Five facts about the health law’s contraceptive mandate

August 1, 2012

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Remember that part of the health reform law, that requires insurance companies to provide contraceptives at no cost to subscribers? After surviving a heated debate earlier this year, the regulation went into effect today. Here are five things to know about it.

1. It's not just a contraceptives mandate. The health care law does require health insurance plans to cover all FDA-approved forms of contraception. The provision has received lots of attention - but it's just one of seven gender-specific preventive health services that insurers also have to cover, all of which fall under the Women's Preventive Health Amendment, that Sen. Barbara Mikulski (D-Md.) introduced during the Congressional debate. Insurers must now cover domestic violence screening and counseling, breastfeeding supplies and annual preventive care, such as pap smears and pelvic exams.

2. It takes effect today, but for some it could take awhile to kick in. If you show up at your doctor's office today, chances are slim that physicians will be handing out free contraceptives. That's because the new regulation only kicks in at the start of a new insurance plan year.  A lot of employer-sponsored plans, for example, stick with the calendar year. For those plans, co-pays for contraceptives won't go away until the start of 2013.

For certain plans, it could be even longer: The health reform law allows certain health plans that existed before it's enactment to be grandfathered, meaning they were exempt from some new regulations - including this women's preventive health regulation. In those plans, no-cost contraceptives won't start until 2014.

How to know if you have a grandfathered health insurance plan? You'd probably have to contact your carrier. Once you get them on the phone, the National Women's Law Center has a few questions that should do the trick.

3. It could shape women's choice of what form of contraceptives they use. Interuterine devices, or IUDs, are the most effective form of contraception. One study found they are 20 times more effective than birth control pills. They also tend to be the most expensive, with copays that range upwards of $100. In recent years, women have increasingly moved toward using more permanent forms of contraception, like IUDs. This new requirement, which removes cost barriers to such contraceptives, may accelerate that trend.

"I think a real positive out of this is access to long-acting, reversible contraceptives," says Dr. Douglas Laube, the board chair of Physicians for Reproductive Choice and Health. "They're finally going to be affordable."

4. Contraceptives won't cost patients, but that doesn't make them free. Pharmaceutical companies are not handing contraceptives out to doctors offices' without sending insurance companies a bill, too. Health plans ultimately end up paying the cost for any increased use of contraceptives. The Guttmacher Institute estimated in a 1998 paper that adding contraceptive coverage would cost $21.40 per person per year in extra health insurance spending.

The Obama administration says that, on the balance, this requirement will save insurers money: While insurers have some upfront costs, they could see savings from pregnancies prevented. The research, however, conflicts: Some state-level studies have shown their own contraceptive mandates to slightly raise the prices subscribers pay.

5. There's also the possibility that the courts could eliminate it altogether. A number of legal challenges to the mandated coverage of contraceptives are currently winding their way through court. Most recently, a federal court in Colorado blocked the Obama administration forcing an air conditioning company to comply with the requirement, ruling that there's at least a decent shot that its could get overturned. That company argued that the new mandate conflicts with its religious beliefs and violates laws meant to protect their freedom to practice.

That Colorado ruling only applied to one company and was a temporary injunction, meaning the court still needs to decide on the actual merits of the case. A ruling there against the contraceptive requirement could have more significant implications.

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