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Bills, Bills, Pills

On October 18, 2007, the office phones of Senator Christopher Dodd and US Congresswoman Rosa DeLauro started ringing off the hook. Yale students, upset at a sudden and dramatic increase in the price of birth control prescribed through Yale University Health Services were calling their Democratic representatives to protest. The 2005 Deficit Reduction Act (DRA), a law originally aimed at curbing Medicaid fraud, had simultaneously ended a long-standing tradition whereby pharmaceutical companies sold birth control to university health centers at deeply discounted prices. The arrangement had allowed schools to provide prescriptions to their students for as low as four or five dollars a month, but recently, prices have jumped to as high as fifty dollars. Participants in a phone-in organized by the Reproductive Rights Action League at Yale (RALY), the students calling in their complaints–every minute, for hours–had a simple demand: Fix it.

The group’s co-chair, sophomore Alice Buttrick, believes that the price hike was a legislative oversight. Susan Yolen, vice president of public affairs for Planned Parenthood, agrees. “It’s not our impression that this was intentional,” Yolen says, adding that Planned Parenthood is currently involved in lobbying efforts to reverse the bill’s unforeseen consequences. Yet more than a year after the DRA was enacted and six months after RALY’s well-attended phone-a-thon, many Yale women are still paying ten times more for their birth control than they were before the law went into effect. Despite both public mea culpas from legislators who support reproductive rights and the recent proposal of a bill that would allow universities once again to receive discounted drugs, the issue has taken the back burner to the war in Iraq, the presidential election, and a looming economic recession.

The question is not whether well-organized nationwide opposition will eventually win the law’s repeal through a war of bureaucratic attrition, nor whether Yale women can bear the brunt of the price increases. The question is whether, while lobbyists prod Congress to get around to correcting its blunder, the victims–low income women at universities across the country–can stand to wait.

Few people, even those directly involved in fighting the legislative snafu, understand exactly why prices for prescription birth control have suddenly skyrocketed. Both Yolen and Buttrick are fuzzy on the specifics, given the length, scope, jargon, and acronym-heavy language of the DRA.

Peter Steere, associate director of Yale University Health Services, offers a clearer explanation: Federal law mandates that Medicaid programs receive drug manufacturers’ “best price” for prescription drugs. Prior to the law’s passage, campus clinics and other “safety-net” health-care providers were excluded from the “best price” calculus so that manufacturers could sell discounted pills to universities without also having to lower Medicaid prices. The DRA closed this loophole for university clinics, while many other low-cost providers–such as Planned Parenthood and some community health centers–remained unaffected. In the New Haven area, low-income and uninsured women can still receive discounted birth control at the Fair Haven Community Health Center, the Hill Health Center, the Haven Free Clinic, and, of course, Planned Parenthood.

But when it came to universities like Yale, pharmaceutical companies were faced with a choice: Continue selling discounted prescription birth control drugs to student centers and see their profits plummet, or raise prices. They chose to raise prices.

The confusion surrounding the act has bred resentment and led some students to suspect that the DRA’s consequences were entirely by design. Though Buttrick is certain that the law was an “accident” and Yolen concurs that “it’s not our impression that this was intentional,” at the Yale Women’s Center, talk of the price hike among board members past and present quickly snowballs into a broader discussion of the Bush administration’s assault on the rights of women, especially poor women.

Isabel Polon, the Women’s Center’s political action coordinator, has her doubts about labeling the price increase an innocent oversight. “Whether it was an oversight, or whether it was intentional,” she says, “Congress in general doesn’t have women’s rights as a priority. We know where the administration stands on these issues.”

Chase Olivarius-McAllister, who served as political action coordinator last semester, is even more explicit. “It’s about breaking the backs of poor women. The legacy of this administration is going to be that they made poor women’s lives awful on every front.”

For these activists, the passage of the DRA, coupled with Congress’ failure to enact any timely corrective legislation, is not an isolated incident; it indicates the Bush Administration’s hostility towards women’s rights as well as a general, nation-wide complacency. “This is not seen as a necessary health service that women are entitled to,” Presca Ahn, a coordinator at the Women’s Center, adds. “[Congressmen] don’t want to talk about it until they get a call every second from Yale University students.”

Despite the high turnout at the rally phone-a-thon, it’s unclear how many Yale students have been tangibly affected by the act. While Steere has noticed that many women now buy their birth control one month at a time (instead of stocking up on four cycles), he hasn’t seen an overall drop in the numbers of contraceptive prescriptions. Although a Yale College Council committee has been exploring the issue, and Steere has heard “the occasional expression of frustration,” he observes that students have not been complaining “as loudly or frequently as some might have thought.

Polon attributes a lack of student response to the university’s socio-economic demographics. “On other university campuses there has been an uproar,” she explains. “Twenty dollars isn’t going to make a world of difference to the average Yale student, but that’s not the case in the country in general.”

Meanwhile, on campuses across the nation where the average student is far less well-off, student groups have held widely-attended rallies and protests. And while it may be easy to assume that the average Yale student won’t have a problem paying an extra forty dollars a month, Yolen notes that “it’s one thing if you’ve got parents who will willingly cover this cost, and it’s another thing if you’re a scholarship student.”

Even those whose parents can afford to absorb the price hike have an uncomfortable conversation ahead of them. “I’d probably have difficulty confronting my parents if I said I needed to go on birth control and I needed this money,” says Ahn. “I can’t afford it with the money I make for myself.” The assumption that the DRA has not affected Yale women also ignores the thousands of Yale staffers who are served by the Yale Health Plan. “This is not an abstract group of people you’re helping out of the goodness of your heart,” Buttrick emphasizes. “You have to do this to help yourself.” Unfortunately, whether or not Yale students want to help themselves–whether or not they even need help–there’s little they can do. Except, of course, wait.

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