Whitney, an Indiana-based pediatrician who asked that her last name be withheld, had been using a year-long birth control ring called Annovera for nearly a year when she recently changed jobs, and her new insurance provider declined to cover the ring. Prior to the ring, Whitney had been using an IUD, knowing that a long-term birth control method would work best for her. But without coverage for her Annovera ring, she’s had to change to an alternative that hasn’t been working well for her. Aside from challenging her insurance company, however, Whitney says she “doesn’t have any other option right now but to use this non-preferred method.”
Stories like Whitney’s are common, according to Dr. Raegan McDonald-Mosley, CEO of the reproductive rights campaign Power to Decide, despite how under the Affordable Care Act, insurers are legally required to cover the full range of contraceptive methods, without any out-of-pocket costs. It’s through this mandate of the ACA that about 65 million Americans are able to access birth control without a co-pay.
Amid escalated attacks on reproductive rights, including a Supreme Court case that could reverse Roe v. Wade and a pandemic that’s created significant logistical barriers to get contraception and abortion, McDonald-Mosley emphasizes that patients trying to get reproductive care “aren’t doing this as a political act.” Birth control is a ubiquitous part of the lives of people of all ages, faiths, and communities. But as the FDA approves more and more forms of contraceptives, from new patches with lower hormones, to non-hormonal contraceptive gels, many private insurers are doing everything they can to shirk the ACA’s birth control mandate and avoid covering less traditional methods.
One patient McDonald-Mosley recently worked with concluded that a non-hormonal septic contraceptive gel would work best for her—only for her insurance company to require her to pay $300 out-of-pocket for just 12 applications of the gel, which she couldn’t afford. Health care providers like McDonald-Mosley are trying to help their patients choose the right contraceptive method for their unique needs, only for insurance companies to “undermine that decision-making, undermine the patient-provider relationship, and weaken patients’ overall trust in the medical system,” she says.
It’s a problem that Washington Sen. Patty Murray, who serves as chair of the Senate Committee on Health, Education, Labor, and Pensions, is well aware of. Her office has led recent Senate efforts to hold private insurance companies accountable, and has worked closely with patients who say their insurers are failing to meet the requirements set by the ACA’s contraceptive mandate.
“Way back when we passed the ACA, we made sure it includes coverage of the entire range of FDA-approved methods—not some, all,” Sen. Murray told Jezebel. “Now I’m hearing from women telling me they have to jump through all kinds of hoops to get their insurers to pay for it, being required to do crazy things like try at least five contraceptive methods and prove they didn’t work before the insurer agrees to cover the birth control they want.”
The senator expressed particular concern with how a requirement like this could affect someone’s physical and mental health due to the varying side effects they may experience as a result of repeatedly changing birth control methods, just to get their insurer to fulfill its legal duties.
Murray, a long-time leader on advocating for birth control coverage and reproductive rights in the Senate, has recently partnered with Oregon Sen. Ron Wyden to call on the Biden administration to reaffirm the ACA’s birth control mandate, monitor private insurance companies, and investigate patients’ complaints. A guidance from the White House last month essentially put insurance companies on notice, and stated that it “may take enforcement or other corrective actions.”
The guidance is an important step forward, Murray says, and she hopes that next, the Biden administration will build upon it by issuing comprehensive direction on insurers’ responsibilities for contraceptive coverage, and “take swift enforcement action against insurers who fail to comply with those responsibilities.”
Dr. McDonald-Mosley says Power to Decide is working to help the federal government in its monitoring of both private and public insurers by showing people how to report violations to the federal government on its website. Reportable violations from insurers include denying coverage even after a health care provider communicates the necessity of a particular birth control method for their patient, or requiring people to prove their non-preferred contraceptive methods don’t work for them before agreeing to cover their preferred one.
Mara Gandal-Powers, director of birth control access and senior counsel at the National Women’s Law Center, says NWLC is investigating the situation and working directly with patients who are being made to pay out-of-pocket costs for contraception. NWLC has a hotline on its website through which individuals can contact the organization for help with figuring out why they’re being charged, and also get help with appealing a denied claim for contraceptive coverage.
Gandal-Powers says the expanding amount of options for birth control methods is an exciting development for people who have long struggled with side effects from more traditional forms of birth control, like the pill. But if insurers refuse to cover new methods that might better fit people’s specific health needs, this “just goes against the heart of what the ACA birth control benefit really is supposed to do.”
“From an equity perspective, it’s a problem that the only people who can access the new methods are those who can afford the out-of-pocket costs,” Gandal-Powers said. “When you’re talking to your health care provider about what birth control is right for you, you should be able to take the money out of the equation—it should be about your needs.”
Barriers to birth control are just one dimension of an escalating war on reproductive rights, after 2021 alone saw a record-breaking 106 new state-level abortion restrictions enacted. “Access to birth control is never going to be the cure-all solution when access to abortion is curtailed, because people will always need abortion, no matter what,” she said. “But particularly knowing what the stakes are for someone who can experience pregnancy, it’s important for there to be good birth control coverage at all times, with everything hanging in the balance.”
Even as a pediatrician, Whitney says that prior to her experience struggling to get insurance coverage for her contraceptive method of choice, she wasn’t fully aware of her rights as a patient, the legal obligations of insurance companies, or the options for recourse that she and other patients have. “Patient education can go a long way,” she said. “I’m now well versed in the hoops you have to jump through, but I worry about the women who may not be, who don’t know they can contest an insurance company’s denial, and could be taken advantage of.”