Oklahoma state Rep. Doug Cox is an anomaly, and he knows it. As a self-identified pro-life Republican in a deep red state, Cox makes for an unlikely ally in the reproductive rights movement. But that hasn't stopped him from being an outspoken critic of his colleagues' efforts to scale back access to contraception and abortion services.
In a letter to his fellow Republicans, Cox admonished the modern GOP for its fixation on controlling women's bodies. Writing in response to a proposal to ban Medicaid coverage for emergency contraception and allow pharmacists to refuse to fill prescriptions for birth control, Cox asked, "What happened to the Republican Party that I joined? The party where conservative presidential candidate Barry Goldwater felt women should have the right to control their own destiny?" On the House floor this week, Cox blasted his colleagues for pushing Texas-style restrictions on providers and regulations around emergency contraception that he called "prejudiced against women."
Beyond his voting record, Cox is something of an outlier in his party for another reason: He seems to have genuine empathy for and an understanding of the women in his state making incredibly personal medical decisions.
Cox is an emergency room physician who has, by his own count, delivered 800 babies. He considers himself pro-life, but supports -- both in his capacities as a lawmaker and a doctor -- a person's right to make private medical choices. "Now, I’ve never performed an abortion, but I can tell [someone] where to go," he told Salon during a phone conversation about the current reproductive health landscape in Oklahoma. "And if my colleagues have their way, that place would not be in Oklahoma."
Cox spoke with Salon about the proposals currently advancing in the state Legislature, what he hears from his constituents on the ground (spoiler: Railing against abortion rights is not a top priority for the average Oklahoman), and the other ways that he breaks with his party to vote with his conscience. Below is a transcript of our conversation, condensed and lightly edited for clarity.
One of the laws currently being considered in Oklahoma would impose Texas- style restrictions on abortion providers. Members of your party who support the bill have claimed the measure would protect women's health by tightening regulations. What's your take on that?
The bill here in Oklahoma places the Board of Health in charge of setting standards and protocol for abortion clinics. First of all, it is totally unnecessary. It is put out here under the guise of, "We are trying to protect the health of patients." When in reality we all know this is nothing more than an attempt to throw up barriers to women's access to abortion services.
I've delivered 800 babies. Never performed an abortion and never will -- but I hate unnecessary legislation. And this is totally unnecessary.
Any facility in Oklahoma that provides abortion services is already licensed by our state health department as a specialty hospital, and they have to meet all the rules and regulations, as far as what equipment they have to have, resuscitative measures, et cetera, that any specialty hospital in our state -- whether it’s a bone and joint clinic or a cardiac hospital or what -- has to meet. So there is no need for further regulation.
More concerning to me is the fact that now, for the first time, they’re placing the board of health in charge of determining basically what our best medical practices are. That’s never been done before, and there’s a reason it hasn’t been done before. Our state board of health, some of its member -- for instance, one of them is an immediate past president of the human resources division of Chesapeake Energy. [This board member] has no medical knowledge whatsoever. She is a great board of health member, but it’s out of her bailiwick to determine what doctors should and shouldn’t do while taking care of patients.
There is a dentist on our board of health; there are maybe three family practitioners -- great physicians, but there are parts of medicine that are out of their expertise. It would be like asking me, as an emergency room physician, to set the rules and regulations for brain surgery. And so this is starting down a slippery slope.
Now, I’m not saying that they’re going to broaden it to other areas of medicine, but it sure sets a dangerous precedent, and that’s the reason I oppose that bill. In fact, I tried to amend the bill. If we’re gonna regulate abortion clinics, let’s put the board of health in charge of regulating the practice of dermatology. There’s a reason, unbeknownst to my other colleagues here, there’s a reason I picked [dermatology] and it's because the bill’s author’s wife is a dermatologist.
So I had a little fun with it. But, I’m just saying it’s unnecessary and we don’t need that bill.
What has the response been when you raise these issues to your colleagues? Because I feel like this is so sensible, and it seems like your voice -- as a physician who personally identifies as pro-life -- could hold a lot of weight here.
You would think so, and it’s kind of disappointing that it doesn’t.
But I sympathize with my colleagues. A number of them have come to me in private to say, "We understand your arguments, we respect your arguments, we wish we could vote that way but we’re afraid to." Oklahoma is such a conservative state, and such a pro-life state. It’s easy for me as a physician to stand up and explain in lay terms why I voted the way that I voted. They have a little bit more difficulty doing that, and they’re so afraid of being labeled as pro-choice in a very conservative state, that they’re just afraid to vote their conscience.
Do you think that can change? What you're saying is, "Look, I’m a physician who is personally pro-life, but this isn’t a matter of what my personal views are, this is a matter of public safety and access to healthcare." Do you think voters in Oklahoma would be open to hearing that?
I think that they would be willing to hear that. I think it’s a difficult message to get out. You almost have to be standing in front of a crowd and yelling it. You can’t explain that in a 30- or even 60-second story on a newscast, so it’s a difficult message to get out.
And the interesting thing is my colleagues are so afraid of going home and facing their district. But I can honestly say, even as a physician, that I have never -- and I have been here 10 years -- had a person upset over my vote on these issues. My constituents -- and I dare say the constituents of my colleagues -- are more worried about jobs, they’re more worried about being able to afford food and clothes for their family, they’re more worried about what they’re gonna do if they get sick with no healthcare.
Abortion is not high on their radar screen. Now, when it does become high on someone’s radar screen is when their 14-year-old daughter gets pregnant. That’s where I’ve had conversations that non-physician members [of the state Legislature] have never had. Behind the closed door of an exam room, when I have that parent with that daughter there saying, “I’ve never viewed myself as pro-choice. I’ve never supported abortion. But my daughter’s 14 years old and she’s pregnant. We talked about it, we prayed about it, and we think she wants to have the pregnancy terminated. Where can I go?”
Now, I’ve never performed an abortion, but I can tell them where to go. And if my colleagues have their way, that place would not be in Oklahoma, which effectively is going to close that choice to low-income people.
So, as a physician I say, the old adage -- the old fable, the old biblical term -- don’t throw stones in glass houses. Don’t criticize someone until you walk in their shoes.
On that point, I wonder then what your view is of the Medicaid expansion, which your state has rejected. Do you see this is a good thing or a bad thing for Oklahoma?
You know, Medicaid is an entitlement program. Once you give someone an entitlement, it’s hard to take it away. But for us to be able to help a large number of uninsured -- knowing that medical expenses are the No. 2 cause of bankruptcy in our state behind credit card debt -- and to be able to do it with 100 percent federal money initially, decreasing to 90 percent later ... to me that’s a hard thing to turn down.
I mean, I see it in my work in the emergency room every day. People who need help and can’t get it because of lack of insurance. And these aren’t lazy people who are too lazy to work -- they’re hardworking Oklahomans who have a job, a low-income job, where they don’t have company-provided healthcare insurance.
And so, to me, that money’s going to go somewhere. I would just as soon it come to Oklahoma to help our people.
Now let's talk about birth control.
Yes, let's. The other measure that you're challenging right now is about the regulation of emergency contraception. Your colleagues want to prevent people under the age of 17 from buying Plan B over the counter.
To me, to equate a morning-after pill with an abortion is irresponsible.
The only thing a woman knows in these situations is that she’s had unprotected intercourse and that there’s a risk of pregnancy. She doesn’t know that she’s pregnant because there’s no way to know -- even a blood test is not positive that quick. The chances of her being pregnant are pretty slim, but why take that chance when you can prevent it with a pill? Just like you can prevent it with an IUD, which you don’t hear people railing against IUDs, but I suppose that will be next. [Editor's note: Sadly, people are railing against IUDs .]
But I find it very discriminatory that a 14-year-old boy can stop in a truck stop and buy all the condoms that he wants, where he can control his destiny, and yet we’re taking a choice of controlling her own destiny away from a female. We've had over 2,000 pregnancies of among teens 17 and under -- and remember that 75 percent of people who deliver babies when they’re 17 got pregnant when they were 16. The reason that’s important is those kids who are 16 and under would not be allowed to buy the morning-after pill without a prescription.
This also discriminates against low-income people, because they’re less likely to be able to afford to go to a doctor, less likely to have the insurance to get the prescription. Meanwhile, any time you make it available by prescription only you’re basically adding $100 to the cost. Especially for someone who doesn’t have a doctor, because that initial office visit is going to be 100 bucks.
So it’s discriminatory against women, it’s discriminatory against low-income people. You also hear, “Oh, this medicine is related to steroids. There’s potentially a lot of side effects.” Well, this medicine has gone through extensive testing by the Food and Drug Administration. And the FDA is not perfect. And the FDA is in Washington, D.C., so Oklahomans don’t like it, but it has served the public of the United States quite well over the years. The morning-after pill is FDA approved, and -- as I said in my debate yesterday -- I dare say there are more people who have allergic reactions to the latex in condoms than have reactions to the morning-after pill.
And so, again, that’s a smokescreen to cut off women’s choices. And it’s frustrating to me. I’m a Republican, but I guess I’m a fiscal conservative but a social moderate, because it’s frustrating to me that the Republican Party is going down this road. And whether they want to admit it or not, they’re alienating women and minority voters in this country, and the pendulum’s going to swing on them if they’re not careful.
I also wonder too, from the perspective of a fiscal conservative, why there is so little talk among lawmakers about the actual costs associated with unintended pregnancies. So denying people access to birth control, passing laws to shutter providers -- these things have consequences.
The cost of teen pregnancy is horrendous. I really consider limiting access to contraception -- and I consider the morning-after pill a kind of contraception -- to be a very pro-abortion stance, because unwanted pregnancies are the only ones that are aborted. Access to contraception helps prevent unwanted pregnancies, therefore it helps prevent abortions.
It’s interesting -- in 2010 we had over 2,000 teens get pregnant -- teens 17 and under. In 2011, that number dropped to about 1,700. Oklahoma is only, at that time, maybe 2.5 million people. That’s a tremendous drop. That’s the largest drop in teen pregnancies we’ve ever seen. It’s kind of ironic that this was the same year that access to Plan B became widely available. I wonder if there’s any correlation. [Laughs.]
The restrictions that are being considered in Oklahoma right now are similar to regulations in Texas and elsewhere that have passed and later challenged in the courts. This kind of litigation is often incredibly expensive.
We've spent a fortune in Oklahoma on these antiabortion laws. We've had many overturned in the courts, but then we tweak them a little bit, make another run at it and watch as they get overturned again. Oklahoma is a very conservative state -- the saying is that in your first term, if you want to get reelected, you have to vote on an abortion bill and on a gun bill. That's the nature of the state in which I live.
Oklahoma is a great place. I love our rugged individualism. But sometimes we cut our nose off to spite our face, and it's really at the expense of the taxpayers.
Your colleagues in the House don't seem ready to hear you on this issue, and they aren't slowing their efforts to scale back access to basic medical care. Do you see a breaking point here?
The real way to stop this trend is for women to stand up and say, "Hey, we're sick and tired of this. We don't want more government in our lives. We want a balanced budget. We are sick and tired of you trying to control our reproductive health." We need to leave these issues between women, their doctors and their God.
As a physician, that's what I most resent. The practice of medicine is between me and my patient -- in an exam room behind a closed door. To have the government in there is very frustrating.
What's unfolding in Oklahoma mirrors the national trend toward rolling back reproductive rights and regulating access into virtual nonexistence. Right now your support for reproductive rights makes you an outlier in the GOP. What would you tell your colleagues -- in the state Legislature and in the national party?
The reason I am a Republican is because this is the party of less government, and we should be the party of less government in all aspects -- including women's reproductive health. We need to stop the government from interfering in personal decisions that should be made between a woman, her God and her doctor.