On July 8, the Supreme Court ruled 7-2 in favor of the Trump Administration’s rule to allow employers and universities to opt out based on religious and moral grounds of the Affordable Care Act’s (ACA) mandate to provide contraceptive care. The rule significantly broadens the exemption guidelines under the ACA’s contraceptive guarantee. Consequently, many women, particularly low-income women and women in college, could lose an essential resource that protects their health and economic well-being. The government estimates the court’s decision could result in lost access to cost-free birth control for about 70,000 to 126,000 women.
Over 99% of women between the ages 15-44 who have been sexually active have used one or more different contraceptive methods. As a preventive care resource, contraceptives have myriad public health benefits. A recent article in the Health Affairs Blog found that by preventing unwanted pregnancies, contraceptives can lead to 860,000 fewer unintended births, 810,000 fewer abortions and 270,000 fewer miscarriages. Since unintended pregnancy rates are higher for low-income and non-Hispanic Black women, better access to birth control could be extremely beneficial.
For example, access to birth control can result in lower poverty levels among women by allowing them to better plan for investments like education that lead to higher future earnings and greater wealth-building capacity. Access to birth control is shown to be correlated with long-term economic benefits such as increased higher education enrollment, increased labor force participation and higher wages. Women who have access to legal contraception beginning at ages 18 to 21 make 11% more per year by the time they’re 40 than those who did not.
Birth control is also used by women to prevent and treat health-related issues brought on by their menstrual cycles or genetic conditions. In 2015, 70% of birth control pill users cited non-contraceptive health benefits as a reason for using the contraceptive. Birth control can help relieve menstrual cramps and migraines, regulate periods and help with chronic conditions like endometriosis or polycystic ovarian syndrome. The association between birth control, health and economic gains makes the coverage guarantee a step forward for women’s economic equality by reducing cost barriers and increasing agency.
Unfortunately, cost is the number one barrier to accessing effective contraceptive methods for women. The Center for American Progress found that one in three women ages 18-44 would not be able to pay over $10 a month for birth control. The Guttmacher Institute found that two-thirds of women would switch to better methods of contraception if they did not have to worry about the cost, and that without insurance coverage, long-term contraceptives, which tend to be more effective, start at costs as high as $1,000.
Without widespread coverage, cost will remain a significant barrier to contraception, especially for low-income women. The coverage guarantee in the ACA granted millions of women access to cost-effective contraceptive methods. Since 2015, 55 million women acquired no-copay birth control. Out-of-pocket expenses for birth control pills and IUD insertions fell by 20%, and the annual dollar savings per contraceptive user for each method was between $248 and $255. Additionally, women were more likely to use long-term contraception methods after the ACA was implemented than before.
The Supreme Court’s decision to remove the injunction on the Trump Administration’s rule will undo progress created by the ACA’s contraceptive coverage mandate. It will increase the annual cost of contraception by $584 for each user. Inevitably, women with lower socioeconomic status will be disproportionately impacted as they have less resources to invest in effective contraception.
Contraception gives women more control over their bodies, their health and their present and future lives. Such power over women’s agency should not be left to employers who cite religion or morality as a justification for rejecting contraceptive coverage.
Roxana Ruiz was a special initiatives intern with NCRC.