During a debate Tuesday night, Ed Gillespie, a Republican who is running for Senate in Virginia, made a rather bizarre claim that repealing the Affordable Care Act would somehow make it easier for women to get birth control, even though the ACA currently requires insurance plans to cover it without a co-pay. “The reason that non-prescription birth control, and other non-prescription drugs, are not covered is because that’s the rule in Obamacare,” Gillespie argued. “My point is that if you replaced Obamacare with market-oriented reforms, people could purchase the insurance of their choice. Many women would purchase plans that would cover over-the-counter non-prescription birth control pills.”
Many Republican candidates this season have been touting over-the-counter birth control as some kind of “alternative” to the Affordable Care Act, but Gillespie’s statements came the closest to sounding like an actual proposal. It is true that many doctors and pro-choicers—including myself—have pushed for birth control pills to be sold over the counter. But there’s a number of reasons that repealing Obamacare will not, in fact, make it easier for women to take control of their reproductive health care. On the contrary, it will make it much harder.
1) Repealing Obamacare would not make birth control pills available over the counter. Gillespie made it sound like the ACA itself is preventing women from swooping in and buying birth control pills over the counter (OTC). That is simply false. Prior to the ACA, birth control pills weren’t OTC; there’s no provision within the law requiring that they stay prescription-only. Repealing Obamacare would just mean that the U.S. Department of Health and Human Services couldn’t require insurance plans to cover birth control. The only way for birth control pills to be sold OTC is for one of the drug companies to petition the Food and Drug Administration for the ability to do so, and for the FDA to approve that petition. The OTC status of birth control pills is not affected one way or another by the ACA.
2) None of the Republicans endorsing OTC birth control pills will ever have the power to make that happen. Gillespie and other Republicans promising to repeal the ACA and replace it with OTC birth control pills would, if elected, only have the power to potentially do the former. If they have a big enough majority, they could repeal the ACA by overriding a presidential veto, though it’s very unlikely that they will ever get that big a majority. But it’s even more unlikely—in fact, it’s impossible—that they’ll make birth control pills OTC. As noted in point #1, only the FDA has that power, and birth control drug companies must apply for OTC status to even get the gears in motion. So far, no drug companies have even bothered applying. The repeal-and-replace plan can’t work if there’s no way to replace it. You’re only left with repeal.
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3) Birth control pills can be made available OTC without repealing the ACA. Nothing about the ACA is stopping drug companies from applying for OTC status for birth control pills, and nothing in the ACA is stopping the FDA from approving that application. The two things are unrelated. And if the FDA did approve OTC birth control pills, nothing is stopping insurance from covering the pill anyway. You would simply have your doctor write a prescription for you to trigger the coverage, much the way it works for emergency contraception now. It is true that the ACA doesn’t allow for insurance to cover non-prescription contraception. But that provision could be changed without repealing the entire ACA.
4) The ACA has a proven track record of improving women’s access to contraception. A recent report from the Guttmacher Institute shows that the ACA has had a dramatic impact on women’s ability to afford contraception. Since the fall of 2012, the percentage of privately insured women who got the pill with no co-pay went from 15 percent to 67 percent. Similarly, for those who received injectable contraception, it went up from 27 percent to 59 percent. For the ring, it went from 20 percent to 74 percent; for the IUD it went up from 45 percent to 62 percent.
5) Replacing insurance coverage of contraception with OTC birth control pills would actually reduce options for many women. Gillespie suggested his idea would improve women’s choice of contraception by saying, “I have faith in the women of Virginia to make those determinations about what is the best plan and policy for them and their medical needs, not to have a set proscription in terms of what plans you can and cannot buy.” The problem with his plan is that stripping mandated contraception coverage from insurance plans and replacing it with OTC birth control pills would significantly reduce choice. Without the ACA mandating that birth control be covered without a co-pay, many insured women who want an IUD, an implant, sterilization, or the ring would be out of luck: They’ll likely be forced to pay full price for these forms of contraception, as well as for the doctor visits to get them. Being reduced to the birth control pill or a condom is not a way to improve choice.
6) There’s more to health care than contraception. There’s been a lot of attention paid to the mandate requiring contraception to be covered by health insurance, but in reality, that’s just a teeny-weeny part of what the ACA does. For everyone, the ACA prevents insurance companies from rejecting you for pre-existing conditions, makes it harder for them to wiggle out of covering you if you become sick, and forces insurance companies to meet federal minimums of what they cover in their plans. The ACA also made sure millions of previously uninsured people got health insurance, either through their parents, Medicaid, or exchanges that make insurance more affordable and help some folks out with subsidies. Repealing it would strip millions of Americans of all health care, including reproductive health care. You can’t replace that with some OTC birth control pills.
In the end, the “ACA vs. over-the-counter birth control” argument is a false choice. Repealing the ACA will not make OTC birth control happen. It’s not even going to make OTC birth control happen any faster. The only thing that would happen if we repeal the ACA would be that millions of Americans would lose their health insurance, including their contraception coverage—and no woman would find it one iota easier to get the contraception.