1972: Immaculate Contraception

By Carly Priest

“To unapologetically ignite, and together, rise”

Immaculate Contraception

“Take the Pill once a day, keep basic civil liberties at bay”? It’s not exactly the old adage about doctors and apples, but given the recent revisions to the Obama-era contraception mandate, maybe we should consider an aphoristic revision.

In October, the University of Notre Dame announced its university health care plan would no longer fully cover contraception, affecting employees and students. Notre Dame’s announcement came in response to Trump loosening the contraception mandate provision of the Affordable Care Act, which required most private insurance plans to fully cover all FDA-approved forms of female contraception.[1] The decision to rescind contraceptive coverage should come as no surprise to those who remember Notre Dame’s lawsuit back in 2012, when the University “sued for relief from the ACA mandate” (the case was eventually dropped).[2] After a firestorm of criticism, the University of Notre Dame then announced that it would not, after all, rescind full-coverage of FDA-approved contraceptive devices.[3]

So, problem resolved, no?

Though the University of Notre Dame eventually withdrew its October decision to rescind coverage, we must acknowledge the fullness of why an attempt to end full contraceptive coverage is so politically problematic in the first place. The rollback of the contraception mandate discriminatingly, deliberately, and deplorably restricts the freedom of women, particularly those who have less access to fiscal and social capital.

Practically speaking, birth control copayments are expensive.  Out-of-pocket costs can be prohibitively high— Prior to the ACA, the average woman who sought contraceptive care spent hundreds of dollars annually on birth control medications.[4]  In the case of oral contraceptives alone, the percentage of women shouldering copayments for oral contraceptive care dropped from 21 percent to three percent in a two-year period.[5] Moreover, the Henry J. Kaiser Family Foundation further reported that there was no statistically-significant increase in the number of women who went on birth control during that same two-year period.[6]

But, back to Notre Dame (not to pick on the University). The Notre Dame website states that health insurance is required for all full-time graduate, doctoral, and international students (undergraduate students are “encouraged,” though not required to have coverage). Interestingly, full-time graduate students on scholarship may be subsidized by the University for purchasing the Notre Dame University health insurance plan, thus establishing a fiscal incentive for students to enroll in coverage. From what I can gather from the Notre Dame Health Services and Financial Aid Office webpages, some of the financial aid packages extended to undergraduate students may also have university healthcare as part of their scholarship-covered expenditures.

Fiscally-incentivizing students to select a health insurance plan that includes no full coverage for female contraception is preposterous. Tangentially, imposing restrictions on the loophole through which some women could theoretically obtain no-cost contraception seems intensely more problematic. As the Chicago Tribune reported: “The [University of Notre Dame medical plan will cover contraceptives if they’re used to treat a specific medical condition, not as a method to prevent pregnancy. Those medications will come with standard prescription copayments.”[7] Really Notre Dame? Though I applaud the University for its recognition that various forms of birth control are standard and accepted treatments for an array of medical issues, the greater question—agency— still stands. Are we going to lie to each other because I cannot afford a copayment?

According to the current health insurance policy of the College of the Holy Cross, students may opt-out of the college health insurance policy if they are able to prove their coverage under a comparable plan. If health insurance is required for enrollment at Holy Cross, we may infer that those who opt-out of the school plan do so because they have 1) good health insurance, and 2) more to gain (i.e., better coverage) by opting-out.

Herein lies the bulk of my disquiet: When Notre Dame pulls out of no-copay contraception, they throw to the wolves the very women for whom it could be most financially difficult to find and fund an alternative form of gynecological care.  Even if an outside organization (all hail Planned Parenthood) could provide contraception on a free and reduced-fee sliding scale, a potentially-prohibitive financial burden can still be imposed on women seeking care, in travel fees and time away from school or work. Such financial obstacle could render contraception inaccessible to even fully-insured individuals.

That there is a whole slew of problems which emerge in attempts to restrict the agency and liberty of women bears repeating. Look, anyone who attends a four-year college or university has a certain (though individually-variant) degree of privilege. While I gesture in this article toward a tiny slice of the problem today—student health insurance plans of Notre Dame and Holy Cross—know that I also point an accusatory finger to all of those institutions which will unfairly impose undue financial burden on the very women for whom finding an alternative form of care could be most difficult. Step aside and trust women—Individuals must have the opportunity to make their own medical decisions based on their own bodies and lifestyles.

[1] Ranji, Usha; Alina Salganicoff, Laurie Sobel, and Caroline Rosenzweig. “Ten Ways That the House American Health Care Act Could Affect Women.” The Henry J. Kaiser Family Foundation. Published May 07 2017. Accessed November 13, 2017. https://www.kff.org/womens-health-policy/issue-brief/ten-ways-that-the-house-american-health-care-act-could-affect-women/#Contraceptive.

[2] Browne, Paul. “Notre Dame, on religious liberty grounds, sues for relief from federal mandate.” Published December 3, 2013. Accessed November 13th, 2017. https://news.nd.edu/news/notre-dame-on-religious-liberty-grounds-sues-for-relief-from-federal-mandate/.

[3] “Notre Dame Reverses Decision to End Birth Control Coverage” http://money.cnn.com/2017/11/08/news/economy/notre-dame-birth-control/index.html

[4] Ranji, Usha; Alina Salganicoff, Laurie Sobel, and Caroline Rosenzweig. “Ten Ways That the House American Health Care Act Could Affect Women.” The Henry J. Kaiser Family Foundation. Published May 07 2017. Accessed November 13, 2017. https://www.kff.org/womens-health-policy/issue-brief/ten-ways-that-the-house-american-health-care-act-could-affect-women/#Contraceptive.

[5] Ranji, Usha; Alina Salganicoff, Laurie Sobel, and Caroline Rosenzweig. “Ten Ways That the House American Health Care Act Could Affect Women.” The Henry J. Kaiser Family Foundation. Published May 07 2017. Accessed November 13, 2017. https://www.kff.org/womens-health-policy/issue-brief/ten-ways-that-the-house-american-health-care-act-could-affect-women/#Contraceptive.

[6] Ranji, Usha; Alina Salganicoff, Laurie Sobel, and Caroline Rosenzweig. “Ten Ways That the House American Health Care Act Could Affect Women.” The Henry J. Kaiser Family Foundation. Published May 07 2017. Accessed November 13, 2017. https://www.kff.org/womens-health-policy/issue-brief/ten-ways-that-the-house-american-health-care-act-could-affect-women/#Contraceptive.

[7] Crary, David. “Lawsuit Targets Trump’s Rollback of Birth-Control Mandate As Notre Dame Plans to End Coverage.” Chicago Tribune. Published November 3rd. 2017. Accessed November 13TH, 2017. http://www.chicagotribune.com/news/nationworld/midwest/indiana/ct-lawsuit-trump-birth-control-notre-dame-20171102-story.html.

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