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After a blood clot made it unsafe for her to take birth control
pills, Liz Van Voorhis switched to an intrauterine device a few
years ago. It was free — thanks to the Affordable Care Act,
which in 2012 required insurance plans to cover contraceptives
at no cost to customers.
Five years later, though, president-elect Donald Trump’s pick
for health secretary, Tom Price, is
on record for opposing that rule. The Republican-majority
Congress is moving to repeal the health care law. And Trump has
vowed to defund Planned Parenthood.
Van Voorhis was counting on the birth control mandate to cover
a new IUD in 2017, and would have trouble single-handedly
affording a device, which costs up to $1,000.
But if that mandate vanishes along with the health care law
Trump has sworn to repeal, she fears that she would no
longer qualify for insurance coverage because she has diabetes,
an expensive condition. “I shouldn’t have to make the decision
between my health and if I can afford it,” the 37-year-old told
Van Voorhis isn’t the only woman worried about affording and
accessing birth control under Trump: Planned Parenthood’s
CNN last week that the organization has seen a 900%
increase in women trying to get IUDs. Those fears have also
translated into a reported uptick in business for on-demand
birth control startups — like the Pill Club, Nurx, and
Maven — that in response are temporarily making it cheaper and
easier to order contraception through their apps and websites.
These promotions aren’t entirely altruistic, of course. In the
unprecedented political climate, capitalizing on concerns is
also a way to gain new customers.
“Our own patients were [asking], especially after the election,
‘What’s going to happen to my coverage?’” said Nick Chang, CEO
of the Pill Club, a
Silicon Valley startup that writes and fills birth control
prescriptions. “We have only so much we can control in terms of
what Trump and [vice-president-elect Mike] Pence and Price do.
But one of the ways that we can help patients right now and
prepare them for anything that happens down the line is to give
them protection and backup options.”
Since December, the Pill Club has been offering the Fallback
Solo emergency contraceptive for free to customers with
insurance; doses vary from six a year to one every three
months, depending on coverage. (Emergency contraception is also
covered by the birth control mandate.) The Pill Club only
writes prescriptions in California, but can ship to people who
already have prescriptions across 10 states.
Until the end of January, New York City-based Maven is offering customers a free
telemedicine visit with a doctor or nurse to get a birth
control prescription, or just reproductive health advice.
Maven, which can prescribe in 47 states, ships orders to a
pharmacy for the customer to pick up.
“A lot of women have been writing in, asking questions, talking
about how nervous they are,” CEO Katherine Ryder said. (She
added that not all patients were worried. When Maven referenced
a “stressful” election in an email to clients offering mental
health visit discounts, “a lot of people wrote back and said
they weren’t stressed at all,” Ryder said.)
Nurx, a Y Combinator startup that raised $5.3 million last
gave new customers $45 toward birth control in December.
It’s doing so again in January (promo code: “TinyHands”).
The startup, which also covers delivery costs, ships to
California, Washington state, Washington, DC, New York,
Pennsylvania, and, as of last week, Virginia and Illinois.
“We have a lot of users who are concerned that they would lose
access to birth control and certain users who were talking
about stockpiling birth control,” said Hans Gangeskar, who
co-founded the San Francisco startup. Nurx doesn’t encourage
hoarding, and birth control pills usually expire after about 12
months, but “we always think it’s a good idea for women to have
an extra pack or two, from a logistical perspective,” he said.
The birth control mandate is rooted in the Affordable Care Act,
but the law doesn’t have to be repealed for the mandate to end.
says insurance must cover preventive health benefits for
women, and leaves it up to the Department of Health and Human
Services to decide what counts. In
2011, it decided that birth control counted. (The rule was
later clarified to mean that of the 18 categories of birth
control that are FDA-approved, most
insurers have to cover at least one drug or device in each
category. That means, for instance, that some health plans
cover certain brands of birth control pills at no cost to
consumers, but don’t cover others.)
The new administration could simply write a regulation that
says otherwise. “That policy of requiring no co-pay for
contraceptive coverage was huge and allowed many millions of
women access to birth control care in a way that made it
accessible and affordable,” said Amy Friedrich-Karnik, senior
federal policy advisor at the Center for Reproductive Rights,
an advocacy group. “That policy and that access is really
threatened,” particularly for low-income women and women of
Still, it’s hard to predict how quickly the Affordable Care Act
as a whole will actually go away, and whether or not
alternative sources of birth control, like startups, could
become crucial as a result. The startups also say they are
optimistic about staying operational even without the health
care law: “You will need the pill whether you have Obamacare or
not,” Chang said in an email.
Repealing the law may be more difficult than initially
portrayed by the Republicans who repeatedly campaigned on that
pledge. Congress moved forward last week on setting up a
repeal bill, but GOP leaders — and Trump himself — are
mixed messages on if they’ll establish an alternative and
what that might be. Some 20 million Americans received
insurance coverage under the law.
Even if the birth control mandate were to go away, that doesn’t
mean that all women would have to pay out of pocket for it.
A few states — Maryland, Vermont, Illinois, and California
— have in recent years passed their own laws that require
insurance plans in those states to cover contraception, from
pills to IUDs, at no cost to customers. These state laws will
continue to provide coverage regardless of what happens to the
federal law, said Susan Berke Fogel, director of reproductive
health at the National Health Law Program.
However, those laws don’t apply to everyone in those states;
California’s law, for example, exempts health care plans for
In addition, certain birth control pills cost relatively little
out of pocket, so some women may still be able to afford them
if their coverage goes away. Nurx, for instance, says that it
plans to keep selling some medications for as low as $15 a
month to uninsured customers.
Still, the uncertain future unnerves many women like Van
Voorhis. As for what she’ll do when it comes time to remove her
IUD this year, she’s not sure.
“If anything, the choice is probably that I would consider not
pursuing [an IUD] in the future and just ending my current plan
of health,” she said. “And optimistically hoping that someone
talks some sense into the right people, and we have the right
type of advocacy to make a change.”