“Our objection isn’t to including vasectomy, but mandating that it be free of charge,” said Leslie Moran, senior vice president of the New York Health Plan Association. “At a time when we are looking to ensure affordability, we shouldn’t be looking to add new requirements and new costs that would be borne by all premium payers.”
When you consider that a vasectomy is far less expensive and less invasive than tubal ligations, it's weird that they are not covered. The Guttmacher Institute argues leaving coverage out of the ACA was a mistake:
Vasectomy and condoms were left out of the Affordable Care Act’s guarantee of contraceptive coverage without out-of-pocket costs, despite their proven health benefits and long history of inclusion in other public and private programs.
The ACA requires coverage for tubal ligation, but not vasectomy? WTF? Asking for a friend.