The Supreme Court's ruling on the ACA's birth control mandate could cost women hundreds of dollars each year

Supporters of women's health rally outside the Supreme Court in Washington, DC, March 23, 2016, as the Court hears oral arguments in 7 cases dealing with religious organizations that want to ban contraceptives from their health insurance policies on religious grounds.

Any employer with a sincere religious or moral objection can now opt out of covering contraceptives in employee health plans, the Supreme Court ruled Wednesday. That decision could cost those who use contraception hundreds of dollars per year in out-of-pocket costs alone. 

The case stems from a 2018 rule issued by the Trump Administration that expanded the types of employers who could opt out of the provision in the Affordable Care Act mandating that preventive health services, including birth control pills, rings, intrauterine devices, etc., be covered by most insurance plans at no additional cost. Now, any employer, including some publicly-traded companies, can choose to drop contraceptive coverage if they have a religious or moral objection.

In 2013 — the first year the mandate was in effect for many health plans — women saved an estimated $1.4 billion on birth control pills alone, according to a study from Health Affairs.

The SCOTUS ruling could result in up to 126,000 women losing contraceptive coverage, costing $584 each annually, according to estimates from the Department of Health and Human Services. That said, the cost of birth control varies greatly depending on the type, with longer lasting, more effective varieties like IUDs costing significantly more upfront than other types, like the pill. The Health Affairs' study found that women saved, on average, $254.91 per year on the pill after the ACA's mandate went into effect.

That cost barrier could make contraception unaffordable for many, according to the Guttmacher Institute, a pro-choice research organization. 

"Numerous studies have demonstrated that even seemingly small cost-sharing requirements can dramatically reduce preventive health care use, particularly among lower-income Americans," writes Adam Sonfield, Guttmacher's associate director of policy analysis.

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In fact, co-pays as low as $6 prevented some women from obtaining birth control before the ACA, according to the National Women's Law Center (NWLC), while one in three Latina and four in 10 Black women of reproductive age say they cannot afford to pay more than $10 for contraception. Women were more likely to forego the more expensive, more effective birth control forms like IUDs, according to Health Affairs. And women from lower socioeconomic backgrounds will be disproportionately impacted by the ruling, according to Health Affairs

At the same time, women who have access to legal contraception beginning at ages 18 to 21 earn an estimated 5% more per hour and 11% more per year by the time they're 40 than those who do not have access to birth control, a 2019 report from the Institute for Women's Policy Research found. Contraceptive access has also been found to increase women's college enrollment by up to 20%; the substantial increase in women's labor force participation between 1970 and 1990 was largely due to the pill.

"Access to contraception has life-long economic benefits: enabling women to complete high school and higher levels of education, improving their earnings and labor force participation, and securing their economic independence," the NWLC wrote in its amicus brief.

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