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Literature Review 5 without insurance is around $750-$850 (Eisenberg, McNicholas, Peipert, 2013). Further, the cost of implants and IUDs do not include the cost of a doctor’s office visit or the insertion procedure. Women with private insurance are typically in a much better position, because under the Affordable Care Act most private insurance plans must cover at least one form of each of eighteen contraceptive methods without copays. However, some women with private insurance still face difficulties. First, while the insurance plan must cover at least one form of several types of oral contraceptive pills without copays, they can use “reasonable medical management techniques” to steer women towards cheaper pills. Therefore, a woman who is prescribed an expensive brand-name oral contraceptive may still face out-of-pocket costs. Second, some insurance plans are impermissibly charging women for family planning counseling, for costs associated with the insertion or removal of long-acting reversible contraceptives, or for certain contraceptive methods (National Women’s Law Center). Finally, some women are covered by grandfathered plans or plans offered by religious employers, which are exempt from this policy. Therefore, “high out-of-pocket costs, deductibles, and copayments for contraception limit contraceptive access even for those with private health insurance” (Access to Contraceptives, 2015). Additionally, insurance companies can limit the number of contraceptive products dispensed; 73% of women are unable to obtain more than a month’s supply of birth control pills at a time, despite the fact that many women do not refill their prescriptions on time each month (Access to Contraceptives, 2015). Another barrier to oral contraceptive access is the Medicaid gap. In 2012, the Supreme Court ruled states could decide whether to expand their Medicaid programs under the Affordable Care Act to individuals with incomes of up to 138 percent of the federal poverty level (Kelberg, 2015). Thirty-one states have expanded their Medicaid programs, but North Carolina and many other states have not (Where the states stand on Medicaid expansion, 2016). More than 4 million Americans are therefore in the “Medicaid gap”, in which they do not not qualify for Medicaid because of their state’s decision, but do not earn enough income to be eligible for subsidies on the Affordable Care Act’s private insurance marketplace. Since the beginning of 2016, 129,320 women in North Carolina are in the coverage gap and are left without insurance, which poses a significant barrier to accessing oral contraceptives (Garfield and Damico, 2016). Even if contraceptive costs are affordable, many women, particularly low-income women, cannot take time off work to visit a clinician to obtain birth control because they are not afforded paid sick leave. The United States is the only one of 22 rich countries that fails to guarantee workers a form of paid sick leave (United States Lags World in Paid Sick Days for Workers and Families, 2016). In North Carolina, an estimated 1,462, 772 private sector workers do not receive a single paid sick day (Institute for Women’s Policy Research & National Partnership for Women & Families, 2015). On a collective scale, 65% of 2008 births from unintended pregnancies in the U.S. are funded by public insurance programs like Medicaid, compared to 36% of intended pregnancies, totaling $12.5 billion. However, without publicly funded family planning efforts, it is estimated that the annual public cost of would be $25 billion (Sonfield & Kost, 2013). These figures only include costs of delivery and essential care for women and newborns, not any future costs associated with an unintended addition to a family.