Marylanders will have an easier time getting birth control next year under a sweeping new law aimed at expanding and protecting people’s access to contraception.
Under the law, which goes into effect Jan. 1, insurers are required to provide most forms of birth control with no out-of-pocket costs to the patient. The law also requires insurers to cover vasectomies, or sterilization, for men without charging out-of-pocket expenses. And insurers must pay for over-the-counter birth control, including the Plan B emergency contraception, also known as the morning-after pill. The pill is taken after sexual intercourse to prevent a pregnancy.
Women will be able to get birth control pills and other contraception in six-month doses rather than having to refill a prescription every month, and they will no longer have to get pre-authorization from an insurance company to get implants and IUDs, which slowly release spermicide or hormones into the body to prevent pregnancy.
Maryland, which passed its law in 2016, is among about a dozen states that have strengthened birth control laws in the last few years in response to gaps in insurance coverage and legal and political threats to the federal Affordable Care Act, according to the National Institute for Reproductive Health, an advocacy group.
Some of the states, including Maryland, mandated the change shortly after passage of the Affordable Care Act, which required birth control coverage but had loopholes that still made it hard for people to get it. For instance, insurers could limit the variety of birth control pills they covered. The federal law only required that one type of all forms of contraceptives be covered with no co-payment. Lawsuits by opponents of the federal law and attempts by congressional Republicans to repeal it also have threatened the future of the federal law.
“On the ground, the protections were not as expansive as they could be,” said Del. Ariana B. Kelly, a Montgomery County Democrat who was lead sponsor of the bill in the Maryland House of Delegates. “We thought there was more we could do to go in the opposite direction of what we might see the federal government doing.”
Even more states began adopting laws after the election of President Donald J. Trump, who made it a priority to repeal the Affordable Care Act, also known as Obamacare. The state laws would stay in effect even if Obamacare does not.
“You are now seeing states step in again and make sure we have enshrined in our laws that women are guaranteed access to affordable contraceptive coverage,” said Andrea Miller, president of the National Institute for Reproductive Health. “After the election it became so abundantly clear that the Trump Administration was laser focused on attacking access to contraception,” Miller said. “That put more winds in the sails at the state level.”
Miller said Maryland’s law was one of the more comprehensive and robust that she has seen.
The bill met some early resistance from insurers because it would cost them money. Although the bill was signed in 2016 it did not go into effect right away to give insurers time to prepare. The law applies only to insurers regulated by the state of Maryland. Some plans offered to Marylanders will not be covered, such as those that are issued from other states.
Tinglong Dai, an assistant professor at the Johns Hopkins Carey Business School, said some insurers might not like such contraception coverage because of the immediate costs. Other insurers may welcome it as a way to test the long-term implications of no-cost contraception, he said.
Delegate Kelly said lawmakers worked closely with insurers to address concerns.
CareFirst BlueCross BlueShield, the state’s largest insurer, said in a statement: “We appreciate that legislators worked with us to help address most of our concerns.”
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One stipulation of the new law is being questioned by Maryland Insurance Commissioner Al Redmer, who wants to ensure that covering vasectomies won’t void health savings accounts. Employers and workers contribute tax-deductible contributions to the plans to cover health costs. Under IRS rules for such plans, only preventive care procedures can be offered without a deductible or co-pay. Redmer has asked the IRS to clarify whether vasectomies qualify as preventive care.
Sen. Delores G. Kelley, a Baltimore Democrat who sponsored the bill in the Senate, said that by covering vasectomies without co-pays the law takes an important step in recognizing the reproductive rights of men. Women’s sterilization was already covered at no cost to the patient.
“We need all people to have their human rights recognized,” she said. “People ought to have the rights to plan their families as they want.”
Delegate Kelly said she would eventually like to see even more birth control coverage. For instance, some states allow women to get 12 months’ worth of birth control at a time, compared to six months in Maryland. And condoms are not covered by the law.
The Maryland bill was a top priority of the legislature’s Democratic leaders, House Speaker Michael E. Busch and Senate President Thomas V. Mike Miller. It was co-sponsored by half of the state’s lawmakers.
Planned Parenthood of Maryland was a lead advocate for the Maryland law, which a spokeswoman for the organization said goes a long way toward ensuring more woman are able to get birth control.
“This makes sure that all Marylanders have expanded access to the type of birth control that they want,” said Dana Robinson, director of communications and marketing.