“Psst! 🗣 Birth control should be over-the-counter, pass it on,” freshman congresswoman Alexandria Ocasio-Cortez tweeted last week. Turns out, it wasn't just a tweet — she was foreshadowing a plan. On Thursday, Rep. Ayanna Pressley introduced a bill together with AOC, Rep. Katie Hill, Rep. Ami Bera, and Sen. Patty Murray that would make OTC birth control affordable and accessible.
The bill is very similar to one that Washington state's Sen. Murray introduced in 2015, Mairead Lynn, the senator's senior press secretary, told Refinery29. It would build on contraception coverage access in the Affordable Care Act (ACA) by ensuring that when the FDA approves birth control pills for OTC use, you wouldn't need a prescription or have to pay extra out-of-pocket fees.
"Bodily autonomy is a basic human right," Massachusetts Rep. Pressley said in a statement provided to Refinery29. "Reproductive justice is not only a healthcare issue, it is also an economic issue and a civil rights issue. The Affordability is Access Act removes expensive barriers to contraceptive care — affirming a person’s right to make decisions about their body, if and when to start a family, and their future."
“It is a brutal form of oppression to seize control of the one essential thing a person should command: their own body," Rep. Ocasio-Cortez said in the statement. "Women should have the right to own and control their own bodies. I am proud to support the #FreethePill legislation, which would make birth control over-the-counter,” she added, referring to the hashtag supporters of the bill are promoting.
"Reproductive healthcare is as personal as it is critical," California's Rep. Hill, who recently opened up that she once considered an abortion, and ended up having a miscarriage, said in the statement. "We’ve seen over and over this administration’s attempts to roll back the basic rights of women and make it harder for them to access birth control. It’s time to stand up and loudly say: Not on our watch."
OTC birth control has an unexpected supporter. Texas Sen. Ted Cruz, who also recently responded to an AOC tweet about congressional ethics, has once again been lurking on the New York representative’s Twitter. Sen. Cruz seems to have an appetite for bipartisanship lately, which comes off as a little suspect considering that he is the Republican senator with the most partisan track record.
"I agree," Cruz tweeted in response to AOC's original post about OTC birth control. "Perhaps, in addition to the legislation we are already working on together to ban Members of Congress from becoming lobbyists, we can team up here as well. A simple, clean bill making birth control available over the counter. Interested?"
Reproductive rights advocates say he might have ulterior motives. In trying to understand why a staunch conservative would push for OTC birth control, it's important to remember that the 2010 passage of the ACA — which Republicans are continuously trying to dismantle — required insurance companies to fully cover a number of preventative medications, which included essentially making birth control free for all Americans with health insurance. We can see why members of the GOP might favor birth control being available through the free market over the ACA's plan. Also, under the ACA, some employers with personal or religious objections to birth control still have to cover it in their insurance plans — which has been a pain point for Republicans.
Rep. Pressley had some fun responding to Cruz. "Hi there @TedCruz, hit up our girl @PattyMurray, she and I have already written the bill, album dropping tomorrow," she tweeted. "@AOC's vocals (and original co-sponsorship) = on-point. @KatieHill4CA's an original, too. Just call it the Destiny's Child of OTC birth control." She later added, "To those asking, yes @PattyMurray’s the Beyoncé of the group. Thank you for your long-standing leadership on reproductive justice, Senator."
This isn't the first time Republicans have been interested in OTC contraception. In 2017, Republican Sens. Joni Ernst and Cory Gardner reintroduced the Allowing Greater Access to Safe and Effective Contraception Act, which would fast-track applications for FDA approval of OTC birth control pills and allow you to pay for that birth control with a healthcare savings account or flex spending (repealing the ACA's restriction on using such accounts for this purpose). Former congresswomen Mia Love and Barbara Comstock introduced companion legislation in the House. “Women wear many hats in their increasingly busy, daily lives; they should have the ability to access routine-use contraception directly from their local pharmacy,” Sen. Ernst said in a statement.
Experts in the field, including the American College of Medicine and the American College of Obstetricians and Gynecologists, have supported making the pill available OTC. Oral birth control is among the most studied, safest drugs in existence. But one issue that tends to pop up with the topic of OTC birth control is the cost. “Over-the-counter is more convenient, but it's more expensive to consumers than a prescribed drug that's covered by insurance,” Stuart O. Schweitzer, PhD, a professor of health policy and management at the UCLA Fielding School of Public Health, told Refinery29 previously.
Recognizing this issue, AOC tweeted a followup to her original post: “It should be free, too — like in the U.K.!”
Refinery29 reached out to Sens. Cruz, Ernst, and Gardner for comment and will update this story when we hear back.