We've been hearing a lot about how a Trump administration might roll back the contraception mandate of the Affordable Care Act, which could mean millions of women losing access to the no-copay birth control they've had since 2013. (That is, of course, assuming they don't repeal it entirely.) States have been working in recent years to protect coverage of this preventive care within their borders and some have even included an additional type of birth control: vasectomy.
Currently, insured women can get their tubes tied with no out-of-pocket costs, but insurers are not required to cover the male equivalent of sterilization (which blocks sperm from getting to the seminal fluid) without cost-sharing. Some argue that not covering vasectomies the same way as the Pill perpetuates the misguided idea that birth control is solely a woman's concern. The American College of Obstetricians and Gynecologists (ACOG) recommended in September that vasectomies be fully covered as part of the ACA, but any expansions of the law are doubtful at this point.
Excluding vasectomies from insurance coverage doesn't make sense from a cost-benefit standpoint, either. Covering birth control is a public health benefit that reduces unintended pregnancies and even preterm births, but some women would simply prefer to use male-only methods, like condoms or vasectomy, which don't come with side effects. Condoms may be cheap but they're much less effective—only 82 percent effective with typical use compared to 99 percent for vasectomy. But that procedure can cost up to $1,000. Still, it's about four times cheaper than tubal ligation, plus it's safer and much less invasive: A vasectomy can be done in 20 minutes with a local anesthetic while a tubal ligation is abdominal surgery under anesthesia. The Associated Press reports most state Medicaid programs cover vasectomy as do some private insurers.
A few states seem to have gotten the memo. In the past two years, Illinois, Maryland, and Vermont have passed laws that require private insurers in the state to cover contraception including vasectomies at no cost. (California passed a law protecting no-copay birth control but sadly excluded male sterilization.) And, just last week, New York Attorney General Eric Schneiderman introduced a contraception law that would include vasectomies. It passed the Assembly on Tuesday and is now with the Senate.
As Schneiderman's spokesperson told the AP: "Birth control cannot be the sole responsibility of the woman in a relationship." Insurance coverage of vasectomy will only further that idea.