Since the election I have been asked repeatedly, “So what happens next” when it comes to reproductive rights. Will Roe v. Wade fall? Will abortion become illegal? Will birth control become unaffordable or worse, will the most effective methods (intra uterine devices or IUDs) be falsely reclassified as abortifacients?
While those appear to be the end goals of our President Elect, Vice President-Elect, and many Cabinet members it will almost certainly take at least one more Supreme Court vacancy, in addition to the one that we already have that is, for Roe to take a fatal hit. Getting rid of Roe, the abortion law that supersedes all others, will take time and there is simply no guarantee that it would fall to a legal challenge. After all Sandra Day O’Connor was a conservative appointee, yet she essentially saved Roe in 1992.
The most immediate assault on reproductive health care is far more likely to be an attack on contraception. If Rep. Tom Price becomes Secretary of the US Department of Health and Human Services (HHS) expect the Affordable Care Act (ACA) to go, possibly in favor of his Empowering Patients First Act. Despite Trump’s promises, dismantling the ACA will take time. Possibly two-three years and will be a cumbersome process that involves Congress, however, contraception coverage can be addressed more swiftly and with greater surgical precision.
Rep. Price, an orthopedic surgeon. has made no secret of his ill-informed views on contraception. He doesn’t believe that a single woman has ever had issues affording birth control. He has co-sponsored a Personhood bill for fertilized ovum and is a member of the American Academy of Physicians and Surgeons, a group of doctors who have pushed a veritable rogue’s gallery of scientifically discredited medical beliefs from abortion causing breast cancer, to vaccines causing autism, to global warming being beneficial for humans, to AIDS denialism.
In 2011 the The Institute of Medicine (IOM) rightly designated contraception as primary care and recommend full coverage without cost-sharing. Prior to the ACA women of reproductive age spent 68% more on out-of-pocket health cares costs than men, in part due to the cost of contraception and unfortunately more than 50% of women reported not using their method as directed due to cost.
Since the ACA access to no cost contraception has increased dramatically and now almost 90% of women with insurance have no out of pocket coasts even for an intrauterine device (IUD), which is the most effective but expensive form of reversible birth control. Abortion rates are also at their lowest level in decades, in part due to expanded coverage of contraception costs and increased use of the most effective forms of birth control, IUDs and implants.
As Secretary of HHS Price has the ability to redefine preventative care so it doesn’t include birth control and he doesn’t need the approval of Congress to do so.
Based on his previous statements and actions there is no reason to believe that he will not go after contraception. This ruling could go into effect for 2018 plans. Obviously some health plans will continue to cover contraception because it’s both cost effective and the right thing to do and some will do it because many states has legislated some contraceptive coverage, but the cost is likely to go up for almost all women and so for many the most effective forms of birth control will once again be too expensive. It is also more likely Price will look to insert conscience clauses and promote the lie that IUDs cause abortion so health plans can have a “honest” way to back out of contraception coverage.
Price can also work with Congress to remove birth control coverage from Medicaid plans and will most certainly work to stop federal funding for Planned Parenthood. This has been Vice President Elect Pence’s vocal wish for years, so Price will have all the help he needs inside the Beltway. Planned Parenthood, with their sliding scale, has long been a contraception safety net for many women.
There will be more unplanned pregnancies and so abortions rates will rise. Approximately 50% of these unplanned pregnancies will end in abortion whether it is legal and safe or not. The refusal of people like Price, being a doctor make sit much worse, to accept that contraception reduces abortion is maddening beyond belief.
With the new government we will be ushering in a post-factual world for women’s reproductive health care. It’s ironic that Rep. Tom Price’s own health care reform plan is called the Empowering Patients First Act. The type of medicine Price supports is the exact opposite of empowerment. His lies do not advance health care, they hurt women. Perhaps he should rename his plan the Empowering Male Patients Only Act.