Biden-Harris Administration Proposes New Rule to Expand Affordable Contraception Coverage

In a continued effort to protect and expand access to reproductive health care, President Joe Biden and Vice President Kamala Harris have announced a new proposed rule that would significantly enhance contraception coverage under the Affordable Care Act (ACA).¹

The proposed rule marks a critical advancement in reproductive health care, significantly expanding access to affordable contraception for millions of women. | Image credit: RFBSIP - stock.adobe.com

This move comes at a critical time, as reproductive rights face increasing threats following the Supreme Court’s decision to overturn Roe v Wade. The proposed rule aims to expand contraception access without cost-sharing for millions of women, making over-the-counter contraceptives (OTC) more affordable and accessible and ensuring comprehensive coverage for all FDA-approved contraception methods.

“Every woman in every state must have reproductive freedom and access to the health care they need,” Harris said in a statement.² “That is why I have fought to lower health care costs and protect the ability of every woman to make her own decisions about her own body.”

Since 2012, the ACA has guaranteed women insurance coverage for all methods of birth control without additional out-of-pocket costs, regardless of where they live or how they are insured.³ Because of this ACA rule, over 62.4 million women now have coverage of birth control and other preventive services, improving health care access and economic security. The birth control benefit saved women $1.4 billion on birth control pills alone in 2013, according to a Health Affairs analysis.⁴ This means that women no longer must choose between paying for birth control and paying for other necessities, like groceries and utilities.

However, limited awareness may reduce the number of women accessing recommended preventive care.⁵ Also, the future of these requirements remains uncertain due to ongoing ACA legal challenges, including Braidwood Management Inc. v Becerra, which could eliminate the coverage requirement for certain preventive services.⁶

Details of the proposed rule include the introduction of no-cost access to OTC contraception, including emergency contraception and daily oral contraceptives.¹ Additionally, the rule would require health plans to disclose OTC contraceptive coverage, making it easier for women to understand their benefits. Furthermore, the rule would streamline access to all FDA-approved contraceptives without cost sharing, helping to eliminate barriers to care.

The proposed rule would also have a significant impact on the 52 million women of reproductive age with private health insurance. For many, especially low-income women and those in rural areas, this expansion means easier access to emergency contraception and daily oral contraceptives, which can be critical for preventing unintended pregnancies. The rule also addresses health equity by potentially reducing disparities in access to contraception among marginalized communities, including women of color, who face disproportionate barriers to reproductive health care.

The Biden-Harris Administration’s proposed rule comes at a pivotal moment in the political and social landscape. With abortion access under attack in many states, contraception access has also become a target for restrictive legislation. By reinforcing access to contraception, the administration seeks to safeguard reproductive freedom and empower women to make their own health care decisions, despite ongoing political opposition.

“The majority of Americans believe in a woman's right to make decisions about her own body,” Harris said during the presidential debate.⁷ “And that is why in every state where this issue has been on the ballot, in red and blue states both, the people of America have voted for freedom.”

The proposed rule represents the most significant update to contraception coverage under the ACA since 2012.¹ The rule builds on actions that the Biden-Harris Administration has already taken to expand access to affordable contraception, including implementing the President’s Executive Order on Strengthening Access to Affordable, High-Quality Contraception and Family Planning Services from June 2023.

The proposed expansion of contraception coverage under the ACA may face legal challenges from conservative groups and states opposed to increased access to reproductive health care, particularly in regions where restrictions on contraception are being pursued. Additionally, the insurance industry may push back on the cost implications of covering more contraceptive options without cost-sharing, potentially complicating the rule's implementation. The timeline for finalizing and enforcing the rule will depend on the regulatory process, including public comment and review. To ensure the rule’s success, the Biden-Harris Administration may need to defend it in court and engage in continued efforts to safeguard reproductive health access.

Overall, the proposed rule marks a critical advancement in reproductive health care, significantly expanding access to affordable contraception for millions of women. By building on the original ACA mandate, this rule will not only increase access to OTC and prescribed contraceptives but also help address health inequities in underserved communities.

“While we fight to protect and expand health care, extremist so-called leaders are attacking reproductive freedom at every turn,” Harris said.² “Republicans in Congress have repeatedly blocked legislation to protect the right to contraception across the country. They have also consistently refused to protect access to IVF [in vitro fertilization] and continue to propose national abortion bans.”

As legal and political challenges to reproductive rights persist, this proposal demonstrates the administration’s ongoing commitment to safeguarding women’s health care. If finalized, this rule will provide greater autonomy for women in making personal health care decisions and represent a meaningful step toward protecting reproductive freedoms nationwide.

References

1. Fact sheet: Biden-Harris Administration proposes rule to expand coverage of affordable contraception under the Affordable Care Act. The White House. October 19, 2024. Accessed October 22, 2024. https://www.whitehouse.gov/briefing-room/statements-releases/2024/10/21/fact-sheet-biden-harris-administration-proposes-rule-to-expand-coverage-of-affordable-contraception-under-the-affordable-care-act/.

2. Statement from vice president Kamala Harris on new rulemaking to expand access to contraception. The White House. October 21, 2024. Accessed October 22, 2024. https://www.whitehouse.gov/briefing-room/statements-releases/2024/10/21/statement-from-vice-president-kamala-harris-on-new-rulemaking-to-expand-access-to-contraception/.

3. The Affordable Care Act’s birth control benefit: Too important to lose. National Women’s Law Center. June 25, 2018. Accessed October 22, 2024. https://nwlc.org/resource/the-affordable-care-acts-birth-control-benefit-too-important-to-lose/#:~:text=It%20first%20went%20into%20effect%20in%202012%2C,an%20incredibly%20popular%20part%20of%20the%20ACA.&text=The%20ACA’s%20birth%20control%20benefit%20accomplished%20a,education%20and%20counseling%20without%20any%20out%2Dof%2Dpocket%20costs.

4. Kliff S. Report: Obamacare has saved women $1.4 billion on birth control pills. Vox. July 7, 2015. Accessed October 22, 2024. https://www.vox.com/2015/7/7/8907389/obamacare-birth-control-savings.

5. McCormick B. Women’s awareness of ACA preventive services remains low amid ongoing legal challenges. AJMC. October 21, 2024. Accessed October 22, 2024. https://www.ajmc.com/view/women-s-awareness-of-aca-preventive-services-remains-low-amid-ongoing-legal-challenges.

6. Joszt L. Covered preventive services at risk: V-BID Summit breaks down the Braidwood v Becerra case. AJMC. March 20, 2024. Accessed October 22, 2024. https://www.ajmc.com/view/covered-preventive-services-at-risk-v-bid-summit-breaks-down-the-braidwood-v-becerra-case.

7. Grossi G. Abortion in the presidential debate: Trump defends state bans, Harris vows national protections. AJMC. September 16, 2024. Accessed October 22, 2024. https://www.ajmc.com/view/abortion-in-the-presidential-debate-trump-defends-state-bans-harris-vows-national-protections.