers the provision of birth control pills as necessary preventive health care.

"Before health reform, too many Americans didn't get the preventive health care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs," the agency said. "Often because of cost, Americans used preventive services at about half the recommended rate."

The government described family planning services as being "an essential preventive service for women and critical to appropriately spacing and ensuring intended pregnancies, which results in improved maternal health and better birth outcomes."

Other Preventative Measures Covered

Under the rules announced in 2011, insurers are also required to provide, at no cost to consumers:

  • well-woman visits;
  • screening for gestational diabetes;
  • human papillomavirus DNA testing for women 30 years and older;
  • sexually-transmitted infection counseling;
  • human immunodeficiency virus (HIV) screening and counseling;
  • breastfeeding support, supplies, and counseling;
  • and domestic violence screening and counseling.

2018: Trump Weakens Birth Control Coverage Mandate

On November 7, 2018, the Trump administration issued two final regulations allowing employers to deny women insurance coverage for birth control measures as a preventative health service.

The first of the two rules issued by the Department of Health and Human Services allows exemptions to the Obamacare contraceptive coverage mandate for entities that object to such coverage based on religious beliefs. The second final rule allows coverage exemptions to nonprofit organizations and small businesses that have moral, non-religious objections to contraception.

“The Departments estimate the exemptions may affect the coverage of approximately 6,400 women, and state that in no case will they impact more than 127,000 women, which the Departments suggest is far more than will actually be impacted,” said the Department in a press release.

The religious and moral exemptions provided by the rules apply to institutions of education, issuers, and individuals. However, the exemption for moral beliefs does not extend to publicly traded businesses, and neither the moral nor the religious exemption apply to federal government agencies or entities, according to the Department.

“These rules affect a small fraction of the 165 million women in the U.S.” Stated the Department. “The rules leave in place contraceptive coverage guidelines where no religious or moral objection exists, and they do not change the Health Resources and Services Administration’s authority to decide whether to include contraceptives in the women’s preventive services guidelines for other entities.”

Issued in the form of federal regulations at the direction of a presidential executive order, rather than an act of Congress, the rules may be amended or repealed at any time by the current or future presidential administrations.

Updated by Robert Longley