This morning, the Supreme Court delivered a win for Hobby Lobby and other "closely held" corporations seeking to restrict contraceptive coverage. Today's 5-4 decision does not strike down the Affordable Care Act's (ACA) contraceptive mandate all together, but it does represent a significant challenge to women’s health, rights and economic security.
Before today's decision, more than 100 complaints were filed against the contraceptive mandate, the ACA requirement that all employer-based health plans cover, without cost-sharing, all FDA-approved methods of contraception, including emergency contraception (EC) and long-acting reversible methods (LARCs) such as intrauterine devices (IUDs). That requirement is based on the Institute of Medicine's evidence-based recommendation that a range of contraceptive education, counseling, methods and services be made available to all women so they can avoid unwanted pregnancies and better plan and space their families to promote optimal birth outcomes.
The majority of the 27 million women who are already benefitting from the provision will continue to access the contraceptive method of their choice without cost-sharing. But that doesn't help the thousands or more women whose employers deem certain (or potentially all) kinds of contraception unacceptable.
What makes the mandate novel is not the requirement for comprehensive contraceptive coverage (28 states already have similar laws in place), but the prohibition of co-pays or other cost-sharing requirements. Conservatives like to argue that affordability is not equivalent to access. But for many women, they are one an the same. Indeed, nearly one-third of U.S. women reported that they would like to change their contraceptive method, but could not do so because of financial restrictions. Studies have shown that 75 percent of women who request an IUD opt out once they learn about the associated costs, and that women who need to pay more than $50 are one-tenth as likely to actually get an IUD compared with women required to pay less.
Cost is a particular issue for low-income women and for young women (some of whose parents work at Hobby Lobby or similar companies and will no longer have access to the contraceptive method of their choice). Birth control isn't cheap. As the Guttmacher Institute noted in its amicus brief to the Supreme Court, the upfront cost of having an IUD inserted can cost upwards of $1,000 — more than a month's salary for a full-time minimum-wage worker.
The ACA's contraceptive mandate ensures continuity of care. In times of economic instability, more than half of U.S. women would like to reduce or delay childbearing because they cannot afford to have a baby. Ironically, the same factors that make women want to delay or prevent childbearing make it difficult for them to do so. Nearly a quarter of U.S. women surveyed reported using contraception inconsistently in order to save money.
IUDs are increasingly popular because of their ease of use and effectiveness. In a recent study of 10,000 young women, 75 percent of the participants opted for a long-acting method like an IUD or hormonal implant over all other methods. Both unintended pregnancy and abortion rates plummeted among those involved in the study. This is not surprising — IUDs are 45 times more effective than the pill, and 90 times more effective than the male condom, at preventing pregnancy.
The ACA attempts to address the impossible decisions many women are forced to make. Do I pay for rent, gas or groceries or pay for the medical care and services that enable me to plan the timing and size of my family? Do I provide for my children or buy a prescription that might enable me to manage a host of other medical issues? Today's decision will allow these injustices to persist.
Not only does today's decision stand in contrast to the health, rights and wellness of U.S. women and their families, but it counters the broader public health and economic benefits gained by women having unfettered access to family planning. Today nearly half of all pregnancies in the United States are unintended, a rate higher than any other rich country. An investment in family planning far outweighs the health and financial implications associated with unwanted pregnancies, such as pre- and post-natal care, maternal disability and death, and abortion care.
While the court claimed to recognize the benefit of providing cost-free access to contraceptives, it ultimately decided the mandate was a burden on employers' exercise of religious freedom. It shifted that burden right onto the shoulders of women who will now have to figure out how to access and pay for basic health coverage. These days it seems like that is a burden that will never be deemed too heavy for women to carry.
Flynn is a fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.