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Future of birth control uncertain as state abortion bans loom

“We know that even small amounts of cost-sharing for birth control can make a difference to people who may or may not get it, especially given the financial hardships people have had over the past few years” , says Mara Gandal-Powers, senior attorney and director of birth control access at the legal center who is among those calling for tougher federal enforcement.

The Food and Drug Administration is also facing increasing pressure to approve two applications for over-the-counter birth control pills that have been pending before the agency for years. Several other countries allow pills, and mainstream medical groups like the American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American Medical Association have endorsed the practice in the United States.

“I hear about so many barriers young people in particular face when a prescription is required – from long wait times for appointments to health care providers refusing to prescribe a contraceptive because of their religious or moral beliefs,” says Angela Maske, who works with the Advocates for Youth group and runs the #FreeThePill Youth Council which led a recent protest outside the White House, with a fake pharmacy counter filled with fake birth control pill boxes to sides of things like cough syrup.

HHS celebrated Roe’s 49th birthday earlier this year by establishing a reproductive task force to examine policies that could protect access to contraception. The White House has set up its own Gender Policy Council to make a similar effort. Neither group has yet proposed specific policy changes.

The Center for Medicare and Medicaid Services has been pushing for expanded coverage, which could help millions of patients afford birth control and other services. But top priorities like extending Obamacare grants and expanding Medicaid to a dozen holdout states have been sidelined since Biden’s Build Back Better legislation foundered last fall.

Proponents also argue that the federal government could also do more to preserve Medicaid’s longstanding provision allowing patients to go to any qualified provider they choose. in light of Texas kicking Planned Parenthood out of Medicaid and other states taking similar action.

Asked by POLITICO at a health journalism conference whether the administration is considering issuing new guidelines or stepping up enforcement of Medicaid’s “provider choice” provision, CMS administrator Chiquita Brooks-LaSure, said only that her agency “continues to monitor what is happening in the states with respect to access and to ensure that coverage is meaningful.

Meanwhile, Congress is unlikely to act on the issue anytime soon, even as narrow Democrat majorities look increasingly under threat midterm in November. House Democrats have pushed some legislation to expand birth control access to veterans and active duty members who aren’t covered by the ACA’s free birth control policy, but the proposals died in the Senate. Maloney’s “Birth Control Access Act,” which would crack down on pharmacists refusing to fill birth control prescriptions, received no hearing from this Congress, let alone a floor vote.

A possible opportunity for proponents of access to contraception: Many states, including some conservative ones, are now focusing more on addressing high rates of maternal mortality, especially among black women, and expanding of Medicaid coverage after a woman gives birth. Spacing pregnancies can help, and policymakers and advocates are pushing to boost contraception right at the time of childbirth — and to change insurance payment policies to facilitate this.

Advocates are also looking to individual states to expand access to contraception by changing telemedicine regulations and allowing more pharmacists to prescribe contraceptives, ensuring they have the training to do so and raising awareness, so people know it’s an option. But, Elizabeth Nash, Guttmacher’s acting deputy director for state issues, notes that “getting state legislators to support additional funding is difficult, even in the most progressive states.”

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