Abstract During the fall of 2014, in what seemed like a change of heart, Republican congressional candidates began calling for a policy that reproductive rights advocates have supported for years. Over-the-counter (OTC) oral contraception (OC) became these candidates ' way to connect with the women alienated by the Republican Party in recent elections. They emphasized how OTC access would allow women themselves, not employers or the government, to have control over contraceptive decisions. Liberals responded that this new effort was just a Trojan horse--legalizing OTC access would not only increase the actual price tag on OC, but it would also remove OC from the Patient Protection and Affordable Care Act's extended insurance coverage of contraception. Additionally, reproductive rights advocates noted that it is the Food and Drug Administration (FDA ), not Congress, that legalizes OTC drugs, and the FDA has not received any applications from drug manufacturers who want to sell OC OTC. In reality, both sides have something of a valid argument. OTC OC would be an important step toward reproductive autonomy for American women. It is also correct, however, that an immediate liberalization of OTC presents several issues, economically, politically, and culturally. Despite these valid critiques, OTC access for OC is a change that is worth the time and effort to move past politics and get it right, for many reasons. Requiring insurance companies and Medicaid to reimburse women for OTC OC purchases is a step toward establishing an accessible market and ensuring corresponding reproductive autonomy for women in the United States, which should accompany legalization of OTC OC. INTRODUCTION In 2014, Americans spent a lot of time, energy, and money arguing about oral contraception (OC or control pills)--specifically, who should pay for it. Yet, the public debate surrounding whether employer-sponsored insurance plans should cover OC was mostly unproductive as far as advancing women's reproductive autonomy is concerned. That is because the current United States prescription-only access system for birth control pills fails to serve the needs of the women who stand to gain the most from access to OC. The employer mandate debate only took us further away from realizing a system that would promote access for all women--that is, legalizing an over-the-counter (OTC) Food and Drug Administration (FDA) designation for OC instead of limiting it to prescription-only status. Despite the seemingly groundbreaking contraceptive mandate in the Patient Protection and Affordable Care Act of 2010 (ACA), which transferred responsibility for the monetary cost of OC from women to their insurance companies, (1) all women's access to OC did not improve, nor was the controversy surrounding it reduced. The ACA's provision that insurers have to now pay for OC was intensely contentious among the American public, and the Supreme Court ruled in 2014 that employers with a religious objection to contraception do not have to comply with the ACA's employer mandate. (2) This controversy took attention away from the fact that, notwithstanding the obvious benefits of reducing the price of reproductive planning for women with employer insurance plans, the contraceptive mandate fails to help large segments of women, some of whom stand to benefit most from increased access to OC--specifically women who are unemployed, work part time, are undocumented, or are still on their parents' health insurance (3)--and fails to address the problematic nonmonetary costs of the prescription access system. OTC access would address these issues. With the approval of the American College of Obstetricians and Gynecologists, (4) OTC access is a safe proposal from a public health perspective and one that women want. (5) This Note argues that legalizing OTC access is safe, desirable, and furthers women's autonomy over reproductive decisions. …
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