Contraception access after health care reform: A preliminary look at the impact of mandatory insurance coverage in Massachusetts

Background:

In 2006, Massachusetts passed legislation mandating all residents have health insurance by July 2007. Because women have less access to employer-sponsored insurance and earn less than men, an insurance mandate could pose a significant financial burden for low-income women.

Purpose:

We explored the impact of health care reform on low-income women's access to contraception.

Methods:

This study has four components: (1) systematic review of subsidized health insurance plans (2) self-administered surveys of family planning agencies (3) in-depth interviews with family planning clinic staff (4) eight focus groups with low-income English and Spanish speaking women across Massachusetts.

Results:

Data collection will be completed in February 2009. Preliminary findings show that though reform has enormous benefits for some women, many women, such as adolescents, undocumented immigrants, women with incomes at or around the financial cutoffs or with variable employment continue to face barriers in accessing care. Women identified multiple obstacles to maintaining insurance coverage, noting they frequently lose coverage, which may affect contraceptive use. Additionally, they indicate they receive little information about which contraceptive methods are covered under their plans; plan websites provide inadequate information about which methods are covered and how much they cost. The presentation will include analysis of data from clinics and more in-depth information on women's experiences.

Conclusion:

Health care reform should explicitly address access to contraception for low-income women. Lessons learned from Massachusetts's experience should inform other state or national health care reform.