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McCain’s Birth Control Dodge

It was not what he said, but what he didn’t say that’s caused the uproar. Asked this week about the iniquities between health insurance coverage for birth control and Viagra, Sen. John McCain (R-Ariz.) sidestepped the issue.

“It’s something that I had not thought much about,” he told a reporter not very straightforwardly from the Straight Talk Express, his campaign bus. “I don’t usually duck an issue, but I’m — I’ll try to get back to you.”

That evasive response could anger many women voters. For decades, women’s rights advocates have battled for contraceptive coverage as a simple necessity of health and well being. Though there is no male equivalent to prescription contraceptives, the fact that Viagra is covered under some plans while birth control is not smacks many as unjust. That McCain declined to weigh in on the topic may well be difficult to remedy.

(Matt Mahurin)
(Matt Mahurin)

As the video of McCain’s comments raced across the Web, the issue quickly became campaign-trail ammunition for Democrats as well as the reproductive-rights community. Both groups assailed the likely GOP presidential nominee for being out of touch when it comes to women’s health.

“Women in America are still waiting for his answer,” Cecile Richards, the president of Planned Parenthood, said in a statement.

But the issue of a federal mandate for covering prescription contraceptives is one that extends far beyond a single candidate in a single election season. Legislation that would require most health-insurance plans to cover birth control has been bouncing around Capitol Hill for years. But a combination of factors — including insurance industry opposition, conservative ideology, the taboo nature of the topic and a male-dominated Congress — has conspired to defeat each vote. While McCain has hardly been supportive of reproductive rights, women’s health groups say, these other pressures have defined the debate.

Chief among these pressures has been opposition from the insurance industry, for which coverage regulations have historically been anathema. Not only do coverage mandates cost the companies more money, the industry argues, but they infringe upon the commercial liberties of free-market capitalism.

But advocates contend it would benefit the companies to prevent pregnancies, rather than having to pay for them. “It’s a heck of a lot cheaper to cover contraception than to cover a birth,” said Adam Sonfield, a senior public-policy associate with the Guttmacher Institute, a reproductive-health research group.

In addition, many Americans tend to treat birth control as a lifestyle choice, not a health-care issue. Indeed, many conservatives tend to treat the issue as a personal choice falling outside the realm of public health.

But statistics point to a different reality. The average woman, for example, spends roughly five years of her life being pregnant or trying to get there, and nearly 30 years trying to avoid pregnancy, according to NARAL Pro-Choice America, a reproductive rights group.

Suzanne Novak, an attorney with the Center for Reproductive Rights, said that existing federal anti-discrimination laws should make it clear that health plans must include birth control.

“In comprehensive health plans, they cover all men’s needs,” she said. “But for women, they’ve got this carve-out.”

Not that there haven’t been some victories along the way. In 1998, for example, Congress passed legislation requiring that prescription birth control be covered for federal employees. The mandate, however, didn’t include the private sector. In the absence of a federal law, 27 states — including Arizona — have enacted mandates of their own. Those state mandates have caused many national plans to cover birth control even in states where the mandate doesn’t exist — another factor dictating the absence of a federal statute.

“The pressure to do something at a federal level has been relieved by state mandates,” said Susan Cohen, director of government affairs at the Guttmacher Institute.

The issue surfaced this week after Carly Fiorina, a high-profile McCain campaigner and possible running mate, wondered whether there isn’t a bit of sexism underlying health coverage determinations.

“Let me give you a real, live example, which I’ve been hearing a lot about from women,” the former Hewlett-Packard CEO said Monday, while discussing women’s health issues in Washington. “There are many health-insurance plans that will cover Viagra, but won’t cover birth-control medication. Those women would like a choice.”

But the comments don’t mesh with McCain’s record on the issue. Twice in the last decade — in 2003 and 2005 — the Arizona senator has voted against legislation requiring insurance plans that cover prescription drugs to also cover birth control. Confronted with Fiorina’s sentiments, McCain was stuck: If he replied that it is, indeed, unfair that contraceptives are not covered, then he flip-flops on his earlier votes; if he answered no, then he risks alienating women voters. Instead, he punted.

“I don’t recall the vote,” McCain said. “I’ve cast thousands of votes in the Senate.”

The saga also reveals the power of YouTube and other video-sharing Web sites to stir debate — and uproar — over campaign-trail happenings. Tait Sye, a Washington-based spokesman for Planned Parenthood, said the group has been trying for months to broadcast McCain’s stance on reproductive rights — without great success. Yet the arrival of one video clip has delivered the message in a few short days. It’s not one that will play well with any Hillary Rodham Clinton supporters who might be seeking an alternative to her former Democratic rival, Barack Obama.

“The message to women voters is that he’s either out of touch,” Sye said, “or he doesn’t care.”

Or the issue is too discomforting for some lawmakers to approach.

“When it comes to something like contraception, people get very uncomfortable,” Cohensaid. “That’s an attitude that John McCain evinces.”

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