Obamacare's Free Birth Control Mandate Works, Study Finds

Obamacare's contraceptive mandate, the controversial provision of the president's health care reform bill that requires insurers to cover the costs of birth control, appears to increase access to the medication, according to a study published this month in the journal Health Affairs.

Women who aren't required to pay a co-pay or share the cost in other ways are more likely to continue to use birth control pills over the long term, and since the law was implemented, more American women have been able to consistently use the medication.

The study's authors, led by Dr. Lydia Pace at Brigham and Women's Hospital, pointed out that around 47 percent of all pregnancies in the United States are unplanned. Increasing patients' access to medications that allow them to better control their reproductive choices, therefore, has the potential to produce a large impact on individuals and families.

"Since the pill remains the most common contraceptive method, nonadherence among women seeking to avoid pregnancy is a critical public health concern and strategies to promote adherence could help reduce unintended pregnancies among women," said Pace in a press release.

"Our study finds that cost-sharing does impact women's ability to use pills as prescribed and that reducing cost-sharing, as achieved by the [Affordable Care Act], may help women use pills consistently," she noted.

Overall, the law appeared to decrease the rate at which women discontinue or interrupt their use of birth control pills by around 3.5 to 7.5 percent.

It may seem obvious that reducing the cost of a medication would make it easier for patients to take it more consistently. However, it's important for studies like this to confirm these predictions, which underscore the fact that cost has prevented many women from accessing birth control.

Just as important, too, however, is the finding that mandated coverage for birth control has only increased usage rates modestly. As the authors note, this suggests that there's still much more policymakers could do to increase access to this medication.

One limitation for many women is that despite the law, obtaining birth control without having to pay can be very tricky, as Dr. Tracey Wilkinson, a physician, pointed out at Vox. This is because insurers only have to provide the coverage for a limited number of contraceptive types, and doctors may not know which type is covered by their patient's insurance when they write the prescription.

So what does that mean in practice?

"Too often, I have patients return or call my office telling me that their insurance didn’t cover the birth control I prescribed, that there was a copay they could not afford or some roadblock has appeared that effectively denied them the method of contraception we had discussed," Wilkinson writes.

The Health Affairs study, which looked at more than the claims of more than 600,000 female patients from 2010 to 2013, found that these occurrences were significant. About 25 percent of patients buying generic forms of birth control had to cover at least part of the cost. Nearly 50 percent of those who bought brand-name versions also had to pay.

The contraception mandate itself remains hotly debated. In the 2014 landmark decision Burwell v. Hobby Lobby, the U.S. Supreme Court ruled that closely held corporations with religious objections to contraception did not have to abide by the contraceptive mandate when purchasing insurance for their employees.

Proponents of the mandate and women's health issues strongly criticized the Hobby Lobby decision. Others argued it didn't go far enough and that no company should be required to purchase insurance that conflicts with deeply held moral beliefs.

The study was funded by the Mary Ann Tynan Fellowship in Women's Health; the Eleanor and Miles Shore Scholars in Medicine Program; the National Institutes for Health's Building Interdisciplinary Research Careers in Women's Health K12 Program; and the North Carolina Translational and Clinical Sciences Institute grant.

Photo credit: Bryan Calabro via Wikimedia Commons