President Trump recently renewed the "repeal and replace" battle cry promising to make the 2020 election a referendum on Obamacare. While many speculate about the impacts of potentially repealing the Affordable Care Act, a new study published in the journal Contraception found the debate is already impacting women's health across the U.S., namely their contraceptive choices.
Under the ACA, Americans gained access to prescription contraception without out-of-pocket costs. This included intrauterine devices, or IUDs, that had long been favored by doctors because of their effectiveness, but shunned by women because of their historically high out-of-pocket costs.
The data shows that uptake of IUDs under the ACA both reduced women's total out-of-pocket health care costs by 40 percent and reduced unintended pregnancies. But given that the "repeal and replace" debate is heating up again, how are women responding to potentially losing this birth control benefit?
For the new study, the team turned to Google Trends, a public archive of aggregate internet searches, where searches often mirror what the public is thinking and doing with their health.
The team monitored the fraction of Google searches emerging from the U.S. for the three most popular reversible contraceptive methods between January 1, 2004 through October 31, 2017, one year following the 2016 presidential election. This included searches for IUDs (those mentioning "IUD" or IUD brands "ParaGard", "Mirena", "Skyla", "Liletta", and "Kyleena") contrasted against searches for oral contraceptives and condoms.
Searches for IUDs were cumulatively 15 percent higher than expected the year following the 2016 election, reflecting 10 to 21 million more searches than normal. Searches for IUDs were significantly higher in all states except Nevada, and the increase was consistent regardless whether the state was won by Trump or Hillary Clinton.
Moreover, patterns in search trends mirrored the political debate on Capital Hill, revealing for the first time that just the conversation in Washington is impacting women's choices. For instance, searches for IUDs reached a record high in May 2017, with 8.3 million total searches that month, when an ACA repeal advanced in the House.
At the same time, the team found searches for oral contraceptives and condoms remained stable or declined, respectively, the year following the election -- reinforcing the finding that women's increased interest in IUDs is uniquely related to the ACA debate.
Republicans under Trump have tried unsuccessfully to repeal and replace the law.
A lawsuit challenging the ACA's constitutionality, brought by 19 Republican governors, puts the GOP in a political bind over supporting the repeal of a law that is popular with consumers and their constituents. Trump recently said Republicans would unveil an ACA replacement after the 2020 election.