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.

Value a major secret to living well: unpaid household work

If some people have been following our blog and been attracted to and impressed by what we've been eating--from Fried Rice to Dal & Aloo Gobi, or even just sausages with peppers & onions and mashed peas, you've hopefully realized that the reason we eat so well is all the cooking Jasmine does, how well she does it, and perhaps most importantly (especially for the SNAP challenge), that she cooks from scratch.

This last means that not only are our meals more healthy, because they don't have a lot of processing or preserving chemicals in them, but also that the cost of food is quite low, compared to pre-prepared or partly-prepared foods that I used to eat (like jarred spaghetti sauce, Trader Joe's Mandarin Orange Chicken, etc) before Jasmine was in my life.

But we can eat this way only because we, as a unit, have the time, energy, and willingness to invest in this unpaid household labor.  And by "we," I mean Jasmine, who does almost all of it in our house. We've been able to afford mostly because, until I quit Colgate, I was making a lot more money than she, as she was teaching part-time, on an adjunct basis, and not put upon with any (in truth, I should say "as many") extra administrative responsibilities as I was.  So she has had time & energy to spare for unpaid household labor.

This rather traditional (but not un-progressive) arrangement seemed to come rather naturally to us, partly because for Jasmine to achieve greatness as a poet doesn't necessarily depend on slogging through the trenches of typical academia, whereas for me to achieve . . . well greatness is not exactly the right word . . . as a political scientist, does require it.  But also because Jasmine has a knack and a penchant for performing such household labor excellently.  While I would be slogging at the office, Jasmine has always been willing to slog through the trenches of baking no-knead bread, perfecting new recipes, taking charge of nutrition & shopping, not to mention other important aspects of unpaid household work, like doing laundry, cleaning, doing the dishes.

We were lucky, though, because of how much money I earned: in fact, it put us in the top 25% of households according to income.  My salary alone was only around $15k less than couples where both work.

But this is not most people's experience: in 2008, the median income for (heterosexual) couples where only the husband worked was about $30k less than if they both worked; among couples where only the wife worked, it was $40k less.  Those differences of $30k-$40k of annual income in America makes the difference between a secure place in the upper-middle class (the median income of a family where both parents work would place them above about 85% of households in our country), and a struggle to pay for even some of the many accoutrements of middle-class life: nice house, two cars, vacations, sports or lessons for kids, family vacations, ample retirement funds & college funds, a TV or two, cable, smartphones etc.

And indeed, all this is aside from the constantly hard-pressed situation of single-parent families, whom the combination of government + consumption demands expect to work at least one full-time job, and often more, and who also get almost no help paying for child-care.  The idea that a single-parent ought to stay home most of the day and perform the kind of unpaid labor that Jasmine does to make our lives excellent, much less to provide care, and solid parenting, self esteem, and life-lessons for his (or, as well all know is far more frequently the case, her) own children would be anathema to most of the political & budgetary establishment of this country, who would never countenance the idea of such "takers" getting any outside support for the task of raising the next generation of Americans instead of working multiple low-wage jobs and paying through the nose for childcare.

Why do we live in a society where so many of the things that make family life rich, delicious, and a good environment for raising children are considered "luxuries" that ought to give place to retirement & college savings, and other "normal" middle-class consumption expectations (unless you're really rich)?

It's a tough question, and it's not all about politics or policy, but there are ways that policy can support people bucking the trends of our society, and does, in other countries, like Germany, Sweden, and Switzerland, which Bernie wants to emulate.  In America, it will take a revolution to change these kinds of things--the political revolution that Bernie is calling us to is not the whole solution (just as getting Bernie elected president is not the whole of the political revolution this country needs; we need big change in Congress, too!).  But a political revolution is a good beginning to get people thinking about how lots of things need to be different in this country, including the how we value (and how our government encourages us to value) to value family & labor (both unpaid in the house, as well as outside the home).  That's one big reason why we're for Bernie.