A matter of equity: Gender, health care, and the categorization of contraception in the Affordable Care Act

Is contraception part of health care or is it something distinct that has no place within debates about health? Such questions remain part of American discourse and policy making decades after the introduction of prescription contraception, and despite the millions of American women currently utilizing such methods. This paper utilizes interpretive policy analysis methods to examine the changing categorization of contraception vis-à-vis health insurance as part of the 2010 Patient Protection and Affordable Care Act. The paper begins with a brief overview of the history of contraception and health care, showing how contraception's classification has been debated within both state and national level policy making. The paper then focuses in on the policymaking processes leading up to contraception's controversial inclusion among preventive care benefits within the Affordable Care Act. In the process, it examines the frames that have been used by advocates on both sides of the issue to position contraception as either within or outside of health care and illuminates the powerful symbolic role played by contraception and women's health issues more broadly within these debates. Data analyzed includes official policy documents, formal statements (written and verbal) made by policy actors, and related media accounts of the debate between 2009 and the present. The interpretive category and framing analysis is facilitated by use of Atlas.ti to identify patterns and ensure reliability of findings.