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The era of free birth control is at an end — this is how much Trump's new rule could cost women

MarketWatch logo MarketWatch 10/7/2017 Kari Paul

Video by Wochit

The cheap and even free birth control that American women have enjoyed for the past five years could soon come to end, and both activists and health care companies are rushing to fill the potential void.

The Trump administration said Friday it will roll back the Obamacare requirement that employers offer coverage of a variety of birth control methods by allowing employers to get an “moral exemption” based on their religious beliefs. That could put a financial burden on millions of women and even result in a complete loss of access to birth control, advocates say.

Women saved $1.4 billion on birth control pills alone in 2013 after the Affordable Care Act’s birth control benefit was passed, according to National Women’s Law Center, and overall spending on prescription drugs decreased due to the change. The rollback of the birth control mandate would reverse these social and financial benefits, Blanchard said.

And if companies and insurers stopped offering free birth control, these out-of-pocket expenses would be shouldered by millions of women.

“Getting a prescription for birth control can be difficult — women have to be able to get to a doctor and pay for an appointment,” Kelly Blanchard president of Ibis Reproductive Health, a women’s health care advocacy group said. “All of these can become delays or complete barriers to accessing contraception.”

Insurers could refuse to cover contraception for religious or moral reasons

Through the birth control mandate, health plans were required to provide all kinds of contraceptives, including hormonal birth control, intrauterine devices, sterilization procedures, and emergency contraception free of cost. With the Trump administration repealing the rule, any health insurer could refuse to cover contraception for religious or moral reasons. 

Oral contraceptives are available over the counter in California, Oregon, and Washington and expanding access nationwide has come up a number of times in recent years, notably in the 2014 elections. Many advocates have pushed for contraceptives to be available both over the counter and covered by health insurance. The Food and Drug Administration approved the sale of emergency contraception like Plan B for over-the-counter sales in 2013, but oral contraceptives for daily use still require a prescription from a doctor in 47 states.

Even as Ibis and other advocacy organizations work to pursue an application for an Food and Drug Administration-approved over-the-counter birth control pill, Blanchard said mandated coverage of birth control is still important to protect. Since the insurance coverage provision was passed, the U.S. has seen an increase in women using highly effective birth control methods, a decrease in teenage pregnancies, and a decline in unintended pregnancies overall.

“If it is rolled back we will see the imposition of old barriers, which means people will be put in a position where their own decisions over whether to have a family will be put in the hands of their employer which is an assault to their autonomy, their family, and potentially their health.”

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There are low-cost alternatives to insurance-provided birth control

Insurance coverage also isn’t the only way for women to get low-cost access to birth control. The number of on-demand birth control services has also risen in recent years, further increasing access to the birth-control pill. Currently, around a dozen services offer prescription birth control through the use of telemedicine — consultations through phone, video, or app — by doctors in states where it is allowed at varying prices.

Nurx is one such service that delivers birth control to people in California, DC, Illinois, New York, Pennsylvania, Virginia, and Washington with or without insurance. The cheapest option without insurance starts at $15 a month including the doctor consultation. Most women with insurance receive birth control through the program free.

Nurx chief executive Hans Gangeskar said he’s seen a spike in business fueled by the uncertainty over the pending health-care legislation. “We have a lot of people coming to us concerned their access to birth control is going to be restricted,” he said. “For people without insurance, birth control can be exceptionally expensive, at more than $200 a month.”

Gangeskar believes telemedicine is the best solution to spiraling health costs. Other companies including The Pill Club, Maven, Lemonaid, and PRJKT RUBY offer similar services. PRJKT RUBY, for example, sends pills at a flat rate of $20 a month, which isn’t covered by insurance. As the fate of birth control coverage remains uncertain, many women are pre-emptively stocking up on birth control options and installing long-term solutions like IUDs.

But President Trump has said insurers and companies should be able to choose. “For too long, the federal government has used the power of the state as a weapon against people of faith, bullying and even punishing Americans for following their religious beliefs,” the president said in May.

Kari Paul is a personal finance reporter based in New York. You can follow her on Twitter @kari_paul.


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