Cruz, Ocasio-Cortez efforts on birth control access face major obstacles

Sen. Ted Cruz’s (R-Texas) offer to work with Rep. Alexandria Ocasio-Cortez (D-N.Y.) on making birth control available without a prescription has raised hopes that conservatives and progressives may find common ground on an issue that has long divided Republicans and Democrats.

But the two parties are miles apart when it comes to the cost of birth control and who pays for it — major sticking points that will likely complicate efforts to craft a bipartisan compromise between the staunch conservative and liberal firebrand.

But Cruz sparked intrigue this week when he agreed with an Ocasio-Cortez tweet calling for over-the-counter birth control.

{mosads}“I agree,” he tweeted in response. “A simple, clean bill making birth control available over the counter. Interested?”

Cruz’s office did not respond to questions about what a “clean” bill would look like, or if he planned to introduce legislation.

Ocasio-Cortez told reporters, after Cruz reached out to her, that the cost of birth control will need to be addressed.

“They just want to do a clean, over-the-counter bill. But they don’t want to make adjustments for affordability,” Ocasio-Cortez said. “If we’re talking about access, access is about: Is this readily available for purchase? And if so, is it readily available for purchase at a price that is accessible to most working people?”

Several health organizations, including the American College of Obstetricians and Gynecologists, say birth control pills are safe enough to sell over the counter, and doing so would increase accessibility while potentially decreasing unintended pregnancies.

But the U.S. remains one of the few Western countries that doesn’t allow for that level of access. Only the Food and Drug Administration can approve birth control for over-the-counter sales.

{mossecondads}Congress has tried to address the issue, but the main proposals from Republicans and Democrats approach over-the-counter birth control in two different ways.

Courtney Joslin, a commercial freedom fellow for R Street, said progress has been slow going.

“We are working on trying to get some bipartisan support and it is really difficult because it’s so politically charged,” she said.

Legislation backed by Sen. Patty Murray (D-Wash.), Rep. Ayanna Pressley (D-Mass.), Ocasio-Cortez and others would require insurance coverage of over-the-counter birth control, with no prescription requirements and no extra costs.

Insurance companies currently have to cover 20 methods of contraception, but only when it is prescribed by a doctor. That’s the case with Plan B, a form of emergency contraception available over the counter, but many insurers require patients to have a prescription before they will pay for it.

Some Republicans take issue with Murray’s bill because they oppose forcing insurance companies to cover birth control, arguing it can violate the religious or moral beliefs of employers. A Murray aide said the senator sent Cruz information on her bill but has not heard back on whether he will cosponsor it.

The Texas Republican has never introduced an over-the-counter birth control bill since becoming a senator in 2013.

A Republican-backed bill would work around the insurance provision by allowing patients to use health savings accounts to purchase over-the-counter birth control when it becomes available in the U.S.

Those accounts allow employees to save pre-tax dollars for health care purposes, but a provision in the Affordable Care Act bans the use of the funds for over-the-counter drugs.

The Republican measure, introduced in March by Sens. Joni Ernst (R-Iowa) and Cory Gardner (R-Colo.), would speed up the government’s review of petitions filed by companies that want to sell their birth control products without prescriptions.

But Democrats and reproductive rights groups oppose the bill, arguing that women shouldn’t have to pay out-of-pocket for birth control, or continue to get prescriptions for a drug that is available over the counter. The GOP measure would also limit over-the-counter (OTC) sales to adults.

“Women seeking contraceptive care shouldn’t find they have to pay extra, ask permission, or hurdle barriers put up by politicians who think their ideology is more important than a woman’s personal health care decisions,” Murray said in a statement.

Planned Parenthood called Murray’s proposal a “stark contrast” to Ernst and Gardner’s legislation, arguing that it would “impede birth control access while claiming to do otherwise” and result in women paying high out-of-pocket costs.

Kelsi Daniell, a spokeswoman for Ernst, told The Hill that the intent of the legislation “is simply to provide women access to the contraception of their choice over-the-counter, and allow women who utilize a tax-advantaged savings account for health care expenses to purchase their OTC contraception with those funds.”

Joslin said that while she hopes Democrats and Republicans can merge their two bills and work together, she also realizes both sides have strong objections.

“Insurance coverage is a big issue for Republicans and it probably will be difficult to get Republicans on board,” she said. “And then a lot of Democrats have issue with the age restriction on the over-the-counter bill. Those are, I think, the major two things that the parties are going to have to work out between themselves.”

Republicans or libertarians might also oppose insurance coverage of over-the-counter birth control because they say it interferes with the free market.

“In general, once a drug becomes over the counter, its prices come down because it’s subject to market competition,” said Jeffrey Singer, a medical doctor and a senior fellow at the Cato Institute. “If you really want to improve access, then you don’t want insurance injected in the middle of it because it makes the price higher than it otherwise would be.”

Still, reproductive rights groups argue that if women are paying for insurance, they shouldn’t have to pay more for over-the-counter birth control at the pharmacy.

“Fundamentally, birth control is health care, and so it should be covered by your insurance,” said Mara Gandal-Powers, director of birth control access and senior counsel at the National Women’s Law Center.

Mike Lillis contributed.