For a long time, women like Emily White a bouncy, blonde, 19-year-old college student were absolutely irresistible to pharmaceutical companies.
The drug manufacturers weren't interested in her brains. Rather, this was what you might call an opportunistic attraction based solely on sex and money. It suited everyone just fine.
Here's how it worked: Pharmaceutical companies offered phenomenal discounts on contraception to college and university health centers. That meant White paid $15 for her NuvaRing (a popular monthly vaginal insert). In turn, the pharmaceutical companies got a chance to hook the young 'uns when they were becoming sexually active, and hopefully milk them for the full price of that contraception later.
Everyone was happy. But recently, when White went to purchase her NuvaRing at the University of Colorado at Colorado Springs Student Health Center, she was hit with a case of sticker shock.
"Forty dollars," she says, "is a big difference from $15."
At first, White was ticked. Then she found out the health center wasn't simply trying to gouge her. Prices were going up at university and college health centers across the nation, thanks to a Medicaid bill that Congress passed in 2005.
Locally, UCCS and Colorado College health centers have been bombarded with women who can no longer afford their preferred birth control. White's roommate, Nikki Caravella, says the new high prices might mean the difference between her staying on contraception or taking her chances.
White didn't fully understand what had happened in Washington, but she did know that only pay from a new job a gig at a sporting-goods store would help her buy her birth control.
"I'm hoping that it won't take away from my schoolwork," she says.
Cause and effect
Like many young women, White is a little embarrassed to talk about sex. Her dad still thinks she's a virgin, and she's not sure she'd be comfortable using her parents' health plan to purchase birth control. Besides, she's not even sure their plan covers that. She could switch to a cheaper, generic brand of contraception, but she doesn't want to do that.
"I like [the NuvaRing] a lot because I don't have to remember to take a pill every day, because I probably would forget," she says.
White doesn't think the increased price in birth control will decrease sexual activity on campus. She thinks many women will make whatever sacrifices they can to continue buying their contraception.
"I think that if students are really going to want [contraception], they're going to find a way to pay for it," she says. "But I think it's still something that people are going to be angry about ... a lot of people don't even know why it happened."
The reason is complicated. In 2005, Congress passed the Deficit Reduction Act, with the intention of cutting back on wasteful Medicaid spending. One of the act's effects was to limit pharmaceutical companies' ability to offer bargain prices to most clinics that is, unless they wanted to pay much heftier rebates to Medicaid (calculated through an intricate formula). That meant offering women like White a discounted price became prohibitively expensive.
The act began affecting college and university health centers at the beginning of 2007, but most students didn't notice until spring, or even more recently, because health centers stocked up and thus were able to delay a price spike.
Mary Hoban, spokeswoman for the American College Health Association, says Congress didn't set out to hurt college students; the impact was an "unintended consequence."
Her organization tried appealing to the Centers for Medicare and Medicaid Services to allow an exemption for college and university health centers, but was turned down. The ACHA also has vainly tried to tack amendments onto larger bills making their way through Congress.
Most recently, the ACHA convinced congressman Joseph Crowley, D-N.Y., to introduce a stand-alone bill in the House, which could be strengthened by a companion bill in the Senate. It's too early to say if this latest effort will work.
"I recognize that there are probably lawmakers who are pleased, even inadvertently, that college students or young people might have less access to contraception which gets at, I think, why this has not been so easy to fix," Hoban says.
In the meantime, young women across the nation are feeling the pinch. Caravella, will soon need to decide whether to continue buying her birth-control pill.
It will be a tough choice. Caravella is sexually active, but that's not the only reason she uses birth control. Her pill helps control her periods, which are painful and marked by exceptionally heavy bleeding. Her doctor wants her to stay on the pill. But Caravella's not sure she'll be able to afford it.
Even now, she says, "I sometimes sacrifice different medications just to eat."
Caravella has used her mother's health plan for years in order to afford expensive asthma medication and contraception. But after her next birthday, Blue Cross Blue Shield will drop her at 22, she'll be too old to be considered a dependent.
Solving the financial dilemma won't be as easy as getting a job. Caravella already has one; she's putting herself through college, and says she has no disposable income. She doesn't know how she'll afford her asthma medications, let alone birth control.
"I can't do it out of pocket," she says. "I'm on some of the newer [asthma] medications right now, and some of them can cost up to $700."
Stephanie Hanenberg, director of the UCCS Student Health Center, says she's doing her best to help students afford contraception. Many students have switched from brand-name products to generics, for which she's been able to get a small discount.
Hanenberg has also urged students to get on the university health plan, but she says many can't afford to pay about $1,700 up-front for a year's insurance. In the meantime, the self-funded clinic is losing money.
"My cost went up over 1,000 percent to buy the birth control, and so I had to increase our costs, and I actually lost profit," Hanenberg says.
The same problems exist at CC.
"Some folks have to choose a price as opposed to a product," explains Kym Sova, a nurse practitioner at the college's Boettcher Health Center.
Both women say they worry about the effects of price hikes. There could be more unintended pregnancies, especially among low-income women.
At CC, the changes have spurred Lindsay Scallan to action. Scallan, a feminist and gender studies major with a minor in film, is planning to make a short film on the issue.
She thinks Congress' lack of action speaks to a larger issue.
It starts, of course, with sex. While many older folks don't want to think of young people doing the deed, Scallan says, the fact is, it happens. And that's not going to change just because it's more difficult to get birth control.
"There's kind of this expectation that women be sexually available ... you can either be hip and cool, or you can be a nun," she says of the average college woman's views.
Scallan says access to birth control is about more than sex, or the fear of sex. It's about women being able to control their own destinies by harnessing their reproductive abilities.
"If you can't afford [birth control]," she says, "you're basically back to the same era as when birth control was illegal."