For more than a decade, most people have been able to access contraception and other preventive health services at no cost. This guaranteed coverage has been a lifeline for millions of women. However, there are efforts to restrict women's access to contraception, potentially limiting their right to control their own futures.
In "Project 2025: A Presidential Transition Project," certain groups outline their intent to exclude some forms of emergency contraception from no-cost coverage. The Affordable Care Act (ACA) requires most private health insurance plans to provide no-cost coverage—without copayment, coinsurance, or deductible—for recommended preventive services. This benefit includes the full range of U.S. Food and Drug Administration-approved birth control methods and counseling, including emergency contraception. Rescinding no-cost coverage could have significant consequences for women nationwide.
A new Center for American Progress analysis estimates that if Project 2025 were enacted, nearly 48 million women of reproductive age would lose their guaranteed no-cost access to emergency contraception. Without this guaranteed coverage, millions of women may not have access to emergency contraception when they need it.
According to a national survey, nearly one-quarter of reproductive-age women who have ever had sex with a man report having used emergency contraception at some point. In other words, nearly 10 million women with guaranteed free contraception coverage today have used emergency contraception at some point in the past.
"Make no mistake: Project 2025 isn’t just about preventive care coverage," said an analyst from the Center for American Progress. "It is another attempt by right-wing extremists to undermine women’s bodily autonomy." Emergency contraception is described as completely safe and effective at preventing pregnancy before it occurs.
There are concerns that restrictions on contraception might not end here. Bills introduced in Louisiana and Oklahoma in the past two years would restrict access to several types of emergency contraception, including some intrauterine devices (IUDs).
The authors used 2022 data from the American Community Survey to estimate the number of women of reproductive age (defined as ages 15 to 49) with employer-sponsored insurance (46 million nationally) or direct purchase insurance in each state and the District of Columbia. They assumed that the 8.2 million women with direct purchase insurance were in qualified health plans subject to the ACA’s no-cost preventive service coverage guarantee.
They subtracted the number of reproductive-age women with employer-sponsored insurance plans that are “grandfathered” and exempt from the preventive service coverage guarantee using a 14 percent estimate from the 2020 KFF Employer Health Benefits Annual Survey, resulting in an estimate of 47.8 million total women of reproductive age in private plans with guaranteed no-cost contraception coverage.
National estimates from the National Survey on Family Growth from 2015 to 2019 were applied for the proportion of reproductive-age women who have had vaginal intercourse with a man (87.8 percent) and those who have ever taken emergency contraception (23.5 percent). This led them to estimate that 20.3 percent of all reproductive-age women have ever used emergency contraception.
Applying that share implies that approximately 9.7 million women in plans with guaranteed no-cost contraception coverage have used emergency contraception in the past.
This analysis does not account for employer-based health plans with religious exemptions from covering contraception or other exclusions.
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