Why I See Trump's Repeal of the Birth Control Mandate as an Attack on Healthcare

Friday was a difficult day to be a person who uses contraception. It was also a difficult day to be a person who uses medication and healthcare in general. I believe the announcement of the Trump administration’s decision to end the requirement for contraception coverage should have alarmed everyone working for affordable, accessible healthcare. It caused a familiar mix of frustration and anxiety to start forming in my stomach.

It was similar to the anxiety I felt abstractly during the threatened Affordable Care Act repeals earlier this year, and the frustration I felt concretely when I recently changed insurance providers. Searching through my new insurer’s formulary lists, calculating my new monthly co-pay for using a specialty drug based on its category (after anxiously hoping to find it on the list at all), budgeting for the inevitable maximum out-of-pocket costs, hoping my current doctors are all still “in-network” and I won’t have to begin my PCP and specialist searches all over again. For those of us living with chronic illness, having someone other than ourselves and our doctors make medical decisions is nothing new.

You may not realize how many approval steps there are between you and your doctors’ treatment decisions and actually getting your medication, especially once that medication becomes long-term and insurers realize they’re in it for the long haul. I used to regularly run out of migraine medication halfway through each month, and because insurance will not cover more I’d spend the second half of each month in fear of my own neurology. I also, of course, spent a significant portion of those days lying in bed in severe pain. I can think of three separate months-long delays on MS medicine because of slow-moving miscommunications between my doctor, my insurance and my specialty pharmacy. Switching to a new insurance provider means switching to a new pharmacy, and both have layers of paperwork required to prove that your doctor really meant it when she wrote the prescription in the first place.

While my biggest outrage over this contraceptive rights rollback isn’t about jumping through administrative hoops, the idea of HR becoming another entity to decide whether my doctor legitimately prescribed my medication is absurdly frustrating. And this is assuming employers don’t prefer a flat-out ban on all contraception, forcing us to buy medication at full out-of-pocket prices, adding to already excessive monthly medical costs. If employers choose a case-by-case basis, would we have to submit paperwork to “prove” our birth control is used for a purpose that doesn’t offend the organization’s morals? How long would the waiting period be? How often would they need that paperwork renewed? I wonder what kind of hourly commitment is required to add this additional medical approval system to our lives?

Additional third-party approvals are not the only similarity between this attack on reproductive health and the dysfunction of American healthcare system in general. Defenders of the contraception opt-out have claimed “responsibility” as one of their primary talking points, insisting they refuse to be forced to pay for someone else’s “choices.” This is a refrain frequently used against the chronically ill, regardless of illness or treatment, implying that illness is a direct result of carelessness and people with long-term medical needs are somehow gaming the system. Supporters of the ACA repeals suggest that making healthcare unaffordable/unobtainable will somehow make people more responsible. When used in the context of contraception, “responsibility” is a way to attack a specific gendered group and push the idea that people wanting basic healthcare are entitled. We are reframed, again, as people trying to game the system into paying for what people not involved in our care have decided are non-necessities.

This anxiety and fear is nothing new to the chronically ill. We’ve been through this fight with each ACA repeal bill. The fundamental beliefs behind broad ACA repeals and this targeted limit are the same: healthcare is seen as a privilege, and needing medication you cannot afford seen as a moral failing.

Editor’s note: This story reflects an individual’s experience and is not an endorsement from The Mighty. We believe in sharing a variety of perspectives from our community.

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Thinkstock photo via areeya_ann.