How Oregon's Fight To Expand Birth Control Access Is Influencing Other States

Oregon Gov. Kate Brown signed two bills into law last week that swiftly expanded women’s birth control access in the state. One of the laws, which allowed women to obtain contraceptives directly from pharmacists without a doctor’s a prescription, splashed across national headlines. The other law, however, stayed relatively out of the limelight but could make significant strides for women across the nation, healthcare activists said. The little-known provision allowing women to pick up a 12-month supply of contraception at one time is being closely watched by national women's rights leaders and could have a profound effect on many states' approach to contraception laws, they say.

Oregon's new law comes amid a national debate over easily accessible contraception. Healthcare advocates argue that women should have unchecked access to over-the-counter contraception, but opponents of such measures have argued that readily available birth control methods could encourage promiscuity and the transmission of sexually transmitted diseases. Conservative leaders have fought in recent years to undermine a provision of the Obama administration's Affordable Care Act that requires all private health plans to provide contraceptive coverage at no cost to their patients and have stalled efforts to make birth control accessible to women without access to medical care.

Oregon's law requires insurance companies to supply 12 months of prescription contraceptives at a time. Some patients have to visit a pharmacy every 30 days under current insurance policies. Other insurance companies allow patients to obtain a three-month supply through the mail.

Democratic lawmakers in other states have expressed interest in passing legislation similar to Oregon's new 12-month supply law. The Washington, D.C. Council introduced a 12-month dispensing bill earlier this year, which was not met with any opposition at the hearing. The bill was co-sponsored by nine members of the council and is currently under congressional review after the mayor signed it.

New York is also considering a bill that includes 12-month dispensing as part of an array of measures that would improve women’s access to birth control, according to Mara Gandal-Powers, a counsel for health and reproductive rights at the National Women’s Law Center in Washington. Other jurisdictions that are considering similar legislation include Rhode Island and Washington state. Washington adopted a policy a few years ago that allowed enrollees in the Medicaid program to receive a 12-month supply of contraceptives at once, but many states want to make contraception access easier for all women.

“Instead of going to the pharmacy every month or every three months, a woman will have a year’s supply at her fingertips,” said Elizabeth Nash, a senior state issues associate at the Guttmacher Institute, a reproductive health organization in New York, in an e-mail. “So there is less chance for her to miss pills. And I think making a year’s supply available also makes sense because people’s lives are chaotic; we move, we change jobs, we have ups and downs, and this at least makes using contraception a little bit easier.”

Oregon’s 12-month supply legislation also ha sparked interest at the federal level. Democratic members of the House of Representatives wrote a letter this month asking the Department of Health and Human Services to require health insurance companies to stop allowing the practice of only issuing one to three months of contraception at a time. They urged the federal government to require health insurers to provide women with access to a one-year supply of birth control at a time without any out-of-pocket costs. The letter, written by Rep. Jackie Speier, D-Calif., and Suzanne Bonamici, D-Ore., and signed by 53 other representatives, cited the numerous medical benefits of providing access to a year-long supply of contraceptives.

"Women today are often busy with work and managing child care, which makes picking up a monthly prescription impractical,” Bonamici said in press release. “My home state of Oregon just passed similar legislation, and I join my colleagues in urging the Department of Health and Human Services to require insurance companies to provide coverage for 12-month birth control prescriptions."

A study in 2006 from the American College of Obstetricians and Gynecologists found that dispensing a one-year supply of oral contraceptive pill packages was associated with a 30 percent reduction in the odds of conceiving an unplanned pregnancy, compared with dispensing just one or three packs. “Health insurance programs and public health programs may avert costly unintended pregnancies by increasing dispensing limits on oral contraceptives to a one-year supply,” the study concluded.

Oregon’s new law is not completely free from controversy. Some Republicans in the state Legislature opposed the bill, citing concerns from employers and insurers, and the Oregon Catholic Conference openly opposed the law, expressing concern that it would encourage sexual activity among young people. If similar legislation is passed in other states, Catholic churches and far-right leaders in those states are likely to voice their opposition, as well.

"Is there an unexamined assumption that expanded access to birth control is a good thing?" Oregon Catholic Conference spokesman Todd Cooper asked, according to an Associated Press report. "Will this encourage sexual activity on the part of young girls and boys? And what are the consequences of that?"

Oregon’s other birth control bill signed into law a few weeks ago allows a pharmacist to dispense contraceptives to an adult--without the adult providing evidence of a previous prescription for the contraceptive -- and to a minor if the minor has evidence of a previous prescription, Nash said. California signed a bill in 2013 that allows pharmacists to give patients contraceptives without a prescription, but that law is not yet fully in effect. Nash said rules have been proposed to govern the California program, and those rules might be finalized in the fall. Oregon’s new birth control laws will go into effect on Jan. 1.