February 11, 2019
After the 2016 U.S. presidential election, when Donald Trump was elected and vowed to repeal and replace the Affordable Care Act (ACA) with its mandates for inexpensive or free birth control access for women, the number of women who began using intrauterine devices (IUDs) and implants, both known as long-acting reversible contraception (LARC), notably spiked.
In a research letter published on February 4, 2019, in the journal JAMA Internal Medicine, researchers found that there was a 21.6 percent increase of women with commercial insurance getting LARCs (either IUDs, such as Mirena or Paragard, or an implant, such as Nexplanon) in the 30 days following the 2016 presidential election, as compared with the rates in the 30 days before the election. LARC insertion rates had stayed about the same in the same time period in 2015.
Such long-acting birth control is highly effective at preventing pregnancy; it can be used for up to 12 years without requiring replacement. With the Affordable Care Act in place since 2012, the median out of pocket costs for an IUD went down from $40 to $0, note researchers, who followed nearly 3.5 million women with private health insurance to determine LARC usage. An IUD can cost up to $1,300 when paying for it out of pocket and not covered by ACA mandates, notes Planned Parenthood.
Trump tried to remove birth control coverage from the ACA in 2017, but federal courts have blocked the efforts. With ongoing legislation in different states, two January 2019 court decisions mandated that nationwide birth control access must remain in place, while the state suits move forward to determine if larger group employers can decide to take away birth control coverage through their health insurance plans due to moral or religious objection, according to an article published on January 14, 2019, in Vox.
What does this mean for women who are still concerned about their access to low-cost or free birth control — especially in the latter half of Trump’s presidency, and in future years should Trump win re-election?
“If you are feeling apprehensive about birth control, it is a good time to talk to your healthcare provider about it,” says Mara Gandal-Powers, director of birth control access and senior counsel on reproductive rights and health at the National Women’s Law Center in Washington, DC. You don’t have to wait until your next appointment for a Pap smear or vaginal exam, which could be a year or more away. “Most people should still have birth control coverage right now, but it’s clear where this Administration is trying to go. I understand why people are factoring in the political realities in their decisions — it’s real.”
Since the 2016 election, the Trump-Pence administration has tried to curtail existing birth control coverage as detailed in the ACA, and has tried to limit access, said Leana Wen, MD, the president of Planned Parenthood Federation of America. “Our patients were concerned that their access to birth control and healthcare would be at risk under the new administration,” she said in a statement. “The Trump-Pence administration has continually tried to cut access to reproductive healthcare, including the latest attacks on Title X, the nation’s only federal program dedicated to family planning,” which includes birth control coverage.
Trump also appointed conservative Brett Kavanaugh to the Supreme Court in October 2018, which helped bring the Supreme Court’s leanings more to the right. Kavanaugh and Supreme Court Justice Neil Gorsuch “are not friends to birth control,” says Gandal-Powers. In cases where employers have wanted to cut birth control access on moral or religious grounds, “they would have voted for the employers so that those employers would offer health insurance coverage that would not include birth control at all.” Kavanaugh has referred to some birth control methods as “abortion-inducing drugs,” according to an article published on September 7, 2018, in Vox.
Yet the 2019 midterm elections saw more Democrats elected to the U.S. House of Representatives, making it clear that “they are the most pro-choice House in history,” says Gandal-Powers. “We know we have great champions in the House and Senate for birth control.” Indeed, Alexandria Ocasio-Cortez, who was elected to the House in late 2018 and upset the long-term incumbent representing her district in New York state, has castigated Kavanaugh on Twitter, writing in September before she was elected: “Brett Kavanaugh doesn’t even know what birth control IS. He doesn’t deserve to pass a 7th grade health class, let alone a Supreme Court confirmation. I refuse to allow women LGBT+ rights to degrade. I refuse to live in a world less free.”
A New Vaginal Ring Was Approved by the FDA in 2018
Annovera (segesterone acetate and ethinyl estradiol vaginal system), a combined hormonal contraceptive and longer-acting vaginal ring that allows users to wear a flexible plastic ring for three weeks at a time for up to a year of use, was approved by the U.S. Food Drug Administration (FDA) in August, 2018. While it is not a LARC because it ne to be removed for a week every month, the year of use makes it an improvement from the existing Nuva Ring, which requires women to get a new ring each month. “A longer-lasting prescription and less frequent need for refills improve a birth control method’s efficacy rate,” according to an Everyday Health report. The 12-month use for Annovera also avoids the potential for needing to pay for a new device before a year is up, should birth control coverage become an out of pocket expense for women.
Essure, a birth control method that had been described as “the closest procedure akin to a male vasectomy” in an Everyday Health report, was removed from the U.S. market at the end of 2018, following a July 2017 announcement by parent company Bayer regarding Essure’s declining sales. Extensive patient reports of Essure’s safety record also likely played a role in the declining sales, noted several patient advocates.
Talk to Your Doctor About Contraception Sooner Rather Than Later
No matter what the future holds in terms of whether birth control will continue to be covered by the ACA or whether women will be required to pay out of pocket for its use, experts agree that talking to a doctor or other healthcare provide is crucial, whenever you have any questions about your birth control method.
RELATED: What Is Emergency Contraception?
“Birth control methods are not one-size-fits-all,” said Wen in a statement. “A method that’s right for one person may not be right for another. It’s important for every person to talk with their doctor or other healthcare provider about which method may work best for their health and their life.”