Obamacare, Birth Control, & Me

Today is the day. As part of the Affordable Care Act, insurers will have to cover some preventative services — birth control pills among them — without copays or cost-sharing, in the first plan year that begins on or after today’s date.

Okay, so my plan rolls over in September. Technically, the first of next month is the day for me. But today is the day I am going to start thinking about it.

Because this pill, I’m not so sure it’s working out for me. I woke up in too much pain to get out of bed on the first try. And between the desert summer, my sweat, and the amount of fluid coming out of my vagina, I’m finding it awfully hard to stay adequately hydrated. Not to mention that what I’d really, really like is to be able to stack pills and — as long as I’m spewing out fantasies here — suppress pain and bleeding completely. (I would say “at least down to normal levels,” but at this point, I believe I have already had enough extra pain and blood to feel like I deserve to be done now.)

Cost-wise, I’m pretty lucky already. I have health insurance, for one. For two, I’m on a pill that my insurance plan considers Tier 1, which makes the copay pretty affordable. But that’s balanced against, you know, the fact that these pills aren’t really doing their job so well. But that’s more a “medical science has shit-all to treat my endo” issue, not so much a health care affordability issue.

Which is why I feel a bit guilty for hoping what I’m hoping and considering what I’m considering.

There are some pills that my insurance will never classify as Tier 1 because they cost approximately eleventy billion dollars per pack. They are, however, of such a variety as to lend themselves toward stacking. In the past, I’ve been afraid to try them for two reasons: fear they might not work and fear they would. If they didn’t work, that meant I would have spent a ridiculous amount of money to trade a known set of symptoms and side effects for another set that was equally craptastic — or perhaps even more so. (Not to mention, the joy of adjustment side effects.) If they did work, that meant I’d either resolve to try to go on them permanently — which, in reality, would likely mean I delayed refills some months due to lack of sufficient monies — or know that there was something out there that did work but that I couldn’t afford it reliably.

Except now — well, in September — I would be able to afford it. Which doesn’t mean it will work and still leaves the question of whether the hormonal side effects are worth switching (could get better, could get worse). However, financially, I could afford to risk it — and if it worked out, I could afford to continue taking a medication that actually helped me. That’s no small thing.

And I understand, yes, that this is not what this provision of the Affordable Care Act was designed to do. Access to affordable contraception is not the same thing as me wanting to try some brand name pills on the chance that they’ll help my endometriosis symptoms. For folks using hormonal contraceptives for, you know, contraception, not being at risk for unplanned pregnancy due to lack of finances is a big fucking deal.

And yet, this is also true for pain management. Starting September 1, I may no longer have to tell my doctor, “If it’s not generic, don’t even bother.” Being able to choose a medication based solely on how well it works (or might work), rather than how much it costs, is a big fucking deal.

Pildora lighht

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