Remember the 2012 Republican presidential debate in which ABC’s George Stephanopoulos, seemingly out of nowhere, pressed Mitt Romney repeatedly for his views on contraception? After a contentious back-and-forth, a frustrated Romney declared, “Contraception, it’s working just fine, just leave it alone.”
In the 2014 midterms, Democratic candidates have taken up where Stephanopoulos left off, and they’re certainly not leaving contraception alone. In some key Senate races, Democrats have even charged that Republicans would “make birth control illegal.” (That’s from Colorado Democratic Sen. Mark Udall, directed at GOP opponent Rep. Cory Gardner.) But now, instead of Romney’s irritated protest, the GOP has a new policy response, which strategists hope will “neutralize” (the word used by one operative) the Democratic attacks. But it’s still to be seen whether that is possible, or even whether Republicans will agree among themselves that the idea would both work politically and be good policy.
The idea is to make the birth control pill available over the counter, to all, 24/7, without a prescription. It’s becoming a trend among Republican candidates in Senate races around the country. In North Carolina, GOP candidate Thom Tillis recently embraced it. So has Ed Gillespie in Virginia. Mike McFadden in Minnesota. Gardner in Colorado. And one of the leading proponents of the move is a potential 2016 GOP presidential candidate, Louisiana Gov. Bobby Jindal.
The most intense debate over the idea has taken place in Colorado, where Gardner unveiled a birth control TV commercial last week. “What’s the difference between me and Mark Udall on contraception?” Gardner asked in the ad. “I believe the pill ought to be available over the counter, round the clock, without a prescription — cheaper and easier, for you.” Udall, Gardner said, would “keep government bureaucrats between you and your healthcare plan,” resulting in “more politics, and more profits for drug companies.”
Gardner first rolled out the proposal in a Denver Post op-ed in June. The birth control pill has safely been in use since it was first approved 44 years ago, Gardner argued. “When other drugs have that kind of track record, we approve them for purchase without a prescription,” he wrote. “Name-brand drugs like Advil, Pepcid, Claritin, Prilosec and many others were once sold by prescription only, but moved to over-the-counter sale once they’d been proven safe and unlikely to be abused.”
Democrats reacted with an almost sputtering rage. How dare a Republican try to move in on their issue! Gardner’s ad was “jaw-dropping,” the Udall campaign said. “Congressman Gardner will do anything to hide his backwards agenda from Colorado women,” added a Udall spokeswoman. “The undeniable fact is Gardner continues to push radical, anti-woman measures that would ban common forms of birth control. One 30-second ad doesn’t make up for that.” Planned Parenthood, which supports making birth control pills available over the counter, wasn’t happy with a new ally. “This is simply a cynical political attempt to whitewash [Gardner’s] terrible record and agenda for women’s health,” said a group spokeswoman.
The Democrats’ critique of Gardner focuses on his support in the past for so-called “personhood” initiatives which define life as beginning at fertilization. Critics, mostly on the Democratic side, say personhood measures would lead to the banning of some types of birth control. Whether that would really happen is unclear. “A lot of legal ambiguity remains,” noted an analysis by PolitiFact last April. “Because no state has passed a personhood measure, we don’t know how it could impact specific types of contraceptives.”
Nevertheless, last March Gardner, already in a tight, highly competitive race, abandoned his previous support for personhood. “I was not right,” he told the Denver Post. “I can’t support personhood now. I can’t support personhood going forward. To do it again would be a mistake.”
“The fact that it restricts contraception, it was not the right position,” Gardner continued in his remarks to the Post. “I’ve learned to listen. I don’t get everything right the first time. There are far too many politicians out there who take the wrong position and stick with it and never admit that they should do something different.” A few months later, Gardner introduced his proposal to make the pill available over the counter.
Now, some Republicans hope Gardner has essentially defanged the opposition as far as birth control is concerned. “Strategically speaking, Cory checkmated both Udall and the Democratic Senatorial Campaign Committee on this issue,” one party operative told me. “Think about it, their entire campaign was based on the strategy of making Cory look radical on birth control/contraceptives/abortion…In response to that, Cory took the populist position on contraception both in terms of access and cost. That Udall allowed him to was a mistake; instead of criticizing, he should have echoed Cory. Their entire campaign strategy has been effectively neutralized.”
In North Carolina, Republican Thom Tillis is a more recent advocate, coming out in support of over-the-counter sales of the pill just last week in a debate with incumbent Democratic Sen. Kay Hagan. “I actually agree with the American Medical Association — we should make contraception more widely available,” Tillis said. “I think over-the-counter oral contraception should be available without a prescription. If you do those kinds of things it will actually increase the access and reduce the barriers for having more options for women for contraception.”
Aides say Tillis read quite a lot about the issue recently and was influenced by the American College of Obstetricians and Gynecologists recommendation in favor of over-the-counter sales. “The policy makes sense to him,” said one aide. Still, it was no surprise that Democrats immediately criticized Tillis, arguing that even if the pill were available over the counter, women would still have to pay for it, while Democrats support making it free, as it is under Obamacare.
For Tillis and others, one of the most influential single statements on the issue was written by Jindal. An op-ed by the Louisiana governor, “The End of Birth-Control Politics,” ran in the Wall Street Journal in December 2012, not long after the American College announced its position. Besides approving of over-the-counter sales on the substance of the issue, Jindal wrote that if the federal government adopted the policy, it “would take contraception out of the political arena.”
“As a conservative Republican, I believe that we have been stupid to let the Democrats demagogue the contraceptives issue and pretend, during debates about health-care insurance, that Republicans are somehow against birth control,” Jindal wrote. Making the pill available over the counter (to anyone 18 and over) would not only reduce its cost, Jindal argued; it would give more power to individuals while taking it away from the government and from the big pharmaceutical companies.
“Democrats have wrongly accused Republicans of being against birth control and against allowing people to use it,” Jindal, a former assistant secretary of Health and Human Services, concluded. “That’s hogwash. But Republicans do want to protect those who have religious beliefs that are opposed to contraception. The latest opinion from the American College of Obstetricians and Gynecologists is a common-sense call for reform that could yield a result everyone can embrace: the end of birth-control politics.”
If Gardner’s experience with Udall and Colorado Democrats is any guide, that conclusion might be a little premature. But even if there were no Democratic criticism, the idea has been controversial among some conservatives. There have been arguments about it in some Catholic circles, and more generally, it has put some pro-lifers in an awkward position. In his article, Jindal noted that under the Obama administration the morning-after pill is available without prescription — a development many pro-life organizations strongly opposed. Although the birth control pill works differently, some pro-lifers are still not comfortable making it available over the counter. And they won’t be happy with pro-life Republicans like Jindal, Gardner, and others taking that position.
Other conservative policy types are more comfortable with the idea. “I support it myself, basically because the pill doesn’t fit into any of the categories of reasons the Food and Drug Administration uses to make a drug a prescription drug,” said Yuval Levin, a former George W. Bush aide who has written extensively on health policy. “I’m not sure if it’s an idea that would in fact have the kind of political purchase that Jindal and some others think, but I do agree on the substantive merits.”
Levin notes that Jindal’s proposal was not hugely controversial when it appeared late last year. Yes, some groups, including the Catholic bishops, opposed it, but it didn’t set off a major conflict. One reason for that could be that as a policy it will be acceptable to the vast majority of conservatives. But another could be that, beyond Jindal himself, no prominent conservative political candidate had publicly embraced the idea back then. Now, several have.
But even if conservatives mostly agree on the proposal, there is still little basis to conclude that Democratic attacks have been “neutralized,” or, more broadly that “the end of birth-control politics” is at hand. Democrats from President Obama on down have been pretty resourceful in their attacks, and there’s no reason to think a single policy innovation will stop that — at least until the voters have their say.
