No, Birth Control Coverage Won’t Go Away


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High school students in San Francisco at an anti-Trump protest outside City Hall.

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Jim Wilson/The New York Times

Hours after Tuesday’s election results were final, tweets, Facebook messages and articles began bouncing around the internet urging women to go seek birth control right away. “Get an IUD Before It’s Too Late,” advised a Daily Beast headline. “Here’s Why Everyone Is Saying to Get an IUD Today,” explained a popular New York Magazine piece.

“My phone was ringing off the hook,” said Andrea Miller, the president of the National Institute for Reproductive Health, who said her organization heard from some anxious women, concerned that their birth control options might become quickly and severely limited.

A lot could change in the new administration. But, even with major policy changes, contraceptive access is likely to remain broad.

Reproductive health care is one policy area where Donald J. Trump in the White House and Republicans controlling the House and Senate could have a big impact. The Affordable Care Act increased access to women’s health, and related regulation required health insurers to cover all approved forms of birth control without charging women any co-payments.

Any changes would take months — or, more likely years — to take effect. The intrauterine device, an effective, safe and long-acting form of birth control, may be a great choice for a lot of women. But women don’t need to rush out and get one right away for fear that birth control will be outlawed any time soon.

The most vulnerable regulation is the requirement that health insurers cover contraception for all women without a co-payment. That rule, which has small exceptions for certain religiously affiliated employers, means that contraceptive coverage is now a standard part of health insurance. The absence of a co-payment also means that women can get costlier methods of contraception — like the IUD — without paying a lot of money for the device or for doctors’ visits.

Which Birth Control App or Website Should You Use?


That regulation could be changed without involving Congress. But it would take some time. Regulations can’t be rescinded willy-nilly, and the Trump administration would need to go through a formal notice and comment period before finalizing a new rule. Mr. Trump has given no clear indication that such a policy change is a priority for him. But even if it is, and the process starts right after his inauguration, it will take months and will not affect current health plans. That means that contraception without co-payments won’t go away for at least a year, maybe longer.

“It is not going to be a snap-your-fingers change,” said Alina Salganicoff, vice president for women’s health policy at the Kaiser Family Foundation.

Even if the regulation went away, most insurance plans would continue to cover most forms of birth control. Ms. Salganicoff and several colleagues published a report on the state of contraceptive coverage last year. They found that, before Obamacare, 28 states required health plans to cover contraception, and 85 percent of employer plans had it as a covered benefit. The Equal Employment Opportunity Commission ruled in 2000 that any health plan that covered preventive health services also needed to cover birth control. That is the world we would return to if the mandate was rescinded.

There’s a financial incentive for covering birth control, and insurance companies know it. Unlike most preventive health services that health insurance pays for, birth control tends to have a quick and measurable return on investment. Women without reliable birth control access are more likely to become pregnant, and the costs of prenatal care and childbirth are substantial. Even without a legal requirement, most insurers used to cover birth control, and they have a business case to do so.

Without the Obamacare rule in place, coverage could get patchier, and more women might have to pay for a portion of their care or face more limited choices of covered birth control methods. IUDs are relatively expensive devices, and often require a few office visits for counseling and insertion. Insurers tended to charge women more to get them than they did for comparatively less expensive birth control pills. Even some pills could get quite expensive. Co-payments for birth control, before Obamacare, varied widely. Generic pills tended to be inexpensive, but some women were paying $50 a month for the pill of their choice.

A bigger threat to contraceptive access, of course, is the repeal of Obamacare itself. Whether and how the health law would be erased remain unclear. Mr. Trump told The Wall Street Journal on Friday that he hoped to amend the health law rather than eliminate it entirely. A repeal bill passed by Congress last year, and vetoed by President Obama, would leave about 22 million people without coverage, many of them women who are using their health insurance to pay for birth control.

Even an Obamacare repeal would take time to pass Congress, and would most likely take years to be implemented. If you want an IUD now, get one. But they won’t go away any time soon.

“It’s a real threat,” said Gretchen Borchelt, vice president for reproductive rights and health at the National Women’s Law Center. “But let’s not panic.”

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