The Trump administration and Republican members of Congress have already taken a number of actions to roll back birth control access for low-income people — but activists, women’s health organizations, and state lawmakers are prepared. Lawmakers have introduced bills to retain or expand birth control access in several states.
In anticipation of Republicans’ efforts to roll back birth control access through repeal and replacement of Obamacare, five states — New York, New Mexico, Oregon, Hawaii, and Massachusetts — have introduced or advanced legislation that would allow people to continue accessing contraception without out-of-pocket costs.
Some states are trying to expand the types of birth control coverage people receive. Lawmakers are also introducing legislation that would make it easier for people to buy birth control.
Currently, people who can get pregnant have to go back to the pharmacy every one to three months to get oral contraceptives. But now several states could allow people to receive a 12-month supply of birth control in one visit — something that reproductive health advocates have been pushing for years.
“People are acutely aware of what is at stake now that we have Donald Trump in the White House.”
Tarina Keene, executive director of NARAL Pro-Choice Virginia, said people came out “in droves” to testify for a state-level bill allowing women to receive a year of birth control at once.
“People are acutely aware of what is at stake now that we have Donald Trump in the White House,” Keene said. “I’m not talking about just the attacks we’ve seen on birth control and abortion since Trump has been in office, but attacks on the ACA [Affordable Care Act]. People understand what they’ve been enjoying access to in the past few years, and that that is in danger.”
The danger is coming across multiple fronts.
The Trump administration has shown its hostility to reproductive rights by tapping Tom Price, who once said that “not one” woman has ever struggled to pay for birth control, to lead the Department of Health and Human Services (HHS). President Donald Trump also selected two other fierce opponents of abortion and birth control for prominent positions within the department. And he signed an executive order last week that would make it easier for employers to claim religious exemptions to providing contraceptive coverage.
In mid-April, Trump signed a law allowing states to withhold federal funds from clinics that provide abortions, which would make it even more difficult for women to access both abortions and preventive services.
And the current version of the Republican health care bill poses yet another grave risk to reproductive health, as it would allow states to waive essential health benefits, such as maternity care and birth control. Women would be disproportionately affected by the bill’s lack of protections for people with pre-existing conditions.
Activists and state lawmakers are responding to those threats with a variety of different tactics.
Preserving ACA birth control access
Several states have advanced or passed legislation to preserve birth control access as it is codified under the ACA. Some states, such as California, Maryland, Vermont, and Illinois had already passed bills codifying the ACA’s birth control coverage mandate as early as 2014.
Since Trump took office, politicians in more states have introduced new legislation protecting birth control coverage. In March, the New Mexico’s House of Representatives passed a bill to provide contraceptives without co-pays, as the ACA does. This law would also expand access by providing over-the-counter birth control, one-year refills on birth control pills, and male contraception, such as vasectomies, at no cost. Only two states require coverage of male sterilization. That bill now awaits passage by the State Senate.
In January, New York Attorney General Eric Schneiderman introduced legislation that would guarantee free access to birth control if the Republican health care bill passes Congress. That bill is also still in committee. Massachusetts lawmakers introduced a similar bill, but it has been stuck in the State Senate’s Committee on Financial Services since January.
Hawaii, the District of Columbia, Massachusetts, Oregon, Nevada, and Washington also have pending legislation to retain these ACA benefits. Nevada’s state assembly passed legislation that would require birth control to be provided free of co-pays and provides 12 months of birth control at one time. It’s now in the State Senate’s Health and Human Services Committee.
Although 28 of 50 states have laws that require private insurers to cover birth control, only a few have mandates for cost-free birth control.
Expanding ACA benefits
Some states have gone even further, including Oregon, Maine, and Tennessee, by introducing legislation requiring that insurers cover every unique form of birth control under the 18 categories outlined by the ACA.
A 2016 study by the The National Campaign to Prevent Teen and Unplanned Pregnancy found that only one in 50 women have reasonable access to a full range of contraceptive methods. In 2015, a Kaiser Family Foundation study found that insurance providers were making exceptions for contraception coverage to IUDs and sterilization, worrying reproductive health advocates. The Obama administration put together guidelines in an effort to close those loopholes.
Pending Oregon legislation would require every insurer to cover all types of contraceptives drugs and devices approved by the FDA. It also requires that people be able to access that coverage without co-payments, co-insurance, or a deductible.
In additional, Oregonians would be able to access other reproductive health care services without those costs, such as prenatal care and screening for STIs. Not only would the bill expand health care access in a number of ways for cisgender women, but it would also protect against discrimination on the basis of gender identity. It passed the House Healthcare Committee in April. Tennessee’s bill, which requires coverage for emergency contraception and sterilization and allows people to access 12 months of birth control at a time, is in the Senate Commerce and Labor Committee.
Making it easier for women to get birth control
Research shows that allowing people to purchase a year’s worth of contraception in one pharmacy visit reduces the chances of unintended pregnancy because women will be less likely to miss a pill if they have a continuous supply of birth control. A 2011 study published in the Obstetrics and Gynecology journal found that people with a one year supply were 30 percent less likely to experience an unintended pregnancy. A continuous supply also reduced the likelihood of an abortion.
Colorado, Nevada, and Virginia lawmakers have all introduced legislation expanding the amount of contraceptives that can be purchased at one time. The aforementioned Virginia bill recently passed the state legislature. Colorado’s bill is awaiting final Senate approval.
Karen Middleton, NARAL Pro-Choice Colorado’s executive director, said the bill has bipartisan support in the state legislature. State Sen. Don Coram (R) said he supported the bill because he is familiar with issues of unintended teen pregnancy in his district. Montrose High School — located in his district — has been called “Maternity High School” by residents of the surrounding area, Coram told local reporters.
Colorado is a unique state, Middleton said, because Republicans have more flexibility to support reproductive rights. Colorado voters have rejected personhood amendments — which defines the “unborn child” at every stage of gestation as a person — three times.
“There is a broad sense that this is a relatively pro-choice state, and while it is difficult for Republicans to take votes like that, I think there is a level of respect and being hands-off around some of members who say, ‘I am not going with the caucus with this.’ I am going to stand firm,” Middleton told ThinkProgress.
Middleton said she has seen “extremely high” levels of activism on reproductive rights issues this year, particularly since House Republicans passed Trumpcare. She said Republicans have an opportunity to break from their party now that voters are fearful of threats to birth control access.
“There are people we will never be able to convince, but there are lots of pro-choice Republicans who support [reproductive rights] who have been quiet or silent on this issue because the federal government has allowed them to go with their party,” Middleton said. “Now is the time to break that mold and see more leadership from Republicans who know access to birth control is common sense.”
Other states are working on granting pharmacists authority to provide birth control to people who can get pregnant without first requiring them to visit a doctor. A Hawaii bill, which passed the legislature last week, grants pharmacists prescriptive authority. A pharmacist checklist would ensure that people who have certain risk factors would still have to go to their doctors to get a prescription. Last year, the state also passed a bill allowing people to receive 12 months of birth control at once.