This week, Senate Democrats, led by Washington Sen. Patty Murray, introduced a measure in support of making certain FDA-approved methods of birth control available over the counter. Allowing pharmacists to dispense oral contraceptives without a prescription has been a long time coming in terms of the medical consensus on safety, but the issue didn’t get much political traction until it became a flashpoint for Republicans during the 2014 midterms.
Murray’s proposal, introduced Tuesday, is in favor of making oral contraceptives available over the counter pending FDA approval. So is a measure introduced last month by Cory Gardner, the Colorado Republican who made the issue something of a shield against critiques of his record on reproductive health during his Senate campaign. (Gardner voted to defund Planned Parenthood, supported personhood and opposes the Affordable Care Act, the healthcare law that gave millions of women access to no-cost birth control.)
But one of these things is not like the other, one of these things just doesn’t belong. (Can you tell which thing is not like the others by the time I finish my blog?)
Let’s start with how these two named their legislation. Gardner called his bill the Allowing Greater Access to Safe and Effective Contraception Act whereas Murray’s is called the Affordability is Access Act. Murray, by all appearances, is subtweeting Gardner’s bill.
Like I wrote last year, there was never anything meaningful at stake with Gardner’s campaign promises about over the counter birth control. In order to deflect criticism about how he’s voted on or talked about fair pay, public health funding and the constitutional personhood of zygotes, Gardner committed to proposing a measure that would support pharmacists legally selling oral contraceptives over the counter, while dodging the question of affordability.
Birth control is expensive. As I've pointed out before, taking a monthly pill pack of oral contraceptives can cost up to $600 every year in some places. And with family planning funding and mandatory coverage through insurance plans on the chopping block for Republicans, there is nothing about the proposal that would address cost barriers that millions of women continue to face. But Gardner still packaged his bill as a measure to increase accessibility and lower costs.
“It’s time to allow women the ability to make their own decisions about safe, effective, and long-established methods of contraception,” he said in a statement at the time. “Making this medication available over the counter would increase access in rural and underserved areas, save consumers money by increasing competition and availability, and save women time by increasing the ease of getting the safe contraception they need.”
Gardner’s talk about market forces bringing down costs has been questioned, repeatedly, by experts who monitor that kind of thing. (For example, Plan B is now available over the counter. It is still expensive as fuck.) Taken as a whole, Gardner’s proposal seems a whole lot like political cover for the GOP’s repeal-Obamacare-and-throw-millions-into-medical-uncertainty-and-literal-mortal-peril thing.
Murray, maybe seeing an opportunity to ding her Senate colleague (or, you know, having an actual investment in access), stuck the word “affordability” into the title.
Here’s her statement on the measure:
I believe strongly that women should be able to get the comprehensive health care they need, when they need it—without being charged extra, without asking permission, and without politicians interfering. Making approved birth control pills available over-the-counter is another important step forward in terms of women’s access to health care. But anyone will tell you that if something is too expensive, it doesn’t matter how easy it is to get. It might as well be on the moon. [...] Affordability and access go hand in hand -- you can’t have one without the other.
Like the GOP proposal, the Democratic version of the measure won’t do much to the status quo on cost for people without insurance, though it doesn’t much pretend otherwise. But it does ensure that insurance companies continue to cover birth control, whether it's sold with or without a prescription. “What we’re saying with this legislation is, if you’re paying for your insurance, you shouldn’t have to pay twice,” Murray said.
The Affordability Is Access Act also isn’t being packaged alongside repeated attempts to repeal the Affordable Care Act. If it passes and the FDA plays ball, it’s just another option on the table. Low-income women who don’t have insurance will still struggle to afford birth control, and women with insurance who don't need to see the doctor for a refill, lose their pill pack or find themselves away from their pills for whatever reason could have the option to pick up another one wherever they happen to be.
Another point of distinction: Gardner’s measure has an age restriction. If you’re under 18, you’re out of luck. (Garbage age restrictions aren’t strictly a Republican tick, either. Former Health and Human Services Secretary Kathleen Sebelius overruled the FDA when it announced that the drug was safe for all ages, and President Obama backed her on it.) The Republican proposal would waive application fees to fast track the FDA’s approval process, but Murray’s contains no such incentive. Neither bill expands access to contraceptives that require a visit with your physician, like IUDs that have to be inserted by a medical practitioner.
These are similar proposals, but not the same proposal. And the GOP bill, given the party’s legislative agenda and the context of the rest of their platform, mostly looks like a stunt project for lawmakers to point to and say “see, you can still get birth control!” while they push to cast millions off their insurance and let employers deny birth control coverage to employees.
Both sides will accuse the other of playing politics, and there will be a fight over how best to move forward that may result in both measures stalling entirely. Meanwhile, people who need and want reliable, affordable access to contraception -- through a visit with a physician or over the counter, with insurance coverage or without -- will be left to figure it out on their own.