In my years of practicing medicine as an OB/GYN, I've learned not only about the female reproductive system but also how an ever-changing landscape of laws regulates it. Most recently, at the end of January, the Biden administration proposed a new rule to expand access to birth control under the Affordable Care Act. It reverses some of the limits to birth control that the Trump administration enacted in 2017. If the new rule passes, employers would no longer be able to opt out of coverage for contraceptives based on "moral exemptions." (Religious exceptions are still accepted, even under this new proposal.)

Understanding the indirect and direct costs of excluding birth control coverage is important in evaluating coverage. State and federal policy changes can mean expensive changes; understanding how this directly affects the women in your organization, as well as internal discussions about your organization's mission and what that means for how you support employees, can help you build a meaningful health plan that also manages costs.

Keeping up with changes in health care regulations is challenging for all the key players: payors, providers, and patients. What hasn't changed is that women bear the brunt of the decisions that lobbyists and legislators make without their input. As a provider, an advocate, and a leader in digital health for women, here are my recommendations for what employers, advisors, and brokers should know about birth control and why it's an essential health benefit to cover.

  1. Know that providers may prescribe birth control as treatment for hormonal imbalances, not just to prevent pregnancy.  Menstrual issues, like missing periods, heavy bleeding, or painful cramps, are common among women and people who menstruate. Hormonal birth control alleviates many of these symptoms and significantly enables women with these symptoms to improve their quality of life. More severe conditions, like Premenstrual Dysphoric Disorder (PMDD), can cause debilitating mental health symptoms that often require both mental health medication and hormonal birth control to treat. Endometriosis, which affects the lining of the uterus, involves painful symptoms that hormonal birth control pills relieve. Even at a natural stage like perimenopause (the years before menopause), taking birth control pills can address symptoms like hot flashes and irregular periods. For people with these conditions, denying access to safe, effective, clinically validated care has real consequences on their health and well-being.
  2. Center your health plan around the idea that patients deserve autonomy in their health care choices. The patient-provider relationship is sacrosanct. I see this relationship as a partnership: I support my patients to make the best health decisions for themselves, and I respect their choices. It is moments when we both decide on a treatment plan only to discover that it is financially out of reach for the patient, that I'm reminded that it's not just the patient and me in the room. When a health plan artificially limits a patient's choices for treatment, it strips them of their autonomy and directly affects the quality of their treatment. When health plans exclude birth control coverage, it's a clear message that the patient's preferences and choices don't matter, even if the organization believes this to be a way to signal its values.
  3. Limits to contraceptive coverage overwhelmingly hurt women and further stigmatize women's bodies. Women and people assigned female at birth face the largest disparities in health care. This is partly because longstanding biases, sexism, and lack of research stigmatize women's health. This stigma enables misinformation and false equivalencies–for instance, the misconception that emergency contraception terminates a pregnancy. (Let me be clear: emergency contraceptives are not abortifacients. By definition, contraceptives prevent a pregnancy from occurring in the first place. There is no pregnancy to terminate.) When employers or insurance carriers decide for women, they're perpetuating the unfortunate history of how medical institutions dismiss women's bodies and medical needs.
  4. Get the complete picture on costs: covering birth control can manage and prevent avoidable claims. Finally, there's the bottom line: the indirect and direct costs of unintended pregnancies are higher than the cost of covering birth control. Prenatal care, childbirth, miscarriages, and health complications from pregnancy all raise costs. Indirect costs include: employee absence, maternity leave, and short-term disability. Organizations can support their employees and prevent incurring some of the highest medical expenses by providing access to a wide range of covered birth control options.

After the Supreme Court's decision on Dobbs v. Jackson, I was heartened to see how many organizations stepped up to support their employees. While politicians and legislators influence policies, it is employers and their partners who can make substantial differences in women's lives.

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