Americans are living in strange times, when even access to our most basic reproductive health care feels up in the air. While many Republicans are railing against Obamacare (and the birth control mandate that came with it), a small group of them have offered new legislation that would help make the birth control pill available over the counter. The bill, called the Allowing Greater Access To Safe and Effective Contraception Act , would fast-track applications for FDA approval of over-the-counter birth control pills. It would also allow you to pay for that birth control with a healthcare savings account or flex spending. Sounds like a good idea right? Well, as it goes in politics, it depends. Before we can truly grapple with whether this new plan is good, we have to address the elephant in the room: Obamacare was great for people who need birth control. Under that plan, the uninsured rate among women dropped by 44% , and insurers were required to cover in full all 18 types of FDA-approved birth control, from the pill to the IUD. This was a boon for many women — especially poor ones — who went from either going without birth control or paying hefty monthly co-pays for their pills, rings, patches, etc. to having that cost rolled up into the cost of their health insurance. In other words: A lot of women who needed it got it for no extra cost, and those who still had to pay something shared the cost with their health insurance company. This was controversial. Conservatives, including Trump’s nominee to head the Department of Health and Human Services Rep. Tom Price (R.-GA), claimed the mandate encroached on religious freedom because it required people to pay into a system that paid for birth control, a touchy subject for Catholics and other people of faith. Rep. Price is also the guy who once claimed that there’s not one woman in the country who couldn’t afford it. ( Wrong .) The fact that Trump picked him to run HHS doesn’t bode well for birth control being covered by insurance. Which brings us back to over-the-counter birth control pills. On its own, it’s a great idea. How can you argue that running into your pharmacy to pick up a pack of pills without a prescription wouldn’t ease access? Certainly it would for many people. The problem, however, is cost. “Over-the-counter is more convenient,” says Stuart O. Schweitzer, PhD, a professor of health policy and management at the UCLA Fielding School of Public Health. “But it’s more expensive to consumers than a prescribed drug that’s covered by insurance.” A 2013 study from the journal Contraception found that 62% of women surveyed think over-the-counter access to the pill is a good idea, and the most they would be willing to pay for it is about $20 per month. “It has the potential to be really beneficial,” says Raquel Dardik, MD, an ob-gyn and clinical associate professor at NYU Langone Medical. “If the price point were correct, and women could reasonably access it, it would reduce costs for the healthcare system overall.” The problem is, we don’t know what the pharmaceutical companies will charge. Plan B, the emergency contraceptive pill that went over-the-counter in 2011, sells for around $50. That is the only example we have of a similar drug on the shelf. Depending on the pill, the out of pocket cost right now can range from $20 to $100 per pill pack, explains Sally Rafie, PharmD. Of course, birth control choices aren’t just driven by costs — but also by side effects and other health concerns, such as acne, polycystic ovary syndrome, endometriosis, and more. In other words, many women are on the pill for reasons beyond preventing pregnancy, and you often have to try a few before you find one you like using. That’s why there are more than 100 pills on the market, which brings us to the next problem.