ACA helps reduce abortions through better access to birth control

Two of the nation’s most divisive issues – abortion and the Affordable Care Act – are having a convergence that could defuse the political explosiveness of both.

That is the prospect that emerges from two recent reports. One showed the results of a six-year program in Colorado in which teenage girls and poor women were offered for free or at little cost intrauterine devices and implants that prevent pregnancy for years. More than 30,000 chose the long-acting contraceptives.

The results were dramatic. The agency that conducted the program, the Colorado Department of Public Health and Environment, reported that teen births dropped 40 percent, abortions fell 35 percent and the state avoided more than $80 million in Medicaid costs.

Paige Johnson, a vice president of Planned Parenthood of South Atlantic, which includes North Carolina, said, “It’s great to have these examples like Colorado that demonstrate that if cost is not a factor, women will consistently choose the very best method, and you will see a decrease in unintended pregnancies. And that’s a win-win for everybody.”

In a second report in the journal Health Affairs looked at how the Affordable Care Act is affecting women’s out-of-pocket costs for contraception. The health care law requires that private health insurance plans cover contraceptives.

ACA lowers costs

In analyzing claim data from a large insurance provider, researchers from the University of Pennsylvania found that from June 2012 to June 2013 the mean out-of-pocket expense for the pill declined by 38 percent and the mean expense for an IUD or an implant declined by 68 percent and 72 percent respectively.

The report noted that the drop in cost could prompt more women to try longer-acting contraceptive methods. It said, “Because long-acting reversible contraceptive methods are more costly up front, it is possible that removing financial barriers to all methods might induce women to choose long-acting reversible contraceptive methods at higher rates.”

Taken together, the two reports suggest that the highly contested ACA requirement for contraception coverage could further reduce already declining abortion rates by reducing the number of unwanted pregnancies. That would occur primarily through wider use of much more effective forms of contraception.

Women moved away from using IUDs after infection problems arose with the Dalkon Shield in the 1970s. But IUDs and implants are much safer now, and women are increasingly turning to them. According to the Guttmacher Institute, 11.6 percent of women who used contraception in 2013 used long-term methods, up from 2.4 percent in 2002.

Costs shape choice

What holds back even higher use of long-term methods is not personal preference or health concerns, but costs. That pattern was shown by the CHOICE project, a study of 9,256 women offered their choice of contraceptive at no cost. Three out of four chose a long-acting, reversible contraception method.

Before the ACA, the medical procedure to insert an IUD could cost a woman $1,000 or more if it was not covered by health insurance. Now it is available through private insurance and Medicaid at little or no cost.

But there are still barriers. In North Carolina, the failure to expand Medicaid under the ACA blocks many working-poor women from access to long-term contraception. Many teenagers are uninformed about the option or unwilling to seek it through their parents’ health insurance. Some plans don’t provide contraception coverage for religious reasons.

Conservatives have leaned heavily on opposition to abortion and the ACA for political traction. But if they really want to reduce abortion, the answer is to embrace the ACA and, in North Carolina, expand Medicaid. Greater access to better birth control will serve two conservative goals: It will increase many women’s opportunity to prosper and reduce the demand for government support.

Isabel Sawhill, a Brookings Institution economist who has written a book, “Generation Unbound,” about the cost of single parenthood, told The New York Times in its report on the Colorado project, “If we want to reduce poverty, one of the simplest, fastest and cheapest things we could do would be to make sure that as few people as possible become parents before they actually want to.”

This story was originally published July 11, 2015 at 4:00 PM with the headline "ACA helps reduce abortions through better access to birth control."