The United States Supreme Court recently ruled against the Obama administration requirement that all employers must provide birth control insurance for women. Administration lawyers knew they were on shaky ground going in, because there were no provisions for male sex lives, such as Viagra, and that meant the policy was discriminatory, and the Supreme Court might rule that all corporations have the same rights, regardless of size, which further weakens the long-term viability of the ACA.

Most employers have health insurance that covers birth control anyway, and those that did not presumably had women paying $25 a month on their own, so it was simply politics, but now that the political infighting is over, there is a good reason employers should provide it whether they have to or not - it will save a lot of money and make America healthier.

The Affordable Care Act says companies should pay for access to all FDA-approved contraceptive methods without cost-sharing. That "first-dollar coverage" means that women will not pay anything out-of-pocket for their office visits or contraceptive methods - no copays and no deductibles - because the costs will be covered by the company. That sounds bad for businesses but it isn't.

It "has the potential to dramatically shift contraceptive use patterns, to reduce the U.S. unintended pregnancy rate ... and to improve the health of women and families," wrote Carol S. Weisman, Distinguished Professor of Public Health Sciences and Obstetrics and Gynecology, and Cynthia H. Chuang, associate professor of medicine and public health sciences.

In other words, contraception is a competitive advantage. Providing contraception is not a competitive advantage on the front end - it is $25 a month, no one is taking or quitting a job over $25 a month - but it could be on the back end. Women without kids work more hours and cost less in health insurance over the long term.

In the short term, it is instead more expensive. Long-acting reversible contraceptives (LARCs) and intrauterine devices (IUDs) are not used by people who don't want to pay for them, but if they are free, the authors believe more women will opt for those.

To increase contraception uptake, the researchers recommend training primary-care providers and creating seamless referral arrangements between these providers and those who can provide LARCs and call for the "design, assessment and dissemination of woman-centered information and decision tools to help women make optimal contraceptive choices in the context of their own life circumstances and preferences." 

"All of the publicity about the Supreme Court's Hobby Lobby decision may have confused women who have first-dollar coverage through their employer's health insurance or through the new exchanges," said Weisman. "Women need accurate information about their coverage and about their contraceptive options so that they can obtain whatever contraceptive method best meets their needs. Avoiding unintended pregnancy is a key component of women's health that we should not lose sight of."