Under the new administration, the Department of Health and Human Services (DHHS) has undercut men’s and women’s ability to achieve their family planning goals. It was looking promising that male contraceptive coverage would be included in the Affordable Care Act (ACA/Obamacare). But since the new administration, that’s changed.
How did DHHS do that? To get a clear picture, we have to delve into the complicated process of how contraceptives get covered by insurance under the ACA. (This process involves so many agencies and committees that this article has a reference section at the end).
Under the ACA, nearly all insurers must cover female contraceptives without so much as a co-pay. Now, the ACA doesn’t state this explicitly; rather, it references the DHHS and asks them to provide language to recommend which contraceptives should be covered. Once DHHS makes a recommendation for coverage, the recommendations are automatically integrated into the ACA after one year. Technically, DHHS designates the drafting to the U.S. Preventive Services Task Force (USPSTF). But really, the USPSTF is made up of whomever DHHS designates to draft the language.
For the initial language, DHHS delegated the task to the Institute of Medicine (IOM). And they have the language you see now, which covers only female contraceptives. Some gave the benefit of the doubt to DHHS and saw the lack of coverage for men as an oversight.
More recently, DHHS wanted to update the recommendation language for contraceptive coverage. This time they delegated the task to the American College of Obstetricians and Gynecologists (ACOG). ACOG, in turn, created a drafting committee, Women’s Preventive Services Initiative (WPSI).
We spoke with everyone we could to make sure male contraceptives would be included in the recommendation language. We were particularly interested in vasectomies, which are underutilized compared to tubal ligations. Tubal ligations are more expensive, more invasive, and less effective. Yet, tubal ligations are what’s covered by insurance.
To really add pressure, we created a Change.org petition to include male contraceptives in the recommendation language. Over 12,000 supporters added their name! When communicating this to the Secretary of DHHS their office replied that the delegated agency (ACOG) would be in charge of the drafting and that we were targeting the wrong people.
So, we targeted ACOG and their WPSI committee. And so did our network.
It was looking really encouraging. Here’s the draft that WPSI had:
“The full range of contraceptive and family planning services include the following: All contraceptive methods currently identified by the FDA, which include: (1) sterilization surgery for women and men; (2) surgical sterilization implant for women; (3) implantable rod; (4) copper intrauterine device (IUD); (5) IUD with progestin (all durations and doses); (6) shot/injection; (7) oral contraceptives (combined pill); (8) oral contraceptives (progestin only); (9) oral contraceptives (extended/continuous use); (10) patch; (11) vaginal contraceptive ring; (12) diaphragm; (13) sponge; (14) cervical cap; (15) female and male condoms; (16) spermicide; (17) emergency contraception (levonorgestrel); and (18) emergency contraception (ulipristal acetate); and additional methods as identified by the FDA. o Instruction in fertility awareness-based methods, including the lactation amenorrhea method, for women desiring alternative, although less-effective methods. Counseling that allows for discussion of the full range of contraceptive options and emphasizes patient-centered decision making. The most appropriate choice to prevent pregnancy for a woman might include a vasectomy for her partner or use of male condoms.”
We couldn’t have written better language ourselves. Vasectomies were included. Condoms were included. The language even considered future male contraceptives. We were really excited.
Then, the language changed. Every reference to male contraceptives was gone.
The administration changed and the DHHS Secretary changed to Tom Price. Price has been extremely oppositional to contraceptive coverage in general.
Upon learning that ACOG was going to provide language including coverage for male contraceptives, DHHS told them that this was not acceptable. DHHS communicated this through the Health Resources and Services Administration (HRSA), an agency within DHHS who was assigned to work with WPSI.
And there you have it. ACOG actually wanted to include male contraceptives in the language so that it would get included under ACA. This would have been a clear win for everyone. Removing the financial barrier of contraceptives makes it easier for men to get the protection they need, which in turn helps their partners—who already have their options covered. But when the new administration’s DHHS saw that ACOG was going to include coverage for men, it stepped in. And now, men and their partners are left with inadequate contraceptive coverage.
It’s hard to know what’s going to happen with the ACA, whether it will be left fully intact or whether only certain parts will remain. Some states have even taken it upon themselves to make sure their state insurers cover male methods. (Thanks, Illinois, Maryland, and Vermont!)
Right now, the state approach is likely the best option to make sure contraceptive coverage is available. And not just for men, but for women, too.
Affordable Care Act (ACA) – Law determining health insurance coverage
American College of Obstetricians and Gynecologists (ACOG) – Most recent organization designated by DHHS to provide contraceptive coverage language
Department of Human Services (DHHS) – Designated by ACA to give recommendations for contraceptive coverage
Health Resources and Services Administration (HRSA) – An agency within DHHS that communicated with WPSI on the scope of the recommendation language
Institute of Medicine (IOM) – Initially designated by DHHS to provide DHHS with contraceptive recommendation coverage language
U.S. Preventive Services Task Force (USPSTF) – In short, whoever DHHS decides should write their language makes up the task force for this project
Women’s Preventive Services Initiative (WPSI) – Committee formed within ACOG to write newest contraceptive coverage language