By Melissa Flores
California Health Report
Recent federal and state laws strive to make it easier for women to access birth control in California, but clinics and insurers say that the changes have not increased demand for contraceptives.
A state law passed earlier this year allows registered nurses to dispense hormonal contraceptives to expand access to women in rural areas, where doctors and nurse practitioners are harder to come by than in urban areas. Federal Affordable Care Act provisions also went into effect in August 2012 requiring private insurers to cover all Federal Drug Administration approved methods of contraception.
Planned Parenthood and Kaiser Permanente representatives said they have not yet seen a change in the types of birth control methods requested by patients or in how many patients are using birth control, but that they are using the changes to put comprehensive policies in place and better inform patients of their options for contraception.
It has been hard to tell if provisions in the federal health reform have changed how many patients are seeking birth control from them, according to Lupe Rodriguez, the director of public affairs for Planned Parenthood’s Central Coast chapter.
“It’s hard to tell because we work with a lot of people who are uninsured or underinsured,” she said, noting that only 20 percent of patients they see pay out of pocket or use private insurance. The changes to the federal law only affected those with private insurance, not the 80 percent who were uninsured or underinsured.
Planned Parenthood’s Salinas-based health center saw 17,027 patients in 2012. The chapter is part of the Planned Parenthood Mar Monte affiliate, which serves 300,000 patients a year in Monterey, Santa Clara, San Mateo, Alameda and San Benito counties.
Anecdotally, Rodriguez said medical providers have seen an increase in patients who are seeking long-term contraceptive options such as Mirena and Paragard, two intrauterine devices that offer protection for 5 years with Mirena and 10 years with Paragard, but added that increase may be because of drug companies’ advertising campaigns.
The Central Coast Planned Parenthood chapter works with clients from Monterey and San Benito County by offering counseling on family planning as well as free or low-cost birth control, services paid for by funds from the state’s Office of Family Planning through the Family Planning, Access, Care and Treatment program. Known as Family PACT, the program serves 1.8 million low-income residents through 2,200 public and private providers.
Rodriguez said Planned Parenthood is able to provide long-term contraceptives and other alternatives because of the Family PACT program, which funds birth control for women who are under 200 percent of the poverty level in the state.
She said counselors or medical providers talk with patients about the pros and cons of each method, such as the use of condoms to prevent both pregnancy and STDs.
“It is important to give clients an opportunity to make choices,” she said. “If they aren’t prepared, they don’t use it correctly or use it at all.”
Patients meet with a doctor during their first appointment for an exam, but after that Rodriguez said most patients can see a nurse for their birth control needs.
Family PACT also helps providers who work with low-income residents to educate them on the types of methods available to them as well as myths or facts about them. One brochure at Planned Parenthood, for instance, dispels such myths as birth control pills causing weight gain, that intrauterine contraceptives make a woman unable to have a baby anytime in the future or that emergency contraceptives cause abortions.
Private insurers are working to inform patients of changes to their contraception coverage.
Christina Kerby said Kaiser Permanente, which offers coverage in parts of Northern and Southern California, as well as other states, implemented a nationally-consistent preventive care package to comply with provisions in the ACA. It covers barrier methods such as condoms or diaphragms; hormonal methods such as pills and implanted devices, including intra-uterine devices.
Rodriguez said one other upcoming change to services that is being prompted by health-care reform is that the Central Coast chapter of Planned Parenthood is looking to expand beyond reproductive care into primary care.
“We intend to become a patient-centered medical home,” she said. “We already do it at many locations. Salinas provides pediatric care. Hopefully with expansion of new patients and subsidies from the government we will be able to provide it throughout affiliates.”