In addition to making health insurance accessible to the millions of Americans who were previously ineligible or unable to afford it, the Affordable Health Care Act also made it much easier for women to afford contraception. That's because Obamacare prohibited insurance providers from charging co-pays for birth control, according to TIME, but if Trump repeals the ACA like he has promised to, that provision will disappear. How much will birth control be without the Obamacare benefit? The true cost won't be known until the Republicans offer up the replacement plan they've vowed to design, but a 2015 University of Pennsylvania study found that "the ACA is saving the average pill user $255 per year," according to TIME.
One of the major hallmarks of Obamacare is that it ensured that all Americans could get health insurance that would cover essential health care costs, like emergency care, hospital costs, prescription drugs, chronic disease management and rehabilitation services (even for those with pre-existing conditions). But Obamacare also amped up coverage for many aspects of women's health care, too: in addition to the birth control pill, other FDA-approved contraceptive methods, like vaginal rings, diaphragms, sponges, IUDs, Plan B, and sterilization were mandated to also be covered without a co-pay, regardless of whether the deductible has been met, according to HealthCare.Gov.
Although there were some restrictions — Obamacare does not cover abortions or vasectomies, and certain religious organizations are exempt from providing contraception care — the effect of the ACA on out-of-pocket costs has been tremendous. According to TIME, a report by the Kaiser Family Foundation found that coverage of the pill alone "[accounted] for 63% of the drop in average out-of-pocket spending on retail drugs since 2012."
That's a big deal, but in January, Senate Republicans voted down an amendment meant to save the ACA's birth control provision in the repeal process, according to Forbes. And that wasn't even all they voted down: according to TIME, the amendment would have continued to prohibit insurers from charging women more than men for coverage, or from considering pregnancy to be pre-existing condition. It also meant that mammograms and cancer screenings, previously also offered without a co-pay, would require out-of-pocket costs unless Trump's health care plan ends up including them again.
Given Trump's apparent anti-abortion stance, coupled with his determination to see Roe v. Wade repealed by the Supreme Court of the United States, according to CNN, it doesn't actually seem to make a whole lot of sense that he would then also want to make contraception more difficult for women to actually get. After all, unless you are going to completely outlaw sex, it stands to reason that making contraception more expensive will inevitably lead to more accidental pregnancies — and if abortions become illegal (or, at least, pretty much impossible to actually get within a reasonable amount of time and for a reasonable amount of money), that has to mean that there will be an increase in the number of women raising babies when they really were in no position to actually do so, or getting illegal abortions that likely won't be very safe.
In a statement to CNN, Planned Parenthood's chief medical officer, Dr. Raegan McDonald-Mosley, said that contraceptive was "basic health care for women," and that Obamacare has made it much easier for women to access effective, long-term birth control options, like IUDs:
We have seen an increase in IUDs over the last few years thanks to the Affordable Care Act and growing public awareness of their safety and efficacy, and we expect that trend to continue. Planned Parenthood health centers nationally have seen the total number of patients using IUDs increase 91% over the last five years.
In fact, concern about a Trump presidency has meant that, even before he was elected, the number of women looking to get IUDs — which typically can stay in place for years — rose about 20 percent, according to CNBC. Because an IUD would theoretically mean that women wouldn't have to worry about contraception costs even if the ACA is repealed, it naturally seemed like an ideal choice for anyone worried about affording birth control without Obamacare. And given that the initial cost of IUD insertion can be anywhere from $500 and $1,000, it's no surprise that women were rushing to get them while they were still covered by their health insurance plans.
Although both contraception and abortion access are issues that many Republicans are against, the reality is that continuing to subsidize contraception is likely one of the most effective ways to actually reduce the rate of abortions. In fact, it's already happening: according to the Guttmacher Institute, the rate of abortions in the United States is currently at an all-time low, at 14.6 abortions per 1,000 women aged 15–44. While this is, of course, in part due to the increased restrictions placed on abortion at the state level, the rate of unintended pregnancy is also declining, according to a 2016 study in the New England Journal of Medicine, suggesting that promoting birth control — and making it affordable — is an effective way of ensuring that pregnancies that might otherwise end in abortion don't actually occur in the first place.
This approach was seen pretty clearly in Colorado in 2013. According to CBS News, in 2009, the Colorado Department of Public Health and Environment instituted the Colorado Family Planning Initiative, which provides free long-term birth control (like IUDs or implants) to women in the state. The goal was to reduce the rate of unintended pregnancy, but the program turned out to be much more successful than anyone expected. According to The New York Times, the teen pregnancy rate in Colorado fell by 40 percent between 2009 to 2013, and the rate of abortions amongst teens also fell by 42 percent. Young women aged 20-24 saw a 20 percent drop in birth rate, and an 18 percent drop in abortions, according to the Colorado Department of Public Health, especially among young, unmarried women without high school diplomas — a group also at higher risk for unintended pregnancy.
It was cost-effective too: according to the Colorado Department of Public Health, an estimated $79 million in birth-related costs was saved between 2010 to 2012, "making the initiative’s return on investment $5.85 for every dollar spent." And then there are the elements that are hard to quantify — the number of women who wouldn't be pushed into poverty as a result of becoming mothers before they were ready, and can go on to finish their education and get better paying-jobs, or the number of children who won't have to grow up in homes where their needs might not be met.
Despite its success, the program wasn't embraced by everyone. According to NPR, the state voted against providing funding after private funding from the Susan Thompson Buffett Foundation ran out in 2015. That's because, even though subsidizing birth control meant fewer abortions, some lawmakers felt giving teens access to contraception encouraged them to have sex, and that it didn't allow for parental involvement. Private organizations filled the funding gap temporarily, until the state Senate passed legislation in April 2016 to continue the program for a year, according to The Durango Herald.
These days, it seems like the best hope for reproductive rights under a Trump presidency would be that, for some reason, he opts to roll out a health care plan that also provides coverage for contraception and women's health care like Obama did. But given the disdain that many Republicans seem to have for birth control (despite the fact that it actually achieves their desired goal of reducing abortions), it probably isn't likely.
That will of course make things more difficult for women who have to pay out-of-pocket for at least some of the cost of their birth control, but for women who literally could not afford contraception before Obamacare (or most other health care costs, for that matter), it means that Trump's ACA repeal will likely be devastating.