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    Anticipating end of Obamacare, state lawmakers press for contraceptive mandate  

    Advoacates spoke to a legislative aide on Beacon Hill on Tuesday as part of Sexual Health Lobby Day 2017.
    Pat Greenhouse/Globe Staff
    Advoacates spoke to a legislative aide on Beacon Hill on Tuesday as part of Sexual Health Lobby Day 2017.

    Faced with the threatened repeal of the Affordable Care Act, which provided free birth control to women for the first time, Massachusetts lawmakers are scrambling to deliver a bill that would preserve — and even expand — free contraceptive coverage for all state residents.

    A bill introduced on Beacon Hill would expand the provisions of the Affordable Care Act, which guarantees contraceptive coverage without co-payments or deductibles but does not currently cover every form of birth control.

    A coalition of women’s health advocates headed to Beacon Hill on Tuesday to lobby legislators on the bill, as well as other sexual and reproductive health care matters. Among the speakers were Massachusetts Senate Majority Leader Harriette L. Chandler, who cosponsored the bill along with state representatives Patricia A. Haddad, a Somerset Democrat, and John W. Scibak, a South Hadley Democrat.

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    The bill would also let women choose their own birth control methods and switch freely, rather than requiring them to show that a previous method proved problematic and seek insurance approval for a change.

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    Health insurers are likely to balk at that lack of oversight, however, and one group has already called the proposal an “overreach” that would create waste and prevent them from controlling costs.

    ”Unfortunately what Senator Chandler’s bill does is require us to cover everything in the contraceptive world with no copays and . . . no medical management,” said Lora M. Pellegrini, president of the Massachusetts Association of Health Plans.

    “Many of us support Planned Parenthood and the work they do,” Pellegrini said, noting that she has worked for the Massachusetts Women’s Political Caucus, which sponsored last weekend’s Women’s March in Boston. However, she said, “I think the bill is really ill-conceived and goes well beyond ensuring that women have adequate coverage for contraception.”

    Women’s concerns about an erosion of their rights — reproductive and otherwise — fueled the massive Women’s March on Washington and in cities around the world on Jan. 21, and women’s health and reproductive advocates have been alarmed by the swift actions being taken by the new Trump administration.

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    Already, Trump reinstated the so-called Mexico City policy, which bars US funding for family planning services to any foreign organizations involved in abortion services, and the US House passed a bill that would make permanent the measure that annually bars taxpayer funding for abortions.

    Trump also faces a vacancy on the Supreme Court and is expected to announce his nomination Tuesday night. He has said he would nominate a conservative in the model of the late Antonin Scalia, who opposed Roe v. Wade, the ruling that legalized abortion.

    On Friday, Vice President Mike Pence made the first personal appearance by an administration leader at abortion foes’ annual rally, the March for Life, assuring the crowd that “life is winning.”

    With Trump and the Republican-led Congress poised to repeal the Affordable Care Act, women’s rights advocates fear that broad contraceptive coverage could be another casualty. The law that mandated health care coverage for all also considered reproductive health preventative health, guaranteeing coverage of birth control without copayments.

    Women who are sexually active must consider contraception for 30 or 40 years of their lives. That can generate significant expenses, though still far less than the cost of delivering and raising a child. Consider that, even with a copayment, a generic birth control pill could cost $120 a year. The average pregnancy and delivery in Massachusetts costs $10,000 to $12,000, said Dr. Jennifer Childs-Roshak, a family doctor who serves as president of the Planned Parenthood League of Massachusetts.

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    Contraceptive coverage won’t be wiped out if Obamacare is; Massachusetts insurers have been required to provide it as part of their policies since 2002.

    “Previously in Massachusetts, insurers were required to cover, but there was no expectation that women could get the best choice for them without jumping through hoops, or being required to pay copays,” said Childs-Roshak. “With the ACA, one of the big improvements for women has been the idea that you can access birth control without a copay – pills, IUDs, whatever is best for you,” she said.

    Childs-Roshak added that providers should look at the cost per month of birth control, and that some, longer-lasting forms of contraception provide a much better “return on investment,” despite the up-front costs.

    However, Pellegrini said the costs of the bill being proposed are unknown. An earlier, more limited version of the legislation could have increased costs to insurers up to $7 million. Rather than expanding coverage at this time, she said policy makers should be focused on preserving the level of coverage available under the Affordable Care Act.

    “I think they’re trying to, at this moment, correct a problem that doesn’t exist,” she said.

    Stephanie Ebbert can be reached at Stephanie.Ebbert@globe.com. Follow her on Twitter @StephanieEbbert.