For the past two years, women have paid higher prices for birth control at college clinics. And yes, you can attribute that to the administration of President Bush.

Bush's Deficit Reduction Act, which went into effect in 2007 after a Republican Congress passed it two years earlier, increased the reimbursement rate pharmacies had to pay as part of the Medicaid program (see "Birth of a Problem," WW, Aug. 1, 2007).

The higher reimbursement led to higher costs for certain medications sold in bulk at discounted rates, health officials say. College health centers and other safety-net clinics had such discount deals with makers of birth control. After January 2007, those savings stopped and birth-control prices at campus health clinics exploded.

At Portland State University, for example, the cost of NuvaRing, a plastic ring inserted in the vagina that slowly dispenses hormones for three weeks of a woman's cycle, soared from $36 a year to $149 for three months and made the product too expensive even to offer.

President Obama's budget bill, signed earlier this month, includes Medicaid revisions that could reverse price increases for birth control sold on college campuses, says Mary Hoban, director of the American College Health Association.

Whether to reinstate the discounts, however, is being left to the pharmaceutical companies' discretion through incentives rather than an outright mandate. And that leaves some campus health officials in Portland feeling uncertain.

"I would be more secure if the legislation had something saying what the companies have to do and when," says Michael Brody, director of health and counseling services at Reed College. "In the end it's a business, and it's less profitable now than it used to be. I imagine they will be striving to squeeze dollars."

Jessica Cole, operations supervisor for student health and counseling at PSU's clinic, hopes drug companies are hurting enough in this economy to need deals with college clinics again.

"I'm assuming that they saw a steep drop-off from their buyers," Cole says. "Maybe they would be motivated to get their clientele back."

Hoban is optimistic the changes will help bring birth-control costs back down because the Obama budget bill removed the disincentive for drug makers to continue the discount.

Losing NuvaRing because of a price jump frustrated Cole because finding the birth-control method that works best is often a matter of trial and error; having many options available increases the chance a woman will find the one that works best for her.

The birth-control options that became most expensive under Bush were name-brand products like NuvaRing. A simple alternative might be to go generic (a month's worth of generic birth-control pills goes for $12), but that is not an option for women who suffer adverse health effects from oral contraceptives.

Both Cole and Brody reported no noticeable drop in women using birth control as prices rose at campus pharmacies the past two years. Rather, the patients adapted by working together with their doctors to find more affordable birth-control options. But both say that's unfair and unnecessary for students.

"My sense is that it is probably a hardship that the students have more or less dealt with," Brody says, "but a hardship nonetheless."