Unfortunately, women's reproductive healthcare perpetually hangs in balance under the Trump administration. To account for the uncertainty around the contraceptive mandate of Obamacare, some states are taking action to ensure that birth control remains accessible and low-cost for American women, with or without Obamacare.
The contraceptive mandate of the Affordable Care Act (ACA) requires that insurance plans must cover contraception for women without cost-sharing, meaning that the insurance company, not the woman, is responsible for paying for the cost of birth control. Sadly, under the Trump administration, the contraceptive mandate, as well as the entire Affordable Care Act, remain under threat, even though the GOP's initial repeal and replace plan failed.
Indeed, while it would take additional Congressional action to repeal the ACA successfully, the contraceptive mandate has an even more immediate threat. As FiveThirtyEight reported, the contraceptive mandate can actually be revoked at any time by the Department of Health and Human Services. If the department removes contraception from its list of fully-covered preventative services, women could have to start paying out-of-pocket for birth control again.
As a result of the uncertainty surrounding the future of the contraceptive mandate, some states are taking action to ensure that women have access to low-cost birth control, even if the mandate is revoked. According to FiveThirtyEight, states are generally implementing three tactics to help ensure access to and low cost availability of birth control. The tactics consist of making the contraception mandate into state law, requiring insurance companies to pay for a year's worth of contraceptives up front, and letting pharmacists prescribe certain forms of birth control without a physician.
FiveThirtyEight reported that California has already adopted all three of these approaches to help maximize low-cost contraception access for women in the state — and Maryland is on its way to doing the same. Many other states have adopted or are in the process of adopting at least one, if not more, of the above-described tactics. If you wish to learn more about the progress of contraception access and cost legislation state-by-state, FiveThirtyEight shared a helpful chart from the Guttmacher Institute which shows all states (23 plus Washington, D.C.) that have proposed expanding contraceptive access and what the status of state legislation is for each of the three above-described tactics.
FiveThirtyEight indicated that many reproductive health advocates are lauding the progressive and anticipatory moves that states are making to ensure that women's reproductive health and contraception access are protected no matter what, saying that it reflects a promising prioritization of women's health issues. However, the article also indicated that some individuals in the reproductive health community are concerned about state-to-state disparities in contraception access and cost, particularly if the federal mandate is repealed.
It is absolutely encouraging to see some states proactively stepping in to ensure that women can access contraception easily and at low or no cost, even if the federal contraceptive mandate is repealed. However, it is, of course, ideal and imperative that this mandate is not eliminated for the sake of all women, particularly those in states which have not introduced any legislation to expand contraception access.