Birth control start-up plots massive expansion amid uncertain future for Obamacare

Birth control blister packs.
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As Americans wait to see Donald Trump's plan for the Affordable Care Act, a birth control start-up has seen its market step into the national spotlight.

As Nurx, which bills itself as the "Uber for birth control," works on aggressive plans to go nationwide, the very problems it hoped to address have become top-of-mind for many American women. The app connects patients and doctors and ships birth control directly to users, cutting down the cost and stigma of accessing birth control or HIV prevention.

The Y Combinator and Union Square Ventures-backed company is expanding operations from three states to six states this year, and aims to be in all 50 states in 2017. On Monday, it launched in Washington D.C.

"The need for this kind of service becomes even greater [after the election], especially in the South," said Hans Gangeskar, co-founder and CEO of Nurx. "Those people are the ones that need it the most and we can really change that. A substantial portion are on Medicaid expansion and could lose their insurance coverage."

In the aftermath of Trump's surprise presidential victory, the search for post-election news took an unusually intimate route for some Americans: Searches for "Will Trump take away birth control?" spiked 3,550 percent over seven days. (In the chart below, "breakout" indicates a search term grew by more than 5000 percent.)

That wasn't all. Searches for Planned Parenthood, IUDs, Roe v. Wade and "Pence Birth control" all saw searches spike several thousand-fold, according to Google Trends data. Algorithms on Facebook and Twitter also surfaced trending posts about users pondering their options.

Among many other initiatives, the Affordable Care Act required plans in the marketplace to cover doctor-prescribed contraceptive methods and counseling for all women, without copays or coinsurance (except for some religious exceptions.) It also provided health insurance to 16.4 million uninsured people.

If it is repealed, the cost of birth control could go up for women who would be required to meet deductibles, pay copays, or who lose coverage for their preferred birth control method — making cost-saving apps like Nurx more important than ever, said Gangeskar.

Trump has campaigned to repeal Obamacare, though he later said that he would consider leaving some parts intact. His running mate, Mike Pence, has been vocal about women's' health issues, once inspiring a campaign called "Periods for Pence." And because it performs a small number of abortion services, Planned Parenthood has been opposed by congressional Republicans, who now control the legislative branch.

It's unclear whether women's' health will ultimately be affected by the election — Trump has said he doesn't think birth control should require a prescription. But it all comes weeks after Nurx raised another $5.3 million to expand nationwide.

'We've had patients where their [previous] doctor rolls their eyes, will judge them, tell they 'You're stupid if you don't use a condom. You shouldn't be having sex, you need to change your lifestyle,'" Gangeskar said. "The problem that's happening in this election, the rhetoric to attack minorities, Muslims, African Americans, women, legitimizes that kind of judgment. Changing the mood of the national debate can have national consequences."

Infographic courtesy of Nurx

Gangeskar said that while a funding cut to Planned Parenthood or a repeal of the ACA would be emotionally devastating to Nurx, it might help their business. In addition to letting users get birth control and HIV prevention via text-based app and messaging, it also provides out-of-pocket options for as little as $15 per month.

"My prediction is that a lot of users will switch over to cash," Gangeskar said. "For us as a business, demand for our service could increase. Our competitive price difference will be much larger if the ACA is repealed. For those people who no longer have access from Planned Parenthood, our services will be a natural choice. [But] everyone who works here is incredibly upset. There are more scary things that we could go back to if it was repealed. Insurance could refuse cover labor if they didn't want pregnant women working in the company, or things like that, for example."