California deliberating bill to make vasectomies free: a 'game-changer' for contraception legislation

Legislators in California are debating introducing a bill that would make it mandatory for health insurance companies to pay for vasectomies as well as other nonprescription birth control methods like condoms and contraceptive sponges. The Contraceptive Equity Act of 2022 would also prohibit commercial insurance plans subject to state regulation from charging out-of-pocket expenses for those birth control methods, such as copays, coinsurance or deductibles.

Most health insurers are required by federal and state law to provide free patient coverage for prescription contraceptives. However, only 18 birth control methods are covered by those provisions, and even those are just for people with uteruses. This bill would essentially extend that requirement to sterilization and nonprescription birth control.

Liz McCaman Taylor, a senior attorney with the National Health Law Program, an advocacy group that works for the health rights of low-income people, told Los Angeles Times that this legislation is "groundbreaking" and that it is imperative to "think about contraception as something that is relevant for people of all genders."

When it comes to extending what most people typically consider birth control in legislation, the bill is a game-changer. Pregnancy-related laws are frequently written with people with uteruses in mind. The laws intended to enable reproductive justice include contraceptives like birth control, IUDs and vaginal rings. But if equity is the ultimate objective, lawmakers must begin deliberating on contraception that moves beyond just people with uteruses.

A vasectomy is a birth control method that stops the flow of sperm from reaching the semen. Although technically possible, reversing a vasectomy depends on a number of variables, including the patient's age, the length of time since the procedure and any previous fertility problems.

The new law would apply to any health insurance policy issued, modified, renewed or delivered on or after January 1, 2024, if it were to pass.

The National Organization for Women, Center for American Progress, Center for Reproductive Rights and Planned Parenthood Federation of America, to name a few, support the federal legislation.

The Right to Contraception Act, also known as H.R. 8373, was approved by the U.S. House of Representatives in the end of July. The bill, introduced by North Carolina Congresswoman Kathy Manning, establishes a statutory right for individuals to obtain contraceptives. It also grants healthcare providers the right to provide contraceptives and information related to contraception.

Voters in California will decide in November whether or not to enshrine abortion and contraception rights in the state constitution. However, according to Amy Moy, a spokesperson for Essential Access Health, the organization in charge of running California's Title X family planning program, Proposition 1 doesn't address issues like cost and coverage. “The constitutional amendment is kind of the long-term protection, and we are still working to reduce barriers for Californians on the short-term and day-to-day level regardless of their gender,” she said.

After the bill is approved, the finer points such as the frequency and quantity of birth control that insurers must cover and whether patients must pay upfront before being reimbursed later, will be worked out. It would be better, according to Liz McCaman Taylor, if people could simply show their insurance card at the pharmacy counter and leave with the birth control they require.

"We kind of learned that reimbursement wasn't the best model," she said, referring to the nationwide trial of COVID over-the-counter tests. “If people can’t afford to pay out of pocket for it, they’re just not going to get it.” The California Health Benefits Review Program, which examines legislation, predicted that this year in California, 14,200 people with commercial insurance that is subject to state regulation would undergo vasectomies. According to the program, removing cost sharing would result in 252 more vasectomies being performed in the first year of the law.

Many people are aware that they do not want children, and living without children is perfectly acceptable. One of the many steps the state can take to ensure reproductive justice for everyone is to make vasectomies accessible and cost-free to those who are certain they do not want to reproduce.