Is It a State's Right Whether I Get Pregnant?

In truth, the title of this post should be, Is It a State's Right to Decide How and How Much it Costs for Me to Not Get Pregnant? A good subtitle might be: Make BCP OTC. Something I didn't know about Medicaid until I was on it for a second year is that because it is administered by states, a person's Medicaid benefits are only good in the state in which they applied for and were awarded them. That means that, because I recently moved from New York to Virginia, I am unable to use my health insurance to pay for my birth control pill prescription, which runs $35-50 retail, if I fill the prescription outside of New York State. And because we did not have the foresight to apply for insurance through the VA exchange earlier (we would have had to do it by Sept. 15th, 30 days before moving, in order for me to be covered in VA now) I will have no usable insurance (EMT driver, can you get on 81 N?) until December 1st.

To ice them cookies, pharmacies are not allowed to mail prescriptions being paid for with Medicaid out-of -state, presumably to prevent fraudulent purchases of the birth control pill by Virginians, Marylanders, Blue Hens, etc. from the good pharmacies of New York. The choice I have, then, is to pester people I'm not that close to in New York to pick up and mail me my prescription, pay retail in VA (have I mentioned we're on a budget?), or use condoms, which are not that cheap, and certainly not that fun, but they are over-the-counter. All those other miracle drugs for not getting pregnant, such as the patch, the injection, the implants, are all prescription-only. Short of that it's rhythm method and rubbers.

We've discussed the moral double-standards that exist in this country for poor people, and to be on Medicaid, you have to be poor. I have qualified for it for the last year and a half, during which I was adjuncting at Colgate and thus poor. As a nation, we do seem to be comfortable with the government adjudicating how women go about not getting pregnant: anyone (who has the money) can use condoms, and anyone who has access to a doctor to give a prescription can use the pill and other hormonal birth control options that are more desirable, practical, and far more effective than condoms for a number of reasons you have probably already worked out yourself. 

Since the Affordable Care Act passed, a person on Medicaid can get a doctor’s appointment, prescription for BCP and have it filled with no out of pocket expenses--but with considerable bureaucratic and practical hoops to jump through. And even those of us on Medicaid who are most adept at navigating those hoops can get caught in a predicament that amounts to embarrassing yourself just to rely upon the kindness of acquaintances, paying more money than you can afford, or going without. This can happen because we allow these programs, deemed constitutional and essential by three branches of the federal government, to be administered by states as a prerequisite to states accepting them, and the result is that a person availing themselves of a federal program is extremely limited in care not only by what providers will see them (another horror story for another post) or how long they have to wait for that care, but by where they find themselves when that care is required.

All of this leads to a default conservative outcome, and as ultra-conservative as can be: the only way to have sex for free is to have it unprotected. Every other way you need a dollar in your pocket and/or a primary care physician. The implication of such a state of affairs is that those with more access to money and resources deserve more choice in their reproductive health than those who have less. Dan, who already buys his health insurance through the NY State exchange, was able to get a free flu shot while we were at Walgreens figuring out another thing we're going to have to make lemonade out of for the next three months, but as a Medicaid patient I would have had to pay for that too. And as we know, as a man Dan cannot get the pill; it's all on me, as it is for many women when they so understandably fail, even once, to make sure they are medically infertile when they end up having sex under any circumstances and find themselves where so many politicians seem to believe, if you follow the logical outcomes of the policies they support, is where they belong: pregnant and taking responsibility.

Birth Control Pill Over-the-Counter and federally-administered Medicaid are women's rights and social justice issues. The cheaper, preferably free, and easier to obtain reproductive health needs are, the better for some of our most vulnerable populations.