Bright fluorescent lights shone down on Amy Handler as she walked into her college pharmacy on a mission to obtain birth control for the first time. As she discussed her health insurance, however, the pharmacist told her that her three-month pack would cost $120.
Handler was confused. Her parents had good insurance that she expected to cover the cost of her birth control. She asked the pharmacist to check the price again. The pharmacist, unfazed, confirmed the price and offered no solutions to the high bill.
Handler learned that her parent’s insurance, which was provided through the religious university her father was employed at, did not cover the cost of contraceptives. After weighing her options, Handler made the difficult decision to pay the full price out of pocket, a hefty price for a college student’s budget.
Handler’s experience occurred in 2005 when states determined whether they wanted to have a contraception coverage mandate. In states that decided against the mandate, insurers and employers were able to choose whether or not to cover contraception. Experiences like Handler’s may become more commonplace after the ruling of a recent Supreme Court case.
On July 8, the Supreme Court ruled in Little Sisters of the Poor vs Pennsylvania that employers with moral or religious obligations may limit or exclude themselves from providing affordable or free contraceptives in their employees’ insurance plans. People who use birth control may find themselves restricted from obtaining affordable contraceptives if their employers decide to apply for this exemption. Government officials have estimated that the effects of Little Sisters of the Poor v. Pennsylvania could leave as many as 125,000 women without contraceptive insurance coverage.
During the Obama administration, the Affordable Care Act, also known as Obamacare, passed in 2010. The act included a contraceptive mandate that required most employers and insurers to cover contraceptives approved by the FDA cost-free. Since the contraceptive mandate, many more American women have had access to affordable contraceptives.
With Little Sisters of the Poor v. Pennsylvania, many women may suddenly find themselves without contraceptive coverage and have no choice but to pay higher prices or stop using their birth control entirely.
“Those are the people that are going to get affected,” says Handler, who is now Chief of Education and Community Partnerships at Planned Parenthood of Southwestern Oregon. “It’s people who have insurance, who assume it’s going to be covered and then get that sticker shock when they’re trying to access their birth control.”
Without insurance, the birth control pill, one of the more affordable contraceptive options, can cost anywhere from $20 to $50 per pack, a yearly sum of $240 to $600. Approximately 62 percent of women in the United States use some kind of birth control, but about three-quarters of those women would not be able to afford their contraceptives if the price were to exceed $20 a month, according to the Gender and Birth Control Access Report by PeryUndem, a public opinion research firm.
Josie Hinke, a University of Oregon student, currently uses an oral contraceptive. Her father’s insurance covers the total cost of her birth control. However, if her parent’s employers were to opt-out of contraceptive coverage, she says she would no longer be able to afford to buy it every month. Her specific brand of birth control, Tri-Vy Libra Lo, costs approximately $30 a month without insurance.
“$30 a month is ridiculous,” Hinke says. “If that was the case, I would be looking into alternative methods for sure.”
Those who prefer other forms of contraceptives can expect even higher prices. Implants, such as Nexplanon and Implanon, which are inserted into the arm and last approximately three years, cost over $800 each without insurance. Products such as the NuvaRing, a flexible plastic ring that releases hormones to prevent pregnancy, need to be replaced every five weeks and can cost over $100. Intrauterine devices, like Mirena and Paragard, can cost more than $1,000 each.
Little Sisters of the Poor v. Pennsylvania creates a grey area for those who have insurance. Since the contraceptive mandate implemented by Obamacare in 2012, many women expect contraceptives to be covered at low or no cost. Now, many may find themselves in a position where they have health insurance but are excluded from coverage of essential reproductive health treatments, not only for family planning. According to the Center for Young Women’s Health, birth control can be used for treating acne, migraines, irregular periods, severe period cramps and polycystic ovary syndrome. Without affordable contraceptives, people who use birth control to treat their medical issues may not be able to find any affordable alternatives.
This type of ruling can be confusing for the employees who may be affected and for the physicians and pharmacists who need to navigate the changing landscape of women’s reproductive health. Josie Van Scholten, CEO of Women’s Care, a Lane County based women’s health clinic, says it can be difficult for health care professionals to help their patients understand what options are best for them.
“It’s frustrating for us because it’s a constant battle to try and figure out what plan somebody is on to help them understand their benefits,” Van Scholten says. “We have to help people navigate.”
At the time of writing, there are no clear guidelines on how companies can apply for their exemption. But for those who find themselves affected by this ruling and cannot afford their contraceptives, there are a few solutions.
There are two Planned Parenthood locations in Eugene, and all Planned Parenthood clinics work on a sliding-scale payment method where contraceptive prices differ depending on a person’s income and how much they’re able to afford. At Planned Parenthood, a wide variety of birth control, from oral contraceptives to permanent procedures such as sterilization, can cost as low as $0. Handler recommends making an appointment at Planned Parenthood, and says the physicians there will make sure that people can get their birth control for low or no cost.
According to the Oregon government website under the Oregon Reproductive Health Program Manual, Oregon residents whose income is at or below the 250 percent federal poverty line, which is an income of $31,900 a year for a single person household, and are unable to pay for contraceptives, are protected from high prices under the Oregon Reproductive Health Program. The Oregon Reproductive Health Program has a statewide network of health care workers to ensure Oregon residents have access to a myriad of reproductive health services such as contraception and preventative health care.
But the ruling on Little Sisters of the Poor v. Pennsylvania may make stories like Handler’s more common.
“Anything like this is a loss for people’s health and wellbeing,” Handler says. “Every time we limit access, we’re limiting someone’s ability to bodily autonomy, their rights, to make decisions about their body and the life that they want to lead. Any decisions like this really limits people’s basic human rights.”
