A new pitch by Republican candidates to make the pill available without a prescription could have unintended financial consequences for women. KHN’s Mary Agnes Carey and Julie Rovner discuss.

MARY AGNES CAREY: Welcome to Health on the Hill, I’m Mary Agnes Carey. The health law’s provisions on contraception coverage have always been controversial. But now the issue is getting fresh attention in the midterm elections. KHN Senior Correspondent Julie Rovner joins me now with the latest. Hi, Julie.

JULIE ROVNER: Hi, MAC.

MARY AGNES CAREY: Democrats, as we know, have been talking a lot about contraception. This is an issue they are very comfortable with. But some of the new messaging is coming from the Republican side. Let’s take a look at this ad from Senate Republican candidate Cory Gardner.

CORY GARDNER (advertisement): What’s the difference between me and Mark Udall on contraception? I believe The Pill ought to be available over-the-counter, round the clock without a prescription, cheaper and easier for you. Mark Udall’s plan is different. He wants to keep government bureaucrats between you and your health care plan. That means more politics and more profits for drug companies. My plan means more rights, more freedom and more control for you, and that’s a big difference. I’m Cory Gardner and I approved this message.

MARY AGNES CAREY: Cory Gardner and some other Republican candidates in these tight Senate races are talking about birth control being sold over-the-counter. What’s happening there?

JULIE ROVNER: Well, it’s a very interesting turn of events. Of course, a number of women’s health groups, led by the American Congress of Obstetricians and Gynecologists, have also called for over-the-counter birth control, but there’s a little bit of a twist here in the way the Republicans are doing it.

What they are trying is to get out from under the issue of the Hobby Lobby case, the Supreme Court case, that said that religious employers don’t have to provide contraception, which, of course, is one of the requirements of the Affordable Care Act. The Republicans are caught between their religious, conservative base and women, who, of course, like this provision of the Affordable Care Act.

So by saying: “Let’s make it over-the-counter” that will take it out of insurance, and therefore you won’t have the issue with the religious conservatives and it sounds like it will be cheaper for women. Of course, under the Affordable Care Act, it’s no cost to women, so it might in fact end up being more expensive if you make it over-the-counter.

Now some of the Republicans are talking about making it over the counter, but reimbursable, but that of course puts it back into the insurance realm, which is a problem they were trying to get over in the first place.

MARY AGNES CAREY:  But is this nuance about the idea that women might pay more, is that getting through to folks? I mean some of the estimates I have seen are something like $700 a year, for just the pill itself.

JULIE ROVNER: That’s right and remember we are just talking about the birth control pill. Only about a quarter of women who use contraception use the birth control pill. There’s been a push to use more longer acting forms of contraception, which are more expensive; that’s been a barrier and that was one of the goals of the Affordable Care Act to make all forms of contraception available and more affordable.

So not only would women have to perhaps pay this $600 a year, but it’s not clear who if anyone would cover the other forms of birth control things, like the IUD or implants.

Pretty much as far as the polls I’ve seen, I am not sure this is flying with women, whether or not they are sort of aware of it, I think a lot of these Republicans — Cory Gardner for example in Colorado, has in the past supported Personhood amendments, both in Colorado and at the federal level that could make some forms of birth control illegal. He is now saying that was a mistake, he doesn’t support that anymore, but there is some question as to why all of a sudden you see all these Republicans and it’s getting to be half-dozen or more Republicans who are making this an issue in their races, coming out, many of them cutting ads like Gardner saying, “I’m for women. I’m going to make birth control available over the counter.”

MARY AGNES CAREY: You also did a very interesting story recently looking at Catholic health plans that are now selling health insurance to non-Catholics, as well as Catholics. And they’re wrestling with this really interesting tension between meeting the demands in the Affordable Care Act on contraception coverage but also following Catholic Church teaching.

JULIE ROVNER: That’s right. And, you know, this is another sort of bit of fallout. The Hobby Lobby case was about for-profit insurers. There are another line of cases heading toward the Supreme Court from actual religious insurers mostly religious hospitals and universities saying, “We can’t have anything to do with contraceptive coverage, even to the extent of signing a form and sending it to the government saying we object to it.” They won’t even do that. They say that is a violation of their religious doctrine. On the other hand, you have many Catholic insurers who, as you point out, are selling not just to Catholics, although many of them do sell to Catholics.

But in New York, Fidelis, which is a Catholic insurer, was the second most popular plan on the New York health exchange. So they’re selling to non-Catholics. When they get into the market like that, they have to cover contraceptives. Partly because of the Affordable Care Act — in half the states, the states require it. So they have found ways over the years, these Catholic health insurers go back a good number of years, to basically farm that out to a third party, except that in court that’s exactly what some of these other Catholic institutions are saying they can’t do.

So, there’s now some questions looking within the Catholic Church about whether it’s okay, what these insurers have been doing. Because they’re not providing the insurance, but they’re certainly facilitating the insurance. They have to if they’re going to sell to people who are in the regular market. 

MARY AGNES CAREY:   And in your story, I think you quoted one of the bishops sort-of looking at one of these health plans, kind of questioning how they’re handling this coverage.

JULIE ROVNER:  That’s right. There’s a bishop in Little Rock, Arkansas, which is where C.H.I., one of the largest Catholic hospital systems is going to start offering insurance. And they bought a private plan in Little Rock and that got the bishop down there wondering whether this is okay and how they’re going to handle this. He’s actually contacted the Vatican. Apparently, he’s heard back and apparently, they’re still talking. But that’s as much as we know about that.

MARY AGNES CAREY:   Before I let you go, I want to touch on this recent court ruling that could affect access to abortion in Texas. What’s happening there? 

JULIE ROVNER:  This was a federal appeals court. It’s been a long-standing court fight over this Texas law, which has a lot of pieces to it. But this latest piece says that all abortion clinics basically have to meet the same standards as ambulatory surgical facilities. Most clinics in Texas don’t. So the result of this is that it’s going to close down, or force the closure, of all but seven clinics in the entire state of Texas.
Now obviously, this is only Texas that we’re talking about now, but this law has had an enormous amount of publicity. And the idea that abortion could become very, very, very difficult to obtain in Texas — it’s hard to tell if that might spread and concern women in other parts of the country. 

MARY AGNES CAREY:   It’s certainly something worth watching. Thanks so much,  Julie Rovner, Kaiser Health News.