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ACA Contraceptive Preventive Services Comment

April 3, 2023


The Honorable Danny Werfel                                      The Honorable Chiquita Brooks-LaSure
Commissioner                                                              Administrator
Internal Revenue Service                                             Centers for Medicaid & Medicare Services
U.S. Department of the Treasury                                 U.S. Department of Health & Human Services
P.O. Box 7604, Ben Franklin Station                           7500 Security Boulevard
Washington, D.C., 20044                                             Baltimore, Maryland, 21244 


The Honorable Lisa M. Gomez
Assistant Secretary
Employee Benefits Security Administration
U.S. Department of Labor
200 Constitution Ave NW, Suite S-2524
Washington, DC 20210

Re: Coverage of Certain Preventive Services Under the Affordable Care Act (REG-124930-21)

Dear Commissioner Werfel, Administrator Brooks-LaSure, and Assistant Secretary Gomez:   

Thank you for the opportunity to submit comments on the proposed rule, Coverage of Certain Preventive Services Under the Affordable Care Act, which would provide contraceptive access to people currently denied this right to health care due to the moral or religious objections of their employer or insurer. As an organization focused on the health of young adults ages 18-34, we write in strong support of this proposed rule and encourage its immediate application and enforcement. 

Young people of reproductive age throughout the nation are suffering the limitations imposed on their bodily autonomy due to the recent Dobbs v. Jackson Women’s Health Organization Supreme Court decision striking down an individual right to abortion access. Now more than ever, it is essential for young adults to access adequate reproductive care, including coverage for contraception at no cost-sharing as was the intention of the Patient Protection and Affordable Care Act (ACA). Therefore, we are pleased by the individual contraceptive arrangement this rule establishes; allowing individuals subject to plans issued by entities with religious exemptions to, through a third party, obtain contraceptive services at no cost directly from a provider or facility that furnishes contraceptive services. We believe this proposed solution honors the reality that contraception is vital to reproductive health. 

Nationwide, 99 percent of women, regardless of religious affiliation, have used at least one type of contraception at some point in their life. Additionally, contraceptive use among women who are sexually active and not seeking pregnancy is highest among 25–34-year-olds, at 91 percent. Despite the high utilization of birth control, out-of-pocket costs continue to be an impediment to adequate and timely use. According to a 2022 survey, 17 percent of low-income women said the cost of birth control was the leading reason they weren’t using their preferred method. Given the barrier that costs impose on access to birth control and contraceptives, we are especially concerned about contraception coverage for the 3 million students enrolled in health plans issued by institutes of higher education. These students tend to be the most vulnerable to exuberant health costs given that they’re not accessing traditional plans through their family, an employer, or the ACA marketplace. We hope that by establishing the individual contraceptive arrangement pathways, the federal government ensures mechanisms by which all university students will be informed of this option and understand that they are not bound to the religious objections of their schools in terms of contraception access. 

Young Invincibles has long advocated for a health care system that affords everyone the right to essential preventative services at no-cost sharing. Thirteen years after the implementation of the ACA, we are proud more people than ever are accessing contraceptive care. However, the current regulations allowing certain entities to receive religious and moral exemptions from providing contraception coverage means that several people of reproductive age are being left out of the ACA’s protected services. Again, we applaud this effort to create pathways for individuals to access contraceptive coverage free of cost-sharing regardless of the religious objections of their plan issuers. 

Thank you for the opportunity to share our support for this proposed rule. We ask that you give all due consideration to the health needs of people of reproductive age throughout the country. 


Kristin McGuire
Executive Director
Young Invincibles