In light of the current debate over women's reproductive rights and care, it is increasingly clear that the benefits of the Patient Protection and Affordable Care Act (ACA) for access to comprehensive health care will not accrue equally to women across the country. Simply put: There is more agreement on what must be included in comprehensive health care for men than on whether and to what extent contraceptive and reproductive services must be included in comprehensive health care for women.
While it has long been recognized that comprehensive care for men includes sexual and reproductive health, the same has not been true for women. For example, women's health insurance plans have typically allowed exclusions in this area even for pregnancy, and even when it is not a “preexisting condition”; indeed, there are no comparable accepted options for excluding entire aspects of health care for men while providing them for women.
Yet although the ACA assures women access to primary care and many reproductive services without copays, the debate over reproductive services continues. Recent political discussions on access have typically not included discussion of increases in women's education, employment and career continuity attributable to contraception.
In the context of this debate, the Timely Access to Birth Control bill (AB 2348), which has been approved by the state legislature and is now awaiting Governor Brown's signature, may appear to some to be a luxury that California can ill afford. But the reality is that over the mid to long run, AB 2348 would very likely save the state a significant amount of money. The bill allows registered nurses to dispense highly reliable hormonal contraceptives, including the pill. If enacted, doctors and nurse practitioners would be freed up to focus on more complex patient visits. If passed, the bill would increase women's access to reliable contraceptives and reduce the costs of delivering that care.
In a Mother's Day piece for Ms. Magazine Online, I pointed to the savings contraception generates for employers, insurers, and taxpayers. A public dollar invested in contraception saves roughly four dollars in Medicaid expenditures—or $5.1 billion in 2008—not to mention the broader health, social and economic benefits. Moreover, a 2010 study in California of a Medicaid family planning program found that every dollar spent saved the public sector over nine dollars (PDF) in averted costs for public health and welfare over five years. Rather than getting caught up in the national political debate over reproductive health coverage, California legislators should consider the significant cost savings as well as the social and economic benefits of improving timely access to reliable contraception.
On the national front, the goal of the ACA is to expand access to health care for Americans, especially those who currently lack health insurance; but the law also prioritizes improvements in the quality of care and reductions in costs. As we look for ways to provide efficient, high-quality, and cost-effective health care to more Americans, we can't afford to ignore women's health issues, including reproductive health care and the cost savings that contraceptive access provides.
Chloe E. Bird is a senior social scientist at the nonprofit, nonpartisan RAND Corporation. She is co-author of Gender and Health: The Effects of Constrained Choices and Social Policies, Cambridge University Press.
This commentary appeared on RAND.org on September 5, 2012