Contraception has become a political football.
On October 6th, the Department of Health and Human Services (HHS) relaxed the provisions in the ACA stipulating employers must cover birth control for their employees. Entities do not need to provide coverage if they have "sincerely held religious beliefs" or a "moral conviction" against contraception, a result of President Trump's executive order "Promoting Free Speech and Religious Liberty."
According to the HHS, this shift was a reflection of a commitment to upholding constitutional freedoms with conscience rights falling under this purview. "No American should be forced to violate his or her own conscience in order to abide by the laws and regulations governing our healthcare system," said Caitlin Oakley, HHS Press Secretary the day of the release. Some have welcomed this shift. "As a Latina, in general, I have been very openly critical of President Trump. But on this issue, I think this administration has honored religious freedom. Freedom of conscience is something I celebrate as a Latina, as a human being," shared Dr. Ana Samuel of the Witherspoon Institute.
"This has nothing to do with religion. They already had accommodations. This is about taking away fundamental health care-plain and simple," says Bridgette Gomez, Director of Latinx Outreach and Engagement for Planned Parenthood. Previously under the ACA, religious employers were exempt from having to provide contraceptive coverage and non-profit religious organizations received accommodations so that the organization itself did not have to pay or arrange for contraceptive services. However, to some these exemptions and accommodations were not constitutionally sound. "Conscience rights have such weight under the American constitution that if they are abrogated, they must be abrogated in the least restrictive way," states Dr. Ashleen Menchaca-Bagnulo, Associate Professor of Political Science at Texas State University. The implications of holding this position, believes Dr. Menchaca-Bagnulo, is that administrations in the future- regardless of party- will respect the seriousness of conscience rights in their executive actions.
This shift could also be interpreted in the larger scheme of the ACA debate. "Their whole plan is to sabotage the ACA, which as a [latinx] community was a huge step forward to health care access," Ann Marie Benitez, Senior Director of Government Relations for the National Latina Institute for Reproductive Health (NLIRH). Cost is one of the prohibitive factors Latinas experience when trying to access birth control and many have come to depend on ACA approved plans to access them free of cost. But this phenomenon is not the norm. "If we look at Canada's system, for example, contraceptives are not free under their universal health care plans," adds Dr. Menchaca-Bagnulo, "Including free birth control in such a system may not be reasonable. Making lower cost birth control available from clinics and pharmacies could still be a goal of such a system."
It is hard to know how many women will be affected by the new HHS rules. The administration claims only employees of the 200 entities that filed lawsuits will be affected; however, "we don't know how many will be affected because it is up to the employer to decide and that is scary," says Gomez. About 57.5 million women receive health care coverage from their own or their spouse's employer according to the Kaiser Family Foundation.
An imminent danger is misinformation. Denisa, a mother of two, shared that her friends told her she was at risk of losing birth control coverage because of "la ley esa de la religión," or "that religion law." She is covered by Medicaid, which is not affected by it.
Before the ACA, contraceptives represented 30-40% of out-of-pocket health care spending for women according to a study led by Nora Becker, MD, PhD resident physician in Internal Medicine at Brigham and Women's Hospital. Planned Parenthood puts the range of birth control co-pays between $15 and $50 a month. This translates to $180 to $600 a year. If women opted for reversible long term contraception, while more effective and cheaper in the long run, upfront costs could be staggering. "Women on average were paying $250 upfront. But this amount varied even within one insurer. Some women were paying $700 to $800 upfront," adds Becker. Christina, a Latina in her twenties in New York City, remembers considering an IUD brand not covered by her insurance, "they were going to charge me 700-something dollars. I couldn't drop that kind of money."
"Latinas already have a hard time affording birth control," says Gomez. Latinas working full time year round are paid 54 cents for every dollar paid to a white male and in 2015, "20.9 percent of Hispanic women lived in poverty," according to the National Women's Law Center. Fifty-seven percent of young Latinas ages 18-34 struggled to afford birth control before the ACA. Laura, a Latina graduate from an elite women's college in Massachusetts, got birth control in college for the first time because her school insurance covered it. Had she not had insurance, "it would have impacted my other expenses since work study is minimal pay," Laura recalls. "We know from our organizers on the ground that contraception is always a concern in our communities and many have started wondering what it might mean now that they might have to pay out of pocket," says Gomez.
Latinas and women across the board feel their access to birth control is at risk with the constant threat of the ACA repeal and replace. "After Trump was elected, we saw a 900% increase in IUD insertion because women were worried about having access to birth control during his presidential term," says Gomez. Denisa has a 2 year old son, is pregnant with her second child. She and her husband decided not have any more children for now. She is worried about accessing birth control after she gives birth if insurance coverage policies change. "You have to pay for it monthly. It's like having another mortgage!" Latinas already face a host of barriers in accessing birth control, "when you add an additional one... it makes it that much more complicated to access to birth control- something that should be part of basic care for women," says Benitez. "Principle is at stake here," according to Dr. Benjamin Sommers of the Harvard T.H. Chan School of Public Health "of whether we treat contraception as a general approach to health care. It is a treatment, prevention, medication."
The ACA put contraceptives, along with other services such as vaccinations and cancer screenings, on the list of essential care and preventative services that must be covered by insurers. Hormonal contraceptives help women dealing with excessive menstrual bleeding and pain, lupus, diabetes and heart disease according to the NLIRH. But the primary use for most women is pregnancy prevention. "Contraception helps Latinas plan for their families and their well-being. It is truly central to our health," says Benitez. Ann Marie Benitez shared her own experience with contraception. When she and her husband were trying to have their second child, her husband was diagnosed with cancer. Contraception helped her family focus its time and resources on the issue at hand. "It helps make families stronger," she adds. Unintended pregnancies put an additional economic burden on a family resulting in lower health outcomes. Additionally, planning allows women to attain higher education levels and pursue careers before having children, leading to economic stability, according to the Guttmacher Institute.