Birth control doesn't only prevent pregnancy.
On Friday, the Trump administration rolled back an essential Affordable Care Act regulation that required employer-provided health insurance to cover a baseline of birth control methods without a co-pay. Under the Obama-era mandate, closely held private companies (ones with a limited number of shareholders) could opt out of covering birth control if they objected for religious or moral reasons. In those cases, the Obama administration would work with the employers' insurers to still provide birth control coverage to female employees. Now any employer, closely held or not, that has a “moral objection” to the regulation will not be required to cover any contraceptives for women who work there. It will also allow health insurers to refuse to step in and cover birth control, taking that extra coverage away from female beneficiaries. This new rule is effective immediately.
The Obama-era mandate ruled that out of the 18 FDA-approved methods of birth control, at least one form of each had to be fully covered, as in no cost-sharing or out-of-pocket expenses. After the mandate went into effect, it made birth control coverage without a co-pay available to over 55 million women.
The Trump administration ruling says it won’t impact women who rely on other federally funded programs that subsidize birth control for those trying to avoid unintended pregnancy. While birth control should be accessible to anyone trying to avoid pregnancy, many women who use birth control primarily do so for other reasons. In fact, experts previously told SELF that hormonal birth control like the Pill provides ample benefits beyond pregnancy prevention. Hormonal birth control can:
- Control heavy or irregular menstrual bleeding
- Ease severe menstrual cramps
- Lower the risk of endometrial cancer
- Lower the risk of colon and ovarian cancer
- Suppress ovulation that can cause ovarian cysts
- Help lessen endometriosis-induced pain
- Reduce acne
- Help with menopause-related symptoms like hot flashes and night sweats
- Eliminate menstrual migraines
I know firsthand that birth control isn't always used to avoid pregnancy, since I stayed on the Pill for years to regulate a frustratingly irregular menstrual cycle. The Trump administration's ruling acknowledges that birth control can be used to treat various health conditions, but it doesn't see that as reason enough to keep the Obama-era mandate in effect. They also suggest a disturbing workaround for this dilemma.
"In several of the lawsuits challenging the mandate, some religious plaintiffs stated that they do not object and are willing to cover drugs prescribed for the treatment of an existing condition and not for contraceptive purposes—even if those drugs are also approved by the FDA for contraceptive uses," the brief says. "Therefore, the departments conclude that the fact that some drugs that are approved for preventive contraceptive purposes can also be used for exclusively non-preventive purposes to treat existing conditions is not a sufficient reason to refrain from expanding the exemption to the mandate." Never mind that it's a complete invasion of privacy to have to prove to an employer that you're using birth control to treat a health condition, not avoid pregnancy, before they decide to cover it.
Thanks to this new ruling, the health care minefield is likely only going to get more stressful, complicated, and expensive for many women.
I once broke down in tears at a Target pharmacy when my generic pill was discontinued at that location—I was switched over to a name-brand pill without my consent and was suddenly responsible for a three-month pack upwards of $200. I think the pain was all too real for the female pharmacist assisting me, who worked some magic to bring that number down to $9.
Even when I decided to get an IUD, it was a nightmare of phone calls back and forth to my health insurance company and the nurse at Planned Parenthood, amounting to hours of wasted productivity—when I could have, you know, been doing my job. I was so exasperated when I found out my insurance didn't cover my first choice, and I'm certainly not alone. A study released this year from the Journal of Sex Research found that the responsibility surrounding birth control takes an emotional and mental toll on women and contributes to gender inequality. The Trump administration's brief notes that "contraception access can be provided through means other than coverage offered by religious objectors, for example, through "a family member’s employer," "an exchange," or "another government program," completely glossing over the immense time, effort, and stress that can go into finding alternate ways to access birth control.
The new ruling comes at these high costs to appease organizations that morally or religiously oppose birth control (which were already exempt from the mandate after a 2014 Supreme Court case ruled that objection based on religious ground was legal). And even though there is no research to suggest that contraceptives will end an existing pregnancy, some anti-contraception groups are saying otherwise. “No longer will Catholic nuns who care for the elderly poor be forced by the government to provide abortion-inducing drugs in their health care plans,” said Susan B. Anthony List president Marjorie Dannenfelser in a statement Friday.
While the ruling took effect immediately, many women's organizations are already voicing their opposition and working toward a solution. The American Civil Liberties Union announced it will be suing the Trump administration to unblock these new rules. In addition, Planned Parenthood came out strongly against the ruling, as did the National Family Planning & Reproductive Health Association (NFPRHA), explaining that the Trump Administration's move will “reverse some of the important progress made under the health law on achieving health equity for women in this country,” said Clare Coleman, president and CEO of the organization in a statement.
Setting aside the fact that birth control is basic medicine, the ACA mandate also allowed many women access to extremely effective birth control options.
After years on the Pill, I decided to switch to an IUD. Many of my friends were talking about them, and since I'm in a long-term relationship, have a full-time job, and don't want children, an IUD seemed like the best choice for me. My insurance didn't cover my first choice, but the ACA's mandate still allowed me to get my second choice for free.
Having access to long-acting reversible contraception (LARC) options like IUDs and arm implants is incredibly important. LARCs offer more protection than the Pill and are actually the most effective forms of reversible contraception, but they can be prohibitively expensive without coverage. Reversing the Affordable Care Act's birth control mandate may put LARCs like IUDs out of reach for many women again.
In fact, a recent report from Amino, a health care research company, found that without coverage, the cost of IUDs could skyrocket. The report looked at how expensive an IUD would be in each state without insurance coverage. Alaska came in the worst; if an insurer stops covering contraceptives, an IUD will be $1,586, according to Amino's estimates. IUDs will be cheapest for women in D.C. without contraceptive coverage, topping out at $937, which is still an exorbitant amount to pay for something that once may have been covered (and really should be free).
There's also the fact that providing easy-to-access birth control reduces the rate of abortion. An experimental program in Colorado demonstrated just how linear the connection is. In 2009, Colorado began offering free IUDs and implants to teenagers and disadvantaged women. From the start of the program in 2009 through 2013, the state's teenage birthrate fell 40 percent, and the rate of teens trying to access abortions dropped by 42 percent, according to the New York Times. Unintended pregnancy rates also dropped for women who were under 25, unmarried, and hadn't finished high school. If Republicans care about reducing abortions as much as their policies would have you think, decreasing access to birth control isn't going to help.