The rush began right after Donald Trump’s election victory was announced — an unprecedented surge in questions about access to women’s health care and birth control, Planned Parenthood officials say.
With it came a demand for IUDs that marked an increaseby more than 900 percent since the Nov. 8 presidential election, said Dr. Raegan McDonald-Mosley, chief medical officer for the national organization.
Some of those appointments are Walla Walla based, regional Planned Parenthood officials said.
The concern is prompted by fears the Trump administration will change or end the Affordable Care Act provision requiring health insurance providers to cover contraception devices.
Planned Parenthood provided birth control for more that 2 million people last year, 75 percent of those at income levels entitling them to subsidized women’s health care. A 2015 federal report predicted if government funding for birth control goes away, unintended pregnancies could cost taxpayers more than $100 million over the course of a decade.
“Walla Walla saw a huge increase in appointment (requests), and increased interest in long-acting IUDs and birth control implants … some lasting up to 12 years,” said Tiffany Harms, spokeswoman for Greater Washington and North Idaho Planned Parenthood.
“We’ve heard from patients and we’re seeing people who are really concerned about what this administration means for their lives.”
She said the regional Planned Parenthood network saw a 71 percent overall increase in appointments for long-acting, reversible contraception (LARC) procedures since the election. Walla Walla appointments for all services shot up by nearly 50 percent, she noted.
Adding to the post-election anxiety was the Nov. 29 nomination of Rep. Tom Price, R-Ga., as Trump’s secretary of Health and Human Services. The surgeon-turned-congressman, is well known as a consistently outspoken opponent of ACA, also known as Obamacare. So far he’s been thwarted in numerous attempts to repeal ACA and transform Medicare into a voucher-like program for future participants.
Price, who must be confirmed by the Senate, poses a serious threat to women’s health in this country, according to Harms.
Helen Didelius, Walla Walla representative for Human Life of Washington — the state branch of National Right to Life, which advocates against abortion — has other views.
The group does not take an official stand on the use or methodology of birth control, but in regards to ACA coverage of it Didelius said she doesn’t see it as issue.
“My understanding is that the ACA has only been around for two years, so why are we worried about this?” she said. “I don’t think the Affordable Care Act is changing anyone’s opinion…it’s a new policy.
“If it changes, I don’t think it’s going to change anyone’s behavior. If they want contraceptives, there’s ways they can get it.”
Esther Hurni-Ripplinger, executive director of Human Life of Washington, added the organization does take a position on drug-induced abortion, as offered in Walla Walla and other Planned Paretnhood offices.
“Part of the Affordable Care Act funds abortion. For that part we would be pleased to see those funds stricken,” she said.
“I see a lot of hysteria over the issue, which is unfounded.”
Many women seeking reproductive and preventative health services can only afford to do so through government dollars, including the Title X program enacted under President Richard Nixon in 1970. Title X is the only federal program solely dedicated to making sure low-income or uninsured people can access family planning and related health services at reduced or no cost.
In 2015 the Greater Washington and North Idaho Planned Parenthood office subsidized $6 million in health care costs, Harms said.
“It’s not just the cost of the prescription,” she explained. “It’s the cost of travel, taking time off work, getting child care for appointments. Those costs add up.”
The appointment spikes illustrate just how important ACA has been for women to access the birth control method of their choice. Without coverage, out-of-pocket costs for IUDs can range from $500 to $1,000, which can be a major barrier for some women, according to Harms.
“The ACA was a tremendous asset in helping women get LARC methods of birth control,” Harms said.
Oral birth control is sometimes prescribed for managing a non-contraceptive health condition, as well. About 1.5 million women, 14 percent of pill users, do so for menstrual regulation, to lessen painful cramps, prevent migraine headaches and to help control acne, according to Planned Parenthood.
A study commissioned by the organization in 2014 showed one in three women registered to vote struggled to afford prescription birth control, with more than half those polled in the 18-34 age group. As well, the Guttmacher Institute — a research and policy division of Planned Parenthood — found 20 million women from 2010 to 2014 in the U.S. were in need of publicly-funded family planning services.
There are tremendous barriers to birth control access, even with the ACA, Harms said.
“We are not living in a utopia where every woman currently has the tools she needs to stay healthy and plan her future, and we can’t afford to have any of those rights rolled back,” she said.
Rural care gaps
The American College of Obstetricians and Gynecologists (ACOG) says disparities in health care for rural women is apparent.
Rural America is 75 percent of the nation’s landmass and home to nearly 23 percent of U.S. women age 18 and older. Those women have less access to all kinds of heath care and experience poorer health outcomes, the ACOG found in its 2014 report.
As well, sexually active women ages 15-44 were less likely to have received reproductive health services in 2013, and a greater number relied on sterilization for birth control than their urban peers, the association noted.
Price, like many GOP lawmakers, has supported scores of attempts to repeal the Affordable Care Act, and there’s no question his nomination poses grave threat to women’s health in this county, Planned Parenthood officials said in a prepared statement Tuesday.
If his replacement plan cuts access to no-copay preventative services — including sexually-transmitted infection screenings, pap tests, birth control and breast cancer screenings — 55 million women could be affected, officials pointed out.
Last year Medicaid covered more than 16 million women ages 19-64, a jump to 17 percent from 10 percent of that population in 2008 before the ACA was in place, according to the Kaiser Family Foundation.
That number includes women served through state agencies. Washington’s Department of Health partners with Planned Parenthood and other clinics around the state to help families who use government insurance — and those who are uninsured — to get family planning needs met, said Cindy Harris, director of the department’s family planning program.
Its a worthwhile investment of state money, she said: “Typically we tell people that every $1 of family planning costs saves about $7 in other public program costs.”
No ‘wait and see’
Paul Dillon, spokesman for the advocacy arm of Planned Parenthood, said it is uncertain when things are likely to change for women’s health services everywhere. Although most potential changes to the ACA would probably not come until 2018, if preventative care is redefined as not including birth control it could take effect immediately upon Price’s confimation as secretary.
“There’s a lot of uncertainty ahead, but given (Price’s) record, he has taken some really radical and extremist positions,” Dillon said. “As an agency, we’re not going to wait and see what happens next.”
The changes that appear to be coming stand to have significant impact on women — particularly low-income and women of color — their families and their communities,” Harms said. She cited a New England Journal of Medicine study that found that since Texas excluded Planned Parenthood from a state-financed women’s health program in 2013, there’s been an associated 35 percent decline in women using the most effective birth control method and a 27 percent increase in births among women who had been using the organization for such health care.
Last year the Congressional Budget Office projected a net cost to taxpayers of $130 million over 10 years due to unintended pregnancies if Planned Parenthood is defunded, she said.
“There is no debate here.”