It’s not every day that Texas conservative Sen. Ted Cruz tweets at progressive millennial darling Rep. Alexandria Ocasio-Cortez asking to work together on something — especially when that “something” is women’s health issues. But that’s exactly what happened when Cruz offered to help Ocasio-Cortez make birth control available over the counter.
This is not only an immensely popular proposal among Americans on both sides of the aisle, it’s also good policy. Prominent medical groups, including the American College of Obstetricians and Gynecologists, the American Medical Association and the American Academy of Family Physicians, have all agreed that birth control is safe, effective and appropriate for over-the-counter use. Republicans and Democrats should be able to work together to support this commonsense measure.
Cruz and Ocasio-Cortez deserve credit for bringing attention to the issue. However, for real progress to be made, politicians will need to reach across the aisle in more meaningful ways.
So are Republicans and Democrats actually walking the bipartisan walk?
Not quite yet. To be sure, both parties have introduced legislation on over-the-counter birth control. For several years, Republican senators Joni Ernst of Iowa and Cory Gardner of Colorado have led efforts to pass the Allowing Greater Access to Safe and Effective Contraception Act, which would fast track the Food and Drug Administration application process to make a birth-control pill available over the counter. However, that bill has never acquired a single Democratic co-sponsor.
In response, Democrats have introduced their own bill, which would require insurance companies to cover, at zero cost, any form of contraception that becomes available over the counter. The bill is framed as a “challenge to Republicans who have yet to support ensuring any FDA-approved over-the-counter birth control is covered by insurance without cost-sharing and without requiring a prescription.”
The Democrats’ bill speaks to the heart of the left’s message that, without affordability, access is an empty concept. Certainly, barriers surrounding both cost and access are crucial problems that must be tackled. But Democrats know that any bill requiring insurance coverage for contraceptives will raise religious liberty concerns and therefore never make it through the Republican-controlled Senate. Is holding commonsense improvements to access hostage really the answer? Why not focus on solutions where both sides agree?
An over-the-counter birth control pill, even without an insurance mandate, would be a major women’s health victory. The Affordable Care Act may have increased the number of Americans with insurance, yet as of 2017, more than 10 million women between the ages of 19 and 64 still had no insurance coverage. For these women, access to birth control means paying out of pocket for an expensive doctor or nurse practitioner visit, finding a clinic that offers low-cost birth control or, in some states, consulting with a pharmacist who can prescribe oral contraceptives.
These steps are not only costly, but they can also be burdensome in other ways — especially for women who work non-salaried jobs or live in rural areas. An over-the-counter option removes these costs so that the uninsured can go directly to the shelves to obtain the pill.
A clean bill that encourages the FDA to approve an oral contraceptive for over-the-counter use while remaining neutral on the issue of cost could dramatically improve access to contraception for these women. While it may not be Democrats’ ideal bill, it would be a significant step toward giving women more autonomy over their health care needs. And, importantly, it could survive both the Democrat-controlled House and the Republican-controlled Senate.
To be clear, approving an oral contraceptive for over-the-counter use would not eliminate the Affordable Care Act’s mandate that health insurers cover contraception. If a woman’s preferred birth-control method is still cheapest with a prescription that is covered by her insurer, she still has the option to obtain that prescription first. Over-the-counter birth control would simply expand the number of options available, granting women more autonomy over their reproductive health. Additionally, opening the door for over-the-counter oral contraceptives would eventually lead to competitive pricing so that women could purchase contraception based on preference and price — not based on their insurance status.
Cruz and Ocasio-Cortez prove that there is opportunity for real, bipartisan progress on birth-control access — but only if both sides are willing to reach across the aisle. The dueling bills introduced by both parties are important parts of the conversation. Now, for the sake of women across the country, it’s time to bring them together and make over-the-counter birth control a reality.
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