## Short Segments Out-of-pocket costs for long-acting reversible contraception are rising, despite ACA mandates. Today, we'll explore why some insured individuals still face unexpected expenses for IUDs and contraceptive implants. Later, we'll dive into how state policies are shaping reproductive health care access across the U.S. Let's start with the headline: Unexpected Costs for Contraception Under ACA . Despite the Affordable Care Act's requirement for free contraception coverage, many individuals with employer-sponsored insurance plans are still paying out-of-pocket for long-acting reversible contraception, like IUDs and implants. A study published in the journal Contraception highlights that the proportion of people paying nothing for these contraceptive methods has decreased since 2014. This is significant because these methods are among the most effective forms of birth control, yet unexpected costs can deter their use. For instance, Erica M., a 23-year-old with employer insurance, faced unexpected bills for an IUD, despite ACA provisions. The study suggests that high-deductible health plans may contribute to these costs, impacting nearly half of privately insured Americans. As a result, the financial burden could influence contraceptive choices, potentially leading to less effective birth control use. ## Feature Story State policies are creating unequal access to reproductive health care across the United States. Authored by KFF’s Alina Salganicoff, Ivette Gomez, and Usha Ranji, a recent article examines how these policies impact women's access to contraception, abortion, and maternity services. State decisions on Medicaid coverage, professional credentialing, and reproductive rights significantly influence the availability of these services. For example, Massachusetts, Vermont, and Rhode Island rank highest in the 2024 State Scorecard on Women’s Health and Reproductive Care, while Mississippi, Texas, Nevada, and Oklahoma rank lowest. These rankings are based on 32 measures of health care access, quality, and outcomes. Deaths from all causes among women of reproductive age are highest in southeastern states, with preventable causes like pregnancy complications and substance use contributing significantly. Since the 2022 overturning of Roe v. Wade, access to reproductive care has faced additional challenges. While organizations and individuals continue to support sexual and reproductive health rights, the anti-abortion movement remains active, further complicating access. In 2025, the landscape of reproductive health care access is marked by resilience and ongoing struggle. State policies play a crucial role in shaping this landscape, affecting millions of women across the nation. As we look ahead, understanding these policy impacts is essential for addressing disparities and improving access to reproductive health care. Listeners should watch for changes in state policies and their implications for reproductive health services.
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