Bridging the Opportunity Divide

The Rx for Better Birth Control

September 20, 2017
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The Rx for Better Birth Control
Colorado's bipartisan effort to provide birth control to its citizens has led to a 54 percent decrease in unwanted pregnancies. Photo by Toeps/iStock
“The fact is that if you want to end a cycle of poverty, you prevent unplanned pregnancy.”

Back in 2015, word was going around on social media claiming that Colorado — a state that battled high unwanted pregnancy rates for years — had reduced those numbers drastically by changing the way women accessed birth control.

The rumor was right.

Unwanted pregnancies among Colorado women ages 15 to 19 years old have dropped by 54 percent over the past seven years, thanks in large part to the state providing access to intrauterine devices, or IUDs, and long-lasting birth control. The move enabled another progressive bill aimed at reducing unwanted pregnancies to win universal support between Republicans and Democrats.

“I think that if I’m being really honest, we were pretty surprised at the robust bipartisan support we got on this,” says Sarah Taylor-Nanista, vice president of public affairs at Planned Parenthood of the Rocky Mountains, which oversees clinics in Nevada, Colorado, New Mexico and Wyoming. “We anticipated it to be a lot more controversial than it was, and it was really heartening to see it go through the way that it did.”

The bill, which was signed into law in June 2017 by Democratic Gov. John Hickenlooper, allows women to receive a 12-month prescription of birth control pills or patch at no-cost after an initial, one-time, three-month prescription. The bill also required the state to cover three-month vaginal rings, which also prevent pregnancy.

note from the state’s independent governing research body, the Colorado Legislative Council Staff, found that the change in the law would result in “minimal” impacts to the fiscal budget, although it could affect insurance premiums paid by the state, assuaging conservative fears that an exorbitant amount of state funding being funneled towards contraception.

“Sometimes it’s a long ways to the pharmacy,” says Sen. Don Coram, who sponsored the Senate bill and lobbied other Republican senators to view the bill through an economic lens. “The fact is that if you want to end a cycle of poverty, you prevent unplanned pregnancy.”

The bill passed the state Senate with bipartisan support, 22-11.

Coram, a self-proclaimed “redneck Republican,” extolled the social benefits of contraceptive accessibility, something usually heard from more progressive leaders.

“It’s just a common sense thing. I’m from rural Colorado where 70 percent of my district is federally owned land. I don’t have a Walgreens around the block,” he tells NationSwell. “And the fact is, birth control only works when you take it.”

Purple support

Polls conducted in 2014 by Planned Parenthood showed contraception is a nonpartisan issue nationwide — something Colorado legislators were able to use in their advantage. According to Colorado state Rep. Lois Landgraf, a Republican who co-sponsored the bill in the House, a bit of manipulative planning was required to get bilateral support.

“I’ll tell you one thing I did when [testimonies] were heard in the Senate: I asked Planned Parenthood to stay home,” Landgraf tells NationSwell. “As soon as they come to the House, people start thinking about Planned Parenthood and all the negative connotations that it has for some Republicans. Not as if their testimony wasn’t helpful, but if it leads one mind’s astray from the actual problem, there’s no value in it.”

Landgraf says that the bill was a “good bill for women and for men,” but preconceived notions about the organization needed to be erased. In their efforts to replace the ACA, Republicans on the national stage have argued for the defunding of Planned Parenthood, but swing states and districts overwhelmingly support Planned Parenthood’s mission of providing access to contraceptives.

That’s because increased accessibility is especially good for women in rural areas, says Erika Hanson, a legal fellow at the National Women’s Law Center (NWLC).

“These types of laws disproportionately affects women in rural areas, because as with many for services in rural areas, it is very difficult for women to access healthcare,” Hanson tells NationSwell, adding that the NWLC offers a hotline specifically to provide assistance to women who have a hard time accessing contraception. “We hear from thousands of women who are having troubles getting coverage or getting access to birth control and often it is as simple as they can’t find an in-network provider that’s close enough to them. Or they’re getting the runaround from their insurance company about what pharmacy to go to, which may not be close.”

After some initial pushback from Republicans in 2015, the success of Colorado’s IUD program — including a savings of $111 million in birth-related Medicaid costs by the Colorado Department of Public Health and Environment — was enough to convince members of both parties in the state legislature that it deserved to be expanded.

Time bound coverage?

Washington’s tug-of-war over the Affordable Care Act (ACA) has caused states to be wary of future legislation changing the existing contraception mandate, which requires insurers to cover all forms of contraception (though only from one manufacturer). That aspect of the bill has been widely praised among women for eliminating costs associated with getting birth control.

In 2015, during a heated partisan debate on whether privately-held companies should be forced to offer birth control coverage, 49 congress members signed a letter urging the Secretary of Health and Human Services, Sylvia Burwell, to provide a roadmap to insurers for 12-month contraceptive coverage for women across the nation.

No federal guidelines were issued as a result of the letter.

In response, several other states have also expanded coverage beyond federal regulations.

Traditional blue states, such as Oregon and California, have also made oral contraceptives and patches available for year-long prescriptions, a move that reduces unwanted pregnancy by 30 percent. That same study, conducted by the University of California San Francisco’s Bixby Center, reports that extended contraception coverage also lowers the number of abortions by 40 percent.

California also made it a requirement that insurance plans pay for all forms and all brands of birth control. Research shows that lack of brand choice causes two-fifths of women to go without birth control.

But women in states with expanded coverage are at-risk of losing it if their employer disagrees with the use of contraceptives for religious reasons. President Trump is expected to eliminate an Obama-era rule requiring employers to provide birth control through employer-sponsored health insurance plans. The new rule, which mirrors an earlier draft and is expected to be written any day now, would allow employers to omit birth control coverage from health insurance plans completely, according to the Wall Street Journal.

Democrats say 50 million women in the U.S. will be forced to pay for birth control out of pocket.

But the win for contraceptive rights in Colorado is not lost on Planned Parenthood’s Taylor-Nanista, who wants to continue the momentum of bipartisanship within the state and hopefully the rest of the nation, especially in a time where female contraception coverage is at stake.

“Many of our activists and patients are feeling really concerned and hopeless,” she says. “But I think this bill is a great example of what we can do when we think strategically.”

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