On Friday, Dec. 22, President Donald Trump signed the Republican overhaul on the nation's tax code into law. Among other sweeping changes, the law will affect some aspects of health care. So what will the tax bill do to birth control? The answer is complicated, but it's not exactly reassuring.
The GOP's tax bill, voted through Congress this week, included a provision that would undo the individual mandate in Affordable Care Act (ACA, also called Obamacare). This change means that people are no longer required to buy insurance for themselves on the market and are free to opt out of it without penalty. As a result, the nonpartisan Congressional Budget Office (CBO) has predicted the program would likely cause premiums to go up for those that remain on it, potentially leaving 13 million Americans unable to afford their coverage and be priced out of the system over the next decade.
Obamacare has helped women afford birth control.
Obamacare has been a huge step in increasing the affordability, and therefore access, of birth control to women. According to Planned Parenthood, 62 million women have gained access to birth control since the health care bill went into effect.
"This bill will have dangerous implications for years to come," says Center for Reproductive Rights President and CEO Nancy Northup in a statement about the tax bill's passage on Dec. 20. "The repeal of the individual mandate, a central tenet of the ACA, threatens to unravel the program and cause nearly 13 million Americans to lose their coverage." With that insurance goes many people's access to birth control.
On its own, the tax bill is bad news for birth control. But it's not the only thing working against women.
The impact to birth control has been dealt a double-blow thanks the Trump administration's rollback on contraceptive coverage under Obamacare. This rule, which went into effect on Oct. 6, changed a provision of the ACA that required employers to cover their employees' contraceptive care under insurance, allowing exemptions for employers who have a moral or religious objection. The rules, effected by the Department of Health and Human Services (HHS), represented one of Trump's key promises to his conservative base. The decision was widely protested, with hundreds of thousands of people writing in with their complaints to the HHS during the period to submit public comments, which closed a month later.
Two patient advocates for Planned Parenthood spoke to me on Dec. 5 about their reasons for protesting the HHS decision. One of the advocates, Yulisa Vega, is one of the many people taking birth control for reasons other than pregnancy prevention. "I take birth control for medical reasons," they say. "And it’s unfair that I might get that choice stripped from me, because I now have to rely on other forms that aren’t the best option for me."
Another patient advocate, Chelsea Vargas, says she was faced with a massive bill for her birth control after her state's program was defunded, and worries about how the decision will affect people like her. According to Planned Parenthood, the ACA saved women about $1.4 billion a year on birth control, and about a third of women voters have struggled to afford their prescription, including 57 percent of women between 18 and 34.
The change has been temporarily blocked by a federal judge, but it's unclear what's next for the rule.
Cuts to Medicaid could add to the strain.
Republican leaders have signaled that they intend to make cuts to welfare programs like Medicaid and Medicare. Amy Friedrich-Karnik, a senior policy analyst at the Center for Reproductive Rights, also spoke with me on Dec. 4 about the Senate's version of the tax bill, which was passed on Dec. 2. That bill, she warns, could pose a threat not women's access to birth control not just through its ACA provision, but through potential cuts to Medicaid that could be made to finance the bill. Women are substantially more likely than men to be in poverty, and many women with low incomes rely on Medicaid for their insurance. Potential cuts could hit them harder, especially if they need birth control or maternity care. To be clear: No such cuts to Medicaid have been made yet. But she's still concerned.
"There’s a huge amount of women who get their coverage from Medicaid, and we’ve seen [it] under attack from day in this Congress," Friedrich-Karnik says. "What we see in this tax bill is that the cost of the tax cuts that are in this bill are so high, Congress is going to have no choice but to cut back on spending programs, [including Medicaid]. That’s where we see women most vulnerable."
Together, the tax bill — which leave other programs like Medicaid vulnerable to cuts — and the new contraceptive rules spell a nightmare for those who rely on Obamacare for birth control. So if you're on one of these programs, now is the time to stock up.