What Trump's Presidency Might Really Mean for Women's Health
And why we're being encouraged to get IUDs while they're still an option.
In the wake of this week's election, millions of women may be wondering what the changing of the guard could mean for their healthcare and reproductive rights. Big changes to the Affordable Care Act and abortion access are on the table, since both were major parts of the Trump/Pence platform.
But women are worried about other issues as well—like intrauterine devices, or IUDs. In the past two days, several sites have suggested that women who aren’t looking to get pregnant any time soon should jump on this long-acting form of birth control, and the idea has been discussed widely on social media.
Does Donald Trump want to ban birth control? No, not as far as we know. However, plenty of what he and his running mate have proposed do raise concerns about access to healthcare—including, for some women, contraception. Here’s what we know might be at risk, and what to follow in the coming months.
Although Trump has praised Planned Parenthood for helping “millions and millions of women with breast and cervical cancer” (presumably through screenings, diagnoses, and follow-up care), he has also said he's committed to de-funding the organization because it provides abortions.
“Nobody should doubt that’s going to be a big goal of his once he gets into office,” says Jennifer Gunter, MD, an ob-gyn based in San Francisco. “And that’s a big concern, not just for abortion access but for STD testing and all kinds of care that women who don’t have insurance need.” (Even with the implementation of the Affordable Care Act, millions of Americans still go without health coverage.)
Vice President-elect Mike Pence has his own history with Planned Parenthood: As governor of Indiana, his public health spending cuts forced the closure of one clinic that happened to be the only HIV-testing facility in its county. Over the next few years, health officials documented the worst HIV outbreak in the state’s history.
Guaranteed coverage and free preventative services
If you get your insurance through your job or your spouse’s job, it may seem like Trump’s plan to repeal government-subsidized coverage doesn’t affect you.
But portions of the Affordable Care Act apply to all insurance providers—like the part that says preventive services (such as annual ob-gyn visits, mammograms, and prescriptions for birth control) must be provided free of charge, with no co-pay. So does the part that says insurers cannot deny coverage because of a preexisting condition, or that you can stay on your parents’ insurance until you turn 26.
Trump hasn’t detailed yet which parts of President Obama's health care law he would carry over to his new plan, and it’s uncertain how quickly he could dismantle the existing structure. But with the help of a Republican Congress, it’s safe to say that big changes are definitely coming.
Trump has campaigned on an anti-abortion platform and has pledged to appoint conservative Supreme Court justices (at least one) that could overturn Roe v. Wade, sending abortion laws back to the individual states to decide. Pence is also firmly pro-life, having passed strict abortion restrictions as governor of Indiana.
The President-elect has also promised to sign a law that would outlaw abortions nationwide after 20 weeks, before many fetal abnormalities can be detected via ultrasound, and to ensure that federal funding (including Medicaid) is not used to pay for abortions.
Insurance-covered birth control and emergency contraception
The rallying cries to run out and get an IUD that lasts up to 12 years (long enough to “outlast Trump”) may sound a bit alarmist, but there is some logic behind the argument. While Trump has not spoken specifically about this topic, Pence told a conservative talk show host in October that his new boss would repeal the Affordable Care Act’s birth control mandate, which requires employers to cover contraception as part of their company-sponsored insurance plans.
“That would mean that some insurers could choose to drop birth control coverage,” says Dr. Gunter. “And for women who do want IUDs, that could mean spending $600 to $1,000 out of pocket.”
Also at stake: Coverage for prescription versions of emergency contraception (the "morning-after pill"), which many pro-life and religious organizations oppose as well. (Ella is currently available by prescription and covered under the Affordable Care Act, while Plan B and its generic versions are sold over-the-counter for about $50, and not usually covered.)
It’s highly unlikely, under any presidency, that women won’t be able to get any type of affordable birth control. “There will always be generic birth control pills for $5 a pack, so there will always be something,” says Dr. Gunter. “But IUDs and implants have been shown to be the most effective at preventing pregnancy, which should be an important consideration.”
If you were already thinking about getting an IUD, Dr. Gunter says it is a good idea to do so now, without delay. Otherwise, she says, women might want to consider getting one for several reasons—not just because of who's in office. “Don’t get an IUD now because Trump is going to be President in January,” she says. “Get an IUD now because you’ve decided it’s the right method for you and the right time to do it.”