Biden Administration Proposes Historic Expansion of ACA’s Contraception Coverage

President Joe Biden’s administration on Monday announced a plan that would eliminate out-of-pocket expenses for most birth control for a majority of Americans.

Officials called the proposed rule, which affects people with private health insurance, the most significant expansion of contraception coverage under the Affordable Care Act (ACA) in over a decade. They estimate it could benefit 52 million women of reproductive age.

“For the first time ever, women would be able to obtain over-the-counter contraception without a prescription at no additional cost, and health plans would have to cover even more prescribed contraceptives without cost sharing,” said Jennifer Klein, assistant to the president and director of the White House Gender Policy Council, in a call with reporters.

The proposed rule would alleviate a significant financial burden for millions of Americans. The 2010 health law already required private health plans to cover at least one form of birth control for beneficiaries without any out-of-pocket costs. Research shows that the benefit has contributed to higher use of contraception, lower health care expenditures by women, and may have helped lower rates of unintended pregnancy.

But applying the contraception mandate to over-the-counter methods has been difficult.

If enacted, the proposed rule would require health plans cover forms of birth control such as condoms and emergency contraception – both typically bought without a prescription – as well as a new over-the-counter hormonal birth control pill. That pill, known as Opill, hit retail shelves earlier this year, and a six-month supply costs about $90.

Democrats have pushed for years to strengthen enforcement of the ACA’s existing birth control mandate, citing reports of poor enforcement and of women receiving surprise bills for contraceptives that should have been covered. A 2021 survey by KFF, a nonpartisan health policy research, polling and journalism organization, found that 1 in 5 women with private insurance said they had paid something out of pocket for birth control.

Biden administration officials reiterated those concerns.

Health and Human Services Secretary Xavier Becerra said that his agency has heard from people who need a certain kind of birth control only to find out that their health insurance doesn’t cover a prescription for that brand. Insurers are only required to cover one drug per category of contraception. A White House official told reporters during the call that the proposed rule would change that so all FDA-approved drugs and drug-led combination products are covered unless there’s a medication available that will yield similar results.

“We have made clear that in all 50 states, the Affordable Care Act guarantees coverage of women’s preventative services without cost sharing, including all birth control methods approved by the Food and Drug Administration,” Becerra said. “This proposed rule will build on the progress we have already made under the Affordable Care Act to help ensure that more women can access the contraceptive services they need without out-of-pocket costs.”

Reproductive rights have been a hallmark of Vice President Kamala Harris’ campaign for president, and the White House emphasized how both Biden and Harris have consistently taken steps to improve the public’s access to contraception. These measures include Biden’s June 2023 executive order to strengthen access to contraception and family planning services following the Supreme Court’s decision to overturn Roe v. Wade, ending federal abortion rights.

“Dangerous and extreme abortion bans are putting women’s health and lives at risk and disrupting access to critical health care services, including contraception, as health care providers are forced to close in states across the country,” Klein said.

Some Republican state lawmakers have been clear about their intentions to restrict birth control as well as abortion. Conservatives in Congress have called for the defunding of Title X, a federal program offering family planning and related health care services. They have also blocked federal legislation to protect contraception access.

Harris, in contrast, has maintained that “contraception is health care.” Since Roe was overturned in June 2022, Harris has discussed the repercussions of limiting women’s health care during more than 100 events, according to Kristine Lucius, deputy assistant to the president and domestic policy adviser to the vice president.

Harris has also criticized Republican efforts to repeal the ACA, which covers nearly 50 million Americans. Among those protected by the law are more than 100 million people with preexisting medical conditions. The law has already allowed millions of women to save on contraception costs.

The proposed rule will likely have a 60-day comment period, meaning that it will be finalized in 2025, officials said during the call, making it uncertain if it would still take effect if former President Donald Trump is elected. Trump’s position on contraception hasn’t been clear. In May, he gave an interview in which he suggested he would consider certain restrictions, but he later said he would not impose any. Project 2025, which Trump has distanced himself from — even though its writers have ties to both him and his running mate, Sen. JD Vance — does support restricting some forms of contraception.

The departments of Health and Human Services, Labor and Treasury on Monday also issued new guidance to ensure that consumers can access other preventative services without cost-sharing, including Pre-Exposure Prophylaxis (or PrEP), a medication to prevent contracting HIV, and colonoscopies covered under the ACA.