What Gynecologists Think About Obamacare's Repeal

Ashley Batz for Bustle

On November 9, Google searches for "should I get an IUD?" went up by 800 percent. In the weeks following, women rushed to their doctor's office. One month after Donald Trump won the 2016 election, Planned Parenthood received 82,000 donations from "Mike Pence". And now over two months after Election Day, Planned Parenthood says demand for the IUD is up by 900 percent. To say that American women are scared, frustrated, and anxious about the fate of their reproductive rights, the cost of contraception, and their healthcare coverage under a Trump presidency — and an imminent Affordable Care Act repeal — is an understatement.

The Affordable Care Act provides access to preventative services to 47 million women, including free access to contraception like IUDs, which can cost up to $1,000 without ACA. The act has provided insurance coverage to 20 million people who were previously uninsured.

Currently, the repeal is moving forward, but is not yet finalized. On Jan. 12, the U.S. Senate voted 51 to 48 to start working on repealing Obamacare — and next the House will vote. But if it's repealed without an alternative healthcare law in place, then millions of people could likely lose the coverage they gained under the ACA.

So many aspects of this are so frightening and horrifying potentially detrimental to women.

“If the ACA is repealed, millions of women will lose access to affordable birth control, which would be a huge step backwards for women’s health," Britt Wahlin, Vice President for Development and Public Affairs of Ibis Reproductive Health, tells Bustle. "We must be talking about expanding access to contraception, not restricting it. The ACA helps people pay for insurance who wouldn’t be able to afford it otherwise and has other important protections for women, young people, and LGBT communities. We urge all policymakers to think about the dire consequences eliminating the ACA will have for women’s health care.”

Since Trump won the election a lot of women have been seeking advice from our healthcare professionals — many who have been vocal over social media about what's at stake. Dr. Lauren Streicher M.D., Associate Clinical Professor of Obstetrics and Gynecology Feinberg School of Medicine at Northwestern University and author of The Essential Guide to Hysterectomy, says she's even gotten backlash on Twitter for discussing it. "I don't want to talk about politics, but when we have politicians controlling the medical decisions that I can offer to my patients, well then I think it's not only OK for doctors to talk about politics but I think they have an obligation in order to protect the health of their patients."

So what can we expect once Obamacare is repealed? It's still unclear, but gynecologists who've seen the benefits (and problems) from Obamacare firsthand, and are seeing female patients worried about their healthcare on a daily basis, have a lot to say about what could be next — and what we can do.

1. Dr. Sheila Loanzon, Author Of Yes, I Have Herpes: A Gynecologist’s Perspective In and Out of the Stirrups

"From a gynecology perspective, ACA offered guaranteed preventative women's health services, including routine exams and contraceptives. It's easy to become nervous that this available service may disappear. It's important to keep in mind that there are reassuring options. You can take your health and family planning into your own hands and out of the hands of insurance companies. While ACA is still in action, seek a women's health provider for a routine pap/pelvic/ breast exam. We recommend getting these exams every 2-3 years based on your previous history. By getting these preventative exams, you can detect and manage abnormalities before ACA ends. There are also a variety of options for contraceptives, particularly long-term methods like a Nexplanon Rod, which lasts for three years, or IUDs (intrauterine devices), which can last five to ten years. If contraception is a concern for you then consider these long-term devices. *Please note IUDS and Nexplanod will still be available after ACA, but people may have less access to them because they'll be more expensive."

2. Dr. Lauren Streicher M.D., Associate Clinical Professor Of Obstetrics And Gynecology Feinberg School Of Medicine At Northwestern University And Author Of The Essential Guide to Hysterectomy

"So many aspects of this are so frightening, and horrifying, and potentially detrimental to women. Most of young women's healthcare needs in their twenties involve contraception, STI screenings, and well-woman care, and we have a double whammy of not only losing congress, but with Planned Parenthood likely to become defunded, these women are going to be left with very few options — and certainly very few affordable options.
One of the things I think is so clear cut is if you look at the number of unplanned pregnancies in this country — and in general, 50 percent of pregnancies that occur are are unplanned — for the first time in the last couple of years, we saw that number start to go down significantly. It wasn't going down because people were having less sex — it was going down because of greater access to contraception, particularly long-acting reversible contraception (LARC), like IUDS. It doesn't take a genius to predict if there's no longer access to affordable LARC and other contraception, we're going to start to see those unplanned pregnancy rates go up. Obviously this is highly problematic on multiple levels.
We're focusing on contraception and pregnancy prevention, which is appropriate, but don't forget that women rely on their insurance and Planned Parenthood for STI screening and for cancer screening, like pap tests. It is no small thing to no longer have those things be accessible to millions of women."

3. Dr. Michael L Krychman, Sexual Medicine Gynecologist, Executive Director Of The Southern California Center For Sexual Health And Survivorship

"It is concerning that many people will be faced with the challenges of losing their insurance. Too often we focus on sickness rather than wellness and many women will suffer adverse health consequences from limited access to care. Contraception utilization, gynecological wellness, and obstetrical care may suffer not to mention the treatment of sexual transmitted infections which have far reaching implications on overall health."

4. Dr. Alyssa Dweck M.D., Assistant Clinical Professor Dept. Ob/Gyn, Mount Sinai School Of Medicine

"I am hopeful that doctors like myself will be relieved of the overwhelming non-medical tasks we have to deal with (endless charting, electronic chart management, and data entry responsibilities). Sometimes I feel like a glorified data entry clerk rather than a physician. I also pray for a less complicated insurance maze for my patients. I would be thrilled if medical malpractice and tort reform could be addressed. I hope physician choice and hospital choice could be up to patients, not an outside entity."

5. Dr. Diane Horvath-Cosper, Reproductive Health Advocacy Fellow At Physicians For Reproductive Health

“The Affordable Care Act been incredibly beneficial for women, and many OB/GYNs are very concerned about what will happen if it is repealed. For young women especially, the ACA has allowed people to access the contraceptive that best fits their medical needs, without having to worry about some of the higher up-front costs for highly effective methods like IUDs and implants. If you’re a person seeking birth control, there’s no better time than right now to have a discussion with your health care provider about the method that best fits your life.

6. Dr. Colleen McNicholas, Director of the Ryan Program at Washington University In St Louis And Fellow With Physicians for Reproductive Health

"There was a lot of rhetoric during the campaign and very little policy substance. From a patient perspective, the concern about loss of health care coverage [is the biggest worry], and for young patients more specifically, the potential loss to contraceptive coverage tops the list. Remember, nobody plans for or hopes to one day need an abortion. It is those of us who work with people seeking abortion that carry that fear. We have seen what the existing restrictive policies have done to access, to autonomy, and to the men, women, and families we care for.
Access, and that means access to both preventative care, contraception, as well as abortion [is most at stake now.] Even with the successful addition of more than 20 million people to the insured population, women, particularly in conservative states that did not expand medicaid, remain amongst the highest groups of uninsured. With threats to repeal the Affordable Care Act, it is unclear what will happen to medicaid expansion. It is unclear what will happen to the contraceptive mandate. This continues to be a major frustration for the public health community and advocates for reproductive rights. We have a simple, safe, and effective way to prevent unintended pregnancy and reduce abortion rates, yet political ideology prevents policy makers from common sense implementation."

7. Dr. Prudence Hall, M.D, Founder And Medical Director Of The Hall Center

"As one of the most advanced countries in the world, access to healthcare must be mandatory, regardless of a citizen's financial status. If Obamacare is removed, it must be replaced by a better plan that addresses and improves on what we already have."

So What Do We Do?

First, we can take care of ourselves as much as possible, which includes being a mindful of our lifestyle choices. "ACA is great for preventative health," Dr. Loanzon says. "Even without it, it is still important for you to take great care of yourself. Eat well, exercise regularly, be mindful of your choices in terms of high-risk behaviors in sexual activity, smoking, and illicit drugs. By taking these steps, you can prevent health issues from arising positioning yourself for great health moving forward."

Dr. Horvath-Cosper recommends getting screened now, too. "It’s hard to know exactly what will happen going forward, but I’d recommend being proactive about getting routine health care like cervical cancer screenings, STI testing, and breast exams sooner rather than later," she says. "I think we’re trying not to be alarmist, but the fact is that just a few short years ago, preventive services weren’t as well-covered, people could be denied care based on preexisting conditions, and women could be charged more for premiums simply because they were women. OB/GYNs and other women’s health care providers are acutely aware of the gains made under the ACA, and of what our patients stand to lose if it is repealed.”

As for the fate of your birth control? Also unclear, but Dr. Streicher says it's an excellent time to get an IUD. "For women of reproductive age, getting an IUD now is really an excellent idea because they will have coverage for 3-10 years depending on which IUD they choose," she says.

As many OB/GYNs shared above, the repeal of ACA will be damaging for women, but as Trump steps into office, it's more important than ever not to give up. "Be hopeful," Dr. McNicholas says. "There are armies of advocates, physicians, nurses, social workers, administrators, and lawyers committed to ensuring that women and men have access to the full spectrum of reproductive healthcare. We are determined to continue to provide that care in a way tat allows them to exercise their autonomy and rights as they navigate what is best for them. Be informed. Understand what is happening in your state. Continue to demand that you are treated with respect and dignity."

Inspired to do something ASAP? Dr. Streicher has an excellent suggestion: take a minute and donate $10 to Planned Parenthood.