Congressman Cory Gardner, a Colorado Republican who is running for Senate, has a problem. He has a long and scary track record of opposing contraception access, particularly for low income women, at every turn, including a vote against allowing pharmacists to prescribe emergency contraception in 2006, a vote against requiring insurance companies to cover contraception in 2008, a history of opposing expanded contraception access through Medicaid, and a vote against a bill requiring hospitals to make emergency contraception available to rape victims. He's also got a history of pushing for "personhood" amendments that anti-choice activists could use to attack the legality of female-controlled contraception methods like the pill and the IUD by falsely claiming they are "abortion."
These votes might have been OK in Gardner's congressional district, but they are a problem now that he's running for statewide office. As it turns out, contraception continues to be wildly popular with the general public, with 90 percent of Americans rating birth control as "highly acceptable" on a morality scale. Gardner's approach to this conundrum wins points for novelty. Last Thursday, he published an op-ed in the Denver Post arguing that he loves the birth control pill so much now that he thinks it should be sold over the counter without a prescription.
Since "the pill" was first approved 44 years ago, it's been one of the most proven and tested pharmaceuticals of our time. It is safe, reliable, effective, and presents very few risks or complications for the more than 10 million women who use it. When other drugs have that kind of track record, we approve them for purchase without a prescription; the Food and Drug Administration has already reclassified over 100 different treatments. Name-brand drugs like Advil, Pepcid, Claritin, Prilosec and many others were once sold by prescription only, but moved to over-the-counter sale (OTC) once they'd been proven safe and unlikely to be abused.
When treatments go over-the-counter, two things happen: they get dramatically cheaper and consumers save time and hassle by avoiding unnecessary doctors' appointments just to get the pharmaceuticals they already know they need.
That's a dramatic reversal from a man who, just a few years ago, opposed even giving pharmacists the ability to prescribe the same kind of hormonal medications that he now approves of selling over the counter. Since many in the medical community, including the American Congress of Obstetricians and Gynecologists, agree that oral contraception is safe enough to be sold over the counter, we should applaud this change of heart, right?
Not exactly. I might be clapping if Gardner's op-ed wasn't so shady about the issue of cost. He argues in the piece that his proposal would lower contraception costs because, "Almost all therapies that move to OTC drop in price dramatically." That's true, if you ignore the millions of women whose out-of-pocket expenses for contraception above and beyond their insurance premiums have dropped to zero under the Obama HHS requirement that contraception be covered like the preventive care that it is. "Driving the price down for a safe medicine is a better way to provide access to adults who want it than President Obama's insurance mandate," Gardner blithely argues. But how can you drive the price down below what it is for insured women right now, which is $0?
Gardner is hardly the first Republican to propose ending the contraception mandate and replacing it with over-the-counter birth control pills. Gov. Bobby Jindal of Louisiana floated this proposal back in 2012. It's a nice, libertarian-sounding idea that purports to be pro-contraception but just so happens to raise the price of birth control by taking it out of the insurance system. Gardner claims this is a loophole that could be easily shut by repealing a provision that "has blocked insurers from covering OTC medicine without a prescription." But even without that provision, insurance companies have been notoriously hostile to covering OTC medications, which is why you can't flash your insurance card when buying aspirin or Nyquil and get a discount. (You can allow insurance companies to cover OTC medications as much as you want, but you won't ever convince them to actually do it.) Nor does Gardner's proposal address the needs of women who want IUDs or implants, which are increasingly popular insurance-covered contraception methods.
Look, in a country where not everyone has insurance coverage, I am in favor of over-the-counter birth control as an option for the uninsured. But completely replacing mandatory insurance coverage of contraception with an over-the-counter system would raise the costs for far too many women, which would end up reducing access to the pill, despite Gardner's newfound enthusiasm for it.