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Access to Birth Control, Under the Next President

What Obama and McCain's positions on contraception and health services would mean for Americans.
 
 
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It's hard to measure support for access to contraception for two reasons -- "access" and "contraception" both denote very broad categories.  Contraception is everything from condoms to birth control pills to sterilization, and access points range from non-profit distribution to convenience stores to doctor's offices.  Do we consider someone's access more or less limited if they can get birth control pills from Planned Parenthood but the condoms at the grocery store are locked up after 10pm, which is when they discover they need them?  I can't answer that question for you, because it's the very definition of subjective, but I can point out five basic areas where access meets contraception and how the two candidates for President approach them.  As far as I know, both McCain and Obama have not registered an opinion on whether or not it's completely lame of your grocery store to require you to summon a clerk to open the condom display.   

So here's a rundown of five basic questions people ask of themselves when looking to access contraception, and answers Senators McCain and Obama have given through votes and campaign platforms. 

Can I get a prescription from a doctor? 

The chance of getting a prescription from a doctor is 99% based on whether or not you can see one, and that, for most people, depends on if you have insurance that covers this.  Currently, 16% of Americans don't have this basic opportunity.  Both candidates claim they have plans that will get coverage to most Americans and lower costs, but these are claims that bear closer examination.   

The McCain proposal is all about the free market.  The campaign claims that getting people out of employer-provided health care and making them free agents on the market will lower prices.  To reach this goal, they intend to tax employer-provided benefits, with the hope that this encourages people to give up that coverage.  Less people using employer-provided benefits is extremely unlikely to have the results promised by McCain.  We only have so many uninsured people right now because they don't have employer-provided insurance, and therefore can't use their employers' bargaining power to get coverage despite pre-existing conditions.  At best, we will see people just paying more for health care under the McCain plan, but at worst we'll see the number of uninsured go up, meaning that more women will have to turn to non-profits or government programs for birth control access.  Or go without.   

The Obama proposal takes another tack, responding to the fact that most Americans who are uninsured are so because they don't have access to employer-provided health care.  People who already have employer-provided health care don't have to change a thing or pay more for it.  People who aren't able to access that kind of health care will be extended the opportunity to buy into a national health plan that will have guaranteed eligibility, so you won't need to have an employer's power backing you up so you can get insurance.  For people who don't already qualify for Medicaid or SCHIP but still need assistance paying for health insurance, there will be subsidies to help them out. 

By addressing the main cause of insurance gaps---lack of access to employer-provided insurance---the Obama plan will be far likelier to increase the number of Americans who have coverage. 

Can I get contraceptives from non-profits or government programs? 

For people who go to Planned Parenthood or some other non-profits that receive government funds for their health care, this election might also influence their bottom line ability to receive care.  The main thing you're wanting to look at in this department is the voting record on Title X and other family planning programs.  On this issue, the two candidates strongly differ.  McCain attempted to end Title X funding that pays for contraception programs, as well as other women's health care.  Obama is a strong supporter of Title X funding, which causes much consternation amongst anti-choicers.  If you get your contraception---prescribed or over the counter at a discount---or any kind of health care from Planned Parenthood, then this is the funding debate that pertains to you.  

Obama has also sought ways to expand the ways in which the government can make it easier for you to get contraception, by co-sponsoring the Prevention First Act. This legislation would increase Title X spending, but also make it easier to get emergency contraception if you're sexually assaulted. 

Can I get contraception from my pharmacy? 

Under Bush, as you no doubt know by now, Health and Human Services (HHS) tried to expand the right of health care workers to refuse to give you contraception by allowing individuals to decide that they just believe that contraception is abortion, facts be damned.  Refusal clauses are another brain child of the religious right.  They figure if they can't get the government to deny you contraception, they'll get vigilante pharmacists to do it instead.  This HHS controversy is the first time the issue has really risen to the national level, and so we have a fairly cut-and-dry source to look for which Senators will fight against refusal clauses and which won't--- Hillary Clinton's letter of protest against the HHS for this abuse of power.  Barack Obama was one of 28 Senators who signed this.  John McCain did not.  

Do I know how to use this stuff? 

Right now, the federal government doesn't pay for the education of adolescents in the art of not getting knocked up or catching some nasty STI, but instead backs abstinence-only "education", otherwise known as, "Maybe you'll figure it out after the first 3 unintended pregnancies or STI infections" non-education. McCain considers himself a supporter of abstinence-only programs.  Barack Obama has tried to introduce comprehensive sex education in two separate ways.  First was the Prevention Through Affordable Access Act, which would support comprehensive sex education programs.  Then there was the Lautenberg/Menendez amendment to Child Custody Protection Act to reduce teen pregnancy through education. Obama voted for this amendment, and McCain voted against it.  

Can I afford this? 

For a lot of women who use hormonal contraception, affordability depends on whether or not their health care plans cover contraception.  For college-aged women, this often means using discounted pills through student health services, a discount that disappeared after budgetary changes to reduce the deficit in 2005.  To restore access to inexpensive contraception, Barack Obama introduced the Prevention Through Affordable Access Act in 2007, which, if it passes, will rectify the problem and reduce the price of birth control pills on campus. 
Women who rely on insurance co-payment to make their birth control more affordable hit a major obstacle when they have insurance companies that won't pay for it, but will pay for other drugs like Viagra.  McCain voted against a bill that would require equal coverage for women, and asked about it by a reporter for the L.A. Times, tried to get out of the question. Obama, in contrast, championed the Prevention First Act, which would ensure that insurance companies treat birth control pills like they do other drugs, instead of giving them higher co-pays. 

Amanda Marcotte co-writes the popular blog Pandagon. She is the author of It's a Jungle Out There: The Feminist Survival Guide to Politically Inhospitable Environments .

 
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