Elizabeth Nolan Brown // Blog

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Posts Tagged ‘birth control

If Free Birth Control Lowers Costs, Why Haven’t Insurers Made Birth Control Free Already?

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That’s a question I’ve seen a few places, and which Conor Friedersdorf posed to me last week in  a bloggingheads dialogue. At the time I didn’t have an answer. I knew that birch control coverage could save money and I had some facts and figures about it. But if it drove down costs, why didn’t insurers already subsidize contraception?

One commenter at bloggingheads described my position as “let’s subsidize everything less dumb than the dumbest thing we subsidize,” which I liked. The fact that contraceptive services benefit more individuals or could drive down costs more (in terms of pregnancies prevented) than some of the other preventative services that are free under the new healthcare mandate was my rationale for including birth control (I’m a realist; my view is generally if this mandate exists—and it does—then what makes the most sense under it?) But dumb isn’t really the criteria, I don’t think. More like, “Let’s subsidize everything that genuinely is a preventative service and also benefits a large swath of the American public if we’re going to subsidize other less commonly-utilized stuff. I could be convinced to take dumb stuff off the preventative services list. I’m not sure I support the preventative services mandate to begin with. But since that’s happening: Hell, yes, contraceptive services should be part of it.

Much is made of why totally free versus must-be-covered by insurers, but with a copay. The argument is why should middle- or upper-class women have birth control totally subsidized? The assumption being, of course, that ‘birth control’ means the pill, which generally costs between $4 and $30 a month for a copay, with standard employer-based health insurance.

But the free preventative ‘contraceptive services’ could also include more expensive, longer-form birth control options. The IUD lasts between 5-12 years, and is a great option for young women who don’t want kids for some time or women who’ve already had kids but are pre-menopausal. Insurers have been slow to start covering it, and it’s expensive without coverage (between $500 and $1,000, for the IUD and insertion). That’s actually quite cost-effective in the long-run: At $1,000, spread over 5 years, it would only amount to about $16 a month—right around the average monthly oral contraceptive copay. But $1,000 is a lot of upfront cost, and that’s a big reason why women don’t choose this very effective birth control option.

Another very effective birth control option? Sterilization. It costs quite a lot up front if not covered by insurance. Which means it also costs quite a bit up front for the insurance company who’d have to subsidize it. But a woman who has her tubes tied or a man who has a vasectomy can cost less over a lifespan, because they’re not using birth control monthly and they wont’ get pregnant and need pre-natal and maternity care or an abortion. [And these are just the health care costs saved; less unwanted pregnancies brings less poverty, less unwanted societal costs, etc.]

So if this is all such a great deal for insurers, why haven’t they done it already?

Here’s my stab at a theory. The reason insurers haven’t already started offering free contraceptive services, if this drive down costs, is because with employer-based healthcare and folks jumping jobs so much these days, most people only have the same insurance company or plan for a few years. Subsidizing contraceptive services might drive down costs for you (relative to pregnancy or abortion), and in doing so drive down overall health care expenses in this country. It could drive down social costs. But it’s unlikely to substantially improve the bottom line of any particular health insurance company.

Of course, with the way the insurance market works, wouldn’t any given plan be just as likely to have people currently using free contraceptive services, thus driving up costs, and people who’d already benefited from contraceptive services, thus driving down costs? I don’t know. I’m not terribly well-versed in the economics of insurance policies and risk pooling. Maybe any particular insurance company is likely to have a net draw in costs expended and saved by offering free birth control services.

There may be a simpler reason why insurance companies don’t subsidize birth control: Because it’s the way they’ve always done things. The upfront cost—even just in terms of the time of the people involved in doing it—of changing their policy probably wouldn’t outweigh the savings for a while. Or maybe they just figure that women who use birth control will do so regardless, and they might as well make that $12 co-pay each month from each of them. (The latter theory is maybe true now, but maybe less true once everyone must be insured? And also maybe not as relevant when you, again, consider that birth control doesn’t just mean the pill).

Another component of this I’ve written about recently and Conor and I talked about is the conscience mandate. In any discussion of whether religious employers should have to cover contraceptive services, I feel it’s important to note: People use the pill for things other than pregnancy prevention (thanks, Erin, for reminding me of this). A Guttmacher Institute study found 14% of all birth control users rely on the pill solely for non-contraceptive reasons, such as reducing menstrual pain, treating acne or trying to tame irregular periods.

Churches are already exempt from the contraception mandate, but religious employers—like hospitals and universities—want to be able to (and can, now) opt out of covering contraception. And everyone’s framing it like a matter of choice—well, you choose to go to a religious school, or you choose to work for a religiously-affiliated employer. If covered/free contraption was so important to you, you could choose to go to school or work elsewhere (nevermind for now that just going to work elsewhere sometimes really isn’t that simple).

But I think framing it in terms of individual choice is a bad idea; it’s about whether a broad-spectrum of individual employers should be able to opt out of insurance coverage mandates they don’t like. I don’t think they should. Right now, we’re talking contraception, but it opens the door for any employer to opt out any insurance coverage requirements they don’t like.

Please note that this post is less a polemic and more a sort of stream-of-consciousness grappling with thoughts surrounding this issue. It’s a complicated issue. Do share your thoughts with me, too.

ALSO: …
Yes, yes, 1,000 times yes.

Of course access to affordable birth control is primarily a woman’s problem, but how many men have not had babies they didn’t want because the women they were sleeping with were on birth control? Contraception is something that benefits both women and men. Phoebe’s totally right that most men don’t have any idea about how birth control works, and it’s just … sad, and stupid. But I am happy to report that I had a lovely discussion about the benefits of IUDs and the drawbacks of the pill with three women and one man at the bar last night. Anyway, I’ll leave you with Phoebe:

Precisely because contraception is oh-so-private, misconceptions arise – especially, needless to say, among men – about what this “birth control” thing is all about. They easily forget that the very need for contraception comes from women having sex with men. Sparing these men – I might add – 18 years of child-support payments, not to mention the serious possibility of 18 years of continued communications with every woman they’ve ever slept with. It becomes a discussion about women choosing to have sex, when the sex in question by definition involves men. Not such an issue for women who have sex with women.

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Written by Elizabeth

March 6, 2012 at 7:08 pm

Curio: 10/18/2012 (Rambling Media Criticism + Amateur Porn Edition)

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Last week at Blisstree, I posted about how birth control is once again making headlines for making women choose the “wrong” men—which is one of those strange media narrative perversions that happens so often and goes so unremarked on in general that it makes me hate being a journalist [the number of things in the media climate that make me hate being a journalist grow and grow …].

Scientific American blogger Scicurious, a biomedical researcher, is also sketched out by the way media, in general, cover studies relating to birth control: “There seems almost to be glee in the way people spread it.” Though the post seems to mis-peg Jezebel blogger Margaret Hartmann as totally earnest), what Scicurious gets at (and I also find most unfortunate) is that this type of melodramatic coverage is either taken as right on face, or taken as so absurd that the research it’s based on is also taken as absurd. Any valid, potentially interesting parts of the research get obscured. While I’m more inclined to think of this as an institutionally-encouraged problem, rather than rampant stupidity or laziness on the part of individual journalists, I’m not sure—nor of the extent to which this kind of coverage is exasperated by the nature of web media. IN other words, I get terribly existentialist about blogging. (Also: How is there any meaningful difference between blogging and daily web news journalism?)

[Why are we such a mess, that’s what I’m trying to say here, folks. In so much of what I write about, I’m tempted to conclude: We are all Doomed. Other commentary often fails me, but We are all Doomed applies so nicely to so much of the health, food and political news I read.)

Well anyway: Here’s a really terribly funny and also ENTIRELY ABSURD television news segment and accompanying article about a couple who turn to amateur web porn to provide for their young daughter. This is what the cognitive dissonance required to cover this couple’s porn as somehow titillating and deviant while simultaneously trying to frame them as average, upright American parents ends up looking like, I guess:

Hair pulling, biting and ordering each other around are just some of the strangest things the couple said people have asked them to do during their live sessions. It’s all filmed in their bedroom while their daughter sleeps in a different part of the house.

Written by Elizabeth

October 18, 2011 at 8:19 pm

Obama, Contraception & the Stimulus Package

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I find I’m disagreeing a lot today with my favorite feminist bloggers, but here goes again … as much as I’m totally in support less bizarre-regulation of federal funding for family planning, I do not think the proper place for this is in the economic stimulus package.

Jill Filipovic disapprovingly quotes John Boehner asking, “How can you spend hundreds of millions of dollars on contraceptives? How does that stimulate the economy?” Well … yeah. As Jill also points out, the contraceptive funding would be part of an overall initiative to help states fund Medicaid programs, and “Medicaid spending generally isn’t being attacked; it’s contraception spending.” Ann Friedman at TAPPED adds:

Not only will this expand health care services and take some burden off states, it will eliminate the need for states to go to the federal government and obtain a waiver.

But I think Rachel Larimore at The XX Factor and Matthew Yglesias have the right idea when the point out that, despite the maybe worthwhile nature of this provision, the economic stimulus bill is not the right place for it. Rachel writes

Despite Obama’s pledge that there would be no pork in the legislation, Las Vegas’ mayor has been trying to get stimulus bucks for a planned “Mob Museum” for his city, and conservatives are already having fun with such proposals as an extra $50 million for the National Endowment for the Arts. If family planning is so important, do we really want it to be reduced to comparisons to the Mob Museum? Can’t it stand on its own merits?

[…] Make funding for family planning its OWN legislation. Get the debate out into the open. Obama promised hope and change. Congress shouldn’t let him down with business as usual.

If reversing the Bush administration’s insistence that state Medicaid programs apply for contraception/family planning funding separate from overall funding is a worthwhile enough goal—and I think it is, for both the ideologically and the bureaucraticly offensive portions of this provision— than addressing it as an issue in its own right instead of trying to sneak it into the economic recovery bill just seems proper.

Written by Elizabeth

January 27, 2009 at 11:31 pm

More on the HHS Conscience Rights Rule

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New LadyBlog post on the HHS ‘conscience rights’ rule change:

Amanda Marcotte suggests that the administration is trying to push this rule-change through this month — even though it will likely be overturned by Obama or the new Congress — as part of a strategy to draw even more attention to the issue when he/it does. I find this scenario extremely plausible—which is why I think its important to remember that it is the Bush administration that is creating the new rules. Medical practitioners already have the right to refuse to perform abortions, and have since the 1970s.

Ahem.

Written by Elizabeth

December 9, 2008 at 3:42 pm

Posted in Health & Science

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