Republican State Governments Expected To Renew The Culture Wars And Promote Conservative Pseudo-Science On Abortion

Democrats made a tremendous tactical mistake in the 2014 midterms. As the key Senate battles were in red states, Democrats ran as Republican-lite and Obama stayed quiet. As a consequence, turn out was at historic lows as Democratic voters saw no reason to turn out across the country, giving Republicans increased control in both Congress nationally along with in many state governments. (In contrast, once Obama became active after the election, his support shot up in the Gallup poll and multiple other polls).

While many Republicans ran with little talk of their positions on social issues, knowing that doing so might get many more people to turn out to vote against their unpopular views, The Washington Post points out that they plan to pursue conservative goals on social issues now that they are in office:

Renewal of culture wars

A new round of the culture wars is also inevitable in 2015. Mallory Quigley, a spokeswoman for the antiabortion Susan B. Anthony List, said she expects that measures to ban abortions after 20 weeks of pregnancy will advance in Wisconsin, South Carolina and West Virginia. Missouri, too, is likely to take up some abortion-related bills.

In Tennessee, voters gave the legislature new powers to regulate abortion, and state House Speaker Beth Harwell (R) has said her chamber will take up three measures requiring mandatory counseling, a waiting period and stricter inspections of clinics.

Conservative efforts to ban abortions after 20 weeks are based on ignoring science, just as many conservatives do in denying evolution and climate change. Conservatives make pseudo-scientific claims that the fetus can feel pain at this point, despite the cerebral cortex not being developed until well after this point. There is no real controversy over this point in medicine. Conservatives sometimes twist studies showing simple reflexes as indicating that the fetus is feeling pain. Often they misquote researchers to falsely claim their is a scientific basis for their bogus claims. More on this faux controversy over the science here and here.

The 20 week ban is especially harmful to the rights of women as fetal abnormalities are often not discovered until after this point. It is understandable that a woman who discovers after 20 weeks that she is carrying a fetus which has severe brain abnormalities which would prevent survival might want to abort, but Republicans would deny them this choice by setting an arbitrary limit before such abnormalities are apparent. It is also feared that once they set the line at 20 weeks they will use more pseudo-science to justify moving it up.

Conservatives have also practiced pseudo-science in trying to make the abortion debate over the moment when life begins, when development of the human embryo and fetus is a continuum. Conception is a process without an exact moment at which it occurs, and even fertilization can take twenty-four hours.

If conservatives are really concerned about preventing fetal pain their policies are counterproductive. Late term abortions are very rare in this country, primarily done when the mother’s health is in danger. Another common reason for abortions being delayed until after 20 weeks is the inability of the mother to obtain the abortion earlier, often due to roadblocks placed by Republicans making abortions more difficult to obtain. Of course Republican opposition to contraception further increases the number of abortions. If conservatives were consistent in desiring to prevent fetal pain, they should facilitate the ability of women to obtain both contraception and to obtain early abortions even beyond twenty weeks and before the actual ability to feel pain is present.

Republicans Plan To Use Increased Power After Midterms To Restrict Access To Abortion

Remember how the Republicans talked about down playing social issues going into the midterm elections? Now that they are in office, the party of limited government is returning to its agenda of using big government to impose its views upon others. Politco reports on The coming wave of anti-abortion laws–New GOP state legislatures will make access to abortion harder than ever.

The big Republican gains in the November elections strengthened and enlarged the anti-abortion forces in the House and the Senate. But it’s the GOP victories in the statehouses and governor’s mansions that are priming the ground for another round of legal restrictions on abortion.

Arkansas, for instance, already has strict anti-abortion laws. But with a Republican governor succeeding a Democrat who had vetoed two measures that would have banned most abortions beyond a certain stage of pregnancy, lawmakers plan to seek more restrictions — such as barring doctors from administering abortion drugs through telemedicine. Republican gains in the West Virginia Legislature will redouble pressure on Democratic Gov. Earl Ray Tomblin to accept a ban on most abortions after 20 weeks, which he has previously deemed unconstitutional. And Tennessee voters approved a ballot initiative that removes a 15-year barrier to legislation limiting abortion legislation in that deeply conservative state.

Abortion rights advocates have had setbacks in the states for several years, with a surge of legislative activity since 2011. Women seeking abortions may face mandatory waiting periods or ultrasound requirements. Clinics may face stricter building codes or hospital admitting privilege rules they can’t satisfy. Dozens of clinics have shut down in multiple states. Texas, for instance, has fewer than 10 abortion clinics now. A year ago, it had 40…

Republican leaders who will control the U.S. Senate come January say they want to take up abortion this year, perhaps on a House-passed bill that would limit the procedure after 20 weeks. But the reality is that Senate Republicans will still fall a few votes shy of the 60 needed for controversial major legislation. It’s the states where Republicans can enact more abortion limits.

“We came out of Nov. 4th with a lot of momentum,” said Chuck Donovan, president of the research and education arm of Susan B. Anthony List, which is dedicated to electing candidates who oppose abortion. He expects the number of anti-abortion measures proposed in the states to reflect that. “I think we’re about to get another uptick.”

Thirteen states have passed bans on most abortions after 20 weeks of pregnancy — so-called fetal pain bills — and a couple have enacted earlier limits tied to when a fetal heartbeat is first detected, which can be six or seven weeks into a pregnancy. Several of these state laws are being contested in court, and the arguments may eventually end up in the Supreme Court. But that hasn’t deterred more states from eyeing such legislation; in Ohio, a House panel approved a fetal heartbeat bill just a few days ago.

Planned Parenthood President Cecile Richards predicts that 2015 will bring more attempts to enact restrictive state laws. She said she expects “state legislative attacks on women’s health, even though the vast majority of the public wants elected officials to protect and expand access to safe and legal abortion, birth control and preventive health care.”

In some states with Republican control of the legislature there remains hope that any anti-abortion legislation will be vetoed. For example, in Nevada  Republican Governor Brian Sandoval supports keeping abortion legal. The Republican capture of control of both chambers of the state legislature in New Hampshire will be countered by Democratic Governor Maggie Hassan who backs abortion rights.

While this article dealt with abortion, based upon recent history it is also likely that Republicans will use their power to restrict access to contraception.

Republicans Seek To Block Marijuana Law In Washington D.C.

Republicans, members of the party which claims to support small government, individual freedom, and states’ rights, once again shows that it doesn’t mean a word of this.  The Hill reports on one action planned by Republicans:

House Republicans next year will try to block Washington, D.C.’s, newly enacted law legalizing recreational marijuana.

Rep. Andy Harris said he “absolutely” intends to launch a push to dismantle the new law when Congress returns with an empowered GOP majority in the 114th Congress.

While technically not a states’ rights issue, the same principle should apply to respecting a law to legalize recreational marijuana which a majority in Washington, D.C. voted for.

Presumably other top matters on the Republican agenda will include attempts to restrict access to abortion and contraception, and prevent same-sex marriage.

Of course this is as expected. When Republicans speak of supporting small government, it is of a government “small” enough to intervene in the private lives of the individual. When they speak of freedom, they will defend the freedom of businessmen to evade necessary regulations. Otherwise to Republicans, freedom means the freedom for conservatives to impose their views upon others. Republican support for states’ rights is limited to states which wish to enact laws to discriminate against minorities or restrict marriage equality.

Republicans Beat Something With Nothing Other Than Negativity And Fear

Ronald Reagan couldn’t save the Senate for the Republicans in his 6th year. While the closeness of the polls left hope until the end, realistically the Democrats were not in a situation to defy history. There were two tends which the Democrats could not overcome. When people are unhappy, they look at the president regardless of who is actually to blame. Running a campaign based upon negativity was a winning formula for Republicans. Democrats were further hampered by the older and whiter electorate in midterm elections as once again large portions of the Democratic base stayed home for a midterm.

Republicans won by avoiding discussion of what they would do in power, beating something (Obama) with nothing. Americans who vote for Republicans to retake control of the Senate out of concern about current problems are as delusional as Russians who want the return of Stalinsim. It makes no sense to trust the party which created the economic downturn with fixing it, and Americans certainly do not want the Republican social or militarist agenda. The party which opposes most government action (other than imposing the agenda of the religious right, foolish military action, or rigging the system to transfer wealth to the ultra-wealthy) is hardly likely to propose real solutions to problems.  Polling on issues generally shows a majority favoring Democratic views but that does not help in elections where Republicans concentrate on distorting the views of their opponents and  hiding their own views.

That said, I am disappointed (as usual) in the Democrats as a political party. Yes, all the fundamentals were against them. So they took the cowardly way out, running away from not only Obama but from principles. If they ran a campaign based upon their accomplishments and the problems with GOP principles they very well still might have lost in this atmosphere, but at least their campaign would have meant something. Plus, considering how close the polls were, just maybe they could have won some more seats.

Of course that isn’t something that can be done in the last few months of a campaign. It requires a change in attitude and behavior of the party every year, acting as if it was a perpetual battle of ideas–as Republicans do even though they run on bad ideas. When Democrats run from their own record and fail to speak out on the issues, they leave themselves wide open to being defined by their opponents.

The Republicans were successful in hiding their most extreme views. They did receive some help from a friendly media in this regard as many of the most extreme statements from Republicans such as  Joni Ernst received too little attention. When Mitch McConnell tried to make his desire to repeal Obamacare more popular by claiming the people of Kentucky would still have their popular exchange, the media concentrated far more on the less important refusal of Alison Lundergan Grimes to say whether she voted for Obama. When liberals spoke out on this, the media did begin to pay more attention to McConnell’s gaffe, showing there is benefit to serious discussion of the issues by liberals. If only Democratic candidates had the courage to do this too.

External events helped the Republicans. Widespread opposition to Congressional Republicans over the threat of a government shutdown of October 2013 was forgotten after the initial failed roll out of the exchanges, even if this was quickly fixed. Republicans gained further by promoting exaggerated fears of ISIS and Ebola.

The Republicans avoided saying what they would do while running, but now will be under closer scrutiny. Republicans decided upon a strategy of opposing everything Obama does, including if he promoted policies previously favored by Republicans, from before he took office. Now that they control Congress, this might no longer be their best strategy. Many Republicans will mistakenly see this election result as a mandate and try to move even further to the right. Some must be intelligent enough to realize that Republican victories with the midterm electorate will not translate into victories with the younger and minority voters who turn out in greater numbers for general elections. While it is hard to see the two parties work together on many of the big issues such as climate change, there might be some pragmatic legislation which both McConnell and Obama could agree on, considering Obama’s long-standing willingness to compromise with Republicans.

McConnell is attempting to portray a more moderate image, but even if this is his personal desire he still has to deal with the far right wing of his own party. He might even find that he cannot pass legislation without Democratic cross over support. It remains to be seen whether McConnell will pass legislation which doesn’t beg for a Democratic filibuster or presidential veto, especially if Tea Party Republicans push through amendments to legislation to attempt to repeal Obamacare or restrict access to contraception. The Tea Party wing is least likely to realize that this election does not signify agreement by American voters with their goals. An example of this was seen with the failure of Personhood measures even in red states. Republicans won midterm elections but their policies remain opposed by a majority of Americans.

Is The Culture War Really Over?

Bill Scher has an article at Politico on How Republicans Lost The Culture War. While it might be premature to say they lost and the war is over, a subject I’ll get into later, he does have some good points as to what went wrong for the Republicans.

Scher makes three main points. First, Republicans stopped being savvy on abortion. Rather than taking the purist position which they actually favor, legislatively the Republicans had concentrated on more narrow victories. Although late term abortions are rare, they made a lot of noise about “partial-birth abortions.”

While Scher sees this as no longer being savvy, I think that the change in Republican tactics was inevitable. They were never satisfied with stopping the rare late term abortions and were bound to ultimately push for what they really want–a complete ban on abortions.

They might have been more open in pursuing this partially due to a misreading of the polls which show Americans to be more ambivalent on Row v. Wade. The problems is that many people in this country don’t really know what Roe v. Wade means, but that doesn’t stop them from saying yes or no to a pollster. However, when the real question is posed, Americans do not want to make abortion illegal, and a majority agrees that women should  have the right to first trimester abortions.  Americans do not want to ban abortions, and imprison either women or the doctors involved.

Misreading the polls might have been a problem for Republicans, and this was compounded by moderate Republicans being forced from the party. The far right wing ideologues who now dominate the GOP would push for their position regardless of how unpopular, just as they push for restrictions on birth control, the second item on Scher’s list–Republicans got weird about birth control. If Americans would not go for Republican opposition to legalized first trimester pregnancies, they certainly did not accept their opposition to forms of birth control which prevent implantation, along with wider attempts to reduce access to contraception.

Hysterical Republican cries of “baby killers” are even more absurd when applied to a fertilized egg which lacks a central nervous system and consciousness. The Republican position here makes no more sense scientifically than Republican attitudes which deny science regarding evolution and climate change.  This also helps debunk the false Republican frame of making the pertinent question be when life begins. Certainly a fertilized egg is alive, but it also is not deserving of rights which trump the rights of a woman to control her own body. The Republican attitude on contraception only acted to expose their fallacious views regarding abortion, not to mention destroy any false claims they might make for being the supporters of limited government and greater freedom. This seems especially absurd to thinking people as providing easier access to contraception is one obvious way to reduce the number of abortions.

His final point is that Republicans bet wrong on gay marriage. Attitudes in this country certainly have changed rapidly. As James Joyner put it, “As we’ve become more educated, appeal to tradition and cries of “We’ve always done it this way!” are simply less persuasive. Ultimately, the arguments for excluding people from marrying others of the same sex were revealed to be provincial at best and simple bigotry at worst.”

However, while liberal Democratic voters might have supported legalization of same-sex marriage, many Democratic leaders were also behind the country on this one. Still, it is Republicans who made a major issue of trying to again intervene in the private lives of individuals, while Democratic leaders were at least ready to get out of the way as the country changed. While Republican have lost on this issue, Democrats also lost the opportunity to win respect by clearly standing for liberal principles before becoming politically safe.

While the country has been becoming more liberal on social issues, and I see this as a gradual process, not a sudden victory, this does not necessarily mean the culture wars are over. This country still consists of those of us who live in the modern world, and a sizable number who continue to reject science and reason and follow conservative ideas.

Fortunately such ideas are diminishing as fewer young support such conservative attitudes, but they are not disappearing entirely. Young people are far more likely to be influenced by the fake news of Jon Stewart than the fake news coming from Fox. Republicans now will have a hard time winning a presidential election if they do not change their views, but with a two party system we cannot exclude the possibility of another conservative Republican president. Democrats have a significant edge in the electoral college, but not a lock.

The presidency is only one branch of government. The Republicans still have the Supreme Court, although they have decided it best to stay out of the marriage issue now that conservatives are clearly on the wrong side of history. Republicans will continue to have an influence in Congress due to structural issues which keep it from being a truly representative democratic institution. Republicans have a tremendous edge in the Senate as the small states receive the same two Senators as the much more populous blue states. The framers of the Constitution never envisioned such a vast difference in population between the large and small states.

Part of the Republican edge in the House comes from gerrymandering, but even without gerrymandering the Republicans benefit from the concentration of Democratic voters in cities, unless districts are made to account for this. Republicans also benefit from a higher turn out by their voters in midterm elections, and they attempt to increase this edge with laws directed towards making it more difficult for minorities and young college students to vote. The right to vote itself might be the next big division between the parties as Republicans continue to pursue voter suppression as a tactic.

Republicans also dominate in a significant portion of the country, primarily but not limited to the deep south. The culture war is bound to continue there, with Republican candidates also seeking to promote their views elsewhere. As Eleanor Clift wrote, the Republican War on Women continues, just more quietly. We might not be hearing comments such as Tod Akin on women’s bodies shutting down in case of legitimate rape, but  have heard plenty of other outrageous statements this year.  Republicans might be trying to be more quiet on social issues, but they are failing, and this certainly isn’t coinciding with a change in their views.  It is also hard to say that the culture war is entirely over when Republicans have been successful in multiple state legislatures to make abortion more difficult, even if the most draconian Republican proposals have failed.

Republicans Losing The Culture War, Helping Democratic Candidates

In past elections, Republicans have turned to social issues to get their supporters out to vote. This year some Democratic candidates are doing the reverse–using social issues in the hopes of getting more women to turn out to vote. The New York Times discussed this in an editorial:

The decision to go on the offensive is in part designed to incite the anger of women and draw support in the November elections, particularly that of single women, who tend to vote in small numbers in midterms. But it is also a reflection of the growing obsolescence of traditional Republican wedge issues in state after state. For a younger generation of voters, the old right-wing nostrums about the “sanctity of life” and the “sanctity of marriage” have lost their power, revealed as intrusions on human freedom. Democrats “did win the culture war,” Alex Castellanos, a Republican strategist, admitted to The New York Times recently.

That’s not necessarily true in the most conservative states. In Louisiana and Arkansas this year, two endangered Democratic senators, Mary Landrieu and Mark Pryor, have not been as outspoken in attacking their opponents’ anti-abortion positions. But even there, Republicans have not campaigned against same-sex marriage.

One of the most telling signs of the cultural change is the number of Republicans who are bucking conservative activists and trying to soft-pedal or even retreat from their ideology. Mr. Gardner now says he opposes a similar bill on the ballot this year in Colorado. It apparently came as a surprise to him that the bill would effectively ban certain kinds of birth control, which he says is the reason for his switch. Several other Republican candidates are trumpeting their support for over-the-counter birth control pills, though they remain opposed to the insurance coverage of contraception required by the Affordable Care Act.

Of course it must be kept in mind that the Republicans who support making birth control pills available over-the-counter might not be doing this out of an increased sense of tolerance. As I recently discussed, making them over-the-counter could mean that they wouldn’t be covered by insurance, and wind up reducing access.

The editorial concludes, “The shift in public opinion might not be enough for Democrats to keep the Senate this year. But over time, it may help spell an end to the politics of cultural division.”

Yes, due to fundamentals involving this year’s election, the Republicans should do better than the Democrats. Polling does show that the Republicans have an excellent chance for taking control of the Senate this year unless Democrats manage to win in some of the races which are currently leaning Republican, but it could be a dead cat bounce for the Republicans. Voters are now far more likely to oppose Republican attempts to increase government intrusion in the private lives of individuals, and less likely to fall for phoney Republican claims of supporting smaller government and greater freedom. This should result in either the Republicans making major changes in their agenda or, more likely, significant Republican loses in 2016 when the fundamentals will again favor the Democrats.

In addition, as more voters support liberal attitudes on social issues, they are more likely to have a favorable view of other liberal ideas. If they already realize that the Republicans are selling a false line about limited government when it comes to social issues, they are more likely to be open to facts about how Republicans, rather than supporting economic freedom as they claim, are actually pursuing an agenda of using government to transfer wealth from the middle class to the wealthy. Once voters figure this out, there might be little support left for the authoritarian right.

Response To Republican Support For Making Birth Control Pills Available Over The Counter

While Republicans have generally been trying to restrict access to contraception, recently some Republicans have been promoting making oral contraceptives available over the counter without prescription. Many people quickly saw through this. It gives the Republicans a way to claim they are removing a barrier to receiving contraception and avoid situations like the Lobby Hobby case. It also does something else–make contraception less accessible for many women. While the Affordable Car Act requires that contraception be covered without out-of-pocket expense to the woman, many insurance plans do not cover over the counter medications. This is also an incomplete response to the issue as there are many other types of birth control, including forms which many Republicans are attempting to restrict.

The Guttmacher Institute issues a statement regarding this topic (via Talking Points Memo):

Birth Control Pills Should Be Available Over the Counter, But That’s No Substitute for Contraceptive Coverage

September 11, 2014

By Adam Sonfield and Sneha Barot, Guttmacher Institute

In recent weeks, some opponents of the Affordable Care Act’s (ACA) contraceptive coverage guarantee have promoted the idea that oral contraceptive pills should be available to adult women without a prescription. Sens. Kelly Ayotte (R-NH) and Mitch McConnell (R-KY), for example, recently introduced the so-called Preserving Religious Freedom and a Woman’s Access to Contraception Act, a bill that would urge the Food and Drug Administration (FDA) to study whether to make contraceptives over the counter (OTC)—though for adults only.

Making birth control pills available over the counter, if done right, would meaningfully improve access for some groups of women. However, such a change is no substitute for public and private insurance coverage of contraceptives—let alone justification for rolling back coverage of all contraceptive methods and related services for the millions of women who currently have it.

The Policy Behind Over-The Counter Contraception
Making birth control pills available OTC has merit, and the Guttmacher Institute is part of a coalition that has been working toward this goal for years. Leading medical groups have also endorsed such a move, including the American Medical Association and the American Congress of Obstetricians and Gynecologists. By removing the need to obtain a prescription, OTC status would eliminate this potential barrier to contraceptive use and thereby increase access.

This is especially true for uninsured women and those who don’t have time for a doctor’s visit or otherwise can’t readily reach a health care provider. However, if the goal is to truly expand access to contraceptive care—and not just provide cover for undercutting insurance coverage for contraceptives—the case to move birth control pills to OTC status should proceed alongside several other important policies and goals:

Protect contraceptive coverage and full method choice: The ACA requires most private health plans to cover the full range of women’s contraceptive methods and services, without out-of-pocket costs for the patient. This policy eliminates cost as a barrier to women’s ability to choose the method that is best for them at any given point in their lives, an approach that has been proven to make a substantial difference in facilitating access to and use of contraceptive services.

Contrary to what some policymakers and commenters have claimed, giving the pill OTC status would not be an effective substitute for the ACA policy. First, it would do nothing to help women access any contraceptive method other than the pill. This matters, since most women use four or more different contraceptive methods over their lifetime to meet their changing needs. If only the pill were available OTC and contraceptives were no longer covered by insurance, women would face significant new barriers in choosing the method that best suited their needs. Cost is a particularly steep barrier for highly effective methods like the IUD or implant that not only have high upfront expenses, but also require a trained provider for insertion and therefore are not candidates for OTC status.

Even for the pill itself, there is no convincing evidence to suggest that moving it to OTC status would substantially lower out-of-pocket costs to patients, let alone come close to the $0 out-of-pocket cost guaranteed under the ACA policy. Rather, making the pill available OTC, if done at the expense of insurance coverage, would replace one barrier (ease of access) with another (cost). Likewise, greater reliance on Health Savings Accounts or Flexible Spending Accounts, as some opponents of insurance coverage have proposed, would also merely replace full insurance coverage with patient out-of-pocket costs—leaving most privately insured women, particularly low-income women, worse off. Uninsured women on average pay $370 for a full year’s supply of the pill, the equivalent of 51 hours of work at the federal minimum wage of $7.25.

Millions of women already benefit from the ACA’s contraceptive coverage guarantee and these hard-won gains must be protected. Rather than substituting for contraceptive coverage of all methods and related services, OTC status for birth control pills should complement and enhance such coverage.

Strengthen coverage for over-the-counter methods: While the ACA’s preventive care provision specifically requires private health plans to cover certain products with over-the-counter status (including the emergency contraceptive Plan B, folic acid, aspirin to prevent heart disease and tobacco use cessation products), a prescription is needed for these items to be covered—essentially negating the benefits of OTC status. This prescription requirement should be eliminated for any current and future over-the counter contraceptives. Coverage of over-the-counter products without a prescription is already the norm in some state Medicaid programs and in the U.S. military’s Tricare insurance program. Further, ensuring full coverage for over-the-counter contraceptives would prevent “free-riding” by insurance companies that benefit from not having to cover pregnancies that were averted through patient out-of-pocket expenditures.

Ensure equal access for young women: Adolescents and young women, who face greater risk of unintended pregnancy and more barriers to accessing contraception than older women, have among the most to gain from a switch to OTC status. However, recent calls to give birth control pills OTC status as a substitute for contraceptive coverage have specifically excluded minors. That would require women 17 and younger to obtain a prescription, without providing any medical evidence to justify such restrictions. This approach would be harmful to adolescent women and would be counterproductive to helping them avoid unplanned pregnancies and the negative health, social and economic consequences that often follow.

In addition, excluding minors would likely not result in a true over-the-counter status, but instead could put contraceptive pills behind the counter, much as happened when the emergency contraceptive Plan B was first approved for OTC sales. To comply with an age restriction, stores would have to require proof of age via a valid picture ID from any woman who looks young enough to potentially be barred from purchasing birth control pills without a prescription. This would be an added hurdle for millions of women, and it ignores the reality that many young women do not have government-issued forms of photo ID.

Keep politics out of FDA decision making: To switch any drug to OTC status, the typical process involves the drug’s manufacturer submitting an application to the Food and Drug Administration (FDA), which—based on several criteria, including the safety and efficacy profile of the medication—decides whether to grant the request. The evidence is quite strong that providing birth control pills OTC would be safe and effective, including for minors. The FDA process should be driven by the evidence and free from political interference by the administration, Congress and others.

It is troubling but not at all surprising that Senator Ayotte and others who purport to be interested in contraceptive access would preempt the FDA with unfounded calls to bar minors from benefiting from any future OTC status for birth control pills. This echoes the longtime political and legal wrangling over minors’ access to OTC emergency contraceptive pills, despite clear evidence that minors could safely use these products without a prescription.

It is also noteworthy that there are dozens of brands and formulations of birth control pills, most of which would likely have to undergo the lengthy and expensive FDA process to gain OTC status separately. Because formulations of the pill are not medically interchangeable, with some women tolerating specific pills better than others, making one or several versions of the birth control pill available OTC would not benefit all current pill users.

Not A One-Size-Fits-All Policy Solution
Just as birth control methods are not “one size fits all” at any point in a woman’s life, let alone for all of her reproductive years, neither is there a one-size-fits-all policy solution to enhance access to the full range of methods, information and services for women of all ages and income levels, regardless of where they obtain their care. A wide range of approaches is necessary to meaningfully respond to women’s family planning needs in a comprehensive way.

One such approach includes making birth control pills available over-the-counter, if done so without additional costs or barriers to women. Doing so can complement and enhance current efforts to help more women become effective contraceptive users, including the ACA’s significant gains for comprehensive private and public insurance coverage for contraceptive counseling, services and supplies.

If anything, contraceptive coverage should be broadened to cover more women and strengthened to eliminate the prescription requirement for OTC methods that are covered. Other urgent priorities include expanded access to Medicaid, public support for safety-net family planning centers and the Title X national family planning program, comprehensive sex education and the development of new contraceptive technologies.

Truly increasing access to contraceptive care requires a multifaceted approach to meet the needs of all women throughout their reproductive lives. Political talking points will not do it.

This article was originally published on Health Affairs Blog at this link.

Click here for a recent statement from the American Congress of Obstetricians and Gynecologists (ACOG) supporting over-the-counter access to birth control pills as part of a broader dialogue about improving women’s health care as opposed to a political tool.

Three Reasons Democrats Might Retain Control Of The Senate

Republicans have an excellent chance to gain control of the Senate this year due to a combination of Republican voters traditionally turning out in higher percentages in midterm elections and the need for Democrats to defend several seats in red states. Current projections from most sources give the Republicans a slight edge but there are a few reasons to believe that the Democrats might hold on to one or two more seats than projected, and retain control of the Senate:

1) The power of incumbency:

Democrats must hold onto seats in red states, but they are states that Democrats have won once before, even if in a presidential election year which was more favorable to Democrats. While they don’t have this advantage in 2014, having candidates running as incumbents might increase the chance of winning. Since 2000 Democratic Senate candidates have usually won reelection in the south, despite their states going heavily to the Republicans in presidential elections. Polls are showing that incumbent southern Democrats remain competitive.

2) Women voters:

Republican hostility towards reproductive rights and attempts to restrict access to contraception as well as abortion has many women voters angry, hopefully enough to turn out to vote. The Hobby Lobby decision might also motivate women.

With their Senate majority at stake in November, Democrats and allied groups are now stepping up an aggressive push to woo single women — young and old, highly educated and working class, never married, and divorced or widowed. This week they seized on the ruling by the Supreme Court’s conservative majority, five men, that family-owned corporations do not have to provide birth control in their insurance coverage, to buttress their arguments that Democrats better represent women’s interests.

But the challenge for Democrats is that many single women do not vote, especially in nonpresidential election years like this one. While voting declines across all groups in midterm contests for Congress and lower offices, the drop-off is steepest for minorities and unmarried women. The result is a turnout that is older, whiter and more conservative than in presidential years…

Single women, Democrats say, will determine whether they keep Senate seats in states including Alaska, Colorado, Iowa, Michigan and North Carolina — and with them, their Senate majority — and seize governorships in Florida, Pennsylvania and Wisconsin, among other states.

The party is using advanced data-gathering techniques to identify unmarried women, especially those who have voted in presidential elections but skipped midterms. By mail, online, phone and personal contact, Democrats and their allies are spreading the word about Republicans’ opposition in Washington — and state capitals like Raleigh — to pay equity, minimum wage and college-affordability legislation; abortion and contraception rights; Planned Parenthood; and education spending.

3) Black Southern Voters:

Black southern voters have long voted Democratic, but now might turn out in high enough numbers to influence the results. Republican efforts to prevent them from voting might backfire, motivating more blacks to turn out:

Southern black voters don’t usually play a decisive role in national elections. They were systematically disenfranchised for 100 years after the end of the Civil War. Since the days of Jim Crow, a fairly unified white Southern vote has often determined the outcome of elections.

This November could be different. Nearly five decades after the passage of the Voting Rights Act, black voters in the South are poised to play a pivotal role in this year’s midterm elections. If Democrats win the South and hold the Senate, they will do so because of Southern black voters.

The timing — 50 years after the passage of the Civil Rights Act and 49 years after the passage of the Voting Rights Act — is not entirely coincidental. The trends increasing the clout of black voters reflect a complete cycle of generational replacement in the post-Jim Crow era. White voters who came of age as loyal Democrats have largely died off, while the vast majority of black voters have been able to vote for their entire adult lives — and many have developed the habit of doing so.

This year’s closest contests include North Carolina, Louisiana and Georgia. Black voters will most likely represent more than half of all Democratic voters in Louisiana and Georgia, and nearly half in North Carolina. Arkansas, another state with a large black population, is also among the competitive states…

Democrats lamented low black turnout for decades, but Southern black turnout today rivals or occasionally exceeds that of white voters. That’s in part because black voters, for the first time, have largely been eligible to vote since they turned 18. They have therefore had as many opportunities as their white counterparts to be targeted by campaigns, mobilized by interest groups or motivated by political causes.

Mr. Obama is part of the reason for higher black turnout, which surpassed white turnout nationally in the 2012 presidential election, according to the census. But black turnout had been increasing steadily, even before Mr. Obama sought the presidency. In 1998, unexpectedly high black turnout allowed Democrats to win a handful of contests in the Deep South; in 2002, Ms. Landrieu won a Senate runoff with a surge in black turnout.

The Supreme Court’s decision last year to strike down a central provision of the Voting Rights Act unleashed a wave of new laws with a disparate impact on black voters, including cuts in early voting and photo-identification requirements.

The Secret To Success In The Senate

warren paul

Congress has a record low approval rating, which perhaps is why the most successful Senators appear to be those who haven’t spent much time there. Barack Obama sure didn’t waste much time in the Senate before successfully running for president. Hillary Clinton is a special case as her time in the Senate is only a small part of her resume, but she didn’t spend very much time there either. The most popular Senator from each party today very well might be a freshman. Both have ignored the old tradition for new Senators to be fairly quiet.

On the Democratic side, Elizabeth Warren has received the most enthusiastic support. There is even a Ready For Warren web site, despite her statements that she has no plans to run for president. She has spoken out the most on economic issues, but is now wading into social issues as well with her comments on the Hobby Lobby case:

I’ll be honest – I cannot believe that we are even having a debate about whether employers can deny women access to birth control. Guys, this is 2014, not 1914 . Most Americans thought this was settled long, long ago. But for some reason, Republicans keep dragging us back here – over and over and over again.

On the Republican side, Rand Paul has generated the most excitement. As his foreign policy views are out of step with those of his party, there are real questions as to whether he has a chance to win a Republican presidential nomination. Gallup found that he falls just slightly behind Mike Huckabee among potential Republican candidates at this time. Aaron Blake looked at other polls to show that Paul is in a strong position to possibly win in both Iowa and New Hampshire, which certainly would give him strong momentum towards winning the nomination. Should Paul manage to win the nomination, a Quinnipiac poll shows that Paul is the strongest Republican candidate against Clinton in Iowa. Of course that might not hold nation wide.

A Huckabee versus Paul race for the Republican nomination would certainly offer a choice of different views. A presidential race between Paul and Warren would do the same, and most likley excite many on both the left and right far more than, say, another campaign between a Bush and a Clinton. Of course a race between Clinton, as opposed to Warren, and Paul is far more likley considering the state of the Democratic race. As I discussed previously, this would lead to a reversal in partisan foreign policy perspective, with the Democrats having the hawk as a candidate. As Peter Beinart pointed out, she sounded more like George Bush than a Democrat on foreign policy on her recent appearance on The Daily Show.

Updates: Digby also questions Clinton’s statement. Politico reports that Warren rallies the base. John Dickerson thinks a Warren run would be a good thing–but primarily to provide a worthy conversation and to “force Clinton to draw clear lines about what she believes, why she’s running, and why her message is something more than ‘It’s my turn.'” I would be more interested in a challenge to Clinton from the left which could actually beat her for the nomination, but that doesn’t look likely.

Hobby Lobby Case Shows That To Conservatives Freedom Means “Freedom” To Impose Their Religious Views Upon Others

Conservatives applauding the Supreme Court decision in the Lobby Hobby case are showing, once again, that to them freedom means the “freedom” to impose their religious views upon others. When conservatives oppose the requirement that a business provide insurance to their employees in any condition they might have a consistent libertarian argument, ignoring the fact that many Republicans supported such mandates, along with the individual mandate, until quite shortly before the Affordable Care Act was passed. When they fight for a specific exclusion based upon some people’s religious views about contraception then we have an entirely different matter. As I noted yesterday, this is hardly any type of victory for religious freedom.

It might be a different matter if all the employees shared the views of their employers, but the reality is that the employers of Hobby Lobby are forcing their views upon their employees. As The New York Times points out:

Nothing in the contraceptive coverage rule prevented the companies’ owners from worshiping as they choose or advocating against coverage and use of the contraceptives they don’t like.

Nothing compels women to use their insurance on contraceptives. A woman’s choice to use or not to use them is a personal one that does not implicate her employer. Such decisions “will be the woman’s autonomous choice, informed by the physician she consults,” as Justice Ginsburg noted. There also is no requirement that employers offer employee health plans. They could instead pay a tax likely to be less than the cost of providing insurance to help cover government subsidies available to those using an insurance exchange.

Including contraception coverage in health insurance also isn’t likely to increase the cost to employers as preventing unwanted pregnancies is less expensive than covering the medical expenses of such pregnancies. Nor can denial of coverage of contraception be justified based upon religious opposition to abortion as making contraception more readily available is an effective means of reducing the number of abortions. This is purely a matter of forcing the religious opposition to contraception held by the religious right upon others.