The Trump administration's ruling last week that allows more companies tois "like a Mack truck driving through the current regulations," said Mara Gandal-Powers, senior counsel at the National Women's Law Center.
Under the Affordable Care Act, all employers except houses of worship were required to provide 100 percent coverage of all birth control methods, no matter what the cost, as part of the law's mandated preventive care services.
But two sweeping new regulations announced last week, effective immediately, would exempt the following entities: Nonprofit and for-profit employers with an objection to contraceptives based on religious beliefs, nonpublicly traded employers with moral objections and college-based student health centers.
How many of the 62 million women who currently benefit from contraceptive coverage will be affected remains unclear until employers begin to take action. The U.S. Department of Health and Human Services maintained in a news release that the new rules "may impact only about 200 entities," which is around the number of employers that have filed lawsuits based on religious or moral objections.
The statement also said the rules would have no effect on over 99.9 percent of the 165 million women in the US.
But women's health advocates believe that number will be much higher. The rule proposed by the Trump administration allowing any employer, school or other entity to opt out of providing contraceptive coverage for religious or moral reasons is "a standard unprecedented in its vagueness," Cecile Richards, president of Planned Parenthood Federation of America, said in a statement. "With this rule in place, any employer could decide that their employees no longer have health insurance coverage for birth control."
California, Washington state, Massachusetts and the American Civil Liberties Union have already filed lawsuits against the Trump administration challenging the new regulations. Bob Ferguson, Washington's state attorney general, successfully sued to block President Trump's travel ban earlier this year.
Nine out of 10 women use birth control sometime during their lives, making it one of the main health expenditures for women in their child-bearing years. The ACA's coverage provision saved women an estimated $1.4 billion on birth control pills in its first year alone, according to a study published in Health Affairs in July 2015.
"The number of women benefiting from the provision has only increased since then, meaning the total out-of-pocket savings on contraceptives is potentially much greater," said Nora Becker, a doctor, health economist and co-author of the study.
The study also found that on average women saved an estimated $255 annually for oral contraceptive pills and $248 for intrauterine devices, two of the most popular forms of birth control.
Contraception coverage has been controversial since it began. Litigation began almost immediately, leading up to a 2014 Supreme Court decision. In two cases, including the well-known Hobby Lobby case, the court allowed a key exemption to the law for religious objections. Hobby Lobby, a closely held private company, and others argued that emergency forms of birth control covered under the ACA constituted a form of abortion and thus violated their religious beliefs. The high court ruling for Hobby Lobby paved the way for more lawsuits.
The current legal situation is further complicated by the fact that -- at first glance, at least -- the new regulations may not supersede state laws, according to the Kaiser Family Foundation. Eight states have laws requiring 100 percent contraceptive coverage and another 20 require coverage with employees paying some of the cost.
Worried about the Trump administration's promise to repeal and replace the ACA, many women have been concerned about losing their contraceptive benefit since last Election Day, said Gandal-Powers. Calls to the National Women's Law Center hotline about the topic increased significantly after the election and inauguration. "Now we're seeing a spike in calls again since last Friday," she added.
For women who think they may be at risk of losing birth control coverage, the following advice might help lower out-of-pocket costs.
Look for a head's up
By law, insurers must give 30 to 60 days notice of any change in their plans. When you get this notification, it may be the time to stock up on birth control pills or consider changing to a longer-term method such as an IUD or implant. These methods have high up-front costs -- as much as $1,000 for an IUD implantation -- that can be hard to afford without coverage.
Best to talk to your doctor as soon as possible about any potential changes or actions you can take if your coverage discontinues, so you can both be ready when the mandatory notification hits.
Consider a generic or lower-cost pill
Several kinds of available oral contraceptives also vary in price. The average monthly cost for birth control pills ranges from $160 to $600 a year. Low-cost generics can be found for some brand names, and some brands cost less than others. You'll need to ask your doctor if a lower-cost substitute that might work for you without side effects is available.
Keep in mind that oral contraceptives are like any other prescription drug. Prices can vary dramatically depending on the pharmacy. It makes sense to compare prices and look for discounts offered by chain drugstores and big-box stores.
Look for low-cost providers
The Trump administration argues that women who lose coverage can find low-cost alternative sources for birth control, including federal health clinics, Medicaid coverage and providers such as Planned Parenthood. The irony, of course, is that these are also being targeted for big budget cuts and other actions by the administration.
For the time being, however, if you have access to a clinic that provides birth control services, you may find the fees are lower.