Evaluating need for contraception and access to it, is one of the most important factors in understanding the state of choice in Ohio. The Affordable Care Act, colloquially known as Obamacare, directly caused an increase in coverage for contraception through health insurance. The Patient Protection and Affordable Care Act was signed into law in March of 2010, though coverage for contraception without cost sharing was not instituted until August 1, 2011. Even then, “grandfathered” plans are exempt from implementing the change until the plan undergoes significant changes. (US department of Health and Human Services, 2011). In 2014, 26% of people with insurance coverage were insured under a “grandfathered” plan and thus did not have guaranteed access to contraceptives without cost sharing (Kaiser Family Foundation, 2015). The ACA alleviated much of the financial strain on women with regard to controlling their reproduction. The Act requires that at least one method from each of the 18 different categories of birth control be covered with no cost sharing. This means that if a woman cannot use that one kind of birth control covered on her insurance plan, she could still be paying out of pocket to prevent pregnancy. The ACA also exempts religious organizations from the contraceptive care requirement in their health plans, creating obstacles for female employees at those organizations (HRSA). Furthermore, short-term health insurance, which primarily covers only major illness and accidents, is not obligated to cover contraception. Finally, there are also still women in Ohio without health insurance, even after passage of the Affordable Care Act.
Many women in Ohio need contraception , both generally and publicly funded. This number of women in need of contraception does not refer to the number of women who cannot access contraception. In 2013 a total of 1,290,050 women were in need of contraceptive supplies and services, out of a total of 2,365,430 women, ages 13-44 (Frost, Frohwirth, and Zolna, 2015). Among women aged 20-44, 537,610 of those in need of contraceptive services or supplies were living above 250% of the federal poverty line, while 560,380 were living below that income marker (Frost, Frohwirth, and Zolna, 2015). A total of 986,770 white women, 185,490 non-Hispanic Black women, and 49,240 Hispanic women were in need of contraception (Frost, Frohwirth, and Zolna, 2015). That same year, a total of 729,680 women were in need of publicly-funded contraceptive supplies and services, “because they needed contraceptive services and supplies, and were either adult women with a family income under 250% of the federal poverty level or were younger than 20” (Frost, Frohwirth, and Zolna, 2015). Therefore the number of women in need of publicly-funded contraception also reflects socio-economic and age demographic information. The number of women in need of publicly-funded contraceptive supplies and services demonstrates a three percent increase in need from 710,200 in 2010, although the overall population of women in this age range decreased by one percent. (Frost, Frohwirth and Zolna, 2015).
Being able to afford contraception can be one of the largest barriers to access. In 2013, 20% of the total women in need of publicly-funded contraception were uninsured (Frost, Frohwirth and Zolna, 2015). The Guttmacher Institute reported that 19% of white women, 18% of Black women, and 34% of Hispanic women that were in need of publicly-funded contraception were uninsured (Frost, Frohwirth and Zolna, 2015). These percentages demonstrate a large socio-economic barrier to access for women of different racial and ethnic groups, but particularly for Hispanic women living in Ohio. Furthermore, the percent of need met by publicly funded providers dropped from 22% in 2010 to 15% in 2013 (Frost, Frohwirth, and Zolna, 2015). The percent of need met by Title X clinics dropped from 14% in 2010 to only 9% in 2013 (Frost, Frohwirth, and Zolna, 2015). Title X is a federal grant project that provides funding to both public and private non-profit organizations for family planning and preventative health services. It is part of the United States Public Service Act, which was enacted in the 1970s. Increased access to contraception through the Affordable Care Act may be one factor that explains why the need met by public providers has decreased. These numbers put Ohio much lower than the national average percentage of total contraceptive needs met by publicly supported providers in 2013, which was 42% (Guttmacher 2014). This indicates that only a fraction of contraceptive need is being met through public services. This lack of coverage should be an indicator of the need to allocate resources to publicly-funded reproductive services.