Attitudes About Mandated Coverage of Birth Control Medication and Other Health Benefits in a US National Sample

Abstract

Earlier this year, the US Supreme Court issued its decision on a challenge to the contraceptive coverage mandate of the Affordable Care Act (ACA). The Court ruled that the mandate did not apply to public corporations objecting on religious grounds. This research letter was written while the Court was reviewing the mandate and before its decision was issued. The aim of this cross-sectional survey administered in November 2013 was to assess attitudes of the public regarding mandated coverage of birth control medications. The survey participants were a representative sample of the civilian, noninstitutionalized US population (aged ≥18 years). Respondents were asked whether all health plans in the United States should be required to include coverage for multiple health services, including birth control medications, mammograms, colonoscopies, mental health services, screening tests for diabetes and high cholesterol, vaccines, and dental care. Support for the mandate was defined by a “yes” answer, and a lack of support was defined as an answer of “no” or “uncertain.” The associations between support for birth control medication coverage and demographic factors were assessed using X2 analyses and logistic regression adjusted using sampling weights. Of the 3505 individuals asked to complete the survey, 2124 (61%) responded. Those who completed the survey were 54% female and 64% non-Hispanic white, 16% Hispanic, 12% non-Hispanic black, and 8% non-Hispanic other race. More than two thirds of the respondents (69%; 95% confidence interval, 67%–72%) supported a policy of mandated coverage of birth control medication in health plans. Support for the birth control mandate was significantly lower than that for other mandated services/benefits. Multivariable regression analysis showed significantly higher support for mandated coverage of birth control medication among women, Blacks, Hispanics, parents with children younger than 18 years living in the home, and adults with private or public insurance, compared with other adult comparison groups. Support for the mandate was not associated with education or income. A small group of adults (7.8%; 95% confidence interval, 6.6%–9.3%) supported requirements for all services except contraceptives. This group included a significantly higher proportion of men (56% vs 41%, P = 0.003), adults older than 60 years (27% vs 10%, P < 0.001), and individuals without children in the household younger than 18 years (39% vs 26%, P = 0.003) compared with those who supported all benefits. Participants were not asked about their religious or political affiliations. More than two thirds of respondents support universal coverage of birth control medications. Support for mandated coverage of several other services was higher. Women, blacks, and Hispanics were more likely to support universal coverage of birth control medication benefits than men, older respondents, and adults without children younger than 18 years.