Thanks to the Affordable Care Act (ACA), women who have health insurance don’t have to pay extra for birth control. The same isn’t true for men who want to prevent pregnancy by getting a vasectomy or using condoms—and that’s a serious oversight, according to a leading reproductive health research group.
“The exclusion of methods used by men simply makes no sense and benefits no one—not men, not women, not families, not health plans,” Adam Sonfield, author of a new analysis for the Guttmacher Institute on “male” contraceptive methods, said in a statement.
Vasectomy is one of the most effective contraceptive methods available, Sonfield notes in his analysis—second only to the contraceptive implant, and even slightly superior to intrauterine devices (IUDs) and female sterilization. It’s also less invasive, less expensive, and less risky than female sterilization.
But right now, the ACA creates a financial incentive for couples to choose a tubal ligation for the woman over a much simpler vasectomy for the man.
Condoms are much less effective at preventing pregnancy than any of those methods, but they have the added benefit of protecting against sexually transmitted infections (STIs). Condoms are also most commonly used by teens and young adults who are at higher risk for STIs, and they are typically offered at no cost by programs like Medicaid and Title X family planning.
The original regulatory decision to restrict ACA contraceptive coverage to “female” methods was not “rooted in some sort of animus against men,” Sonfield writes. “Rather, lawmakers’ and advocates’ focus on women’s health issues was in response to their historical neglect.”
Regardless of who technically uses the method, Sonfield notes, women still reap the massive preventive health benefits of being able to plan their pregnancies. That suggests that failing to cover “male” methods is short-sighted from a public health perspective. It’s also a cultural problem because it “perpetuates the all-too-common view that contraception is solely the woman’s responsibility,” Sonfield writes.
About a quarter of women who use contraception rely on a “male” method as their primary means of avoiding pregnancy, according to the report. That’s a total of nine million U.S. women who rely on either male condoms (15 percent of all female contraceptive users) or vasectomies (8 percent) as their primary method of birth control. For comparison, 26 percent of contraceptive users rely on the pill, 25 percent use female sterilization, and 10 percent use either a hormonal or copper IUD.
There are a number of possible solutions to the problem, many of which have obstacles. The least likely option for change would be an act of Congress, whose members’ current conservative bent almost guarantees that “attempts to undermine contraceptive coverage are more likely than attempts to bolster it.”
States could also do something about the problem, and if enough states did so, that could have ripple effects across the entire insurance market. That could be complicated, however. If coverage for “male” methods counted as a “new mandate,” states could be stuck with the bill.
The Obama administration could choose to interpret the ACA provision differently so that methods used by a man also count as preventive care for women. “That would require the administration to amend its current public stance—not something it would do lightly,” the report notes.
Health plans could help by choosing to cover vasectomies without cost sharing, since it would help their bottom line to encourage patients to use cheaper treatments.
“From that perspective, it seems surprising that health plans—which have the authority to go beyond the basic requirements of the ACA—have not yet acted on their own to level that playing field,” Sonfield writes. Condoms would be a tougher sell, though: “Health plans may fear that they will end up simply paying for condoms that people would otherwise pay for out of pocket, rather than actually helping to increase condom use.”
The most promising avenue to fix this coverage gap, according to the Guttmacher analysis, would be for the U.S. Preventive Services Task Force (USPSTF) to issue a specific recommendation on the issue. The ACA automatically incorporates any USPSTF recommendations into its preventive services requirements after a one-year grace period.
“But regardless of the approaches that advocates and policymakers take to bolstering contraceptive coverage, it is time that vasectomy, male condoms and any future methods used by men stop being treated as second class methods just because they are used by men,” Sonfield writes.