Should Liberals Support OTC Access to Oral Contraceptives?

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There’s been a mini-boomlet lately in Republican candidates supporting over-the-counter access to birth control pills. This is great! There’s very little medical reason to require a prescription for oral contraceptives, and OTC pills are far more likely to be used regularly than prescription pills. It’s nice to see Republicans on the side of good science. But Rebecca Leber warns that not all is as it seems:

There’s a catch. Doctors aren’t the only hurdle between women and contraceptive access. For low-income women, cost can be what’s most prohibitive. Under the Affordable Care Act, the pill and other forms of contraception count as preventative care, which means insurance covers them completely—without any out-of-pocket expenses. This is not a position the Republicans have endorsed. On the contrary, none of the candidates have changed their position on the law more broadly, including their opposition to the mandate covering preventative care like birth control, writes Paul Waldman at the Washington Post. They still want to transfer the costs for other forms of contraceptives, like IUDs and the morning-after-pill, to women directly.

This is all true. But Republican opposition to Obamacare isn’t going to change no matter what, so that hardly matters. What matters is whether Obamacare covers the cost of contraceptives, and that’s what’s causing liberal angst over a cause that we’ve all supported in the past. We’re afraid that if oral contraceptives become available OTC, Obamacare will no longer pay for them.

But is it necessarily true that Obamacare wouldn’t cover the cost of OTC contraceptives? After all, this isn’t an issue that will be resolved by Congress, so there’s no chance of some terrible bill passing that trades OTC contraceptive availability for an end to the Obamacare mandate. The FDA makes the call about whether contraceptives can be sold OTC, and HHS regulations specify which contraceptives are covered by Obamacare. Those regs currently cover “FDA-approved” contraceptive methods, and if the FDA approves OTC contraceptives then HHS will have to modify its regs to make it clear whether those are covered too. There’s no reason they couldn’t choose to mandate coverage of OTC pills that are FDA-approved. Alternatively, they could simply require insurers to continue paying for prescriptions for OTC oral contraceptives, as they do currently for OTC products like spermicides and sponges that are prescribed by a doctor. This would be a good deal for insurance companies since OTC contraceptives would almost certainly be cheaper than prescription versions of the same pills.

So let’s join the Republican cause on OTC oral contraceptives. It’s good science and good policy. And let’s continue to oppose any efforts in Congress to weaken the contraceptive mandate. That’s also good policy.

Or am I missing something here?

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