Gov. Roy Cooper demands affordable access to contraception

Cooper spoke at a large abortion-rights rally in Raleigh, N.C. last May, soon before he vetoed the Republican-controlled legislature's 12-week abortion ban. (AP Photo/Hannah Schoenbaum)

By Michael McElroy

December 11, 2023

Cooper and a group of Democratic governors asked federal health officials to clarify that most insurances must cover non-prescription contraception.

As the country gears up for another election with reproductive rights at risk, the US must protect access to affordable contraception, Gov. Roy Cooper and a group of other Democratic governors told federal officials last week.

The governors made the plea in a letter to US Health and Human Services Secretary Xavier Becerra, asking him to clarify that any health insurers regulated through the Affordable Care Act must cover FDA-approved, non-prescription birth control methods. The letter also urged federal officials to ensure that contraception is covered by Medicare and Medicaid. (Contraception IS covered under these plans in North Carolina.)

The FDA recently approved the first over-the-counter birth control pill, which should soon be on the market. The new drug will be a huge benefit, the governors said, but they also noted that federal officials need to be super clear that these insurance companies will have to cover it.

“It’s absolutely essential that birth control be affordable and accessible for as many Americans as possible,” Cooper said in a press release announcing the letter. “Women shouldn’t have to jump through unnecessary hoops or spend a fortune to access basic health care like birth control, and I encourage the federal government to take action to help.”

The governors are members of the Reproductive Freedom Alliance, a group they formed to “safeguard and improve reproductive healthcare access in the face of an unprecedented assault on the right to primary healthcare.”

Govs. Josh Shapiro of Pennsylvania, Gavin Newsom of California, Michelle Lujan Grisham of New Mexico also signed the letter.

Contraception deserts

While abortion rights have gotten most of the attention since the US Supreme Court struck down Roe v. Wade last year, health care professionals and reproductive rights groups have been warning that contraception is also at risk from far-right Republican lawmakers.

In a separate opinion issued alongside the Court’s decision overturning Roe, conservative Justice Clarence Thomas argued that Roe’s inherent protections of contraception should also be reconsidered.

But contraception doesn’t have to be banned in order to be at risk.

More than 635,000 women in North Carolina live in counties with limited access to “the full range of contraception methods,” including over the counter birth control pills, according to the reproductive rights group Power to Decide.

And more than 12,400 women live in counties “without a single health center” that provides the full range of options.

The Biden administration has issued several executive orders seeking to expand affordable access to contraceptives, and the governors’ letter applauded the effort.

“As Governors, we see firsthand the need for affordable and accessible reproductive health coverage in our communities,” they wrote.

Just the beginning

When North Carolina’s Republican-controlled General Assembly passed its own 12-week abortion ban last spring, party leaders said it was only the first step toward a potentially total ban. Democrats vowed to fight any more restrictions, but they also warned that the assault on abortion rights in North Carolina might not stop at abortion.

Republicans dismissed these concerns, but have already opposed efforts to guarantee easy and convenient access to contraception.

Democrats in the state legislature introduced two bills this year to codify the right to contraception in the state constitution. In essence, the bills would show that the General Assembly “has no legitimate governmental interest in limiting the freedom to use contraception to prevent pregnancy.”

But Republican leadership blocked the bills from even getting a hearing, much less coming to a vote.

And though the abortion ban provides $7 million total over the next two years to increase access to contraception, it puts its thumb on the scale. The bill limits the funding to “long-acting reversible contraceptives,” which are highly effective, but prescription-only methods like IUDs and implantable devices. This funding will NOT go toward birth control pills.

This medically unnecessary restriction, experts say, is rooted in historical efforts to strip low-income women of their reproductive freedom.

A patient can stop using birth control pills anytime they want. But they need a doctor’s appointment to remove a “long-acting reversible contraceptive” (LARC) device.

“Over the past thirty years, physicians and policy makers have relied on LARCS to enact coercive temporary sterilization policies and practices targeted at low-income women,” researchers wrote in a commentary for NC Newsline.

“The rhetoric that has accompanied such policies often portrays these women taking advantage of the welfare system and as incapable and unworthy of making their own reproductive choices.”


  • Michael McElroy

    Michael McElroy is Cardinal & Pine's political correspondent. He is an adjunct instructor at UNC-Chapel Hill's Hussman School of Journalism and Media, and a former editor at The New York Times.

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