Women's health advocates brace against Trump, Republican changes - Colorado Springs Gazette

On Monday, Lisa Cook plans to get an implantable birth control device lasting at least five years.

She hopes Donald Trump's expiration date as president comes sooner.

She's among a surge of women reportedly rushing to get birth control as Trump assumes the presidency and congressional Republicans can take action without fear of a White House veto. That could include stripping federal funding from Planned Parenthood and repealing former President Barack Obama's signature domestic policy achievement, the Affordable Care Act.

In an executive order just hours after being sworn in Friday, President Trump directed government agencies to scale back as many aspects of the Affordable Care Act as possible.

The moves, say Republican leaders, are needed to fix a health care system burdened by rising premiums, high deductibles and shrinking coverage options in rural Colorado and many other parts of the nation.

Local women's rights advocates, health care providers and Planned Parenthood clients, however, fear access to affordable birth control and other services could be swept away in the process.

Many are predicting an increase in unintended pregnancies if funding and health care mandates are scrapped.

"We're thinking about it, really, as a public health crisis," said Adrienne Mansanares, Planned Parenthood of the Rocky Mountains' chief experience officer.

The number of women seeking five-year implantable birth control devices jumped considerably from the same time last year at Planned Parenthood of the Rocky Mountains, Mansanares said. She did not provide specific figures.

Another uptick - mainly of women seeking birth control pill refills or other services, such as Pap smears - occurred at Peak Practitioners, a small women's clinic owned by Judith Chandler, a Colorado Springs nurse practitioner.

"He (Trump) says he has a great plan, but like his income tax, he hasn't revealed that plan to us," Chandler said. "We don't know what's going to be gutted."

Not all women's health care clinics have seen similar spikes. Others contacted by The Gazette said appointments have been relatively flat since Trump's election.

For Cook, 34, the decision was simple.

"It's better than having nothing," she said.

'We can't go back'

For people with private insurance, the Affordable Care Act mandates carriers cover birth control.

And the law, also known as Obamacare, allows almost all forms of birth control to be obtained without a copay, even when patients have yet to hit their annual deductibles.

Medicaid's expansion also vastly increased the number of people eligible for its birth control benefits.

Those changes included birth control pills and highly effective, implantable devices that can last for years. A Colorado program that expanded their use before the health law's provisions took effect helped dramatically reduce unintended pregnancies across the state.

From 2009 to 2014, birth and abortion rates declined by nearly 50 percent for teens ages 15 to 19, and by about 20 percent among women ages 20-24.

Cook, of Colorado Springs, has used such a device for the past five years and it's worked perfectly - no pregnancy scares or complications. She said she got it at a Peak Vista Community Health Centers clinic, and it expires in April.

But she fears there will be changes to the state's Medicaid program, also known as Health First Colorado, as part of a repeal of Obamacare. Others with private insurance are concerned out-of-pocket expenses for birth control could rise in coming years.

"We can't go back - we can't," said Cook. "We fought too hard for this."

Determining whether their fears are grounded in reality is difficult.

Congressional Republicans have yet to introduce a replacement health care plan - offering, instead, vague promises that coverage will remain robust across the nation. Trump, too, has yet to propose a replacement, but has said his plan will "cover everybody."

Insurance coverage under the Affordable Care Act for 2017 is expected to be honored, because that plan year has begun.

For their part, Colorado Medicaid officials are urging caution.

"It's not clear what is going to change fast, and what will take more time," said Judy Zerzan, the program's chief medical officer.

Reaction from Colorado's delegation has been mixed.

In a statement, Sen. Michael Bennet, D-Colo., called for fixing the health law, rather than scrapping it. Should it be replaced, he stressed the next version "must not roll back the progress we have made" on making reproductive health services accessible.

Rep. Doug Lamborn, R-Colorado Springs, however, characterized the law as having caused "disruptions and chaos."

"While I appreciate that there is uncertainty out there for some, I would encourage them to give the new president and the unified Republican government a chance to show that there is a better way forward for health care improvement and reform in this country," he said in a statement.

U.S. Sen. Cory Gardner, who describes himself as "pro-life," recently reintroduced legislation seeking to make birth control available over the counter without a prescription. His plan has come under fire from Planned Parenthood, however, amid concerns that too few options would be available.

Planned Parenthood cuts

More clear has been GOP leaders' insistence on removing federal funding for Planned Parenthood centers across the nation. House Speaker Paul Ryan, R-Wis., announced plans this month to slash that funding. Trump has advocated for such a move, despite having said "millions of women are helped by Planned Parenthood."

Doing so would cut about $400 million in Medicaid money from Planned Parenthood's operations. According to the nonpartisan Congressional Budget Office, that would cause 400,000 people to lose access to that care.

In Colorado, Planned Parenthood said it saw 70,335 patients last year - a figure that may not represent its full caseload. The Colorado Springs clinic was either closed or at reduced capacity for part of 2016 while repairs were made to the building after a gunman stormed the clinic in November 2015, killing three people and wounding nine.

Those patients accessed birth control more than 106,000 times, and nearly as many tests were administered for sexually transmitted diseases.

Thousands of breast exams and Pap tests also were administered.

Removing Planned Parenthood's federal funding isn't about restricting access to birth control, but about the organization's stance on abortion, said Kelly Maher, executive director of Compass Colorado, a nonprofit that promotes limited government and free-market principles.

A decades-old law bars federal funding from going toward abortions, except in cases of rape or incest, or if the pregnant woman's life is at stake. But Maher said federal funding allows the organization to free up other money for abortions.

She also stressed that concern about what could be covered is premature, because Trump has just taken office.

"I'd really urge caution for people who are going over the top in terms of, kind of, scare tactics," she said Friday. "It's not productive for us moving forward. It's just more divisive rhetoric."

Summer Westerbur, a Colorado Springs Feminists board member and a health insurance broker, acknowledged the health law has its flaws.

Deductibles are too high, and narrowed networks have made it more difficult for patients to see the doctors they want, she said.

Still, she added that the law was a boon for women's health care, and several women in her group have benefited from the care Planned Parenthood provides, and from protections afforded through the health law.

She framed Republicans' vows to defund Planned Parenthood as a cruel irony.

"They strongly oppose abortion," she said, "but they want to defund the organization that's responsible for preventing some of the unplanned pregnancies."

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The Associated Press contributed to this report.