Bernie Sanders calls for investigation into the cost of contraceptives

“It is completely unacceptable that plans consistently defy mandated coverage and that there is little enforcement or accountability,” Sanders wrote to GAO Chairman Gene L. Dodaro, urging him to launch an investigation.

Democrats have worked to ensure access to contraception, even as reproductive health services face greater challenges. Last week, Senate leaders held a vote to enshrine contraception as a federal right; the measure failed due to Republican opposition. Far-right conservatives have attacked birth control, falsely framing various methods as the cause of abortions, and access to contraception faces funding challenges at the state level.

“I’m extremely concerned, frankly,” said Rachel Fey, vice president of policy and strategic partnerships at Power to Decide, a nonprofit focused on reproductive health. She fears that access to contraception is facing “death by 1,000 cuts” and that the plans’ lack of alignment with federal law is making the situation worse.

“There is nothing more frustrating than hearing that this is still happening more than a decade after this provision went into effect,” Fey said. “If people still aren’t getting the contraceptives they are entitled to, it becomes an enforcement problem.”

In his letter to the GAO, Sanders cites a recent Vermont state investigation that found three insurers improperly billed residents more than $1.5 million for contraceptives. A 2022 House Oversight Committee investigation found that health insurers consistently denied their members’ requests for free contraceptives. Some insurers refuse to cover certain brand-name contraceptives on the grounds that they cover generic versions that are therapeutically equivalent. But insurers are required to offer women a process to access contraceptives that doctors deem medically necessary.

According to a survey by the non-partisan health research organization KFF, 16 percent of privately insured contraceptive users still had to pay their costs out of their own pocket in 2022.

“The intention of the directive is full coverage of contraceptives for women, but implementation is complicated because there are so many contraceptive methods,” says Brittni Frederiksen, KFF’s deputy director who works on women’s health policy. By law, health insurers are required to cover at least one contraceptive method in each category of contraception, such as oral contraceptives. However, there are hundreds of oral contraceptives that providers can prescribe to their patients, says Frederiksen.

“Writing (regulations) that cover all these things without saying that you have to cover them all in principle is a challenge,” Frederiksen said.

The Biden administration took several steps in January to improve access to contraception. Health Secretary Xavier Becerra sent a letter to health insurers informing them of their obligation to provide free contraception, and the Departments of Health and Human Services and Treasury and Labor issued additional guidelines on implementing the federal requirements.

Fey said the Biden administration could go further and collect complaints from women who face obstacles in accessing contraception, citing the administration’s recent efforts to simplify reporting procedures for patients when they have been denied emergency abortion or other emergency care.

“I would like to see the government do something similar for birth control,” Fey said. “To make it really user-friendly so people can say, ‘Hey, I think I’m not getting the birth control I’m supposed to be getting.'”