The cases on the Affordable Care Act’s contraceptive coverage guarantee that will be heard by the U.S. Supreme Court on March 25 revolve around several important questions of fact that have been misinterpreted and obfuscated by the guarantee’s opponents. To help ensure that the debate is informed by facts, not misinformation, a new Guttmacher analysis—based in part on a Supreme Court amicus brief the Institute filed in January—sets the record straight.
"We want to clarify key points, including many that should be self-evident but have nevertheless been challenged by an ideological onslaught from anti-contraception activists," says Adam Sonfield, a Guttmacher senior public policy associate and author of the new analysis. "Among these points are basics like the fact that contraception is distinct from abortion, that contraceptive methods aren’t interchangeable and that cost and lack of method choice can very much interfere with a woman’s ability to use the method that is most appropriate for her needs and circumstances."
Sonfield presents extensive data from the Guttmacher Institute and other leading authorities that document why the ACA’s requirement that most private health plans cover contraceptive counseling, services and supplies without out-of-pocket costs for patients is necessary and appropriate. The analysis breaks down five broad issue areas:
- Contraception is not abortion: The science of how pregnancies are established and how contraception works clearly shows that contraception is distinct from abortion. Further, by preventing unintended pregnancies, effective contraceptive use dramatically reduces the need for abortion.
- Contraceptive use benefits women and families: Decades of scientific evidence and the life experiences of millions of women show that contraception enables women to prevent unintended pregnancies and to plan and space wanted pregnancies. That, in turn, has myriad health benefits for mothers and babies and promotes women’s educational, economic and social advancement.
- Comprehensive contraceptive coverage improves use: Methods of contraception differ dramatically in their effectiveness in preventing unintended pregnancy and are not interchangeable medically or otherwise. That is why women need access to not just any method of contraception, but to the one most suitable for their individual needs and circumstances. Cost is a substantial barrier to women’s ability to choose and use the best method for them, and removing cost barriers—as the federal policy currently requires—has been proven to make a substantial difference in facilitating access to and use of contraceptive services.
- Contraceptive coverage is not a financial burden: Strong evidence from both private- and public-sector employers shows that contraceptive coverage should be cost-neutral or even generate savings for employers. In addition, public funding for contraceptive services (under programs like Title X and Medicaid) in 2010 resulted in net public savings of $10.5 billion, or $5.68 for every dollar spent.
- Shifting responsibility to the government is not workable: Finally, proposals that—rather than requiring private insurance plans to cover contraception—require the government itself to somehow pay for contraceptive services and supplies for privately insured women are neither viable politically nor workable in practice, and would end up creating new hurdles for women.
"In short, and as laid out in the article, the scientific evidence strongly supports the current federal policy on contraceptive coverage," says Sonfield. "But the Supreme Court must also be aware that its decision could have consequences far beyond contraception. For example, there are many important coverage guarantees included in the ACA, and federal law more broadly, and if the Court sides with the plaintiffs, it could truly open a Pandora’s box of discrimination. Employers might claim religious objections to coverage—for everyone or, for instance, for those who are young, unmarried or gay—of HPV vaccination, STI testing, breast-feeding equipment, maternity care, blood transfusions, HIV medication and mental health care."
Full analysis: "Contraceptive Coverage at the U.S. Supreme Court: Countering the Rhetoric with Evidence," by Adam Sonfield, in the Winter 2014 issue of the Guttmacher Policy Review.