Birth Control

"21st Century Women's Health Act" Would Expand Federal Funding for Everything From Birth Control to Campus Rape Prevention


Liz Henry/Flickr

Senate Democrats are pushing to expand Medicaid coverage for contraception, breast pumps, and more with new legislation they're calling the "21st Century Women's Health Act." The "ambitious pro-choice" bill would also devote more federal money to things like campus rape-prevention programs and mandate that federal officials report regularly on state-by-state abortion access. 

"At a time when the GOP congress is trying to drag women back to the last century, we are offering a bold agenda to strengthen women's health in this century," said Sen. Barbara Boxer (D-California), one of the bill's three co-sponsors, in a statement. This seems to be the key talking point. In a Thursday press call, Washington Sen. Patty Murray, another co-sponsor, called it an effort "to fight back against those who miss the Mad Men era" to lay out "important ways we can and should move forward on women's health." 

While Obamacare requires private health insurance plans to cover all costs for contraception, whether and how it is covered under Medicaid is determined by individual states. The majority of states do cover it (though not necessarily at no-cost to enrollees), but 21 states still prohibit Medicaid programs from covering contraception. Boxer et al.'s bill would require state Medicaid programs to cover 100 percent of birth control costs for all female enrollees, and this is beig pushed as the cornerstone of the legislation. However, there are a lot of other funding promises tucked within. The bill would also

  • Require hospitals to provide any woman seeking care after a sexual assault with information about emergency contraception and the medication itself if so desired (a move sure to go over poorly with religious hospitals). The federal government would pick up the tab for this medication in all instances, even if the victim had private insurance that would cover the medication. 
  • Fund campus-based programs on sexual assault prevention
  • Fund emergency contraception on college campuses
  • Require the Department of Health and Human Services to conduct a study every five years on abortion access across the U.S. and state laws regarding abortion and family planning
  • Fund training for nurse practitioners who specialize in women's healthcare 
  • Require state Medicaid programs to cover breast pumps and "breastfeeding support services" 
  • Provide more federal funding for clinics and health centers addressing family planning services
  • Require all states to start "maternal mortality review committees" and report on the findings 
  • Launch a public awareness campaign to inform women about access to mammograms, immunizations, "domestic violence screening," and other services
  • Create a database for women to report insurers trying to charge them for birth control 

Though the bill has little chance of passing a GOP-dominated Congress, you can see why it holds political appeal for Democrats. It's easy to portray opposition to the bill as opposition to women's health and to rape victims, or as a play to "drag women back to the last century." And at least some Republicans are likely to take the bait, playing up arguments about how taxpayers shouldn't have to pay for anybody else to have sex. 

But the birth control coverage seems the least offensive part here. Perhaps states should be left to decide for themselves how they run their Medicaid programs, but I support state decisions to cover contraception as they do other medications. One recent study found the federal government covers birthing costs for two-thirds of unplanned pregnancies, and that's just the start; once born, those kids are going to need health insurance too, at the very least. Whatever the other benefits, it's also cost-effective to help prevent unintended pregnancies in low-income populations, rather than cover them. 

The other elements of the senators' plan, however, are where things really start to go wrong. Why should the federal government cover emergency contraception for victims with private insurance willing to pay? Aren't college campuses already awash in sexual assault prevention programs? Why does HHS need to conduct its own abortion-law reports, when there are myriad reputable groups—from women's health nonprofits to academic research programs—preparing yearly reports on the same? Why do Washington bureaucrats think they're better equipped to address healthcare access and outcomes in diverse communities than the people that live and work in them? The "21st Century Women's Health Act" mostly seems to stick the federal government in a lot of things being handled perfectly well by community, city, state, university, nonprofit, and private initiatives. Adding D.C. oversight can only make these measures more expensive and less efficient.

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  1. Is that a pic of an IUD and a sweet tart?

    1. Also, I just can’t ENB. Leading with a Boxer quote?

      1. “I just can’t ENB”

        Its not even i don’t know what

  2. but I support state decisions to cover contraception as they do other medications. One recent study found the federal government covers birthing costs for two-thirds of unplanned pregnancies, and that’s just the start; once born, those kids are going to need health insurance too, at the very least. Whatever the other benefits, it’s also cost-effective to help prevent unintended pregnancies in low-income populations, rather than cover them.

    I thought this was a libertarian website.

    1. Shut up and pull out your wallet!

    2. Sterilization is more cost effective.

    3. Yes, so anti-libertarian to think that as long as a welfare program exists, we might as well make it function as cost effectively as possible

      1. Ultimately, all the above issues are about money. That is why the word “fund ” is used so much in your article.
        Subsidize something and you get what???
        As long as a program exists that is a disaster, let’s pretend that it works?

      2. Let’s see how efficiently we can get the Government to violate the Constitution.

        1. This whole “limited government” idea was just a pipe-dream anyway. Get real, people. You’re never going to sell people on “libertarianism” unless there’s some free shit to hand out.

    4. I see it like the gay marriage debate. The government shouldn’t be involved in marriage, but insofar that it is, it shouldn’t discriminate, and gay marraige should be allowed.

      Similarly, the government shouldn’t be spending money like that either. But given that it will no matter what we say, it’d be a hell of a lot cheaper for them to spend it on contraception than birthing, welfare, etc.

      (oh no I’m now a heartless racist eugenics promoter aren’t I)

      1. Yes. Report to …. Well I guess the eugenics promoters have always been in charge, so report to your new office.

    5. Lol!!!

      You noobs crack me up

    6. So, basically, we need this new government program to offset the costs of the other government program.

      Sounds legit.

  3. Why not put a Planned Parenthood on every college campus? That’s where this is headed.

  4. Here we go again, another “Anti-Puppy Killing” bill. What kind of monster would oppose such a bill? Only a cold, heartless, evil, Koch-supported Republican, that’s who.

  5. The biggest barrier to accessing birth control is the requirement that women get an annual gynecological physical in order to get a prescription for it.

    Not only is the physical invasive for many women, and not only does it require paying for the doctor’s visit, there is no medical reason why using birth control pills would require special annual exams of your hoo-hah, unless you think that birth control pill usage is inextricably linked to STD acquisition. A mindset that seems like a relic of the 1950s. (If you’re on BCP, you must be promiscuous.)

    The pill should be made available over the counter, or failing that you should be able to get a prescription with nothing more than a 5 minute chat.

    We make morning-after pills available OTC and they have far more powerful drugs in them, with more significant side effects.

    1. The requirement for an annual exam is classic cronyism.

      You are absolutely right that this is nothing more than a handout to Big Handsanitizer.

    2. Why not simply reduce the requirement to an ultrasound?

    3. Oh, but what you’re describing would require ‘deregulating’.

      and well, that’s just crazy talk. No, its apparently much more *libertarian* to create new entitlement programs rather than un-do the shitty regulations that create barriers to access in the first place. You gotta spend money to save money, you see.

    4. Oddly enough, in “progressive” Europe, abortion is restricted after the first trimester and contraception is available OTC but not covered.

  6. ” And at least some Republicans are likely to take the bait, playing up arguments about how taxpayers shouldn’t have to pay for anybody else to have sex.”

    That argument has the advantage of being 100% correct.

    1. So why are 1005 correct arguments rejected?

  7. Create a database for women to report insurers trying to charge them for birth control

    Paying for something yourself!? What kind of backwards society is this?

    [Futilely grasps for fainting couch.]

  8. Free vibrators for all!

  9. 21st Century Woman – we don’t need a man to tell us what to do, but we would be totally lost without our uncle.

    I’m sure Barbara Boxer doesn’t think women are going to worry their pretty little heads about just how patronizing she (and the left in general) is. When it comes to looking out for those who can’t look out for themselves, they think everybody is as helpless as a newborn kitten. Except straight white males, of course.

    1. Just remember, John Galt is a straight white male.

  10. It’s ironic that they want to hand out free morning-after pills on college campuses, but they don’t want to hand out free birth control pills.

  11. I think the greatest thing is when progressive feminists cry that they don’t need old white men to tell them what to do with their bodies but yet have no problem with asking those same old white men to force people to pay for their birth control and abortions.

    I could give two shits whether a woman gets an abortion or buy an assload of birth control. But why would they want the government to fund it when some asshole can come into office and take that funding away. Anything that the government gives can be taken away in a moment’s notice.

  12. Well, I’m as anti-spending as the next man, but this is a good bill from a libertarian perspective because it would certainly save more money than it would cost.

    Subsidizing contraceptives saves much more than it costs. When an indigent woman gives birth on the government dole, it costs us more than $18,000.00 in obstetric and neo-natal care.

    1. “this is a good bill from a libertarian perspective because it would certainly save more money than it would cost.”


      Its not the business of the Federal Government to intervene everywhere with Sugardaddy money if they can claim that it “saves” money elsewhere…

      that’s just an idiotic excuse that uses one shitty entitlement program to justify the existence of another. There’s nothing “libertarian” about it in the slightest. Its not something the government has has any legitimate reason to be involved in the first place. By your reasoning, ‘sterilizing the poor’ would be ‘libertarian’.

      1. Gilmore, you are wrong. FAILING to have government provide contraception to poor women would COST EXTRA TAXES. The question is, how much EXTRA TAXES are YOU willing to pay for NOT having government provide free contraception to poor women? How about the cost of one childbirth–$18,000.00 extra Federal tax per household per year? Me, I’m not willing to pay ANY more taxes than I have to pay. I think taxes should be kept as low as possible.

        And sterilizing the poor WOULD be libertarian, provided we only sterilize those poor people who wish to be sterilized. Obviously, sterilizing someone against their will would not be libertarian, but offering government-subsidized sterilization to those poor people who desire it would enable us to lower taxes, which is libertarian.

        1. Apparently you’ve interpreted “Libertarian” to mean =

          Unlimited Government Intrusion into Any/Every Aspect of Life *IF* (in theory) It Could Result in Lower Taxes*

          1. Wrong again. That is not my interpretation. To me, libertarian means TWO things: respect for basic human freedoms and rights, AND low taxes. In my view, government intrusion which violates basic human freedoms and rights (such as forced sterilization or mandatory national service) would not, according to my interpretation, be libertarian.

            However, in my view, government action which does NOT violate basic human freedoms and rights and DOES lower taxes, is libertarian. Having government subsidize contraception meets these two criterion: it does not violate anyone’s basic freedoms and rights (no one would be required to use contraceptives if they prefer not to do so), and it does lower taxes.

            If you want a more expensive government policy (such as a government which refuses to subsidize contraception for poor people), then I think YOU should be the one to pay for your more expensive government policy. Not me. I’ll take the cheaper, more rational government policy, thank you very much.

            1. To me, libertarian means”

              Yeah – exactly my point. Your personal definition is entirely inconsistent with the actual *word*

              “Libertarianism (Latin: liber, “free”) is a political philosophy that upholds liberty as its principal objective. Libertarians seek to maximize autonomy and freedom of choice, emphasizing political freedom, voluntary association and the primacy of individual judgement.[1][2]”

              Using government as an experimental social-engineering program, where it taxes everyone, and then hands out the money to certain products or interests groups… all with the vague mandate of achieving some ‘maximal good’ at the ‘lowest cost*’?

              (*which, naturally, is endlessly growing, what with your unlimited mandate for government to try and do nice things for nice people)

              yeah, that’s pretty much “Progressive Liberalism” with a bullshit strap-on of “for cheap

              You really have no fucking idea what you’re talking about. Libertarianism isn’t about “how cheap can we make a maximally intervening, unlimited government

              Its expressly limiting the role of government, and leaving everything aside from its most basic functions up to individuals and markets. aka “liberty”…which by definition has the added component of “individual responsibility” – which is the part where you don’t get knocked up then insist other people pay the bill.

              1. You quoted: “Libertarians seek to maximize autonomy and freedom of choice, emphasizing political freedom, voluntary association and the primacy of individual judgement.”

                But contracepting is an instance of enjoying maximal autonomy and freedom of choice, and is a good use of individual judgement, and a taking of individual responsibility. A policy which makes the ability to do these things dependent on having money is not libertarian, at least not in spirit.

                I can understand your argument, which is really more propertarian than libertarian–you’d like to eliminate all government funding for all medicine, get government entirely out of the medical business, and let the women who give birth shoulder the responsibility for paying their obstetric and neonatal bills themselves. But in real life, women give birth without having money to pay for the costs of doing so. And it’s not just childbirth–poor people who get sick run up medical bills they do not have money to pay. This is a general problem with absolute, no-government, anti-redistributive libertarianism–what to do about people who cannot afford to pay the money they owe. Debtor’s prison? Forced labor camps where they work off their debts? It’s a critical mechanistic question for which I have never heard a libertarian give a good answer, and it effectively cripples absolute anti-redistributive libertarianism as a practical political philosophy. Even Robert Nozick has no good answer.

                1. CONTINUING

                  Meanwhile, in real life, medicine in USA was socialized in 1986, when President Reagan signed a law forbidding emergency rooms from turning away patients on the basis of non-ability to pay. Once that law was signed, anyone could get care without being able to pay for it, and medicine was effectively socialized, and the only thing left for a good libertarian to do is to promote policies which minimize the costs and keep the redistributed medical burden as low as possible. Otherwise, by opposing preventative cost-saving measures, you paradoxically compound the error by making an already socialized system MORE burdensome to citizens.

                  In broader terms, the question of what policies a good libertarian should support in a largely socialist society is different from the question of what social policies a good libertarian would set up, ideally. If you give answers to the latter question when considering the former question, as you are doing, you end up with a more burdensome government, not a less burdensome one.

                  1. CONTINUING FURTHER:

                    So I guess I have two questions for you: .1 Would you repeal the law which requires ERs to care for all comers, and allow ERs to turn away patients, including dying patients, who fail to prove before being admitted, that they can pay for their care? (“I’m bleeding to death!” –“Yes, sir, but where’s your insurance card?”) If the answer to this question is no, then you are, effectively, a medical socialist. But if the answer is yes, then virtually no one in USA agrees with you and you have effectively disenfranchised yourself in the real world. And 2. If you were the supreme lawgiver, how would you have libertarian society deal with people who come to owe more than they own? There are really only two choices: let them declare bankruptcy, which is government forcing the creditor to give up (at least some of) the money owed him, which is a form of redistributive socialism, OR distribute the debt burden to those who can afford to pay, which is another form of redistributive socialism.

                    It’s a puzzle, that’s for sure.

                    1. exactly = you have no idea what the fuck you’re talking about.

                    2. Gilmore: Excuse me. I went through my Rand phase in high school, and I was a philosophy major at an ivy league university, and my senior thesis included a chapter on Robert Nozick (ANARCHY, STATE, AND UTOPIA) and I voted Libertarian in 1980 and I was threshing this stuff (Libertarianism and its essential flaws) out when you were (probably) still an itch in your daddy’s pants. I have forgotten more about libertarianism than you will ever learn.

                      You curse at me, but you have no answers to my arguments or questions.

                      You should seriously consider the possibility that you may not be smart enough to opine meaningfully about complicated philosophical issues like rights, freedom, and government.

                      “In regard to the moral aspects of birth control, the primary right involved is not the “right” of an unborn child, nor of the family, nor of society, nor of God. The primary right is one which?in today’s public clamor on the subject?few, if any, voices have had the courage to uphold: the right of man and woman to their own life and happiness?the right not to be regarded as the means to any end.”–Ayn Rand.

    2. Nonsense. “Spending money to save money” is not a libertarian principle.

      A libertarian move would be to make birth control available OTC.

  13. “Expand Federal Funding “

    No, really? i thought it was about “rights” or something.
    /(I’m really not even cynical enough)

  14. WAR ON WOMYNZ!!!!

  15. “Whatever the other benefits, it’s also cost-effective to help prevent unintended pregnancies in low-income populations, rather than cover them.”

    Except for the issue that “unintended” does not equate to “unwanted”. For this to work as a cost savings, it does. If your intended targets are not motivated to not have children then it falls flat.

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    go to tech tab for work detail


  18. The most striking thing about such legislation is that there has been so much of it, in the last half century, focused on women’s health, and not a single piece of legislation focusing exclusively on men’s health.

    Men’s life expectancy is 7 years shorter than women’s, yet they receive only 35% of government expenditures for health care. In 1920, men died on average only one year sooner than women; in the 1990s, men died seven to eight years sooner.

    When non-whites have about 80% of the chance of whites to reach age 85, we blame it on the powerlessness engendered by racism; when a boy infant has only half the chance of a girl infant of reaching age 85, we call it the price of privilege.
    Blacks die earlier than whites from twelve of the fifteen leading causes of death; men die earlier than women from all fifteen of the leading causes of death.

    The death rates for prostate and breast cancer are similar, and yet there are numerous federal offices on women’s health, and not a single one for men, and the lion’s share of gender specific medical research is done on behalf of women.

    For the history of the shift of the Women’s Rights Movement from an egalitarian to a totalitarian one, see: When Progressive Social Change Becomes Regressive Ideology: From Women’s Liberation to Cultural Misandry

    1. Why is that surprising? Male support for feminist causes is simple straight male mating behavior.

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