Why Birth Control Should Be Free
Found this excellent argument by Adam Sonfield published in Guttmacher Policy Review. If a libertarian or conservative tells you that health insurance should not cover contraceptives, this article contains all of the arguments and facts (including scientific research) you need to rebut them.
It’s worth reading the whole thing, but here’s some excerpts I found particularly interesting:
In the United States, increased contraceptive use—particularly among unmarried women and among teenagers—has paralleled substantial declines in unintended pregnancy and abortion. Notably, increased contraceptive use has been found to be responsible for 77% of the sharp decline in pregnancy among 15–17-year-olds between 1995 and 2002, and for all the decline among 18–19-year-olds over that period.
Contraception’s impact on unintended pregnancy may also be seen in the accomplishments of publicly funded family planning services, which in 2006 helped women avoid 1.94 million unintended pregnancies, 810,000 of which would have ended in abortion. In the absence of this public effort, levels of unintended pregnancy and abortion would be nearly two-thirds higher among U.S. women overall and close to twice as high among poor women.
Similar results have been found through evaluations of specific state programs, including those that expand eligibility for family planning services under Medicaid. California’s expansion helped women avoid 287,000 unintended pregnancies and 118,000 abortions in 2007. In Arkansas, repeat births within 12 months dropped 84% between 2001 and 2005 for women enrolled in the family planning expansion. And in Rhode Island, the proportion of mothers on Medicaid with birth intervals of less than 18 months fell from 41% in 1993 to 28% in 2003, and the gap between privately insured and publicly insured women narrowed from 11 percentage points to less than one point over that time.
A national survey from 2004 found that one-third of women using reversible contraception would switch methods if they did not have to worry about cost; these women were twice as likely as others to rely on lower-cost, less effective methods. According to another recent study of 10,000 women in the St. Louis area, when offered the choice of any contraceptive method at no cost, two-thirds chose long-acting methods—a level far higher than in the general population. Findings like this help explain why rates of unintended pregnancies are far higher among poor and low-income women than among their higher-income counterparts.
Numerous studies have demonstrated that even seemingly small cost-sharing requirements can dramatically reduce preventive health care use, particularly among lower-income Americans. And removing these barriers can have a real impact: A recent study found that when a California health insurer eliminated cost-sharing for IUDs, implants and injectables, enrollees’ use of these highly effective methods increased substantially, and their risk of contraceptive failure decreased as a result.
Costs and Cost-Savings
Yet, although the costs of contraception can be daunting for individual women, insurance coverage of contraceptive services and supplies—both public and private—actually saves money. Guttmacher Institute research finds that every public dollar invested in contraception saves $3.74 in short-term Medicaid expenditures for care related to births from unintended pregnancies. In total, services provided at publicly funded family planning centers saved $5.1 billion in 2008. (Significantly, these savings do not account for any of the broader health, social or economic benefits to women and families from contraceptive services and supplies and the ability to time, space and prepare for pregnancies.) A 2010 Brookings Institution analysis came to the same conclusion, and projected that expanding access to family planning services under Medicaid saves $4.26 for every $1 spent.
In terms of costs and savings for the private sector, multiple studies over the past two decades have compared the cost-effectiveness of the various methods of contraception, finding that all of them are cost-effective when taking into account the costs of unintended pregnancies averted. The federal government, the nation’s largest employer, reported that it experienced no increase in costs at all after Congress mandated coverage of contraceptives for federal employees. Moreover, a 2000 study by the National Business Group on Health, a membership group for large employers to address their health policy concerns, estimated that it costs employers 15–17% more to not provide contraceptive coverage in their health plans than to provide such coverage, after accounting for both the direct medical costs of pregnancy and indirect costs such as employee absence and reduced productivity. Mercer, the employee benefits consulting firm, reached a similar conclusion. And a more recent National Business Group on Health report, drawing on actuarial estimates by PricewaterhouseCoopers, concluded that even if contraception were exempted from cost-sharing, the savings from its coverage would exceed the costs.
So whether you want to reduce abortions, save money, reduce unwanted pregnancies, reduce child abuse and neglect, or just improve women’s health, providing free access to the most effective forms of birth control achieves all of these ends.