It’s been a full year since the 2016 United States presidential election. With months of obscure and confusing health care repeal attempts still hanging overhead, I wanted to better understand how essential health rights for women could change if one of the repeals passes; I wanted to learn more about what’s in the works. The 2010 Affordable Care Act, which still governs our health care system today, requires insurance companies to grant women access to essential health benefits, a.k.a. “Preventative Care for Women,” at no cost. But the Trump administration’s recent mandate, which allows employers to opt out of providing contraceptive coverage, threatens the very rights afforded by the Act, and in particular, access to birth control.
We’re at historic lows in unplanned pregnancy, teen pregnancy and abortion rates in America, and that is in large part due to expanded access to birth control and expanded access to information about sexual and reproductive health. According to analysis by Vox, “These results surprised even researchers who have watched teen birth rates drop for years,” and are attributable to easier access to birth control.
But those rights — and American women’s ability to control their health — aren’t set in stone. I spoke with Erica Sackin, director of political communications for the Planned Parenthood Action Fund, to learn more about the things women should know about birth control coverage, and what we can do to protect women’s health services.
Refresh my memory: How has access to women’s health care changed since the beginning of the Trump administration?
The biggest thing we’ve seen is the rollback of birth control coverage. Before ACA passed, one in three women voters struggled to afford birth control, including 57% of young women age 18 to 34. The ACA mandated your health insurance had to cover birth control, which is important because 99% of women [aged 15–44 who have ever had sexual intercourse] use birth control in their lifetimes. Now, 62 million women have access to birth control, and the rule has collectively saved women $1.4 billion on birth control pills in the first year alone.
What the Trump rule did was two key things: The first is that it expanded which employers could exempt themselves from having to provide coverage of birth control. Up until Trump’s rule passed, the employer exemption was only narrowly available for religious organizations. But even if that employer didn’t want to cover birth control in its health insurance plan, ACA would make sure women would have access and coverage anyway through their insurer.
So if you’re a religious organization, for example, you could refuse to pay for your employee’s IUD, but the insurance company would still pick up the tab?
Yes, for the employee — you — there wasn’t a measurable difference. The question was whether the employer or insurance picked up the tab.
Now, the Trump administration has made it so that any publicly traded corporation or privately held nonprofit could exempt themselves, not just for religious reasons, but for nebulously-defined “moral objection.”
The second key change of Trump’s mandate is that it got rid of the guarantee that insurers have to cover birth control even if an employer doesn’t.
Last week at the University of Notre Dame, we saw the consequences of the rule change. Notre Dame announced that they’d no longer be covering students and employees, so all women enrolled and employed there no longer guaranteed birth control without out-of-pocket-costs covered by their health insurance. (Update: Notre Dame has reversed this decision due to pushback.)
How is this change being justified?
Since Trump took office, he has stacked the Department of Health and Human Services, as well as a number of other departments with people who don’t believe in birth control. For example, Teresa Manning, who oversees the country’s Title X Family Planning Program — the only program dedicated to family planning and preventative health care — doesn’t believe birth control works, nor that the federal government should be helping anyone access it. Title X helps four million low-income and uninsured women per year have access to birth control (that was surprisingly signed into law by President Nixon, a Republican).
We saw a leaked memo from the administration — not only have they attacked Title X health care coverage, but also, the memo outlined an agenda to push women to use “fertility awareness methods” of birth control like the “rhythm method” (only having sex when you’re not ovulating) instead of encouraging people to use birth control methods. This is troubling to me because while some women choose the rhythm method, a lot don’t; the rhythm method has a high failure rate (nearly one in four women who rely on this method in a year are likely to end up pregnant) and is difficult to manage, especially if you don’t have the time to pay attention to your cycle or have a healthy power dynamic in your relationship. It’s also troubling to me because the federal government shouldn’t be in the position of telling women what method of birth control works best for them. The federal agenda would take us back to a time before medical advancements when the rhythm method was the main method.
In what way are the effects of these changes intersectional, affecting women differently by race, income-level, and geography?
Income level is a big one because if you’re lower income, young, and/or living paycheck to paycheck, you can’t pay out of pocket for birth control. If you lose access through your insurance, it could cost $600 per year or more. It’s a lot, especially when you’re talking about someone who doesn’t have extra cash or cushion.
Title X program is a program designed to reach women who don’t have any other options. Planned Parenthood serves roughly a third of people enrolled in the program (and state, county, or local health departments serve the rest). When you impact Title X, you take away access to basic health care like birth control, cancer screenings, STD testing. This would impact a lot of people in rural areas, who might not have other women’s health care providers, and in medically underserved areas, especially as the number of maternity and women’s health wards are shutting down.
The impact on women of color is huge as well. In general, 58% of women who use the birth control pill do so for a medical reason that isn’t, or in addition to, pregnancy, such as for endometriosis and polycystic ovarian syndrome, which is especially prevalent among women of color.
What can we do to protect women’s health care?
The good news is that people across the country have managed to block some of the worst health care bills we’ve seen in Congress, bills that would have made it possible for health insurers to not cover maternity care, and treat anything as a pre-existing condition, which would make health insurance prohibitively expensive. If you gave birth or had a c-section, you could be charged thousands more just because of that. The amazing work of activists and supporters reaching out to call their representatives in Congress, taking action, showing up at town halls, marching in the streets, helped defeat those bills.
We’ve seen attacks on basic access to birth control and health care. It isn’t a surprise because of the ideology of who’s in the administration. The fight is far from over. It’s only going to get worse. We’re not just going to see rollbacks of insurance coverage and elimination of programs that help low-income women. It’s possible that we’ll see a rule preventing doctors from providing information about birth control and abortion. Everyone should sign up and stay involved.
I asked Sackin how exactly to stay involved, and here are five things she suggested:
Take care of your own health.
It’s that time of year again — we’re in open enrollment! Get the best plan for you, get care, and stay up-to-date with your annual check ups.
Ask your employer about birth control.
Find out what’s covered by your employer and ask your employer to take a public stance. You can visit fightforbirthcontrol.org for resources on how to have these conversations.
Put pressure on state and local politics.
Monitor birth control changes at the local and state level and keep the pressure turned up on your elected officials. The appropriately titled Vagina Benefits website provides a good breakdown of how these changes will affect you. State and local elections have real consequences, especially when it comes to health care access. Register to vote, get to know your candidates and what policies do they support. Organizations like TurboVote provide voters with text and email reminders for where your polling place and date are.
Call your senator and representative.
We know everyone says to do this any you may be wondering if it works. It’s part of the reason health care repeal has failed so far. So please call them and while you’re at it, maybe call the birth control unbelievers like Teresa Manning at HHS and tell them what you think of the new birth control rule: 1-877-696-6775.
And run for office!
We’ve seen thousands of women stand up and run for office since Trump was elected. And we’ve seen them win. Emily’s List, Run for Something, and She Should Run are all great resources for ways to get involved!
Collage by Louisiana Mei Gelpi.