Authors: Mariah Lindsay and Susan Berke Fogel
Oregon recently passed The Reproductive Health Equity Act (House Bill 3391), a comprehensive bill that will ensure access to women’s health services. It goes beyond the protections created by the Affordable Care Act to ensure access to reproductive health care for Oregonians. The bill, among other things, requires safe and affordable access to abortion; provides coverage of preventative care, including contraceptives, without cost-sharing; and expands post-partum care. It is expansive and part of a larger trend of state legislation aiming to protect contraceptive coverage and abortion rights.
The future of federal requirements to cover contraceptives in the United States is uncertain because of Republicans’ ongoing efforts to overturn the Affordable Care Act (ACA). Several states, however, have taken it upon themselves to ensure and expand these protections if the ACA is repealed and replaced. The first contraceptive equity laws were introduced in the 1990’s when insurers routinely refused to cover contraception even when they covered other prescription drugs.
The latest wave of contraceptive equity laws began in California in 2014, sponsored by the National Health Law Program and Essential Access Health. In the wake of that bill, NHeLP created a Model Contraceptive Equity Act that has since been used to introduce similar legislation in many other states. The Model Act ensures state-level enforcement of the contraceptive mandate, fills in gaps left by federal guidance, and prevents insurers from using medical management techniques (like prior authorization or step therapy) to erect access barriers. Several states have introduced legislation based on the Model Act to provide these and similar protections. States, like Oregon, have seized the opportunity to go beyond the Model Act and add additional reproductive health provisions.
Currently, California, Maryland, Vermont, Illinois, Nevada, and now Oregon have passed contraceptive equity laws. Most recently, Nevada passed a bill similar to the Model Contraceptive Equity Act that protects the access to contraceptives without cost-sharing and is even more expansive in adding additional protections like access to a 12-month supply of a contraceptive at one time.Several other states have introduced similar pieces of legislation in the current legislative session, which are being considered in committees. These states include Alaska, Massachusetts, Minnesota, Tennessee, and Washington, D.C. Oregon’s bill is also more expansive in its provisions and indicative a continuing trend to introduce and pass contraceptive equity laws.
By enacting contraceptive equity laws, states are ensuring that access to and coverage of contraceptives will survive beyond the ACA. These laws will be crucial to maintain and expand access to reproductive health moving forward, particularly if the ACA is repealed and replaced.