The Coming Battle Over the Cost of Birth Control

Health-care reform raised the possibility that birth control could soon by free for most women. But not if conservative activists have their way. Dana Goldstein reports.


Health-care reform raised the possibility that birth control could soon be free for most women. But not if conservative activists have their way. Dana Goldstein reports.

Could prescription birth control—whether the pill, an IUD, or a diaphragm—soon be free of cost for most American women?

Polls suggest the majority of Americans would support such a policy. But the Daily Beast has learned that many conservative activists, who spent most of their energies during the health-care reform fight battling to win abortion restrictions and abstinence-education funding, are just waking up to the possibility that the new health care law could require employers and insurance companies to offer contraceptives, along with other commonly prescribed medications, without charging any co-pay. Now the Heritage Foundation and the National Abstinence Education Association say that, like the U.S. Conference of Catholic Bishops, they oppose implementation of the new provisions.

"It would be a disaster for women's health" to exclude contraception from the new requirements for insurers, said Kelly Blanchard, president of Ibis Reproductive Health.

The conservative groups are particularly worried that a birth control coverage mandate could include teenage girls and young women covered under their parents' health insurance plans. "People who are insured don't want to pay for services they don't need or to which they have moral objections," said Chuck Donovan, senior researcher at the Heritage Foundation. "Parents want to have a say over what's covered and what's not for their children."

Currently, 27 states require insurers to cover birth control, but federal health reform has the potential to go much further—mandating that prescription birth control be offered to consumers in all 50 states and the District of Columbia free of "cost-sharing," or payments at the pharmacy counter.

Reproductive-rights advocates are openly lobbying the Obama administration to enact the birth control changes quickly, citing the United States' high rates of teenage and unintended pregnancy—the highest in the developed world.

"It would be a disaster for women's health" to exclude contraception from the new requirements for insurers, said Kelly Blanchard, president of Ibis Reproductive Health, a Cambridge, Massachusetts-based research organization.

Experts expect the Department of Health and Human Services, led by pro-choice Obama appointee Kathleen Sebelius, to spend the next six to 18 months researching women's health before releasing new guidelines for women's " preventive health care." Under the new law, services and medications defined as "preventive" must be offered to customers of new insurance plans free of co-pays—whether that insurance is employer-provided or purchased on the individual marketplace, whether inside or outside of the new, subsidized health insurance exchanges.

The long regulatory timeline gives opponents of birth control access many months to organize in opposition, though it is more difficult for pressure groups to influence regulation than it is for them to influence legislation. Members of Congress must answer to angry constituents and funders, while bureaucrats are mostly anonymous and far more independent. But Donovan said the Heritage Foundation might ask its political allies to step-in on the issue of birth control regulations. "If HHS oversteps its bounds, we wouldn't be hesitant to recommend that Congress take another look," he said.

Valerie Huber, executive director of the National Abstinence Education Association, told The Daily Beast that when it comes to teen sex, public policy should encourage risk-avoidance through abstinence, not risk-reduction through contraceptive use. "We don't want to see the sexual health of our young people compromised. We are concerned that if there isn't a policy correction, that will be the result. We welcome continued conversations with the [Obama] administration."

The Conference of Catholic Bishops, which so effectively lobbied Congress to exclude abortion from the services covered by health care reform, hasn't yet issued a call to action against expanded birth control coverage or asked local priests to preach against the potential change, as they did during the abortion battle earlier this year. But the bishops are watching the regulatory process closely.

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"At the point at which the voice of the Catholic faithful and other pro-life people would be helpful to persuade the government to do the right thing, there would be an action alert," said Deirdre McQuade, assistant director for policy and communications at the Conference's Secretariat of Pro-Life Activities.

Still, there's a major difference between this battle and the one over access to abortion under health reform—a fight anti-abortion rights forces won. On contraception, opponents are far outside the mainstream.

Unlike on abortion rights, where opinion polling demonstrates a notoriously conflicted public, birth control is wildly popular. Eighty percent of Americans say pharmacists should be required to dispense birth control regardless of their own opinions on the morality of premarital or non-reproductive sex. Three-quarters of American Catholics disagree with their Church's anti-contraception policy. A recent survey of evangelical leaders—the family values crowd—found that 90 percent of them consider hormonal birth control and condoms "morally acceptable."

The business community, too, is enthusiastic. A new report from the National Business Group on Health found that most companies would save money in the long run by providing their employees with co-pay-free birth control.

There's also massive demand for these drugs: According to the Guttmacher Institute, seven out of every 10 American women over the age are 15 are currently sexually active and don't want to become pregnant. Eighty-nine percent of them are using some form of contraception; 15.3 million Americans use prescription hormonal birth control.

"This is just universally supported by folks from all walks of life. It's just common sense," said Cecile Richards, national president of Planned Parenthood. That kind of consensus, Richards enthused, "is so rare in this kind of work!"

Reproductive rights advocates have more than public opinion going for them. The moderate Democrats who partnered with social conservatives to tamp down on abortion access in health reform are generally supportive of birth control. Rep. Bart Stupak, for example, has a history of voting against attempts to defund Planned Parenthood, a cause célèbre among some Republican members of Congress. In a March interview with the Washington Times, Stupak defended the Planned Parenthood clinics is his Michigan district, saying they provide many essential non-abortion health services—chief among them access to birth control.

The White House, which has been criticized by reproductive rights advocates for not fighting harder to expand abortion access under health reform, did not respond to a request for comment on its political strategy concerning birth control regulations. The extent of organized Republican opposition to free birth control remains unclear, as the congressional women's health reform debate was focused almost entirely on abortion and, to a lesser extent, access to breast cancer screenings and maternity care.

That said, free prescription birth control would be unprecedented in the United States—the kind of broad, societal liberalization that conservative activists hunger to prevent. Even in Massachusetts, the only state to have passed comprehensive health reform on its own, these drugs aren't free for most women.

"I don't want to overstate or understate our level of concern," said McQuade, the Catholic bishops' spokesperson. "We consider [birth control] an elective drug. Married women can practice periodic abstinence. Other women can abstain altogether. Not having sex doesn't make you sick."

Dana Goldstein is an associate editor and writer at The Daily Beast. Her work on politics, women's issues, and education has appeared in The American Prospect, Slate, BusinessWeek, The New Republic, and The Nation.

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This piece has been updated to clarify the nature of the National Abstinence Education Association’s critiques of the health reform law.