The Supreme Court decision allowing some employers to exclude contraceptive coverage from their health plans may throw many women back into a situation they thought was history: having to pay for certain kinds of birth control out of their own pockets.
The background: The Affordable Care Act requires all health insurance plans to cover birth control free of charge (that is, with no deductibles, copays, or coinsurance), with limited exceptions made for non-profit religious groups like hospitals or colleges that object to contraception.
But in today's decision, the Supreme Court said that Hobby Lobby, a national chain of 572 arts and crafts stores that operates “in a manner consistent with biblical principles,” could exclude coverage of four specific types of contraceptives that its owners believe violate their religious convictions. (Our sister site, Consumerist, has a great summary of the legal issues.)
At this early point it’s unclear how many other employers might follow suit. The court said that its ruling only applies to “closely held” corporations in which the majority of stock is owned by five or fewer individuals. But according to a quick calculation by Alison Griswold at Slate, about half of the workforce—or more than 60 million people—are employed by this type of business.
Hobby Lobby’s owners specifically object to four contraceptives that they consider “abortifacients,” because of their conviction that the contraceptives could prevent the implantation of a fertilized egg. The four are two emergency contraception pills, Plan B (also available in generic versions) and Ella; and two IUDs, Mirena and Paragard.
What are the options for women whose employers suddenly decide to stop covering those products?
The Supreme Court suggested that the government could do for employees of Hobby Lobby and other such companies the same thing that it has done for employees of religious nonprofits—arrange for their health insurance companies to give them the contraceptives free of charge separately from what the employer pays. But at this early date the administration hasn't released any information on how or whether this might happen.
In the meantime, it looks like the only choice for affected women will be to pay out of their own pocket for these contraceptives, and they are not cheap.
Plan B, the only one of the four available over the counter, costs about $50, with generic versions averaging about $40. The other emergency contraceptive, Ella, available only by prescription, costs $59 through Kwik-Med, an online site authorized to prescribe and mail it.
Interestingly, there’s considerable evidence that morning-after pills don’t work by preventing implantation after all, but Hobby Lobby’s owners sincerely believe they do, which is all that mattered for the five Supreme Court justices who decided the opinion.
The American Society for Emergency Contraception has a useful page of tips on where else to procure these products at reduced price—as well as information on how women can use regular birth control pills (which Hobby Lobby says it will continue to pay for) as a substitute emergency contraceptive.
As for the IUDs, these are typically used not for emergency contraception but for long-term birth control. Both of them are designed to stay in place for up to five years. However, they’re very expensive, with a list price of $927 for Mirena and $754 for Paragard, not counting the cost of the doctor visit for insertion of the devices. That's a price tag that’s likely out of reach for many women.
—Nancy Metcalf
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