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Why Free Birth Control Is a Big Deal

The latest news on Hobby Lobby and Obamacare's controversial mandate


You might have missed some news that broke on Friday afternoon. The Obama Administration has tweaked Obamacare’s “birth control mandate,” in order to comply with the Hobby Lobby and Wheaton College decisions that the Supreme Court handed down earlier this summer.

I’m talking, specifically, about the Affordable Care Act’s requirement that insurance policies cover all medically approved forms of birth control as a “preventative service,” which means women can get them with no co-payments or other forms of cost-sharing. The Supreme Court tossed the old requirement because, according to five conservative justices, it violated the religious freedom of organizations whose owners said birth control (or some forms of it) violates their faith. This new regulation (details here) is supposed to satisfy those concerns, but it seems unlikely to have that effect. Groups like the Family Research Council have already dismissed the new regulation as an “insulting accounting gimmick” and, for all I know, the courts will agree. It’s one more sign that the controversy over contraception, and who should pay for it, isn’t going away anytime soon.

Maybe this is a good time to remind everybody why this requirement matters so much to those of us who support it. Many conservatives look at the price of oral contraceptives, available at places like Target or Walmart for as little as $9 a month, and wonder why anybody except the very poor would need help paying for it. But numerous studies have shown that even modest co-payments can reduce use of medications, particularly when you’re talking about less affluent people who must be careful with every dollar they spend. That’s the whole point of making certain drugs that prevent medical conditions cost-free. It works that way for diabetes and hypertension and, yes, it works that way for pregnancy. Besides, the most effective and, for some women, the most medically appropriate forms of birth control are intrauterine devices (IUDs). Those cost $500 or even $1000 out-of-pocket. Reducing their cost can have fairly dramatic effects on their usage, if the available research is correct.

Still, there’s a much bigger point here that many conservatives (and even some liberals, I suspect) miss. Late last week, lots of people were talking about a story by Sarah Kliff, of Vox, on why teen pregnancy has been declining in just the last few years. It’s a great article, well worth your time, but the part that jumped out at me was the much bigger decline in teen births that occurred many decades ago—in the 1960s, when the teen pregnancy rate fell by about 25 percent. What changed? The big factor, as social scientists (and friends of QED) Harold Pollack and Luke Shaefer reminded me over the weekend, was birth control. The Food and Drug Administration first approved the pill in 1960.

It wasn’t just teenagers on whom the introduction of cheap, highly effective medical contraception had profound effects. It was also older women, including married women, who gained the ability to control the timing of pregnancy and child rearing. It meant these women could have fewer children, if they wanted, and that they could time their child-bearing years in ways that would allow them still to go to school and to go to work. It is not at all coincidental that, with the suddenly widespread use of birth control, women became much more likely to go through college and graduate school and to be part of the workforce—and, more generally, to make the kind of money that would allow them to be more economically independent.

Every now and then, you hear less civilized conservatives attack Obamacare’s birth control mandate because, as they put it, the requirement forces all people to pay extra so that women can have “consequence-free” sex. But historically the consequences of sex haven’t fallen equally on the two genders. They’ve fallen disproportionately and at times entirely on women, in ways that can be truly life altering. That’s why the availability of effective, medically appropriate contraception is so important: It’s among the most important tools we have for making sure women can participate fully in society.

Jonathan Cohn

News from over the weekend:

MAJOR EARTHQUAKE California's Bay Area is recovering from the magnitude 6.0 earthquake that struck over the weekend and left more than 100 injured. It’s the largest quake to hit the area in 25 years. The U.S. Geological Survey warns of potential aftershocks. (San Francisco Chronicle, USGS)

THE FERGUSON STORY: On "Meet the Press" Sunday, Missouri Governor Jay Nixon mostly dodged questions about whether he had confidence in prosecutor Robert McCulloch, whose interest in vigorously pursuing the case is a little suspect. (NBC News) The New York Times has profiles of the two central figures in the controversy—Michael Brown and the officer who shot him, Darren Wilson. (John Eligon, Monica Davey and Frances Robles, NYT)

MILITARIZATION OF POLICE: Obama has ordered a comprehensive review of the military equipment that's been left in the hands of untrained local law enforcement. (Matt Apuzzo and Michael Schmidt, New York Times)

BUSINESSES BEHAVING BADLY: Burger King is looking to purchase Tim Horton's, the Canadian coffee and donut chain, in order to lower its U.S. tax bill. (Liz Hoffman and Dana Mattioli, Wall Street Journal) At QED, Danny Vinik breaks it all down and explains why it's one more reminder about why somebody really needs to close this tax loophole.

COMING UP DRY: Hundreds of rural Californians can no longer get their drinking water from the faucet because of extreme drought. Meanwhile, people in Toledo, Ohio remain weary of its own tap water safety after the city's run-in with toxic algae a few weeks ago. (SF Gate, Toledo Blade

Things to read 

Worst thing you'll read today: Writer for The Federalist wants to ensure that kids who receive a free school lunch are stigmatized for it. Yes, really. 

Department of whoa: Six states and the District of Columbia prohibit the open carrying of handguns. That would be California, New York, Illinois, South Carolina, Florida and...Texas! Who would have guessed that? (Rani Molla, Wall Street Journal

Global warming "hiatus" is back: A new study shows finds that the slowdown in rising global temperature will continue for another decade, because of excess heat going into the Atlantic Ocean. (Justin Worland, Time) QED has more on why this doesn't prove the deniers right. 

Stories we’ll be following today

Earthquake recovery, Ferguson, and, with September approaching, talk about the president’s coming executive order on immigration may pick up again.


Another shooting in St. Louis has focused attention on the phenomenon known as “suicide by cop.” Are police officers getting the proper training to deal with people with mental illness? Rebecca Leber says a few are—but many more aren’t.

Image via Shutterstock