As election results filed in late Tuesday night, Katie Kinkopf started worrying about her birth control.
She feared that free birth control, a controversial provision of the Affordable Care Act, would be revoked under President-elect Donald Trump. As a graduate student already paying for pricey medications, that could add significantly to her monthly financial burden.
Kinkopf, 25, made an appointment for an intrauterine device (IUD) — a form of birth control that’s inserted in the uterus and, for now, is free on nearly all health insurance plans — early the next day.
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President-elect Donald Trump, along with the Republican Congress, will likely repeal the Affordable Care Act, which worked to provide health coverage for the uninsured. What are their plans to replace it? Photo: Getty
Kinkopf is one of many U.S. women concerned about what will happen to them and their health care under the next presidential administration. With about 70 days remaining until inauguration, many have decided that getting an IUD, along with other measures such as purchasing Plan B, is the best way to hedge against potential change.
They’re not wrong to do so. Trump has repeatedly promised to repeal the Affordable Care Act, which requires nearly all health insurance plans to cover contraception. And the controversial birth control mandate, about which two Supreme Court cases have been argued, would be easier to get rid of than the ACA.
CUTE TIPS FOR LADIES PREPARING FOR A TRUMP/PENCE AMERICA:
– stock up on Plan B, it has a long shelf life
– get an IUD while they're covered
— Ella Rodham Dawson (@brosandprose) November 9, 2016
Revoking contraception coverage “will significantly increase women’s out-of-pocket costs,” said Dr. Eve Espey, a professor and chair of the Department of OB-GYN at the University of New Mexico. ”The methods that are most effective are most affected by that potential decision, or those with the highest costs, such as IUDs, implants and sterilization.”
The degree to which things could change would thus vary by plan and type of contraception.
Before the mandate, nearly all employer-based plans covered contraceptives to some degree, though there was variation in how much women had to pay out-of-pocket.
For birth control pills, for example, a typical copay was about $10 or $15, though coverage was less broad for contraceptives such as the patch or implant, said Sandra Hunt, a principal in PwC’s health industries advisory.
Of course, experiences in the pre-ACA era varied. Kinkopf remembers her birth control pills costing $50 out-of-pocket a month, before they were free.
Any woman insured through Medicaid has always had access to free contraception and “will for the foreseeable future,” adds Dr. Pooja Mehta, an assistant professor at Boston University School of Medicine, noting that family planning clinics also offer government-funded contraceptive care.
Changes in coverage would affect consumers in July 2017 at the earliest, Hunt said, depending on the employer’s particular open enrollment cycle. A change before that is possible but “would be highly unusual,” she said.
“For the vast majority of people, unless you work for a religious-based organization, I don’t think we’re going to see significant change,” Hunt said. “It’s a pretty narrow sliver of the market, but it’s real.”
The birth control mandate can be ended independent of the ACA because while the law calls for coverage of women’s health care, it’s up to a government agency — the Health Resources and Services Administration — to decide more specific guidelines.
Right now, that means health insurance must cover contraception along with a whole host of other services, including screening and counseling for domestic violence, HIV and HPV screenings and medical services for women such as Pap smears and OB-GYN visits.
Current guidelines were developed by the nonprofit National Academies of Sciences, Engineering, and Medicine and supported by the HRSA.
But changing them is as simple as administrative action, said Alina Salganicoff, vice president and director of women’s health policy at the nonprofit Kaiser Family Foundation. No ACA repeal is necessary. Congress doesn’t have to weigh in.
Men tweeting about buying stocks. Women tweeting about stocking up on Plan B and getting IUDs.
— Diana Vilibert (@dianavilibert) November 9, 2016
For women still considering getting an IUD before next year’s potential changes, Espey and others suggest using bedsider.org to survey their contraceptive options. Birth control manufacturers include Teva Pharmaceutical Industries Ltd. TEVA, +1.15% Johnson & Johnson JNJ, -0.51% Pfizer Inc. PFE, +4.23% Bayer AG BAYRY, +0.01% Merck & Co. Inc. MRK, +1.14% and Church & Dwight Co. CHD, -4.72%
Because each form of contraception “has side effects, and every person’s body is different,” Mehta said, it’s a decision that’s best discussed with a doctor and thought about.
IUDs are “the most cost-effective option for women” in the long-term, Mehta said. But in the case that removal is necessary, it can be an “expensive medical endeavor,” Espey said (and would possibly, if anything changes, similarly not be covered).
“I think women should always think carefully before trying a contraceptive method,” said Espey, who is chair of American College of Obstetricians and Gynecologists’ long-acting reversible contraceptive work group. “That said, there’s no best contraceptive method — it’s trial and error… it’s most important that women feel good about their particular option.”
Choice is key for women choosing between the multiple contraceptive options out there, Salganicoff and other women’s health experts said.
“What we’ve learned in the field is when women have choices to make the best contraceptive choice for them and their partner, we find that’s the most effective way to reduce unintended pregnancy,” Salganicoff said.