It never occurred to me that getting the contraception I wanted would ever be a hassle.
I grew up in Canada, so my early birth control experiences were a little different than the average American’s. When I needed birth control, I would either walk into the local teen clinic, or make an appointment with my family doctor. I’d show my government-issued health care card if I had it on me, or just sign my name if I didn’t, and leave with a few months’ worth of birth control.
It never occurred to me that getting the contraception I wanted would ever be a hassle, or pose any financial burden. But then I moved to New York, and it became apparent pretty quickly that things were different in the States.
I discovered that unless you were considered very low income and qualified for a government program, you either relied on private insurance, which was typically tied to your job, bought your own at great cost, or like many people, just went without.
In those early years, I learned the hard way what happened when you went to the emergency room without insurance. I also learned that even though you had coverage, certain providers, services, and prescriptions could still be excluded from your plan. This meant my choice of birth control was also a matter of what was covered when I had insurance, and what I could afford when I didn’t.
I wasn’t the only one in that situation, which is why women around the country (well over 90 percent of whom will use contraception at some point in their lives), were thrilled by the passage of the Affordable Care Act (the ACA, or Obamacare), since this required health insurers to provide birth control at no additional cost to users.
And that cost factor was important, not just to me, but to countless people across the country. Indeed, over 55 million American women currently obtain birth control without a copay, something that saved those women an estimated $1.4 billion in 2013 alone.
But things seem to be changing, which means we have to plan for what may come next.
What’s happening with the ACA
With the Trump administration determined to make good on their campaign promises, ACA coverage is in jeopardy. Almost immediately after the inauguration, the first steps were taken towards changing the ACA. This also included several rejected amendments that would have preserved certain components of it, including one that would have kept coverage for contraception. This means that for millions of women, birth control may get a whole lot more expensive.
Some states, including New York, Maryland, Vermont, California, Illinois, Minnesota, Colorado, and Massachusetts, are taking action to ensure that their residents are able to continue access to free contraception. But for women in other states, there is cause for concern. Many are girding themselves for a roll back to the not-too-distant past when decisions about contraception were often based on economic factors, and not on health or preference.
In reality, it is impossible to determine exactly what women will be paying for birth control if the ACA is repealed, since different insurers will be able to set prices and copays as they please. And for those who have no coverage at all, costs will depend on methods, brands, and access.
What you can do in advance
There is a lot of talk about what contraceptive coverage will look like in a post-ACA world.
As Dr. Ann Davis, a New York-based OB/GYN told CNN shortly after the inauguration, “Between last week and this week, my conversations with patients have completely changed. Last week, it was all about, ‘Let’s talk about what’s best for you,’ and it was all about the patient. This week, politics is in the chair next to me.”
Indeed, in the days after the Trump election, the Internet was filled with calls for women to get IUDs, or to stock up on emergency contraception. IUDs can be an incredibly reliable and cost-effective form of birth control, lasting between three and ten years. But that cost effectiveness can go out the window when you consider that without insurance, an IUD can cost up to $1,000.
And what about Emergency Contraceptive Pills (ECPs)? Also known as Plan B, or the Morning-After Pill, ECPs can prevent pregnancy for up to five days after sex. ECPs are available without a prescription, but typically range from $30 to $60 without insurance. ACA insurance currently covers this form of contraception completely, so it could be wise to stock up now in case of future need (just be sure not to use any medication past its expiration date).
It is also important to realize that if you currently have ACA coverage, it will continue at least through the end of 2017. For some women, it could be a good idea to take care of any procedures (i.e. a tubal ligation) that you have been putting off, and get any preventative care that you can.
What you can do if you lose your ACA coverage
With the looming possibility that millions of women could lose the recent gains they made accessing contraception, we all have to start thinking about what this might mean for our continued need to prevent unwanted pregnancies down the line.
One basic strategy will be to use cheaper, more accessible methods of birth control. The most obvious solution is condoms. Condoms are definitely not everyone’s favorite method, but they offer excellent protection from both pregnancy and STIs and they are usually cheap, easy to find, and don’t require a prescription.
Another option is to get birth control from a Planned Parenthood health clinic. There is a lot of talk about defunding Planned Parenthood. This talk is often based on a misunderstanding of how billing actually works (there is no government line item for Planned Parenthood, only for reimbursement for healthcare). How this will play out is still a big question mark. Nevertheless, for the time being, Planned Parenthood continues to offer free and low-cost healthcare, which often includes birth control.
Another idea is to use various apps that have been created to help women obtain birth controls without seeing a doctor, which can help cut down on contraception costs overall.A similar option is to mail order prescriptions. This can often be a more cost-effective choice, and can let you shop around for the best price on your prescription. Some services may even allow you to obtain a prescription after filling out an online health questionnaire, or video conferencing with a provider.
No matter how you do obtain your prescription, make sure to ask for the generic version, since there can be a huge price difference between the generic forms of hormonal birth control and their brand name siblings.
What it all comes down to
For women who are already disadvantaged, the ACA has made a huge difference, since safe, effective birth control is life-changing. And despite what some ACA opponents might argue, there are terrifying consequences to putting it out of women’s reach. The most apparent is that doing so will increase the number of unwanted pregnancies.
No one can predict exactly what the future holds for our contraceptive coverage, but putting some strategies in place now, and preparing for what may come can help us weather what is shaping up to be a pretty complicated storm.