Unlikely partners protect contraceptive coverage

Compromise key for health insurers, reproductive freedom advocates

A YEAR AGO IN MASSACHUSETTS, reproductive freedom advocates and health insurance plans sat down for an unlikely meeting: to find a way to protect access to birth control in the Commonwealth.

Our groups have historically been at odds about access to certain coverages and the insurance mandates to pay for therm. The health plans knew that contraceptive coverage wasn’t merely a piece of the benefit package; they understood that access to comprehensive contraceptive benefits is both essential and deeply personal to the women they cover.  Advocates understood that deciding when or whether to have children wasn’t just a choice every woman should have, but a necessary component for decisions about schooling, family, career, and health.

A desire to protect women’s health care and reproductive freedom brought us together to establish contraceptive coverage requirements in Massachusetts law that would stand the test of time regardless of politics in Washington. To us, this is a model the nation ought to stand up and follow.

Thanks to Massachusetts’ 2006 health care reform law expanding access and coverage for citizens of the Commonwealth, and the model for the Affordable Care Act (ACA), more than 97 percent of Massachusetts residents have health insurance. But on the night of his inauguration in 2017, President Trump issued an executive order stating his intent to pursue “prompt” repeal of the ACA. The possibility loomed large that contraceptive coverage, considered an essential benefit under the ACA, would be threatened. We all understood that preserving contraceptive coverage in Massachusetts required unlikely allies to come together to find a solution.

With both groups agreed on a single goal, the advocates and the health plans, including Blue Cross Blue Shield of Massachusetts and members of the Massachusetts Association of Health Plans, started talking.  If we are being honest, those early meetings were not very productive. Both sides shared a common desire to protect the coverage that the women and families of Massachusetts had come to rely on, but we had significant differences about how to get there.


The Coalition for Choice, a group of advocacy groups including NARAL MA, the ACLU of MA, and Planned Parenthood among others had filed the ACCESS Bill, a comprehensive piece of legislation designed to expand mandated coverage of contraceptives with no copay. The health plans in Massachusetts raised concerns about the impact on consumers’ premium costs if some of the provisions of the bill were enacted.

We worked from for more than eight months, over conference tables, on the phone – and we made progress. We knew the Trump administration was going to gut the contraceptive coverage mandate and we needed to be prepared. Perhaps more importantly, we realized that we agreed more often than we disagreed.

Eventually, a deal was struck, with both sides not getting everything they wanted, but finding solutions that would make a difference to women in Massachusetts—the very definition of compromise.

Last October, the Trump administration issued a draft of new regulations that would significantly broaden employers’ ability to opt-out the ACA’s contraceptive coverage requirement if they had a “moral” objection to providing contraceptive coverage. The addition of a moral objection to the existing religious exemption greatly expanded the possibility for many women that their employer would not offer contraceptive coverage under their health plan.

Earlier that week, we testified as a united front in favor of a redrafted ACCESS bill reflecting our compromise. Once news of the Trump administration’s regulations hit, the ACCESS bill gained steam and with the full support of the advocates and health plans and bipartisan political leaders, the bill sailed through the Legislature and became law.  It was a huge win for health care and a huge win for the women and families of Massachusetts.

Meet the Author
Meet the Author

Rebecca Hart Holder

Executive director, Reproductive Equity Now
The work was complicated and difficult. The lesson is simple: when unlikely stakeholders with historically divergent positions come together to find common ground, legislation can move swiftly, new laws can be created, and citizens can be protected.

So far, Massachusetts has chalked up an important and noteworthy win for Massachusetts women—it’s a recipe worth following.  This is not just limited to healthcare related issues.  Perhaps if more people sat around the table trying to find solutions to problems rather than shout each other down on social media or in the press, we would find a lot more areas of agreement and get things done, and blunt some of the negative actions and inactions coming out of Washington.

Lora Pellegrini is president and CEO of the Massachusetts Association of Health Plans and Rebecca Hart Holder is executive director of NARAL Pro-Choice Massachusetts.