Weisman Carol S, Velott Diana, Zheng Amy, Horvath Sarah, Leslie Douglas, Chuang Cynthia H
Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania.
Urology Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts.
Womens Health Issues. 2025 May-Jun;35(3):151-158. doi: 10.1016/j.whi.2025.03.002. Epub 2025 Apr 24.
State and federal policies have aimed to expand access to contraception by providing coverage of its costs in both public and private health insurance. Yet barriers to contraception coverage remain and are expected to increase after the 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization. This paper describes the history of these policies and current challenges.
We constructed a chronology of federal and state policies providing coverage of the cost of contraception in both public and private health insurance, from establishment of the federal right to contraception through 2024, using published sources and public datasets. We aligned the chronology with the history of the development of contraception technology and practices, as described by historians and social scientists, and with political and legal challenges.
Following establishment of a federal right to contraception after nearly a century of restrictions under the 1873 Comstock Act, three waves of contraception coverage policymaking sought to increase access to contraception by making it more affordable to consumers. These waves included options for states to expand coverage for contraception within the Medicaid program; passage of state contraception coverage equity laws to ensure parity for contraceptive coverage in private health plans; and the Affordable Care Act's national contraceptive coverage requirement and its subsequent modifications, clarifications, and codifications. Post-Dobbs, challenges to contraception coverage include efforts to redefine certain contraceptives as abortifacients and to resurrect some of the restrictions of the Comstock Act. The requirement of no-cost coverage of preventive services is also threatened.
Contraception coverage policy will be impacted by ongoing challenges to contraception and abortion access, as well as changing contraceptive technology and modes of delivery.
州和联邦政策旨在通过在公共和私人医疗保险中涵盖避孕费用来扩大避孕措施的可及性。然而，避孕保险覆盖仍存在障碍，并且预计在2022年美国最高法院对多布斯诉杰克逊妇女健康组织案的裁决后会增加。本文描述了这些政策的历史和当前面临的挑战。
我们利用已发表的资料和公共数据集，编制了一份从确立联邦避孕权到2024年的联邦和州政策年表，这些政策涵盖了公共和私人医疗保险中的避孕费用。我们将该年表与历史学家和社会科学家所描述的避孕技术和实践的发展历史以及政治和法律挑战进行了比对。
在1873年《康斯托克法案》实施近一个世纪的限制后确立了联邦避孕权，随后出现了三波避孕保险覆盖政策制定浪潮，旨在通过降低消费者的费用来增加避孕措施的可及性。这些浪潮包括各州在医疗补助计划内扩大避孕保险覆盖范围的选项；通过州避孕保险覆盖公平法以确保私人健康计划中的避孕保险覆盖平等；以及《平价医疗法案》的全国避孕保险覆盖要求及其后续的修改、澄清和编纂。多布斯案之后，避孕保险覆盖面临的挑战包括将某些避孕药重新定义为堕胎药的努力以及恢复《康斯托克法案》的一些限制。预防性服务免费覆盖的要求也受到威胁。
避孕保险覆盖政策将受到避孕和堕胎可及性方面持续挑战以及不断变化的避孕技术和提供方式的影响。
