With or Without a Birth Control Mandate: Why American Women Still Lose

Another day, another ideological battle in Congress. Two different “repeal and replace” healthcare bills have dominated the news during the last year, the latest being the Graham-Cassidy bill in late September. And on October 6, the Trump administration decided to repeal the birth control mandate, inevitably causing another uproar––even the ACLU is suing the Trump administration for repealing the birth control mandate.

Women have been especially frustrated by the healthcare battle.  Before the Affordable Care Act, one third of women who tried to buy a healthcare plan were turned away, charged a higher premium, or had specific medical conditions excluded from their plans. Women buying insurance on the individual market were charged more than men in a practice called “gender rating.” While the practice was illegal in the employer-based insurance market for decades, only fourteen states prohibited gender rating within the individual market. Where gender rating was legal, women paid an average of 25 to 75 percent more than men for individual plans.

Reproductive healthcare is at the crux of the healthcare culture war between Democrats and Republicans. The birth control pill is one of the most common methods of birth control used by women, yet it remains out of reach for many. Both parties are exercising paternalism by assuming women do not have good enough judgment to take responsibility for their own bodies; Democrats are allowing Planned Parenthood and Obamacare to hold a monopoly over the cash cow that is the unnecessary birth control pill prescription. Meanwhile, socially conservative Republicans obstruct measures that make birth control easier to access and afford.

And the plot thickens: While moderate and liberal Republicans have tried to introduce bills to grant the birth control pill over-the-counter (OTC) status, Democrats have struck them down in order to not dismantle critical political gains of “free” birth control with Obamacare.

While the birth control mandate was heralded by Democrats as one of the most liberating features of Obamacare for women, this could not be further from the truth. Holding the birth control pill hostage to Obamacare still shuts many women out of taking full control in an economic and politically empowering way over their reproductive lives. And although Obamacare may cover women’s healthcare appointments, setting aside time to attend a medical appointment can be difficult. Making the pill OTC facilitates access to contraception since it would eliminate the need for an appointment or renew a prescription. And even though apps like Nurx are offering to deliver the pill to women’s homes, bureaucracy still unnecessarily complicates the process.

Fourteen years since its creation and FDA approval, Plan B emergency contraception was made available over the counter in 2013. Adolescents as young as 16 years old (in some states) can legally consent to sex, and now emergency contraception is available over the counter. Why not make the resources to prevent an unplanned pregnancy easier to access?

Free The Pill is a campaign sponsored by Ibis Reproductive Health, a private nonprofit organization that collaborates with HRA Pharma. Their goal is to persuade the Food and Drug Administration to allow birth control to be administered over the counter. If implemented, women of all socio-economic backgrounds would be able to purchase affordable contraception at their discretion with a consultation from a pharmacist. In states which have championed moving towards OTC birth control like Oregon, California, and Colorado, a prescription from a doctor is essentially replaced with a prescription from a pharmacist. This ensures that women get their blood pressure taken while reviewing a questionnaire with a pharmacist to rule out medical conditions which may conflict with the pill.

Women in 102 other countries have had access to the pill without a doctor visit for decades. According to a study administered in Mexico by the University of Texas, there was little difference in outcomes of screening between women who went to a clinic versus the pharmacy.

One in ten women are still uninsured under Obamacare. According to a national survey administered by the Contraception Journal, one in five women said that the expense of a medical appointment made getting prescription birth control difficult. Another nationwide survey administered by the Pharmacy Access Partnership showed that 68 percent of women want OTC birth control. Some brands may still be covered by insurance. Even if insurers did drop coverage of the pill, the OTC status would promote competition thereby prompting lower prices.  Claritin serves as an example; its prices halved in less than a year after the allergy drug was granted OTC status in 2002. Nowadays, you can buy bulk bottles (100+ pills) for less than three dollars.

Women’s empowerment is inextricably tied to reproductive empowerment. Those who champion reproductive rights should not see the birth control mandate repeal as a defeat, but an opportunity to truly make it accessible.

By trying to legislate morality and paternalism, both parties fail to see how they’re doing millions of women more harm than good.

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Ibis Valdés is a Young Voices advocate and a graduate of  International Law & Human Rights; she is an organizer with Engage Miami, a nonprofit that elevates the youth voice in South Florida elections.

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