WASHINGTON — After Donald Trump won the presidency, Marivic Valencia promptly made an appointment with her gynecologist.
The 44-year-old Madison, Wis., marketer decided it was time to get her intrauterine device replaced, and like thousands of women across the United States, figured there was no time to waste. Since Nov. 9, there has been a monumental increase in interest in the birth control devices.
“I’d had one for the last 10, 11 years. It was time to either renew or think about something else,” she said. “I was looking at other options, and I just didn’t really feel like I had the time to explore all those other options.”
Those included a vasectomy for her long-term partner or getting a tubal ligation, before the new administration took office.
Unlike those options, an IUD — a small device inserted into the uterus through the cervix to prevent pregnancy — is an outpatient procedure that doesn’t require anesthesia, and is considered nearly as effective a method of birth control.
Valencia isn’t worried the U.S. is going to turn into some The Handmaid’s Tale-style dystopia under Trump; her concern is that Trump and the GOP will live up to their promises to repeal the Affordable Care Act, the health reform legislation President Barack Obama signed into law in 2010.
After years of bouncing between being uninsured and getting health care coverage through employers, Valencia has been using the statute to maintain consistent health insurance coverage.
She’s one of an estimated 20 million Americans affected by Obamacare — including about 12.6 million who are using the health insurance exchanges.
“I’m on a health care exchange, and that’s a target. My whole family is on it,” she said. “My concern was what my plan might look like.”
Valencia’s concerns are valid: Senate and House Republicans inserted legislation to defund many parts of the Affordable Care Act as part of January’s budget reconciliation process even before President Trump took office, though it’s a non-binding resolution that doesn’t require his signature.
They also defeated an amendment by Senate Democrats that would have required that the birth control mandate be maintained regardless of the status of Obamacare.
The budget resolution directs four committees to begin writing a full repeal, and Trump has promised to reveal his replacement plan soon — though his pick to run the Department of Health and Human Services, Rep. Tom Price of Georgia, isn’t scheduled for a confirmation hearing until Tuesday.
Meanwhile, Trump signed an executive order immediately after his inauguration ordering his agencies to begin preparing for the act’s repeal, and authorizing them to act to minimize its reach within the extent permissible by law.
But because the contraceptive coverage provisions have no budgetary impact and are a codified regulation with only a minimal religious exemption, the Obama administration’s mandate that birth control must be offered with no copay through insurance plans as preventative care will not be affected by the first part of the Obamacare rollback.
However, there are other changes that Trump could make that could further impact women’s health care coverage, via the regulatory process or executive order — such as like the birth control mandate — long before Congress gets around to the “replace” element of Trump’s promise to “repeal and replace” Obamacare.
Plus, it’s broadly expected that Republicans will somehow eliminate the birth control coverage mandate. Price, the pick to run the agency overseeing the law, said in 2012 that the mandate was a violation of the First Amendment right to freedom of religion, and not necessary to ensure any woman’s access to contraception.
That mandate has been controversial among anti-abortion activists over the past six years. In 2014, it was subject to a successful Supreme Court lawsuit involving the craft retail chain Hobby Lobby, which allows closely-held, for-profit companies with religious convictions to refuse to provide such coverage.
The possibility that the Trump administration and a cooperative, Republican-led Congress will soon drastically alter birth control options has many women worried.
“I used to pay about $30 a month prior to Obamacare, and that was with insurance,” said Sarah Burris, a 31-year-old journalist in Washington.
She had been mulling swapping her monthly birth control pill regimen for an IUD for months after reading several articles about their safety and efficacy, but opted to stay on the pill for medical reasons.
After the election, she called up her healthcare provider and made an appointment to get Mirena, one of four hormonal IUD options on the U.S. market. Mirena can remain in place for five to seven years, while the Paraguard IUD, the only non-hormonal option, can remain in place for 10 to 13 years.
“Knowing it was something I would not have to worry about for the next 5 years was important,” she said. “But hopefully after 4 years I won’t really have to worry about it.”