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Women Brace for Changes to Health Benefits

By Brenda Goodman, MA

Reviewed by Sarah Goodell

Nov. 11, 2016 -- For some women, the election results are getting personal.

Both President-elect Donald Trump and congressional leaders have promised to overturn the Affordable Care Act, also known as Obamacare, as one of their first orders of business.

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One major fear has surfaced on social media: that women could quickly lose access to certain essential health benefits, including birth control, breast pumps, maternity care, and childbirth services. The term IUD was even trending on Twitter as women urged each other not to wait to get reliable contraception. And according to Facebook data, more than 350,000 users have used the term "birth control" since the election.

Jane Doe, MD, tweeted: "Insured? Get your IUD now, before Trump-Pence reverse the requirement for full contraceptive coverage."

Nasty Woman wrote: "Pregnant people who plan to breastfeed: Ask your doctor to write you a prescription for a breastpump before ACA is repealed. They are $400."

It turns out there is reason to fear.

While a full repeal of Obamacare will require an act of Congress -- and probably a lengthy fight -- the coverage for women's services and contraceptives could disappear with the stroke of the new president's pen.

"They do not need a full repeal of the ACA in order to change or restrict the contraceptive coverage provision," says Alina Salganicoff, vice president and director of women's health policy at the Kaiser Family Foundation in Menlo Park, CA.

While certain provisions of the law are spelled out explicitly in its text, when it comes to preventive services for women, the law leaves it up the Health Services and Resources Administration (HRSA) to decide exactly what insurers must cover.

If he chooses, Trump could direct HRSA to apply different rules.

"With an administrative action, changes can be made," Salganicoff says.

She says the contraceptive coverage guaranteed by the law has been incredibly popular with women, and it has resulted in dramatic reductions in women's out-of-pocket spending on prescriptions.

From 2012 to 2014, the average American who had insurance through their employer saw their out-of-pocket spending on prescription drugs drop by an average of about $8 a year. Birth control pills accounted for 63% of that savings, according to data collected by the Kaiser Family Foundation.

Obamacare's birth control benefit has also helped women choose more effective methods and use them longer and more consistently.

A study published in September of 30,000 women enrolled in health insurance through their jobs found that eliminating the co-pay for birth control increased the number of women who chose to use any kind of prescription birth control by more than 2%. Most of the increase was due to women who opted for long-acting methods, like IUDs and implants, which are far more effective than condoms and pills, but also far more expensive up front.

On top of that, a separate study of more than 635,000 insurance claims found that women were more likely to stay on oral birth control after co-pays were eliminated by the law.

So far, the president-elect hasn't made any specific announcements on this point, but one adviser predicts that he is likely to drop the requirement that health plans cover birth control.

"I think it will be one of the first things they will do, sure," says Ed Haislmaier, senior research fellow in health policy studies at The Heritage Foundation in Washington, D.C. He confirms that he's been on several conference calls with members of Trump's transition team where they've discussed how to dismantle various aspects of the law.

"It's easy to do, and it gets rid of a controversial problem in the law," says Haislmaier, citing the objections of religious groups and some employers to the coverage mandate, which has generated two legal cases that been argued before the Supreme Court. In one case, filed by the company Hobby Lobby, the court said companies with a limited number of shareholders didn't have to provide birth control coverage if they object on religious grounds. Another case, filed by religious nonprofits that also want an exemption from the contraceptive coverage mandate, is still in progress.

The Trump campaign has taken many of its policy positions directly from The Heritage Foundation.

If the change is made, it would mean that insurance companies would not be required to offer the coverage. Haislmaier says that it will still be possible to get birth control, however. Many employers and perhaps individual plans will still cover it, as private insurance companies can make their own choices about their plans. But you'll probably have to cough up at least a co-pay to get it, and your plan might not cover every option. Some of the most effective forms of birth control -- so-called long-acting reversible contraceptives, like implants and IUDs -- can cost hundreds of dollars.

It's not clear yet if and when any potential change would affect health insurance policies women buy through the Obamacare Marketplaces, which have open enrollment now through Jan. 31, 2017.

These forms of birth control are also cited by experts as one factor behind the recent dramatic drops in the teen birth rate.

"People will have to pay for them," Haislmaier says.

Any move is not likely to help Trump's standing with women, experts said.

"As we've seen over the last few days, there are a lot of women across the country who feel very strongly about this part of the Affordable Care Act and would object very strongly if it were eliminated," says Adam Sonfield, a senior policy manager at the Guttmacher Institute in Washington, D.C., a nonprofit that studies and advocates for reproductive health rights. "It certainly would cause an outcry."

Planned Parenthood has also pledged to fight any rollback of women's benefits.

For their part, health insurance companies say that for now, the coverage for contraceptives and other preventive services for women remains intact, though Haislmaier says conservatives are opposed to any provisions of the law that impose coverage requirements on insurance companies

"Today, the Essential Health Benefits [of the Affordable Care Act] require health plans to cover one of each contraceptive type with no cost sharing. This includes IUDs. This is a broad requirement beyond Exchange plans. That's what we know," says Kristine Grow, senior vice president of communications for America's Health Insurance Plans in Washington, D.C.

"The fact is, there is still a lot to be learned about what policy changes will be proposed. We are eager to work with policymakers and the administration to deliver real solutions and real results for every American," she says.

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