The choice before Abby Slichter felt urgent.

Worried that the cost of preventing pregnancy might soon soar, Slichter, a 25-year-old living in Minneapolis, decided this year to shift to a long-term form of birth control. She opted for an intrauterine device (IUD), which can prevent pregnancy for years. She and her husband said they wanted more peace of mind until they were ready to have children.

"It became clear that I had to make a decision now because I was — and still am — very scared that I'm going to lose my reproductive rights," Slichter said.

Requests for IUDs and hormonal implants have flooded medical offices and reproductive health centers across Minnesota and the country, as President Donald Trump and GOP lawmakers in Washington take steps to revise the federal government's rules on insurance mandates for contraception coverage.

On Thursday, the Trump administration released details of a proposed new rule to greatly expand the number of employers and insurers who, for moral or religious reasons, can be exempt from a requirement to include contraception as a health care benefit.

The step, which could go into effect soon, is stirring concern that hundreds of thousands of women could be denied access to inexpensive birth control — although advocates of the change say such fears are overblown.

Many women are not waiting to see the impact and are instead seeking methods that last from three to 12 years while the cost is still covered by insurance, providers said.

Demand for IUDs at the University of Minnesota health service has nearly tripled in some recent months, and officials there have had to scramble to keep up with the volume of patients.

Meanwhile, at Planned Parenthood's Uptown Minneapolis clinic, the organization's busiest in the state, appointments for IUD insertions have jumped 83 percent since Nov. 8. The clinic saw 343 clients for IUDs from May 2016 to Election Day; it saw 627 from the election through April. Statewide, Planned Parenthood's IUD appointments spiked 46 percent during that time.

When House Republicans voted in May to replace the Affordable Care Act, commonly known as Obamacare, searches for "IUD" on Google soared, displacing the previous record for that search term, immediately after the November election.

If the government removes the broader requirement that insurance companies pay for preventive health services, then birth control could also get significantly more expensive. Women would likely have to pay out-of-pocket for pills, patches, implants or IUDs, the latter of which can exceed $1,000.

"That's completely out of the range for students and a lot of other young women who are just starting their jobs and relying on having contraception coverage without a copay right now," said Dr. Sabrina Holmquist, associate professor of obstetrics and gynecology at the University of Chicago's Pritzker School of Medicine.

Holmquist estimated that the number of IUD appointments at the medical center has doubled since November, when patients began confiding their worries about losing insurance coverage or access to long-term contraceptives in general.

Greater demand

Although lower-cost pills remain the predominant form of birth control in the U.S., the longer-acting methods continue to grow in popularity for women seeking to avoid unplanned pregnancies, according to the Centers for Disease Control and Prevention. Aside from being the most effective methods on the market, with failure rates of less than 1 percent, IUDs and hormonal implants last several years or more.

The "set it and forget it" design eliminates the human error of remembering to take a pill at the same time each day, doctors say, and is often appealing to women juggling school or a demanding job.

"OB-GYNs have spent the last eight years trying to get [women] to use long-acting birth control," said Ann Laros, assistant director of Boynton Health, the University of Minnesota's health service. "With one Election Day, we have increased it by more than 250 percent."

Health care providers noted that interest in IUDs and Nexplanon, a hormonal implant in the upper arm, were growing long before the November election. However, data from national health networks and IUD manufacturers show that demand for long-acting, reversible contraceptives has surged in recent months.

Sales of Mirena, a popular IUD model that lasts five years, grew 23 percent in the U.S. between the fourth quarter of 2016 and the first quarter of 2017, according to reports from parent company Bayer Pharmaceuticals. The implant Nexplanon jumped 6 percent over the same time period.

"Women are smart. They know that if they get an IUD, it can potentially outlast the Trump/Pence administration," said Sarah Stoesz, president of Planned Parenthood Minnesota, North Dakota, South Dakota, one of the region's largest family planning providers, whose federal funding is under threat by the Trump administration. "They're not leaving anything to chance," Stoesz said of the women rushing in for long-term birth control.

The House GOP's bill, dubbed the American Health Care Act, does not alter the existing law's no-cost contraception mandate. However, this week's proposal by the Trump administration for a rules change would broaden exemptions to the current law based on religious and moral grounds.

Amy Koch, a GOP operative and former Minnesota Senate majority leader, predicts there's little chance many companies will limit benefits for workers.

"I think a company would have to have a deep-seated religious belief to make that decision," said Koch, who supports covering birth control costs. "I don't think any corporation would use it as an excuse. They answer to too many people — not the least of whom are their employees, which they need."

Legislative action

Some states are considering legislation to head off possible restrictions to contraception benefits by aligning their laws more closely with the Affordable Care Act. This year, 14 states — including Minnesota — are pursuing measures to increase the length of birth control pill prescriptions, ranging from a few months to a year. Five states and the District of Columbia already have similar laws. And women in California, Oregon and Washington have birth control pills and other forms of contraception available without requiring a doctor's visit.

Policies like these appear to have broad backing. A 2015 study from the Kaiser Family Foundation found that nearly three-quarters of Americans support covering the cost of birth control.

Despite that support, there's no guarantee it will survive.

That's what prompted Lily Crooks, a 34-year-old preschool administrator in Minneapolis, to get an IUD in January. "It's strange that it took a certain political climate to really make me consider it," Crooks said. "There's a reason people are worried."

Liz Sawyer • 612-673-4648