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These States Guarantee Free Birth Control No Matter What Trump Does

Regardless of what happens to Obamacare, they have us covered.

Michelle Malia

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It’s been a shitty year for reproductive healthcare. Trump has tried tirelessly to repeal and replace the Affordable Care Act with bills that would have led to millions of people losing their health insurance, let states withhold funding from family planning providers that offer abortion, and allowed employers to stop covering birth control altogether if they have religious or moral objections.

One of the big things Obamacare did was give people with health insurance free access to all contraceptive methods approved for women by the Food and Drug Administration—that’s all 18 types except for male condoms and vasectomies—as a preventive service. This includes on-the-fly methods like female condoms, planned ones like the Pill, long-acting reversible kinds like intrauterine devices (IUDs), and permanent methods like getting your tubes tied. In insurance-speak, this access is called “coverage without cost-sharing,” and it means that you don’t have to cough up co-pays or deductibles.

These Obamacare provisions reduce the barriers separating women from the most effective methods of birth control, and the fewer barriers there are, the better off we are. Studies suggest that once cost-sharing was eliminated, women were more likely to use the Pill consistently and more likely to use a prescription birth control method—especially long-acting ones, which are the most effective and the most expensive. Plus, complete coverage saves women $1.4 billion per year ($255 per person) on out-of-pocket expenses. That’s not accounting for additional costs you could face from getting pregnant when you don’t want to be. As a country, unintended pregnancies cost $24 billion a year in public health spending.

“Everyone deserves the ability to make informed decisions about their health and to control their bodies, which shouldn’t be dependent upon where they live, where they come from, or how they identify,” says Oregon Governor Kate Brown, who signed the state’s Reproductive Health Equity Act, one of the most progressive reproductive healthcare laws in the country, in August. “[This law] is so important as it brings down barriers around individuals’ health decisions and care, and contributes to overall greater public health.”

Even if Trump guts birth control coverage, states can put their own laws in place to require free reproductive and preventive healthcare. And that’s exactly what’s happening.

“We’re facing a crisis here, where the attempts to repeal the Affordable Care Act are very palpable, very much on the front burner, and that includes repealing contraceptive coverage,” says Elizabeth Nash, the senior state issues manager at the Guttmacher Institute, an organization focused on advancing sexual healthcare around the world. “You’re seeing [states] start to mobilize around protecting contraceptive coverage...Fundamentally, this is part of healthcare.”


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In 2014, California became the first state to expand free access offered through Obamacare, and since then, several states have enacted similar laws, which we list below. Last week, Massachusetts became the latest state to guarantee contraception at no cost (no, not the first, despite what Facebook videos might tell you).

All of these laws guarantee that women with health insurance can get free birth control as prescribed by their doctor and they offer extended supply, which means you can walk out of the pharmacy with enough birth control to last for up to 12 months. Both rules make contraception more accessible. “The [state laws] are crafted in a way to eliminate those barriers to make it much easier to access contraceptives, and to be able to access the method that’s best for you,” Nash says.

But because the law is never straightforward or simple, each state has its own quirks. Some cover additional services like follow-up appointments, counseling on contraceptive use, and device insertion and removal for IUDs and implantable rods.

Here’s a list of states with laws that guarantee free access to birth control and in what scope. Healthcare is messy and complicated, so always check with your insurance provider to confirm what your plan covers. We’ll update this story as other states move to protect free reproductive healthcare.

California

Law: SB-1053, effective in January 2016; SB-999, effective in January 2017
Methods covered: all FDA-approved contraceptive drugs, devices, and other products for women as prescribed by your doctor; female sterilization
Extended supply: up to 12 months (that’s thanks to SB-999)
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects
Pay attention to this: This law says your insurance only has to cover costs for contraception if you have a prescription, but a separate law says you can buy self-administered methods—like the patch, the pill, shots, and vaginal rings—without a prescription. In these cases, your insurance should still cover the cost, but it’s best to check beforehand.

Vermont

Law: HB-620, effective dates from July 2016 to October 2016
Methods covered: at least one form of each FDA-approved contraceptive drug, device, and other product for women as prescribed by your doctor; male and female sterilization
Extended supply: up to 12 months
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects
Pay attention to this: The only exclusion here is male condoms.

Illinois

Law: HB-5576, effective in January 2017
Methods covered: all FDA-approved contraceptive drugs, devices, and products; male and female sterilization
Extended supply: up to 12 months
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects
Pay attention to this: Illinois’ law doesn’t apply to employers with self-insured health plans, but it does require insurance companies to cover a 12-month supply of contraceptives at once.

New York

Rule: Regulation 62, effective in August 2017
Services covered: at least one form of each FDA-approved contraceptive drug, device, and other product for women
Extended supply: a three-month supply with first prescription, then a 12-month supply
Other services: device removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects; medically necessary abortions
Pay attention to this: The regulation applies to plans regulated by the state, which includes plans sold to individuals, plans sold to companies with fewer than 100 employees, and plans that larger companies buy from insurance companies. Employers that are self-insured don’t have to follow the rule. There’s a bill in the state senate that would require coverage without cost-sharing, but as of November 2017, it hasn’t passed yet.

Oregon

Law: HB-3391, effective dates from August 2017 to January 2019
Methods covered: any FDA-approved drug, device, or product; male and female sterilization
Extended supply: a three-month supply with first prescription, then a 12-month supply, thanks to HB-3343
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects; abortions
Pay attention to this: Oregon is the first state to require insurance providers to cover the full cost of abortions with no exceptions, and anyone can get reproductive health coverage regardless of gender identity or citizenship status.

Nevada

Law: AB-249 and SB-233, both effective in January 2018
Methods covered: all FDA-approved contraceptive drugs, devices, and other products for women as prescribed by your doctor; female sterilization
Extended supply: a three-month supply with first prescription, then a 12-month supply
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects
Pay attention to this: If you switch health insurance plans after getting an IUD or implant, the new insurance may charge you if/when you want it removed.

Maryland

Law: HB-1005 and SB-848, both effective in January 2018
Methods covered: all FDA-approved contraceptive drugs and devices as prescribed by your doctor; male and female sterilization; emergency contraception (even without a prescription)
Extended supply: a two-month supply with first prescription, then a six-month supply
Other services: none
Pay attention to this: Maryland was the first state to require coverage of over-the-counter emergency contraception without cost-sharing. Still, the law only applies to plans regulated by the state.

Maine

Law: HP-860, effective in January 2018
Methods covered: at least one form of each FDA-approved contraceptive drug, device, and other product for women as prescribed by your doctor
Extended supply: up to 12 months
Other services: none
Pay attention to this: Insurers are only required to cover one form of each method (e.g. one type of pill), but if your doctor says your method is medically necessary, it has to be free.

Massachusetts

Law: H-4009, insurers have until May 2018 to comply
Methods covered: all FDA-approved contraceptive drugs, devices, and products for women; female sterilization; FDA-approved emergency contraception (like Plan B)
Extended supply: a three-month supply with first prescription, then a 12-month supply
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects
Pay attention to this: Massachusetts’ law doesn’t cover male condoms or FDA-approved birth control pills with no generic equivalent. Insurers aren’t required to cover brand name products when a generic is available unless your doctor says it’s medically necessary. The law also does not apply to self-insured employers.

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