In the months leading up to the 2014 midterms, Cory Gardner seemed pretty obsessed with birth control. The Colorado senator-elect talked up his alleged support for over-the-counter birth control while on the trail, and released a campaign ad back in September directly addressing the issue. In the ad, Gardner said, "I believe the pill ought to be available over the counter, ’round the clock, without a prescription. Cheaper and easier for you." The campaign spot is all soft lighting and smiling women, nodding warmly as Gardner talks a good game about "more freedom" for women and less profits for drug companies.
Gardner, of course, pitched the idea in a cynical attempt to downplay his record on reproductive health. Because maybe if he said he wanted oral contraceptives to be available over the counter, women would forget that he supported personhood, opposes the Affordable Care Act and wants to defund Planned Parenthood. (Oh, and the whole I don't want the government standing between you and your health provider thing doesn't square so well with Gardner's opposition to abortion rights.)
Gardner's motives were transparent enough, but now additional experts have weighed in and debunked the idea that making oral contraceptives available without a prescription is a better bargain than having insurance cover them. As Amelia Thomson-Deveaux reported at FiveThirtyEight, the plan just doesn't hold up:
Donald Downing, a clinical professor at the University of Washington’s School of Pharmacy, has been researching over-the-counter contraceptives for nearly two decades. Right now, he said, it may be inconvenient for women to go to their doctors for birth control prescriptions, but thanks to the ACA, they pay nothing for the pill itself. Buying birth control over the counter would certainly require less effort, but without a mechanism to force insurance companies to cover it, women would end up paying more.
Downing told FiveThirtyEight that one way to potentially remove barriers to access would be to allow pharmacists to prescribe birth control. That way, it would still be covered through insurance but available on the spot. (That said, this wouldn't work for all birth control. Certain kinds, like the copper IUD, must be inserted by a medical professional.)
“I have been arguing that birth control should go over the counter for years," he said. "But what the Republicans are proposing just isn’t a cheaper or better solution.”
And Kelly Cleland, a research specialist at Princeton University’s Office of Population Research who monitors the cost of emergency contraception like Plan B, said prices have remained static since it was made available over the counter and that cost remains a barrier, particularly to low-income women. “When the generics were about to go onto the shelves I thought there might be a price war that would push the cost down,” she explained. “But that really hasn’t happened, and I don’t see a sign that it will.”
A health economist also told FiveThirtyEight that market forces could bring down costs, but that still wouldn't make over-the-counter birth control cheaper than birth control covered by insurance. “Any improvement in access is likely to be merely a convenience issue,” according to Joshua Cohen, a health economist at Tufts University. He added that women "would pay more out-of-pocket for the OTC contraceptive than they would for the prescription product.”
The consensus is that in order for over-the-counter birth control to be accessible to all women, particularly low-income women, the no co-pay provision of the Affordable Care Act is essential. But Gardner and the other Republicans who have claimed to back expanded access to contraceptives want to gut the law that has made that a possibility for millions of women.
And while it's satisfying to have economists and health researchers call out Gardner's plan for what it was -- politics -- it seems it was never really a plan at all. Despite a lot of talk on the campaign trail, over-the-counter birth control is not on the agenda for the remainder of this session or in January when Gardner is sworn into the Senate.
Maybe Gardner ought to explain his change of heart.