“As long as it’s before the inauguration.”
“Anytime before the new Congress takes over.”
“Before Obama leaves office…”
Women are frantically calling our Philadelphia contraceptive clinic to get their IUDs, implants and sterilizations before Jan. 20. It used to be that women scheduled contraception around life events – weddings, desired number of children, education and career goals. Now they are scheduling appointments around the congressional calendar. They fear that a new administration will take away their contraceptive coverage. And for good reason.
Contraception is used by 99 percent of women in the U.S. at some point in their reproductive lives, regardless of race, religion or state of residence. Use of contraception allowed women to participate more fully in the workforce and to plan their families. Since the passage of the contraceptive mandate in 2011 as an essential health benefit in the Affordable Care Act (the ACA or “Obamacare”), women have had the opportunity to choose the type of birth control that was best for them without having to consider cost. However, the Republican-controlled Congress has made the repeal of the ACA a priority during the next few weeks. While that law may be phased out over a period of years, the contraceptive mandate risks being repealed much sooner – and that is bad for everyone.
The contraceptive mandate was issued in August 2011. Kathleen Sebelius, the Secretary of Health and Human Services (HHS) at that time, took the recommendation of the Institute of Medicine to include female contraception as essential preventive care. HHS then issued a rule that all women with insurance (public and private) would have access to all forms of birth control without cost sharing. This allowed patients, in consultation with their doctors, to choose the best method, without consideration of deductibles and co-pays.
According to a 2015 study, this reduced out-of-pocket costs for privately insured women by about $250 per year. President-elect Trump has named Rep. Tom Price as his pick to take over as Secretary of HHS. In previous plans that Price has put forth to overturn the ACA, he removes the provision requiring insurance companies to cover contraception and even maternity care. While complete repeal of the ACA and potential loss of prenatal care must go through Congress, the contraceptive mandate is a rule set through HHS that Secretary Price could revoke quickly.
This could have devastating consequences for patients. Earlier this year, I saw a patient with a “grandfathered plan,” meaning that it was exempt from the contraceptive mandate. She desperately wanted an IUD, as her birth control pills had failed her and she had ended up with an unintended pregnancy. However, she could not afford the upfront cost of an IUD insertion and went home with the same method that had failed her previously because it would cost her only $15 per month. By the end of five years, this less effective method will actually cost her more than the IUD she wanted all along. And if the pills fail again, the insurance company that wouldn’t pay for her IUD may end up paying for a pregnancy instead, which will costs many times more.
We know that by providing women access to affordable contraception, we give them the opportunity to decide when they are ready to have a family; but we also decrease unintended costs to our health system. In the U.S., about half of pregnancies are unplanned. Unplanned pregnancies are more likely to be high risk. High-risk pregnancies are more expensive. Yet, existing laws provide taxpayer money to pay for these high-risk pregnancies when the patients are uninsured.
Quite simply, access to appropriate birth control increases the likelihood of planned pregnancies, which leads to earlier, more regular prenatal care and healthier pregnancies and births. The government saved $13.6 billion dollars in 2010 by investing in family planning services, according to the Guttmacher Institute. That is a savings of more than $7 for every $1 invested in birth control. A Colorado program to provide Long Acting Reversible Contraception (LARC) to young women decreased the state's annual abortion rate by 10 percent and increased levels of educational attainment. In every way, providing contraceptive access to women just makes sense.
Yet, women are in danger of losing this key element of preventive health care on Jan. 20. And we are all going to pay the price.