Leah Spoolstra – The Collegiate Staff
On Oct. 6, the Trump Administration announced a change to the Affordable Care Act (ACA) that will allow employers to opt out of covering birth control in health insurance.
In 2012, the birth control mandate was issued into law under the ACA by President Barack Obama, which required that employers provided free contraception to eligible employees, unless the company identified as a religious organization. The birth control mandate was recently revoked by President Donald Trump, which now allows employers to be exempt from providing such care for moral obligations.
The methods of contraception that were provided for free were separated into FDA approved categories, which included barrier, hormonal, implanted, emergency birth control, as well as sterilization, education, and counseling. This recent change to the ACA is estimated to affect 120,000 women who were formerly covered under the health insurance from their employers.
While this is an approximation of people affected of the 55 million women in the United States who are between the reproductive ages. Ruth Lednicer, the director of media and communications for Planned Parenthood in Michigan, expects this number to be higher than expected and that unintended pregnancies may rise because of it.
“We don’t know how many women this will affect,” Lednicer said. “We have seen in the past when there is less access to affordable contraception that unintended pregnancies go up, teen pregnancies go up, and sadly, abortion rates go up, as well. Under Obama Care (ACA), women had access to birth control with no copay.”
As the gender studies coordinator at Grand Rapids Community College, Susan Williams is worried that many companies may choose to stop covering birth control.
“The federal government is rolling back the ACA’s contraceptive mandate and expanding the religious exemption to any employer, including small businesses and organizations, who morally opposes birth control,” Williams said. “We have no idea how many employers will do this, so it’s almost impossible to gauge how bad this is going to be.”
President Trump stated that he will not tolerate religious discrimination toward a company whose beliefs contradict the use of contraceptives. While religious nonprofit organizations, hospitals, and churches are not required to include birth control, initially all other companies had to cover women’s health care. The Trump Administration is hopeful that companies with religious owners will be allowed to express their views against providing contraception.
When it comes to women’s health issues, Lednicer believes that companies should not have an option to discontinue coverage for birth control and that this change provokes gender discrimination.
“I think that we’re seeing from this administration is consistent with everything that they have been trying to do when it comes to women’s reproductive health care, which is to make it harder for women and to punish women by making it harder for them to access (health) care,” Lednicer said. “Your employer should not be able to make a decision that your doctor made for you. If your doctor tells you that you need a prescription, your employer should not be allowed to say that you do not need (the prescription) because they are morally opposed to it.”
Before the ACA mandate, birth control was covered by a majority of health insurance agencies with a low copay, typically $20 a month. Currently, without insurance, women can purchase birth control pills for about $50 per month, which is considered relatively low compared to other prescriptions than may range into the hundreds. Despite the already low payments for birth control, intrauterine devices (IUD) can cost women approximately $1,000 for a three to six year coverage. Previously, IUDs, Plan B One-Step, and hormonal birth control was mandatory to be included in health insurance provided by employers.
Geron Turke, an obstetrics and gynaecology practitioner at Mercy Health Physician Partners, considers there to be benefits of birth control and acknowledges the risks of making birth control less accessible to women with lower wages.
“There will be a difference between those who are able to afford hormonal contraception,” Turke said. “(Women who can afford) will probably continue to use birth control for both contraceptive and noncontraceptive benefits. However, those who have an inability to pay for the medication are less likely to use (birth control). Barrier contraception carries a higher risk of unintended pregnancies than does hormonal contraception, while hormonal contraception is more expensive than the occasional use of condoms or diaphragms.”
The majority of women affected by this repeal are considered to be working class women who are under the age of 40. In some cases, companies that hire hourly employees limit their hours so that the company does not have to supply health care coverage. This causes a shift in which the lower economic class women are not necessarily being covered by health care, which causes them to not have the resources to afford birth control.
While economists speculate whether or not the the women affected by this change are those who have a high enough income to cover contraception, Planned Parenthood works with a sliding fee scale for women without insurance to pay for birth control.
“It makes women make the choice of having to pay out of pocket for the cost of birth control, which can be anywhere from oral contraceptive, which can be $50, to an IUD, which could be $1,000,” Lednicer said. “It puts the complete focus on (women), which can cause very dangerous health conditions.”
Richelle Smith, 35, of Grand Rapids believes that women deserve an opportunity to have access to affordable care.
“(Birth control) needs to be free or relatively inexpensive, otherwise we are not going to help the people that need to be helped,” Smith said. “The (women) who can afford it don’t care whether the companies cover it or not, if they can do it and they want it, they will pay for it. We are catering to either the women who wouldn’t do it because of the cost or for the cost.”
There are several factors that will affect the future of contraception coverage. Through studies by Health and Human Services (HHS) and Planned Parenthood, since the birth control mandate was enacted, abortions have lowered, hospital bills for unintended pregnancies have steadily declined, and women save an average of $1.4 billion in birth control copays.
While some women believe that free birth control is a right, others argue that it should require a copay, instead. Even though the circumstances are low, there are certain cases in which a woman could die during labor due to other diseases, such as diabetes. Oral and hormonal birth control methods are widely used for menstruation regulation, hormone imbalance, treatment of severe acne, and help with pain from endometriosis.
Despite these uses, critics argue that not all oral birth control users take the medication to treat a health problem. Medications and treatments for issues and illnesses such as blood clots, high blood pressure, depression, anxiety, and multiple sclerosis require extensive copays. For this reason, some people provide a solution of reverting back to insurances covering all but a low cost copay. This would allow for companies to pay less for health insurance, especially in a male dominated industry, while allowing women access to contraception.
Lednicer believes that, if birth control cannot be free for women, that offering an option for affordable care is important and will cost less in the long-term.
“It is in everyone’s best interest if a woman can decide when and if they want to get pregnant than it costs us as a society for unintended pregnancies and kids that a couple cannot afford to have,” Lednicer said. “In an ideal world, I think that it would be important to have birth control be as affordable as possible, with free being as affordable as possible. Ideally, I would like it if birth control was available for free, but if it is absent, than a copay will still allow women to have affordable coverage.”
While Lednicer hopes to continue free contraception, Smith said that insurance should be reasonable with copays.
“I don’t necessarily think that (birth control) has to be free, but I think that it is fantastic that it is,” Smith said. “It would have to be really inexpensive, not like our copays and our insurance is structured now.”
Due to the rollback on birth control coverage, people question if it is a company’s right to decide the care that a woman receives. Since this mandate typically only affects women, some people view this issue as gender discrimination by not allowing women to have proper health care. Other people, however, wonder if this birth control mandate was unjust in the first place because it does not require any coverage for male contraception. While female birth control was covered by health insurance, men do not have access to the same care. With recent research emerging regarding new male contraception, it is still unclear whether or not this will be covered under health insurance.
Williams views this change as biased and that it is not the responsibility of government officials and employers to decide health care benefits.
“We have a long way to go to improve maternity care in this country, and taking (birth control) out of insurance plans would cause the U.S. to regress rather than progress,” Williams said. “There is, whether intentional or unintentional, underlying gender discrimination in this rollback. (Women’s) medical treatments and medications guided by and regulated by the morality of individual government officials and employers is unfair treatment under the law.”
Williams said that women should have the option to determine what health care they receive and that the employer should not make that decision.
“What else can your employer make moral judgements about that affect your employment, health, and, ultimately, your rights as an individual, regardless of whether you are a male or female?” Williams said. “This isn’t simply a women’s issue. For large groups of women, access to inexpensive birth control is a health care necessity, not a choice.”
Lednicer believes that this change will negatively impact women and their decision of how and when they can have a child.