We found that employer-sponsored coverage achieves cost savings while reducing unintended pregnancies and subsequent abortions.
IN the first few days of his administration, President Trump has taken steps to repeal Obamacare and reinstated the “global gag rule” — a highly criticized policy that restricts U.S. funding for health providers in low-income countries that provide abortion counseling.
These early actions signal his prioritization of health-care reform and reducing access to abortion. Previously, Trump has said he would keep the “strongest assets” of the Affordable Care Act: Protection against insurance discrimination for individuals with pre-existing conditions and the ability for young adults to remain on their parents’ insurance until age 26. Another component of the ACA that Trump should retain if he wishes to improve health care and reduce abortions? Mandated employer-sponsored coverage of contraception.
As a refresher, the ACA included a provision requiring preventive health services, including contraception, to be included as a covered benefit under employer-sponsored insurance plans. This mandate has become a highly controversial component of the act.
Studies from The Guttmacher Institute and Princeton University and others show that contraception is a safe and cost-effective method for preventing unintended or mistimed pregnancies that can lead to subsequent abortions. On a societal level, contraception creates high value: It can improve the health of women and families and reduce abortions while saving women, insurers and the government significant amounts of money (mostly recently estimated to save $10.5 billion dollars annually).
The mechanism for cost savings is simple: Contraception reduces costs associated with unintended pregnancies and abortions avoided through pregnancy prevention. However, in addition to fears of religious infringement, opponents of the mandate worry that employer-sponsored coverage could lead to increased abortions, suggesting that a small number of contraceptives could result in pregnancy termination (a theory that has been refuted as lacking substantive evidence by even pro-life clinical experts).
As researchers at the University of Washington who study the value of health programs, we developed — in collaboration with Dr. James Trussell, a senior research demographer at the Office of Population Research at Princeton University — a rigorous and peer-reviewed economic model to evaluate the impact of employer-sponsored contraception coverage on costs and pregnancy outcomes, including abortion. The economic model was developed from the employer’s perspective to simulate pregnancy costs and outcomes associated with private insurance coverage. It included information on contraception use and failure rates, pregnancy outcomes, marital status and age, based on data from the National Survey of Family Growth.
We found that employer-sponsored coverage achieves cost savings while reducing unintended pregnancies and subsequent abortions. Not providing coverage would result in 33,200 more unintended pregnancies, 13,460 more abortions and a cost increase of more than $250 million per 1 million women.
Women are highly price-sensitive to contraceptive costs, meaning that as their out-of-pocket costs increase (which would happen if their employer-sponsored insurance dropped contraception as a covered benefit), they are less likely to use contraception and more likely to experience unintended pregnancies and seek abortions — yielding the exact outcome (more abortions) that the Trump administration wants to avoid. In fact, one of the most effective and affordable ways to prevent abortions is providing contraceptive coverage at little or no cost to women.
According to Kaiser Family Foundation, 59 percent of U.S. women receive employer-sponsored insurance and could potentially be affected by repeal of the mandate. Particularly for low-income women, the repercussions of lack of insurance coverage for contraception could play a significant role in reinforcing the cycle of poverty and economic stagnation that often accompanies unintended pregnancy.
Maintaining the contraception mandate is good for women, good for employers, good for the budget, and, we would argue, compatible with the pro-life movement as well. While Trump considers components of the ACA to keep, contraception coverage is one component that he must not overlook.