Call off the culture war over birth control, left and right! Bobby Jindal has an elegant solution to rise above the fray. Or so he thinks.
Seizing on recommendations from the American College of Obstetricians and Gynecologists that some hormonal birth control be available over the counter, the Louisiana governor and presumed presidential hopeful seeks to play them against the Affordable Care Act. He claims that Obama's big government is actually making it harder for women to access birth control, despite the fact that the ACOG recommendations would work best in tandem with the Affordable Care Act birth control provisions, not instead of them.
Making birth control more accessible in any way possible is generally a good idea. But in Jindal's haste to find "the end of birth control politics," he ignores some crucial benefits of the Affordable Care Act as well as the deep-seated opposition to many forms of birth control, not just insurance coverage of it, among his own allies.
"We have been stupid to let the Democrats demagogue the contraceptive issue," Jindal writes. This neatly elides the fact that it was Republicans in Congress and the party's presidential candidates (led by Rick "Birth control is not OK" Santorum) who spent months this year "demagoguing" this issue, calling it an infringement on religious liberty. Democrats may have set them a trap that also energized a crucial part of the base, but Republicans enthusiastically marched into it.
And, as Adam Sonfield, senior public policy associate at the Guttmacher Institute, puts it, "He’s attempting to sidestep the actual policy argument before us: it’s never been about whether contraception is legally available for Americans to purchase. Rather, it’s been about conservatives’ attacks on the programs, policies and providers that would make the full range of contraceptive options accessible and affordable, particularly for disadvantaged Americans."
As for the "religious liberty" claim on insurance coverage, which Jindal endorses, Sonfield says, "This is not about forcing people with 'a religious objection to contraception' to 'purchase it for others.' When your boss contributes to your health insurance premiums, it’s no different than when he pays you a salary or provides you with sick leave, or contributes to the Health Savings Accounts that Governor Jindal so strongly supports. Rather, your boss is compensating you for your work, and how you make use of your salary and benefits should be your business, and yours alone. No boss should have the right to impose his religious beliefs on your private actions."
Making oral contraceptives available over the counter is a partial solution at best, because it doesn't fix the cost issue and the related concern of access to long-acting, reversible contraception, which Obamacare directly addresses. Requiring that all insurance plans fully cover birth control without a co-pay is meant to make it easier for women to access the most effective forms of birth control, which tend to be more expensive and harder to get insurance to cover; it's unlikely you'll ever be able to get an IUD inserted at a pharmacy. It's also supposed to remove any cost barrier, at least for insured women, the ranks of which the ACA is intended to expand. The ACOG recommendations mainly gave a medical imprimatur to the idea that you don't need a doctor's visit to get the most commonly prescribed form of birth control, but conceded that there was no way of knowing how much those pills would cost, especially if they were the more complex compounds that some women need to avoid side effects. "Any plans to improve access to OCs by moving towards behind-the-counter or over-the-counter access should address issues of cost," was as far ACOG got.
Jindal also doesn't mention Medicaid or Title X funding to Planned Parenthood, which goes toward contraceptive access for low-income women. But given how much his Republican colleagues want to get rid of both Title X and Planned Parenthood funding, that would interfere with Jindal's magic plan to "take contraception out of the political arena."
"Thanks to President Obama and the pro-choice lobby, women can buy the morning-after pill over the counter without a prescription, but women cannot buy oral contraceptives over the counters unless they have a prescription," Jindal writes. At first glance, this seems like giving bipartisan credit where it's due, until you realize that many on Jindal's side erroneously equate with abortion the high dose of hormonal birth control pills taken up to 72 hours after unprotected sex. To those attuned to this particular dog-whistle, Jindal is implying President Obama and "the pro-choice lobby" are conspiring to make it easier for women to "abort" (by which they mean blocking an hours-old fertilized egg from implantation, which the morning after pill has never been shown to do) than to prevent. To most everyone else, it just seems like a twist of ridiculous government bureaucracy, and Jindal gets to have it both ways without conceding that the main opposition to emergency contraception access comes from his own camp.
And Jindal conveniently doesn't mention the fact that young people under 17 are unable to access emergency contraception without a prescription, despite the fact that the sooner you take it, the more effective it is. This was first due to a politicized handling of medicine under Bush, and more recently a politicized handling of medicine under Obama, both of them acquiescing to the hysteria of social conservatives like Jindal. Which brings us to another pressing issue that Jindal addresses only indirectly: Minors' access to contraception. He writes, "Parents who believe, as I do, that their teenage children shouldn't be involved in sex at all do not deserve ridicule." That's true, but do they deserve the ability to deny their "teenage children" access to birth control if they're going to have sex anyway? He says these over-the-counter rules should apply to women over 18, despite the fact that the ACOG recommendations didn't say that at all.
State policies vary in allowing minors to confidentially access birth control in all or some circumstances, but the U.S. Supreme Court has recognized the right of minors to access birth control privately, because the right to privacy does not “come into being magically only when one attains the state-defined age of majority." This, of course, has been politicized -- not by the public health community, but again, by Jindal himself in this Op-Ed. Just because you want to pretend to be above politics doesn't mean they magically go away.