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Research Letter |

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

Michelle H. Moniz, MD1; Matthew M. Davis, MD, MAPP2; Tammy Chang, MD, MPH, MS3
[+] Author Affiliations
1Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor
2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
3Department of Family Medicine, University of Michigan, Ann Arbor
JAMA. 2014;311(24):2539-2541. doi:10.1001/jama.2014.4766.
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Published online

Access to contraception improves maternal and child health.1 The Patient Protection and Affordable Care Act (ACA) requires most private health insurance plans to cover contraception without a shared patient cost to improve access. However, debate continues about applying the contraception coverage mandate to public corporations that object on religious grounds2,3; the US Supreme Court is reviewing the ACA’s contraceptive coverage requirement. We assessed attitudes about mandated coverage of birth control medications.

A cross-sectional survey was administered in November 2013. The survey used the online KnowledgePanel (GfK Custom Research North America), a national panel established through probability sampling of the civilian, noninstitutionalized US population (aged ≥18 years). Respondents were asked, “Do you think that all health plans in the United States should be required to include coverage for the following services: birth control medications, preventive services like mammograms and colonoscopies, recommended vaccinations, preventive screening tests for diabetes and high cholesterol, mental health care, and dental/tooth care including dental screenings and tooth problems?” Possible responses included yes, no, uncertain, and refused to answer. The response rate was determined using RR1 of the American Association for Public Opinion Research.

Descriptive statistics were calculated for all items. χ2 Analyses and logistic regression were performed to assess associations between support for birth control medication coverage and demographic factors, applying poststratification sampling weights to draw national inferences (2-sided P < .05 or 95% CI not including the null was significant). Support was defined as answering “yes” and do not support as answering “no” or “uncertain.” Statistical analyses were performed with Stata version 13 (StataCorp). The University of Michigan medical institutional review board declared this study exempt.

The response rate was 61% (2124/3504). Respondents were more likely to be white, older, and have higher levels of education and income than nonrespondents. After applying sampling weights, respondents were 54% female; 64% non-Hispanic white, 16% Hispanic, 12% non-Hispanic black, and 8% non-Hispanic other race. Most respondents (69%; 95% CI, 67%-72%) supported a policy of mandated coverage of birth control medication in health plans. This proportion was significantly lower than the proportion that supported other benefits (Table 1). In multivariable regression analysis, support for mandated coverage of birth control medication was significantly higher among women, non-Hispanic blacks, Hispanics, parents with children younger than 18 years living in the home, and adults with private or public insurance vs comparison groups (Table 2), but was not associated with education or income.

Table Graphic Jump LocationTable 1.  Attitudes About Mandated Coverage of Specific Benefits in Health Plans
Table Graphic Jump LocationTable 2.  Respondent Characteristics Associated With Support of Mandated Coverage of Birth Control Medication in Health Plans

Among a small group (7.8%; 95% CI, 6.6%-9.3%) who supported all benefits except birth control medications, there were significantly higher proportions of men (56% vs 41%, P = .003), individuals older than 60 years (27% vs 10%, P < .001), and individuals without children younger than 18 years living in the home (39% vs 26%, P = .003) compared with those who supported all benefits.

Overall, 69% of respondents supported mandated coverage of birth control medications in health plans, with significantly higher odds of support among women, black, and Hispanic respondents. Support for mandated coverage of birth control medication was lower than for other benefits, including services that have prompted public debate (eg, vaccination and mental health services). The small group who supported coverage for services except birth control medication included a higher proportion of persons unlikely to use such coverage.

Findings are potentially limited by lack of information about respondents’ political views, voter record, and religiosity; social desirability bias (minimized by an anonymous, online survey); and cross-sectional design that may not capture rapidly evolving opinions. Potential response bias due to differences between respondents and nonrespondents was addressed by poststratification weighting and minimized by lack of disclosure of survey content at time of invitation to participate.

In this study, the majority of participants supported universal coverage of birth control medications, as well as mandated coverage of several other services. These results are similar to prior polls describing support for the contraceptive coverage mandate among 61% to 66% of US adults.46 In this study, women, black, and Hispanic respondents were more likely to support coverage of birth control medication benefits than men, older respondents, and adults without children younger than 18 years. These findings may inform the ongoing national debate around the contraceptive coverage mandate.

Section Editor: Jody W. Zylke, MD, Senior Editor.

Corresponding Author: Michelle H. Moniz, MD, Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, 2800 Plymouth Rd, Bldg 10 G016, Ann Arbor, MI 48109 (mmoniz@med.umich.edu).

Published Online: April 22, 2014. doi:10.1001/jama.2014.4766.

Author Contributions: Drs Moniz and Davis had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Moniz, Chang.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Moniz, Davis.

Administrative, technical, or material support: Moniz, Davis.

Study supervision: Davis, Chang.

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Davis reported that he serves as chief medical executive for the Michigan Department of Community Health. No other disclosures were reported.

Funding/Support: This study was funded by the Robert Wood Johnson Foundation Clinical Scholars program and the University of Michigan Health System.

Role of the Sponsor: The Robert Wood Johnson Foundation Clinical Scholars program and the University of Michigan Health System had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The findings and statements included herein are those of the authors and do not necessarily represent the opinions of the Michigan Department of Community Health.

Butler  AS, Clayton  EW, eds. A Review of the HHS Family Planning Program: Mission, Management and Measurement of Results. Washington, DC: National Academies Press; 2009.
Gossett  DR, Kiley  JW, Hammond  C.  Contraception is a fundamental primary care service. JAMA. 2013;309(19):1997-1998.
PubMed   |  Link to Article
Zimmer  EA, Welie  JV, Rendell  MS.  Contraceptives and the law: a view from a Catholic medical institution. JAMA. 2013;309(19):1999-2000.
PubMed   |  Link to Article
Eckholm  E. Poll finds wide support for birth control coverage [published online March 1, 2012].New York Times. http://www.nytimes.com. Accessed March 18, 2014.
Eilperin  J, Clement  S. It's not the pill, it's the payment: what polling says about the contraception mandate [published online January 3, 2014].Washington Post. http://www.washingtonpost.com. Accessed March 18, 2014.
Public Religion Research Institute. Survey: majority of Catholics think employers should be required to provide health care plans that cover birth control at no cost [published online February 7, 2012].http://publicreligion.org. Accessed March 18, 2014.

Figures

Tables

Table Graphic Jump LocationTable 1.  Attitudes About Mandated Coverage of Specific Benefits in Health Plans
Table Graphic Jump LocationTable 2.  Respondent Characteristics Associated With Support of Mandated Coverage of Birth Control Medication in Health Plans

References

Butler  AS, Clayton  EW, eds. A Review of the HHS Family Planning Program: Mission, Management and Measurement of Results. Washington, DC: National Academies Press; 2009.
Gossett  DR, Kiley  JW, Hammond  C.  Contraception is a fundamental primary care service. JAMA. 2013;309(19):1997-1998.
PubMed   |  Link to Article
Zimmer  EA, Welie  JV, Rendell  MS.  Contraceptives and the law: a view from a Catholic medical institution. JAMA. 2013;309(19):1999-2000.
PubMed   |  Link to Article
Eckholm  E. Poll finds wide support for birth control coverage [published online March 1, 2012].New York Times. http://www.nytimes.com. Accessed March 18, 2014.
Eilperin  J, Clement  S. It's not the pill, it's the payment: what polling says about the contraception mandate [published online January 3, 2014].Washington Post. http://www.washingtonpost.com. Accessed March 18, 2014.
Public Religion Research Institute. Survey: majority of Catholics think employers should be required to provide health care plans that cover birth control at no cost [published online February 7, 2012].http://publicreligion.org. Accessed March 18, 2014.
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