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Contraception changes lead to big savings

The evidence suggests when it comes to birth control, the Affordable Care Act is saving a lot of Americans a lot of money.
Image: FILE PHOTO: The Pill Turns 50: A Look Back At Contraception
UNITED KINGDOM - NOVEMBER 22: 50 years ago today the combined oral contraceptive pill was first introduced as a means of contraceptive use in the United...
It wasn't expected to be overly controversial, but the Affordable Care Act guarantees Americans' access to preventive care without a copay. In practical terms, it means millions of women now have access to birth control at effectively no cost, much to the consternation of Republicans who remain fiercely opposed to the policy,
There's been quite a bit of coverage about the public-health benefits of the ACA provision, but the New York Times reported late yesterday on an even more obvious shift: a lot of Americans are saving a lot of money.

Out-of-pocket spending on most major birth control methods fell sharply in the months after the Affordable Care Act began requiring insurance plans to cover contraception at no cost to women, a new study has found. Spending on the pill, the most popular form of prescription birth control, dropped by about half in the first six months of 2013, compared with the same period in 2012, before the mandate took effect. The study, by health economists from the University of Pennsylvania, analyzed health insurance claims from a large private insurer with business in all 50 states and the District of Columbia. It evaluated the effect of the Affordable Care Act, the biggest piece of social legislation in decades, on women's pocketbooks. It estimated that savings from the pill alone were about $1.4 billion in 2013.

For consumers, many of whom wanted contraception but couldn't afford it, $1.4 billion in savings is a substantial figure. What's more, that total is from 2013, which means the savings are likely even greater now.
I should note that the NYT report added, "The study, published online in Health Affairs on Tuesday, was not able to definitively establish whether the law drove women's falling expenditures on birth control, but experts said the magnitude and timing of the decline suggested that it was."
No kidding. Scholars may struggle with proving causation, but unless someone's prepared to argue that the sharp drop in spending is an amazing coincidence, it seems like a safe bet that the Affordable Care Act is driving the results.
There is, however, one lingering question: given the ACA's requirements, shouldn't contraception spending fall to effectively nothing?
Vox's Sarah Kliff noted there are a few reasons why some women continue to pay for birth control coverage:

1. Some insurers weren't complying with the mandate. Two recent investigations -- one by the Kaiser Family Foundation and another by the National Women's Law Center -- found that some insurers were skirting the rules and using a loophole to continue charging for contraceptives. The White House took steps in May to close that loophole, and you can read more about that here. 2. Not every single contraceptive gets covered at no cost. Insurance plans are required to cover every type of FDA-approved contraceptive including pills, patches, and implants. But they aren't required to cover every single option in each category. There are dozens of different birth control pills, for example, and an insurance plan could decide to cover one or two of them. Women who still want the other pills would face charges. 3. Some health insurance plans are "grandfathered." Plans that existed prior to Obamacare becoming law back in 2010 are eligible for a "grandfathering" exemption from the birth control mandate, so long as they don't change their benefit package significantly. Insurers generally do like to change benefit packages, though. So over the past five years, the number of grandfathered plans has shrunk, but some of them still exist -- and don't have to provide birth control at no cost.

Still, the progress overall seems very encouraging. Looking ahead, if "Obamacare" is repealed, as Republican presidential candidates demand, it would mean consumers would either have to go without or the $1.4 billion would come out of their pockets.