This may be the best damn thing to come out of the giant Hobby Lobby mess.
No, I’m not talking about the ridiculous “Protect Women’s Health From Corporate Interference Act,” which Elizabeth Nolan Brown aptly calls the “force all employers to cover contraceptives act.” It’s about the Republican’s counter proposal, the “Preserving Religious Freedom and a Woman’s Access to Contraception Act.”
I’ll give you a minute to stop justifiably rolling your eyes. Yes, this is typical Washington partisan bickering with even less substance than usual. But, amidst the meaningless drivel in both bills (the vast majority of the Republican bill is trying to outlaw stuff that already can’t happen…), something interesting arises. From the “snarky name” act:
The Preserving Religious Freedom and a Woman’s Access to Contraception Act … requests that the Food and Drug Administration study whether prescription contraceptives could be made available safely to adults without a prescription
Well, I’ll be damned. Could this be the beginning of the end of the tyranny of prescription birth control? Maybe—if those who care about women’s access to birth control and free marketeers can work together and get ahead of the game for once.
One of the most unfortunate consequences of the Affordable Care Act is that by putting healthcare in the public domain, fewer health decisions are left to individuals than were before. The recent bickering about birth control in the healthcare mandate is a wonderful example of this. A vital part of women’s health is now subject to the whimsy of partisan politicians. Like most acts of government, this has the potential to affect poor women disproportionately—which means it’s critical that we solve the problem, immediately.
Making birth control available over the counter is the easiest way to do this. Doing so would likely drive down the cost all around, but, failing that, employers can provide their employees with Health Savings Accounts or Flex Spending Accounts. The money (whether taken from the employee’s paycheck, matched by the employer, or there’s a yearly employer contribution) then becomes the employee’s to spend—not the employer’s. This means that employers are off any ethical hook they may feel obligated by, and there are still options for women who cannot afford the cost out of pocket.
I was fortunate enough to have a conversation about this option with Erin Gloria Ryan, news editor of Jezebel, who called the solution “astoundingly sensible” (I hope she doesn’t mind me quoting her on that!). She raised the concern, however, even if there were a serious move to make birth control available over-the-counter, there may be the same kind of pushback against that move that we saw with the Affordable Care Act—namely, that many on the religious right (particularly Catholics) morally oppose birth control. The implication being that they would oppose it being made more available to people.
It’s hard to tell how such a thing would play out, since there are a lot of competing interests when it came to birth control, but I suspect the push back from the religious right will be minimal since they won’t be made to pay for the birth control.
Doctors, however, will likely fight tooth and nail to keep birth control deliverable by prescription only, since they risk losing yearly patients if women do not have to come in to pay for a slip of paper to get the same damn thing they’ve been getting for the past 10 years (the same reason, Ryan aptly noted, why many doctors urge women to get yearly pap smears they don’t need). And since the cost of birth control pills would plummet if made over the counter, pharmaceutical companies have a vested interest in keeping them behind a doctor’s permission slip.
Make no mistake: Doctors and drug makers are going to be the biggest barrier to women getting access to contraception because they, not religious people, have the most to lose from women having full access to contraceptives. Heck, I speak of this as if it were yet to come, but it’s already been happening—has happened. Despite the fact that Plan B—a pill that is the exact same thing as the daily pill—is available to pick up at the pharmacy, the FDA has refused to make hormonal contraceptives over the counter for 20 years. Why? Well, the drug makers have to approach them to start that process. Like that’s going to happen.
Birth control advocates have wasted a lot of time and energy being mad at Hobby Lobby and the religious right for simply not wanting to have to foot the bill for decisions they find immoral, when the most significant barriers to women’s access to birth control aren’t in churches or religious corporations, but in doctor’s offices and drug companies. They are the real enemies here. If people care about increasing access to birth control as much as they say they do, it’s time to pick up the sword and start fighting for it to be over the counter.
Birth control advocates are correct when they say that access to birth control is incredibly important for women’s participation in society. That is why it is important to return as much choice to individual women as possible—and get it out of government’s hands.