No-Cost Contraception For Women: The View From Massachusetts

Here's some local reaction:

Dr. Paula Johnson, executive director of the Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital who was on the IOM study panel that issued the recommendations said if they are ultimately adopted by the U.S. Department of Health and Human services, the nation would be taking "a significant step to improving the health and well-being of women." Johnson continues:

A large number of women are deferring preventive services due to cost. These are women we see every day in our practice yet we may not be fully aware of the care that they are deferring due to cost-sharing or co-pays.

In Massachusetts, we are fortunate to be ahead of the curve. Our state extends generous preventive services to women as part of our Health Care Reform Act that served as the model for the national Affordable Health Care Act, and was cited several times in the IOM report. Still, women of the Commonwealth stand to significantly benefit if these recommendations are accepted and implemented.

Under Massachusetts health care reform and the Affordable Care Act, health care is not just about curing women but about making an often ignored and at risk population healthier. This report also points out the significant gaps in our knowledge about women's health and the opportunities to discover how and why disease is different in women and therefore, how to better prevent it.

And on the reproductive and sexual health blog RH Reality Check, Amanda Dennis reiterates the point that while contraception may be more accessible here, cost is still a barrier:

In Massachusetts, we have already learned some lessons about why it is important to include contraception at no additional cost. Massachusetts passed state-level health care reform legislation in 2006. Reform has already led to a number of improvements in access to health care for Massachusetts residents, however women insured by the subsidized health care plans must pay anywhere from $1 to $50 monthly co-pays for their contraception.

A collaborative study conducted by Ibis Reproductive Health and the Massachusetts Department of Public Health Family Planning Program investigated how Massachusetts health care reform impacted low-income women’s access to contraception. We conducted interviews with women and family planning providers throughout Massachusetts and found that reform has led to improvements in access to contraception for many, but not all women.

First, the good news. Many women in the study said they had “wicked easy” access to contraception after health care reform. A small number of women even said they began taking contraception for the first time after reform because the small co-pays made contraception more affordable than it was before reform when they did not have insurance. One woman explained:

“I know a big factor for a lot of my friends—like the pill is just too expensive so they fore-go it, and they rely on other questionable methods. And I think health care reform will help bring unplanned pregnancies and stuff like that down.”

However, we also found some women continue to have a hard time accessing contraception because of cost. Family planning providers reported that some of the women they see don’t fill their contraception prescriptions because they can’t afford their co-pays. One family planning provider explained that some women cannot afford to pay any co-pay for contraception because they are simply struggling to survive. She said, “If you have a choice between getting your medications or your prescriptions and paying for food, or paying for your bills, which would you choose? They choose not to get their prescriptions.” Another family planning provider explained that even small co-pays are barriers to contraception for some women. She said:

“They’re trying to pay the rent, they’re trying to go to school, they’re trying to work, and keep their kids in daycare…Sometimes paying $1 or $2 can be difficult.”