Accessing reproductive health services on college campuses has never been more difficult, as many students brace for another year of remote learning. Now student leaders at religiously affiliated schools are worried a recent U.S. Supreme Court ruling may lead to changes to their university health-care plans.

Little Sisters of the Poor v. Pennsylvania was focused on denying birth control coverage to employees based on their employer’s religious or moral objections, but the ruling extends to one of the most vulnerable populations seeking comprehensive reproductive health care: college students and other young people.

“I think that this might be a reckoning for university health insurance programs and university health centers,” Rebecca Thimmesch, campaign manager for Advocates for Youth’s #FreeThePill campaign, told Rewire.News.

While religiously affiliated universities like Georgetown University and the University of Notre Dame won’t be changing their student health plans for this school year, student leaders involved in reproductive health say a stronger stance in favor of protecting people’s access to birth control would have been more reassuring, especially as some universities continue online for the semester.

Rachel Harris, a senior at Georgetown, said it’s been hard for her team at H*yas for Choice to find the safest way to continue to provide sexual health resources for students—at a time when it’s more important than ever.

“When I came to Georgetown, I realized the necessity of a club like H*yas for Choice,” Harris, the organization’s vice president, said of the pro-choice, sex-positive reproductive justice group at Georgetown. “The university was unwilling to provide resources like condoms or health seminars for their students, so it became the club’s responsibility to educate and inform.”

The Supreme Court ruling means that universities like Georgetown can now deny access to birth control for students and staff who have no other choice but to rely on university-sponsored health care. According to the student newspaper, about 45 percent of Georgetown’s student body has health insurance through the university.

“I think the cracks in university health care have really started to show as the pandemic has worsened,” Thimmesch said. “Most universities don’t have an adequate telehealth network, and that, coupled with the precarity of a lot of young people’s financial situations, has made it even more important for institutions to step up and continue to ensure access.”

After the Trump administration first released rules allowing employers to claim a broad religious exemption for birth control coverage, Georgetown announced it wouldn’t seek an exemption: The university’s health plans would continue to cover contraception through an Affordable Care Act accommodation.

Harris said that despite the university’s insistence that the no-cost policy on birth control for students on university health care will continue, the fact that Georgetown refuses to distribute condoms on campus or recognize H*yas for Choice as a student organization makes their position on reproductive justice clear.

“Georgetown keeps preaching this value of caring for the whole person, but they somehow think that sexual and reproductive wellness does not entail caring for the whole person,” Harris said.

As an international student, Emily Hardy, a Georgetown sophomore, is required to have university health insurance. At Georgetown, students still have to indicate a “medical” reason, like acne or hormone regulation, to get a birth control prescription from the student health center, and many birth control options aren’t even available at the health center. So when Hardy found out her preferred method of birth control wasn’t available on campus, she decided to go to Planned Parenthood.

Hardy said being able to go to an outside clinic for her birth control is an option she recognizes students at smaller, rural colleges might not have.

These types of barriers to access, along with the impending online semester, can add up to a scenario where access to birth control is severely restricted, she said.

“I think when you add something like a Supreme Court ruling onto these existing barriers that the university imposes on women, particularly young women, you are not helping the situation,” Hardy said.

Access issues extend beyond contraception. Georgetown only completely covers procedures that occur in the university’s clinic and hospital, and Hardy said she will not know how much an out-of-network procedure will cost until she gets the bill.

“I know that if I had to get hospitalized in another state or somewhere that isn’t the campus clinic, my health insurance would not be useful,” Hardy said.

At Notre Dame, it’s unclear how the Supreme Court decision will affect a lawsuit brought by Irish 4 Reproductive Health, an independent student-led organization. With the help of the National Women’s Law Center, the group filed a lawsuit against both the university and the Trump administration in 2018, claiming that Notre Dame was unlawfully refusing to cover certain types of birth control under the university insurance plan, but it been on hold until late last week, when advocates revived their claims against the administration.

“We really need to go in fighting this year because the university can start changing student’s plans as early as fall 2021,” Dani Green, a recent graduate and current president of Irish 4 Reproductive Health, said. “And we’ve seen that directly confronting the university by protesting hasn’t been helping, so we’re hoping that by pursuing a legal route, we can stop any changes.” Green added that the university president’s statement of support for the Supreme Court “upholding religious liberty” hasn’t gone unnoticed.

Green believes staff must be included in the conversation about university health care, especially because workers often can’t speak up due to fear of being fired. Notre Dame is the largest employer in St. Joseph County, the area in which the university is located.

“Students have a little more immunity or ways to get a workaround, and academic faculty have more freedom to make a fuss, whereas staff members are a little more pigeonholed,” Green said.

These issues regarding health care don’t just stop at religiously affiliated universities, though only the religiously affiliated universities would be affected by the Supreme Court ruling.

In California, Dignity Health, a Catholic hospital chain, has contracts with five out of six University of California medical centers, including the University of California, Davis. Eve Banas, the president of UC Davis’ Students for Reproductive Freedom, is fighting to end the university’s contract with Dignity Health because of the hospital system’s history of denying service to transgender people.

“Even though we acknowledge that we probably won’t be one of the universities that loses our access to birth control like other universities, it’s scary to think that even a public university has the right to partner with a religious hospital that has had a discriminatory past,” Banas said.

For Hardy, who is grappling with the restrictions of a religiously affiliated health-care plan, the limits on access to comprehensive health care for everyone are unsettling.

“It starts to become scary when there’s only one valid abortion clinic in your entire state, or when you have to jump through so many barriers to get birth control,” Hardy said. “These are terrifying concepts because it distances access for something that is not political but a personal choice.”