This week, Maryland took what many advocates consider a groundbreaking step toward reproductive freedom when Gov. Larry Hogan signed into law a bill that would expand insurance coverage of all forms of contraception—making birth control pills, Plan B, and vasectomies free for insured residents of the state.
The bill, known as the Contraceptive Equity Act, would requires insurance plans and Medicaid to cover the entire cost of most birth control pills, including non-generic brands, as well as emergency contraception, which can cost upward of $50 out of pocket. The act also allows women to receive birth control six months at a time and lifts pre-authorization for long-acting reversible contraceptives and IUDs.
"This is a great step forward," said Elizabeth Nash, senior state issues associate at the Guttmacher Institute, a non-profit research and policy organization focused on sexual and reproductive health. "It ensures access to all methods."
The type of comprehensive insurance coverage mandated under the Maryland act goes beyond what is offered under the Affordable Care Act, which covers co-pay costs of prescription contraception, said Nash. The bill is one of the first of its kind in the country to strip away barriers to contraceptive access in a significant way for the 62 percent of women currently using birth control, she said.
"This bill really doubles down in ensuring women have access that works best for them," said Nash.
Gov. Hogan signed the Contraceptive Equity Act on Tuesday, but it won't go into effect until 2018. Maryland is now one of 28 states that require health insurance companies to cover the cost of prescription contraceptives, both drugs and devices. Maryland's law, though, is by far the most comprehensive, but a handful of other states—like New York and Washington—have bills pending that would expand coverage under existing law. A few states without such laws, including Minnesota, Ohio, Florida and Alaska, have introduced new bills that would mandate contraceptive coverage.
This year, California enacted a 2013 law that allows people to get birth control directly from their pharmacists without a doctor's prescription. Oregon implemented a similar bill in January. And recently in Vermont, an all-inclusive contraceptive coverage act akin to Maryland's law passed both legislative chambers. The bill is headed to Gov. Peter Shumlin's desk; he is expected to sign the bill soon.
Advocates see any legislation that lifts restrictions and expands contraceptive coverage as a step towards progress. But the comprehensive bills in Maryland and Vermont include one benefit often left out of the fray: Coverage for vasectomies.
State health insurance plans will be obligated to cover vasectomies with no co-pay cost to the patient when Maryland's act goes into effect in 2018. If signed into law, Vermont's bill will require much the same. Yet while a vasectomy is a common birth control method, the procedure is a tough sell for lawmakers crafting contraceptive coverage bills, Nash said. After all, the Affordable Care Act doesn't even mandate coverage for vasectomies, she noted.
But vasectomies are very much a vital part of family planning. By including the procedure alongside prescription pills and devices, Maryland is helping women and men "plan for the families they want to have," said Nash. "It can be a real model for other states," she added.
While some states have made strides, contraceptive legislation is unlikely to move in states like Ohio and Florida, where politicians have enacted sweeping bills that further restrict access to abortion and reproductive health. But the fact that lawmakers in those states have introduced the legislation at all "opens the door for conversation," said Nash.
"Given the range of states, this is clearly an issue resonating across the country," she said. "Some legislators get it."
Nash expects that conversation to gain momentum as we move into 2017. That's because more people are starting to acknowledge that deep gaps in contraceptive coverage and access exist. And a way to close those gaps, said Nash: Through state law.
"We're only going to see more of these bills next year," she said.