Commentary Contraception

Would It Be Better for the Government to Pay for Everyone’s Contraception? No.

Amanda Marcotte

Rick Santorum recently made remarks suggesting that he'd prefer having everyone's contraception covered by the government instead of by insurance plans. That might seem like a good idea on its surface, but in reality it would reduce access to contraception.

In what is sure to get interest as a man-bites-dog story, Rick Santorum recently suggested, however reluctantly, that it would be better for the government to provide free contraception than to have the birth control benefit that’s part of Obamacare, which says that insurance plans must cover contraception like other forms of preventive health care, without a co-pay. It’s tempting to be generous and read these comments as an attempt to meet liberals halfway, but liberals should be wary. This is, after all, Rick Santorum we’re talking about.

Santorum started off with a big fat lie, which should have been the first clue that he’s not above board here; he said that the birth control benefit is “forcing people who have views like me to go out and use my money to buy those products.” Santorum clearly wants his audience to imagine that employers are being asked to buy contraception and, I don’t know, provide it directly to employees at work. That is untrue, no matter how you slice it: Federal law does not require anyone to buy contraception for anyone else or even “pay for it,” as conservatives gripe. Employees’ insurance plans are a benefit that they earn as part of their employment, and if an employee chooses to use that benefit on contraception, their boss is no more “paying for it” than if the employee chooses to use her paycheck to buy contraception out of pocket.

Having scared his audience with a lie suggesting that employers are being forced to have condom bowls in bathrooms (not that this is a bad idea, actually, which is why some employers voluntarily do this), Santorum pretended to be magnanimous to the 99 percent of American women who have used contraception at some point in their lives. “It would be less objectionable to me,” he said, “for the government to go out and say we’re going to pay for all the pharmacies to stock contraception and give them out free. Am I paying for it indirectly? Yes, through my taxes, but I pay for a lot of things with my taxes that I don’t like.”

It’s easy to see how liberals might be baited into thinking Santorum is offering a reasonable compromise here. After all, liberals—and most Americans, in fact—support existing government programs that provide contraception to people who can’t afford it, and condom distribution programs that target all people who have need, regardless of income. It seems easy, therefore, to just embrace this idea as an excellent way to get everyone’s needs met while avoiding these sticky fights over employee-earned benefits.

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Because Santorum was so half-hearted about this, most liberals who reported on his remarks didn’t take his bait, but a couple of people did try to argue that the idea of government-provided contraception for everyone is a great idea.

But I want to push back, in no small part because I think that making contraception a government benefit instead of part of a package of reproductive health-care services is actually a devious idea whose purpose would be to make contraception harder to get. Even though Santorum suggested just paying pharmacies to hand out contraception, in reality a plan like his would mean removing prescription contraception from its current channels and centralizing it into a government bureaucracy. That would mean that instead of just going to your doctor for a check-up every year and getting a prescription—and charging the visit, like all of your health care, to insurance—you would have to make a special “contraception-only” trip. That trip may even be to a government agency instead of your regular doctor. Already many women, especially poor women, struggle to make it to all their doctor’s appointments, so adding another one entirely would be an outrageous burden on access.

And it’s very unlikely that pharmacies would cooperate with separating out contraception when billing insurance companies, which might mean centralized locations would have to be employed for contraception distribution, creating a barrier for women who would no longer be able to pick up their birth control pills alongside the other things they need from the pharmacy.

Basically, Santorum’s idea would mean separating contraception from mainstream medical care. Once separated out, of course, it would be much easier for conservatives to start targeting the contraception distribution centers for cutbacks or insist that they be put in locations that aren’t accessible. (You know, like they do to abortion clinics.) In addition, separating out contraception from all other medical care in this way would reinforce the false notion that birth control is not “legitimate” medical care, which would contribute to marginalizing and stigmatizing it. That contraception centers would be targeted for aggressive shut-down techniques is beyond dispute. Already places like Planned Parenthood and other family planning clinics are shutting their doors due to budget cuts and other attacks from conservatives. This would just make that happen on a much bigger scale.

The safest place for contraception to be is in the mainstream of medical care—available through your regular doctor and local pharmacy and covered, like all other needed health services, by your insurance provider. This helps reinforce the notion that contraception is, in fact, a normal part of health care. And it would make it much harder for conservatives to marginalize contraception or shame women for using it. This way gives women autonomy and privacy; just imagine if everyone had to go to a contraception center for contraception—the anti-choice protesters would love that! But most importantly, it demonstrates that women’s health care is just as important as men’s—just because a form of health care is associated with women doesn’t mean it isn’t real health care.

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