A Brand-New, Much-Needed Birth Control Bill

There's been a lot of talk lately about over-the-counter birth control. Some of the discussion has acted more as a veiled attempt to undermine the Affordable Care Act, which is crystal clear in Senators Cory Gardner and Kelly Ayotte's recent over-the-counter birth control bill that would — surprise, surprise — not apply to contraception covered by health insurance plans. As a response, Sen. Patty Murray introduced the Affordability IS Access Act on Tuesday, which would expand access to contraception while also ensuring women don't have to pay any more out-of-pocket expenses.

Murray's bill builds upon the guaranteed no-copay coverage enshrined in the Affordable Care Act by allowing FDA-approved birth control pills to be sold at pharmacies for routine use. Yes, that means no prescription necessary.

"Affordability and accessibility go hand in hand," Murray said in a news conference call Tuesday. "We felt that women shouldn’t have to pay out their own pockets for a critical part of their health care."

Insurance companies that do not comply would be penalized, and stores owners and employees will not be allowed to block anyone from purchasing the contraception, ensuring that those so-called conscience laws won't get in the way.

It's a step up from the Senate Republicans' proposed legislation, which would make FDA-approved contraception available over-the-counter but force women to pay for it full price, regardless if the consumers have health insurance or not. Gardner said in a statement last month his bill would "increase access in rural and under-served areas" and "save consumers money by increasing competition and availability."

But Murray disagreed. The senator criticized Gardner's policy on Tuesday, claiming the Republican tactics "would take women backward."

"They’ve [Senate Republicans] said they support over-the-counter birth control pills, but they are also dead-set about taking away women’s access," Murray said. She added the Republicans' bill would have women paying as much as $600 each year for birth control pills, whereas her bill would still ensure that there's no-copay under a woman's insurance plan.

The Affordability is Access Act is supported by doctors and reproductive health advocates, including the American Congress of Obstetricians and Gynecologists, which has repeatedly endorsed over-the-counter birth control when it's paired with health insurance coverage. ACOG first recommended that oral contraceptives should be made over-the-counter in 2012, but noted at the time that cost will continue to act as a barrier for many low-income and middle-class women. The association also rejected the Senate Republicans' plan last month because of the lack of insurance coverage.

ACOG President Dr. Mark DeFrancesco called Murray's bill "the right approach" to expanding contraception access. "It recognizes that over-the-counter access is not a one-size-fit-all solution, because birth control is not one size fits all," he said. "The health care system helps each woman get the right type of birth control for her."

Planned Parenthood Action Fund and NARAL Pro-Choice America also endorsed Murray's bill. Cecile Richards of Planned Parenthood said the approach would continue the success of the Affordable Care Act, which had women saving $483 million more just in the first year of the birth-control mandate, according to her organization's figures.

As over-the-counter birth control becomes a major talking point on both sides of the aisle, it's important to understand not only how the measure could truly expand access, but also how it could potentially place limitations on women. The Senate Republicans' bill only applied to birth control pills that were not covered under the ACA, which would effectively limit the types of oral contraception women could buy at their local store. Murray, however, pointed out that her bill would allow oral contraception covered under the ACA to be purchased over-the-counter.

While some critics question whether it's truly safe to sell hormonal contraception without a prescription, Murray ensured that her bill would make the FDA the "sole authority." All contraception would have to go through a rigorous FDA application and testing process before being placed on the shelves, the bill states.

DeFrancesco added that oral contraception is "safe and effective" enough to be sold without a prescription. "Oral contraception has similar or lower-risk profiles than other types of medicines already available without prescription," he said.

Earlier this year, a study published in the journal Contraception found that the rate of unintended pregnancies could decline by 25 percent if birth control was sold over-the-counter with insurance coverage. Researchers also found that 21 percent of low-income women are very likely to use over-the-counter contraception, and an additional 11 percent to 21 percent of low-income women would use over-the-counter birth control if there were no out-of-pocket expenses. Overall, the number of women not using any form of birth control — or a form less effective than the Pill — could be reduced by 36 percent if these measures were taken.

For DeFrancesco, these numbers make sense. The physician stressed that low-income women, who may already lack funds to pay for a wellness exam or doctor's visits, would perhaps be the ones who benefit the most from over-the-counter contraception.

Uninsured women, too, would have much greater access to contraception, though it's unclear at this time how much women without insurance would have to pay under Murray's bill. Still, ACOG sees it as a way for uninsured women to cut costs by forgoing the out-of-pocket cost for a doctor's visit.

"There are many women in America whose lives would be improved if they could go to their local pharmacy and take control of their reproductive choices without a prescription," DeFrancesco said. "[Women's life] choices are impacted by the accessibility of the full range of contraception in America."

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