States lead fight for birth control access
WASHINGTON — Not long after President Donald Trump took the oath of office, a busload of women’s health advocates made the first of a series of 860-mile round trips from Las Vegas, Nev., to the state capital, Carson City. Their mission: to push state legislators to expand insurance coverage for contraception.
It worked. Gov. Brian Sandoval of Nevada, a Republican, last week signed a measure requiring insurers to cover 12 months of birth control at a time, with no copayment.
Nevada is not the only state where birth control is suddenly on the legislative agenda. With the future of the Affordable Care Act — former President Barack Obama’s signature health care legislation — in doubt and the Trump administration planning to roll back the act’s mandate that employers cover contraceptives, the battle over birth control is shifting to the states.
Currently, 28 states have some type of “contraceptive equity” law aimed at making birth control cheaper and more accessible. Many of those measures, including the one in Nevada, were adopted in the late 1990s. Trump’s election has again brought the issue to the fore.
“We are on the cusp of seeing another push, a more aggressive push at the state level to protect affordable access to contraception, just like we saw in the late ’90s when women realized Viagra was getting coverage and birth control wasn’t,” said Andrea Miller, president of the National Institute for Reproductive Health, a New York nonprofit that advocates for reproductive rights.
“The feds can set a floor,” Miller said. “States can decide to do better.”
Several states are expanding access by requiring insurers to cover a year’s supply of contraceptives at a time, as opposed to the customary three months. In Washington, Gov. Jay Inslee, a Democrat, last month signed a bill that would do just that, and Colorado’s Democratic governor, John Hickenlooper, signed a similar bill this week.
Lawmakers in Massachusetts and New York are considering similar bills. In New York, Eric Schneiderman, the attorney general, has proposed farreaching legislation that would cover all forms of birth control, including vasectomies, without copays and at no cost to the patient. (“Obamacare” does not require insurers to cover vasectomies.) The bill has passed the New York Assembly, but awaits action in the state Senate.
Schneiderman, a Democrat, called for similar legislation last year, but said in an interview that Trump’s election increased his sense of urgency.
“We were anticipating this attack would come,” he said.
More than 55 million women now have access to free birth control under the Affordable Care Act, according to a study conducted by the Obama administration. But the Trump administration has drafted a far-reaching rule, leaked last week, that would greatly expand the number of employers and insurers that could qualify for exemptions from the birth control mandate by claiming a moral or a religious objection.
For religious conservatives and antiabortion advocates — many of whom oppose the contraceptive coverage mandate because it includes drugs that they say can induce abortion — the proposed rule was a welcome shift. Archbishop William E. Lori of Baltimore, in a statement issued on behalf of the U.S. Conference of Catholic Bishops, called the draft “encouraging news.”
But hundreds of thousands of women, many of them poor, could lose access to no-cost birth control if the rule goes into effect. For women like Tacy Geesaman, a 34-year-old mother of two in Las Vegas, who took one of the lobbying bus trips to Carson City, and is contemplating a run for public office, the Trump administration’s draft rule is a call to action.
The Affordable Care Act, which passed in 2010, did not explicitly call for insurers to provide birth control free of charge; it called for “preventive services,” like mammograms, to be offered without copays.
But the Obama administration interpreted “preventive services” as including birth control; insurers are now required to cover 18 birth control methods approved by the Food and Drug Administration, at no cost to the patient.
A series of lawsuits filed over the past five years helped chip away at the contraceptive coverage requirement. In 2014, the Supreme Court ruled that family-owned businesses could not be forced to pay for coverage that included contraception if doing so violated the business owners’ religious beliefs.
That same year, California became the first state to pass birth control legislation codifying Obamacare’s requirements, which provided a blueprint for other states to do so.