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Table 2 Policy Timeline: Changes in Federal US Policy (2009–2019) Impacting Contraceptive Access

From: The impact of US policy on contraceptive access: a policy analysis

Date

Policy Change

Theoretical Impact ‡

Jan 2009

Barack Obama inaugurated as US president

-

Feb 2009

Health Information Technology for Economic and Clinical Health (HITECH) enacted as part of the American Recovery and Reinvestment Act of 2009, increasing Health Insurance Portability and Accountability Act (HIPAA) privacy/security

↑ Approachability

Apr 2009

The Food and Drug Administration (FDA) lowers over-the-counter emergency contraceptive age to 17 years old

↑ Availability/ Accommodation

Jun 2009

Title V abstinence-only-until-marriage program expires

↑ Approachability

Dec 2009

Mikulski’s Women’s Health Amendment to the Patient Protection and Affordable Care Act (ACA) passes, adding women’s preventive care as mandated services

↑ Affordability

Dec 2009

Consolidated Appropriations Act of 2010 creates Teen Pregnancy Prevention Program

↑ Appropriateness

Mar 2010

ACA signed into law

↑ Affordability

Mar 2010

ACA amended through the Health Care and Education Reconciliation Act (HCERA) to include student loan reform, close the Medicare Part D donut hole, increase Medicaid payment rates, and expand Medicaid

↑ Affordability

Jun 2010

US Medical Eligibility Criteria for Contraceptive Use published to provide recommendations on safe use of contraceptive methods

↑ Appropriateness

Dec 2010

Healthy People 2020 establishes federal prevention agenda

↑ Appropriateness

Dec 2010

Consolidated Appropriations Act of 2011 ends Community-Based Abstinence Education grant program and eliminates abstinence-only portion of the Adolescent Family Life Act

↑ Approachability

Jan 2011

National Defense Authorization Act of 2011 creates TRICARE Young Adult, extending military member dependent coverage

↑ Affordability

Apr 2011

“Dear Colleague letter” sent to colleges and universities regarding new Title IX guidance on student harassment

↑ Acceptability

Aug 2011

ACA interim final rules announced in which the US Department of Health and Human Services (HHS) adopts IOM women’s preventive care guidelines, adding contraceptive coverage and preventive services to those covered by the ACA

↑ Affordability

Dec 2011

HHS overrules FDA decision to make emergency contraception available over the counter regardless of age

↓ Availability/ Accommodation

Dec 2011

Consolidated Appropriations Act of FY 2012 revives federal funding for abstinence-only programs by establishing the Competitive Abstinence Education (CAE) grant program

↓ Approachability

Jan 2012

Final rule church exemption from ACA contraceptive requirement announced

↓ Affordability

Feb 2012

Final rule ACA church exemption revised, extending it to other religious employers

↓ Affordability

Jun 2012

National Federation of Independent Business v. Sebelius Supreme Court of the United States (SCOTUS) ruling upholding most ACA provisions but making Medicaid expansion optional for states

↓ Affordability

Aug 2012

ACA contraceptive mandate implementation begins

↑ Affordability

Jan 2013

Final Omnibus Rule fills gaps in existing HIPAA and HITECH regulations, increasing privacy/security

↑ Approachability

Jun 2013

US Selected Practice Recommendations published to provide recommendations on how to use contraceptive methods safely and effectively

↑ Appropriateness

Jun 2013

Safe Harbor rule announced, updating religious exemption to ACA contraceptive mandate

↓ Affordability

Mar 2013

Campus Sexual Violence Elimination (Campus SaVE) Act integrated into the Violence Against Women Reauthorization Act of 2013, increasing requirements for colleges for sexual assault response and increasing survivors’ rights

↑ Acceptability

Apr 2013

Federal judge rules in Tummino v. Hamburg, removing age and point-of-sale restrictions on levonorgestrel-based emergency contraception, though 3-year market exclusivity was granted for Plan B®

↑ Availability/ Accommodation

Jan 2014

Medicaid expansion goes into effect

↑ Affordability

Apr 2014

Providing Quality Family Planning Services recommendations published, defining core services offered by family planning clinics

↑ Appropriateness

Jun 2014

Burwell v. Hobby Lobby Stores, Inc. SCOTUS ruling that for-profit companies with a religious objection to birth control are exempt from ACA contraceptive mandate

↓ Affordability

Aug 2014

Veterans Access, Choice, and Accountability Act of 2014 allows Veterans with specific burdens to receive healthcare with Choice contracted non-VA providers

↑ Availability/ Accommodation

Jan 2015

Navy increases availability of long-acting reversible contraception (LARC) during basic training and added walk-in contraceptive clinics

↑ Availability/ Accommodation

Apr 2015

Medicare and Children's Health Insurance Program Reauthorization Act (MACRA) of 2015 passes, extending Community Health Center Fund for two years

↑ Availability/ Accommodation

May 2015

HHS clarifies contraceptive methods covered under the ACA as preventive services

↑ Affordability

Oct 2015

Indian Health Service increases over the counter emergency contraception accessibility to Indigenous people

↑ Appropriateness

Dec 2015

Consolidated Appropriations Act of 2016 renames “Competitive Abstinence Education” program “Sexual Risk Avoidance Education” program

↓ Approachability

Jan 2016

Marines restrict availability of LARCs at basic training and begin promoting injectable contraceptives over other methods

↓ Availability/ Accommodation

Mar 2016

Providing Quality Family Planning Services recommendations revised

↑ Appropriateness

Apr 2016

Plan B® market exclusivity expires, allowing all generic emergency contraceptives to be available over the counter without age or point-of-sale restrictions

↑ Availability/ Accommodation

May 2016

Zubik v Burwell SCOTUS ruling sends 7 cases brought by religious nonprofits back to Courts of Appeal

↑ Affordability

Jul 2016

US Medical Eligibility Criteria for Contraceptive Use updated

↑ Appropriateness

Jul 2016

US Selected Practice Recommendations updated

↑ Appropriateness

Dec 2016

Title X eligibility requirements amended, prohibiting exclusion from subawards for reasons other than ability to provide services

↑ Availability/ Accommodation

Jan 2017

Donald Trump inaugurated as US president

-

Jan 2017

Anti-birth-control Katy Talento appointed to the White House Domestic Policy Council

-

Apr 2017

Neil Gorsuch confirmed as SCOTUS justice

-

Apr 2017

Joint Resolution of Disapproval nullifies Dec 2016 Title X eligibility amendment

↓ Availability/ Accommodation

May 2017

Antiabortion activist Teresa Manning appointed to lead Title X programs

-

Jun 2017

Abstinence-only advocate Valerie Huber appointed HHS chief of staff to the assistant secretary for health

-

Jul 2017

Funding for Teen Pregnancy Prevention Program cut two years before grants were scheduled to end

↓ Appropriateness

Sept 2017

Title IX guidance on student harassment (established in 2011 “Dear Colleague letter”) eliminated

↓ Acceptability

Sept 2017

Title V abstinence-only program expired briefly

↑ Approachability

Oct 2017

Interim rules released, extending religious exemption from ACA contraceptive mandate

↓ Affordability

Dec 2017

Interim rules (extending religious exemption from ACA contraceptive mandate) challenged and blocked from implementation pending litigation

↑ Affordability

Feb 2018

Bipartisan Budget Act of 2018 extends Community Health Center Fund for two more years

↑ Availability/ Accommodation

Feb 2018

Bipartisan Budget Act of 2018 rebrands and renews Title V abstinence-only program under new name “sexual risk avoidance education" program

↓ Approachability

Feb 2018

Call for Title X funding applications radically shifts Title X program, emphasizing natural family planning over comprehensive and evidence-based care

↓ Appropriateness

Feb 2018

Strategic Plan for 2018–2022, which states that life begins at conception, finalized as a guide for federal policy

↓ Acceptability

Apr 2018

Funding Opportunity Announcements shift Teenage Pregnancy Prevention Program to promote abstinence-only sex education

↓ Appropriateness

Apr 2018

District Court rules in Planned Parenthood of Greater Washington and North Idaho et al. v. HHS in favor of Planned Parenthood regarding Teenage Pregnancy Prevention grant termination

↑ Appropriateness

May 2018

Domestic gag rule (AKA “Protect Life Rule”) announced, proposing ban on abortion referrals and abortion counseling for Title X recipients

↓ Availability/ Accommodation

May 2018

Domestic gag rule challenged and blocked from implementation pending litigation

↑ Availability/ Accommodation

Jun 2018

VA Mission Act of 2018 provides continuing education for community providers who serve veterans

↑ Appropriateness

Jun 2018

Department of Labor expands reach of Association Health Plans

↓ Affordability

Jul 2018

Circuit court blocks Interim Rules extending religious exemption from ACA contraceptive mandate

↑ Affordability

Aug 2018

HHS shortens Title X funding period from 3 years to 7 months

↓ Availability/ Accommodation

Aug 2018

Centers for Medicare and Medicaid Services extends short-term health plan duration

↓ Affordability

Aug 2018

District Court dismisses Planned Parenthood case against HHS regarding Teenage Pregnancy Prevention Program shift

↓ Appropriateness

Oct 2018

Brett Kavanaugh confirmed as SCOTUS justice

Oct/Nov 2018

Final Rules extending religious exemption from ACA contraceptive mandate released

↓ Affordability

Mar 2019

Domestic gag rule finalized and immediately challenged

↓ Availability/ Accommodation

Mar 2019

Federal judge invalidates Association Health Plans expansion on the grounds that it violates federal tax law

↑ Affordability

May 2019

Comprehensive Contraceptive Counseling and Access to the Full Range of Methods of Contraception establishes procedures for comprehensive contraceptive counseling for Military Health System beneficiaries

↑ Appropriateness

Jun 2019

Nationwide injunction issued preventing ACA contraceptive mandate enforcement against those with religious objection

↓ Affordability

Jun/Jul 2019

Ninth Circuit Court of Appeals denies stay that would block domestic gag rule, allowing it to begin going into effect

↓ Availability/ Accommodation

Jul 2019

Nationwide injunction issued against ACA contraceptive mandate final rule exemptions

↑ Affordability

Jul 2019

District Court rules to allow extension of short-term limited duration insurance

↓ Affordability

Aug 2019

Over 1,000 clinics, including Planned Parenthood, withdraw from Title X

↑ Availability/ Accommodation

Oct 2019

Petitions filed for Little Sisters of the Poor v. Pennsylvania and Donald J. Trump v. Pennsylvania (both are challenging rulings that block Trump’s religious exemption rules for the ACA contraceptive mandate)

↓ Affordability

  1. Policy change is ongoing or has been updated after 2019 (see text for more information)
  2. Impact of policy change according to Levesque et al.'s [33] dimensions of healthcare access, where ↑ indicates a theoretical increase and ↓ indicates a theoretical decrease in contraceptive access