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Stop referring to ‘free birth control,’ because it ain’t

A lot of misleading language surrounds health insurance reform—and yes, it is health insurance reform, not health care reform, because the focus is on the insurance industry—in the United States, along with considerable mixed feelings. It’s far from a simplistic good or bad issue, and this post isn’t about debating the nuances of the Affordable Care Act (ACA) and what it means for the country as a whole. Suffice it to say that it doesn’t, contrary to popular rhetoric, mean that the United States now has universal health care, and many of its ‘benefits’ are targeted at insurance companies, not patients or people who may someday need medical care.

But one thing has had me really steamed up over the last week, and that’s the language flying around over ‘free birth control.’ I expect that from conservatives and people opposed to reproductive health services who want to make it sound like ACA is bringing in the end of the world, encouraging sluts and slatterns everywhere to make free with their virtue. I would like to think the left is better than that, though, and it’s been extremely disappointing and frustrating to me to see even policy wonks and people who are far more educated about the details of ACA than I am referring to ‘free birth control day.’

Across the Internet on 1 August, people were talking about free birth control. Celebratory infographics were displayed. People tumbled all over themselves to talk about how this would bring in a new age of reproductive health services, one where every cis woman could access the preventative care she needed and had a right to.

Only they were wrong. Clearly and patently and obviously wrong, as only a little bit of critical thinking, let alone research, would have revealed.

For starters, ‘free birth control’ only applied to cis women with insurance policies, which means about 57 million out of 98 million cis women in the US. Numerous women are uninsured and not eligible for government benefits, and the statistics are especially stark for women of colour; 34% of Native cis women have no insurance, for example, and 37% of cis Latinas don’t have private insurance either. That means that only about 60% of cis women actually were in the running to qualify for this much-touted ‘free birth control.’

But there’s more. Because having private insurance didn’t mean that you qualified. Cis women with policies that hadn’t changed since 2010 were caught in the grandfather clause, which meant their providers weren’t required to provide reproductive health services with no co-pays on the start date. Furthermore, the elimination of co-pays is dependent on your policy start date. If you just renewed your health insurance in May, well, guess what: You’re going to keep paying for preventative health care until May 2013, when your policy rolls over. So don’t go racing to the gyno just yet, cis ladies.

What about cis women on government benefits like Medicaid? Their benefits are decided on a state-by-state basis, which means conservative states can go right on insisting that patients pony up with co-pays for reproductive health services.

So much for that ‘free birth control.’

Oh, did I mention it’s not free?

As Jodi Jacobson points out, people receiving this benefit are already paying: for their insurance plans.

Why? Because if you have insurance, you pay for it, either by virtue of your labor or out of your own pocket, or, depending on the situation, both. And under the ACA, it is now mandated that your insurance plan cover certain benefits without a co-pay. This does not make them “free.” It means that you are paying for that service as part of your premium. You earned it, you paid for it, it is yours. If you pay for it, you deserve to get it.

Whether you are paying for your insurance out of pocket or receiving it as part of your compensation package at work, you are paying for it. The elimination of copays doesn’t make the services provided free; you are paying for them as part of your contract with the insurance company. Which is why people who don’t have insurance can’t access these services: because they aren’t paying for them. Guess who’s commonly uninsured? Low-income people caught in loopholes where they make too much money to qualify for government assistance, but not enough to actually pay cash for their care.

And as I repeatedly stress: health insurance is not health care, so don’t tell me the answer to this problem is getting more people enrolled in insurance plans. Health insurance can provide (some) assistance with the cost of (some) health care services in exchange for premiums, copays, and deductibles.

This may sound like petty pedantics, but it’s actually critically important. Because the language about ‘free birth control’ was used to score massive political points by politicians who wanted to score big with cis women by positioning themselves as allies of women’s health. As celebrations spread across the Internet, so did specific shoutouts to politicians involved in ACA, including of course President Barack Obama, who is fighting for reelection this year. Tons of free advertising was provided by eager progressives who were willing to ignore the fact that a huge swath of cis women would continue receiving birth control at the exact same cost as before.

Ignoring those women sent them a clear message that they weren’t subjects of concern or interest. And it also meant that it would be that much harder to fight for benefits for them; ‘everybody has free birth control now, yay!’ totally excludes cis women who actually don’t have access to birth control without co-pays. Like other patients who don’t benefit from ACA, their voices are silenced and steamrollered over in the haste to act like it fixes everything.

Where will these giddy celebrants of ‘free birth control’ be when cis women are fighting for actually free reproductive health services for everyone?


  1. Brigid Keely wrote:

    Thanks for making this point, it’s a really vital one.

    Additionally, “free” birth control isn’t the end-all be-all either. I’m eligible for “free” (funded by my and others’ taxes) “well woman care” which includes birth control and… not much else… in my state. But I can’t use hormonal birth control because it gives me migraines, and I can’t use latex condoms because I’m sensitive to latex. Well woman care does NOT cover my hormonal imbalance (PCOS, easily treated with a pill I can fill for free at Target), breast exams or cervical exams until the age of 35, pap smears, etc. While forcing some insurance companies to provide birth control is a step in the right direction, it’s still just a tiny step and there is such a huge gaping need that still needs addressing. It’s frustrating.

    Monday, August 6, 2012 at 1:32 pm | Permalink
  2. Greg wrote:

    You’re incorrect about one fact: birth control coverage without co-pays in new insurance plans is available to everyone, not just cis women. Trans men with ovaries can get the full range of coverage available to cis women, and cis men and trans women with testicles can get vasectomies without co-pays.

    Monday, August 6, 2012 at 1:46 pm | Permalink
  3. Greg wrote:

    Speak of the devil:

    Monday, August 6, 2012 at 1:47 pm | Permalink
  4. s.e. smith wrote:

    Hey Greg, thanks for dropping in to play gotcha!

    Since I’m actually specifically discussing the women’s health policy implications here, though, I’m not overly impressed with your attempt.

    PS: People other than men and women need contraception too.

    Monday, August 6, 2012 at 9:20 pm | Permalink
  5. Greg wrote:

    I’m not trying to play gotcha. I agree with your overall point. In fact, I’ve been making many of the same arguments you’re making to people who’ve been oversimplifying the birth control mandate, and one of the facts that people have been glossing over is that it applies to everyone, not just women.

    Besides, cis men’s access to contraception is a women’s health issue. If someone like Bridgid, who can’t use hormonal contraception or latex barriers, were in a long term monogamous relationship with a cis man, it would be very advantageous for her health if her partner could get his vasectomy covered without a co-pay.

    Tuesday, August 7, 2012 at 12:17 am | Permalink
  6. Catherine wrote:

    “And as I repeatedly stress: health insurance is not health care, so don’t tell me the answer to this problem is getting more people enrolled in insurance plans. Health insurance can provide (some) assistance with the cost of (some) health care services in exchange for premiums, copays, and deductibles.”

    THIS THIS THIS THIS. Right now we have no insurance- because what we can afford would take 1/4 of my food budget and cover nothing including leaving me hanging for the $4000 I spent the other year to get my knee fixed (if by fixed you mean only semi-functional).

    Tuesday, August 7, 2012 at 8:06 am | Permalink
  7. addiejd wrote:


    Look into the Paraguard IUD; it’s copper, not hormonal, and it’s fine for women who haven’t had kids, regardless of what some older doctors say.

    Also, there are polyurethane condoms out there that you might want to try. Much more expensive, but imho unless you’re in an exclusive relationship barrier methods are the only way to stay safe.

    Tuesday, August 7, 2012 at 4:46 pm | Permalink
  8. Sally wrote:

    I just found this out the hard way! I wanted to get an IUD and called my insurance company this past week to see if it would be covered. They said it fell under the deductible, which made me laugh because it will still cost me hundreds of dollars out of pocket. I figured there was some sort of grandfather clause that made that acceptable. Thankfully I can afford it and will still get one since I don’t want to wait until next year just to see IF it might be covered. What really made me laugh was when I called and they had a message telling me not to worry because my coverage won’t change even though the health care act was upheld.

    Thursday, August 16, 2012 at 12:25 pm | Permalink
  9. cath wrote:

    I am profoundly grateful every day that I live in the UK. I pay like 5% of my wages into National Health, so it’s not technically “free,” but I will never, ever move back to the US. I can source birth control for “free” whenever I want/need it. I don’t have to worry about anyone getting up in my business about it.

    Nobody gives a crap about birth control here. It’s awesome.

    Tuesday, September 4, 2012 at 7:44 am | Permalink