The 15-minute walk has become Rachel Harris’s monthly ritual. Every fourth Sunday afternoon — when she usually has time to spare — she walks through the front gates at Georgetown University and seven blocks down O Street to the nearest CVS, where she will pick up her birth control.
It’s inconvenient, but could be worse, says Harris. When she signs for her birth control, she pays nothing for the prescription — just $2.50 for a bag of watermelon-flavored Sour Patch candy to eat on her walk back to school.
Women who get their insurance through colleges and universities with religious objections to birth control — both students and employees — have never known anything different, said Mara Gandal-Powers, the director of birth control access at the National Women’s Law Center. Beginning in 2013, the Affordable Care Act required employers to cover the full cost of birth control. When religious organizations resisted, claiming that kind of coverage would violate their religious freedom, the Obama administration introduced a loophole: Nonprofit groups with religious objections could sign a waiver to request an exemption, prompting insurance companies and the federal government to pay the cost of birth control. Women would still be fully covered.
“The process looks and feels exactly the same as it would if your employer was paying for it directly,” said Gandal-Powers. Women wouldn’t necessarily know that their birth control is paid for by the insurance company, rather than their employer or their university. “You don’t have to jump through any hoops.”
On Wednesday, the Supreme Court will hear arguments for two cases that could reverse these Obama-era policies, debating the constitutionality of birth control rules issued by the Trump administration in October 2017. The rules, currently blocked by the courts, would allow employers with religious or moral objections to opt-out altogether, forcing women on their insurance plans to pay out-of-pocket for birth control.
If this happens, Harris — who works two campus jobs to cover expenses at a school with a “striking” wealth disparity — would walk out of CVS each month with a sizable bill. Students would have to find a way to pay for care they’ve never covered before, said Gandal-Powers.
“We would be going back in time.”
Schools with religious objections should be free to deny birth control coverage to their students and employers, said Sara Jane Woods, a senior at Creighton University, a Catholic school, and the president of Creighton Students for Life. Before coming to Creighton, Woods says, prospective students and employees should be aware of Catholic doctrine: They have the “free will” to decide whether they want to attend a school that does not believe in birth control.
“It would violate the conscience of Creighton and all other Catholic schools to be forced to provide coverage for this,” said Woods.
If you pay out-of-pocket, oral birth control typically costs $30 per month. While other forms may be cheaper long-term, they usually require one large upfront payment, up to $1,300 for an intrauterine device or a Nexplanon implant.
For a college student — particularly during the pandemic, when many students and their families have lost their jobs — those costs can be prohibitive.
“Ninety dollars is a lot of money, especially if you’re a college student trying to make rent, trying to buy groceries,” said Hannah Maher, a sophomore at Loyola University in Chicago — a Catholic school — who is on the university insurance plan.
To get birth control, Maher takes a bus to an off-campus clinic, which operates on a sliding scale. She doesn’t want to have to lie to campus nurses about why she needs the prescription. If birth control was no longer covered by her insurance, she’d still find a way to pay for the pill. “I’m already an anxious mess using two forms of birth control,” says Maher, who uses both condoms and oral contraceptives. But paying out of pocket wouldn’t be easy.
As a sophomore at Georgetown, Kayla Edwards-Friedland is constantly thinking about money. She’s a first-generation college student, at school on a full scholarship. She had to stop taking birth control because she couldn’t afford the cost of mailing the prescription to the Georgetown CVS, she says. The birth control itself was $50 a month, which she says she never would have been able to cover herself.
“I’m not supported by my family back home. I have to work for all my money, supporting myself and feeding myself,” she said. Edwards-Friedland’s Georgetown meal plan only covers 14 meals per week. Other students at Georgetown order Uber Eats “like it’s nothing,” she says. “For me, 50 dollars is the difference between having lunch for multiple days, and not.”
Many students at Catholic colleges and universities come from religious families with conservative values, said Aditi Dinakar, who recently graduated from Creighton, and now lives in Washington, D.C. While some women may be able to seek family support to cover birth control costs, many students she went to school with likely don’t have that option.
“You can’t approach the subject of safe sex with your parents, and [services] like Planned Parenthood are villainized,” said Dinakar. “What options do people have?”
Even if students can afford the smaller monthly payments for oral contraceptives, the Trump administration’s rules could prevent them from accessing more permanent forms of birth control, like an IUD. At the University of Notre Dame, another Catholic university, school insurance technically covers birth control, but requires students to shell out hefty co-pays. Students generally have to pay between $300 and $400 for an IUD, said Chissa Rivaldi, who is working toward her PhD at Notre Dame.
Because of those high costs, she said, “I know multiple people who have made a decision that is less medically beneficial for them.”
If a school has a reputation for neglecting women’s health, students might be reluctant to sign up for the insurance plan at all. When her dad ended her family’s health insurance plan, Natalie Shields considered signing up for insurance through Duquesne University, a Catholic university in Pittsburgh, where she is a senior, graduating this fall. Shields needs birth control for debilitating cramps which, without treatment, cause her to vomit, pass out and miss school for days at a time. She decided against Duquesne insurance after she asked for birth control at a campus clinic.
The physician “said he’d love to, but then pointed at the crucifix in the room,” Shields wrote in a message. “That completely turned me off going on their health-care plan.” She is currently paying for birth control with money from a health saving account.
By opting out of the Obama loophole, schools would be actively trying to stop students and employees from accessing free birth control — going one step further than their current position, where they refuse to pay for the coverage themselves. For a female student or employee, this can be painful, said Rivaldi. Many undergraduates, in particular, feel a “deep emotional connection” to Notre Dame.
“No matter what happens,” Rivaldi said, “you feel like Notre Dame will have your back.”
It can be hard to reconcile those feelings with an administration that refuses to cover your basic health needs, she said.
If the Supreme Court rules in favor of the Trump administration, it will be up to university presidents and provosts to decide if they should continue to allow female students and employees to access birth control coverage.
“It leaves folks very much at the mercy of the school’s leadership,” said Gandal-Powers.
It shouldn’t be this difficult to get birth control in college, Harris, the Georgetown student, says: You shouldn’t have to lie to get a prescription, and you shouldn’t have to walk all the way to CVS.
Those things are “normalized” now, Harris says. “Everyone thinks, ‘okay, this is just the way it is.’”
It’s not hard to imagine how students might react if they suddenly have to pay for birth control. It would be frustrating for a while, she says, but then they’d get used to it. Some people wouldn’t be able to access the birth control they want, others might not be able to access birth control at all.
She can see students shrugging: That’s just the way it is.
