General Articles

ACA Instates Co-Pay-Free Health Care Services for Women

Beginning August 1, 2012, women have access to a range of essential “no-cost” preventative health care services through their private insurance as mandated by the Affordable Care Act (ACA), which was signed into law in 2010 by President Barack Obama.[1] While most of the new services were uncontroversial, the provision for “no-cost” contraception sparked severe backlash. Religiously-affiliated employers and conservative Republicans were enraged by the measure, claiming the reform impinges on their religious freedom in a wholly unprecedented manner.

A total of eight new services will be offered to the roughly 47 million insured women who are eligible to receive the co-pay-free services, which include:

  • annual well-woman visits
  •  screening for gestational diabetes
  • testing for the high-risk strains of the human papilloma virus (HPV)
  • counseling for sexually transmitted infections
  • counseling and screening for HIV
  •  methods of contraception and counseling
  •  breastfeeding supplies, support and counseling
  • screening and counseling for domestic and interpersonal violence[2]

These services are in addition to the already expanded health care coverage under the ACA which provided no-cost mammograms and Pap smears. According to a report released in February 2012, 20.4 million women benefited from these services.[3]

The new coverage is not without limitations, however, and many women will be unable to access co-pay-free health care. First, the 19 million American women who are uninsured will still be paying for these services out of pocket. Second, nearly half of all large employer insurance plans and one third of small plans have not changed since March 2010 when the ACA was enacted, and can therefore be grandfathered in and bypass the new rules. For those women whose plans have changed, it may still be another year before they receive benefits. Insurance plans that started before August 1 do not necessarily have to comply with the law immediately, although some insurance companies are opting to implement the changes early.[4]

Pressure from religious groups and attacks from conservative Republicans pushed the Obama administration to exempt religiously-affiliated universities, hospitals, and social-service agencies from providing the new coverage for one year as they seek a compromise. The original rules had already exempted churches and other religious organizations. Private business owners who argue the mandate conflicts with their religious beliefs are also fighting the law, declaring the measure a violation of the Religious Freedom Restoration Actof 1993 and their First Amendment right of freedom of religion.[5]

Vocally outraged, several Republican members of the House of Representatives  held press conferences, calling the new law the “largest assault we've seen on first amendment rights in the history of our country” and “thinly veiled religious bigotry.”[6] Representative Billy Long (R-MO.) emphatically stated, “We're not the land of the free anymore, and we need to get that straight.”[7] Representative Mike Kelly (R-PA) went so far as to compare the new healthcare coverage to the attacks on 9/11 and Pearl Harbor. At a press conference on Capitol Hill he announced;

“I know in your mind, you can think of the times America was attacked, one is Dec. 7, that's Pearl Harbor Day. The other is Sept. 11, and that's the day the terrorists attacked. I want you to remember Aug. 1, 2012, the attack on our religious freedom. That is a day that will live in infamy, along with those other dates.”[8]

In contrast, Secretary of Health and Human Services Kathleen Sebelius celebrated the new measure with over a half-dozen Democratic Senators at a news conference the day before the coverage was set to begin. From behind a podium with a sign that read “Simply Being A Woman is No Longer a Preexisting Condition,” Secretary Sebelius explained that because co-payments were so high, a number of women were discouraged from getting basic preventative treatment. As a result, “surveys show that more than half of the women in this country delayed or avoided preventive care because of its cost,” she stated. “That's simply not right.”[9]

[1]Jodi Jacobson, “Why ‘Free Birth Control’ Is Not Free,” The Huffington Post, 6 August 2012, accessed 8 August 2012, <>.

[2]Amanda Peterson Beadle, “Eight More Ways Women Will Benefit Under Obamacare Starting Tomorrow,” ThinkProgress, 31 July 2012, accessed 7 August 2012, <>.


[4] Julie Rovner, “Under Health Law, ‘No-Cost’ Birth Control Starts Today,” National Public Radio, 1 August 2012, accessed 7 August 2012, <>.


[6]Erin Mershon, “Mike Kelly Compares Birth Control Mandate To Pearl Harbor, 9/11,” The Huffington Post, 1 August 2012, accessed 7 August 2012, <>.



[9]“Under Health Law, ‘No-Cost’ Birth Control Starts Today,” ibid.