Women Are Seeking Long-Term Birth Control Before Obamacare Is Repealed

By Michele Munz St. Louis Post-Dispatch

WWR Article Summary (tl;dr) During his campaign, President-elect Trump promised to "repeal and replace" the Affordable Care Act, referred to as Obamacare, which uses subsidies to help the poor get health insurance. The legislation mandates coverage for preventive health care such as cancer screenings, pap tests, mammograms and birth control with no out-of-pocket costs.

ST. LOUIS

Angelica Thompson was working part time and earning her college degree in genetics when she got a serious boyfriend. Thompson sought care at the campus health clinic, where she chose a hormone implant under her skin that prevents pregnancy for up to thee years.

Able to stay on her mother's insurance plan, she paid nothing for the implant, which can cost up to $800.

Now 23 and saving money for nursing school while working at Starbucks, Thompson replaced the implant, two months ahead of schedule, because she's unsure what changes lie ahead for her health care after Donald Trump is inaugurated as president Jan. 20.

Thompson said the new implant should last as long as Trump's term.

"The idea of 'we'll wait and see' is disconcerting to a lot of women," she said. "My partner and I, we are 23 years old. We are not ready to have a child. We have professional goals we want to accomplish."

During his campaign, Trump promised to "repeal and replace" the Affordable Care Act, referred to as Obamacare, which uses subsidies to help the poor get health insurance. The legislation mandates coverage for preventive health care such as cancer screenings, pap tests, mammograms and birth control with no out-of-pocket costs.

Republican legislators have said repealing Obamacare will be among the first priorities after Tuesday, the first day of the new Congress.

A loss in contraception coverage is on many women's radar, compounded by worry over Cabinet appointees who are unlikely to enforce the birth control coverage mandate in the meantime or support public funding programs for contraception.

Intrauterine devices and hormonal implants under the skin are the most effective forms of reversible birth control, with just a 1 percent failure rate. But the devices along with the insertion procedures can cost as much as $1,000.

The devices are long-acting, IUDs can last up to 10 years, and can be the best option for women who are done having children or not ready to start a family for several years.

The high cost and uncertain future has prompted Thompson and other women to get the long-acting options now.

At the eight Planned Parenthood clinics in the St. Louis and southwest Missouri region, calls jumped 60 percent in the last few weeks of November, compared with the weeks before the election, said affiliate president Mary Kogut.

The clinics provide family planning and sexual health services to more than 34,000 patients a year.

"People right now are feeling a little anxious about whether there will be insurance coverage and what it will cover, so they are making appointments right now to get in," Kogut said.

Similar increases in calls for women seeking long-acting contraception have been seen at Planned Parenthood clinics across the country, she said.

The day after the election, clinics nationwide saw a 957 percent increase in appointments booked online to get long-acting contraception, compared to the average number of daily appointments for the previous month. The appointments have leveled off, but remain an average of 128 percent higher than the month before the election, Kogut said.

Dr. Denise Willers, medical director for the Women and Infant Care Center at Barnes-Jewish Hospital, said she hears concerns. "Providers are apprehensive and patients are apprehensive," she said, "and I think we all are waiting to see what happens."

Thompson said she doesn't want to wait. Birth control pills are not safe to take with her heart condition, and condoms are too risky.

"I like the fact that it is long term, and I don't have to worry about taking a pill. I found it convenient and effective, and I'm not pregnant," she said. "No one wants to be pregnant before they are ready."

A study published in Health Affairs in July 2015 estimated that more than 55 million women were receiving birth control at no cost. Women saved an estimated $1.4 billion on the pill alone in the first year after the mandate went into effect in August 2012, researchers found.

The pill is the most popular form of birth control, and its average cost dropped by half to about $20 for a three-month supply. Average spending on intrauterine devices declined by about 70 percent to $110, while spending on implants declined by about 72 percent to $91 per implant.

Spending did not fall to zero because some plans phased in the requirement, others received an exemption for religious reasons and some failed to make coverage changes.

Long-acting reversible contraception has become an increasingly popular choice. In 2012, about 12 percent of women using contraception relied on long-acting reversible methods, up from just 2 percent in 2002.

Kogut attributes that to improved access, increased awareness about their safety and having more providers trained in how to implant them.

When women are informed of different birth control choices and cost is removed as a barrier, they often choose long-acting methods, according to a large study by Washington University School of Medicine in 2011, before the birth control mandate.

The study, known as the Choice Project, followed a diverse group of 9,256 women over four years. They were provided access to all birth control methods at no cost, and 75 percent chose the long-acting methods.

The study showed the approach can make a difference in reducing the high number of unplanned pregnancies in the U.S., 45 percent of all pregnancies. Among study participants, the unplanned pregnancy rate was 35 per 1,000 women, compared to 52 per 1,000 nationwide. The abortion rate was six per 1,000, compared with 20 per 1,000 nationwide.

Unplanned pregnancies can have a negative effect on maternal and infant health, while family planning can improve parents' income, stability and mental health as well as their children's well-being.

Kogut said she doesn't expect a change in coverage as soon as Trump takes office, but she understands that some women are anxious. "Hopefully, even after the first of the year, there won't be a quick dismantling of any of those systems," she said.

"We have to wait and see. We just don't know what is going to happen."

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