You are browsing the archive for Contraceptive Mandate 2012.

Birth Control Blasphemy: Contraceptive Hysteria Grips Congress and the Religio-Patriarchy

7:59 am in Uncategorized by RH Reality Check

(photo: benshepherd/flickr)

(photo: benshepherd/flickr)

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

The United States Congress is in the grip of contraceptive hysteria, and there are no signs of early recovery.

Far right members of the House and Senate have decided that there is Nothing. More. Important. than making sure women in this country can not get access to birth control. Given that contraceptive use is effectively universal and that most employer-purchased group health plans already cover contraception, it is a pretty far stretch to assume any support for this outside the Rayburn Building, but that never stops a fanatic.

Let’s recap some basics here. Ninety-eight percent of sexually-active women in the United States use contraception at some point in their lives (including, yes, 98 percent of Catholic women), and most do so for the majority of their reproductive years. This is so we gals can do such radical things as plan whether, when, and with whom to have a child; how many children to have; decide what educational, social and economic goals we want to attain for ourselves and maximize those opportunities we can give our children; and, just basically decide how to live our lives. You know… that whole freedom thing.

To have a total family size of two or three children, the average woman will spend five years pregnant or trying to get pregnant, and nearly three decades trying to avoid pregnancy. (Yes, Cardinal Dolan, we know about abstinence, but thirty years is a long dry spell and we like sex.) Many women also require contraception as a medical intervention to treat problems like poly-cystic fibrosis and dysmenorrhea, among other conditions. Some need to avoid risky pregnancies. And… the vast majority of women using contraception are protecting themselves and their partners from unintended pregnancy. In other words, folks, the gals are using the contraception, but the guys are involved here, too. The whole it takes two to tango thing, you know. I am not getting into the whys and wherefores of women shouldering most of the responsibility for preventing unwanted pregnancies here. But the fact is women are not just protecting themselves, but their partners and frequently their families writ large from the burdens of unintended pregnancy. This is also part of the equation that kinda, you know, gets left out. Including for those Congressmen whose wives and partners clearly have been using some on the side. Read the rest of this entry →

The Cost of Contraception in Insurance Plans: What the Data Say

11:08 am in Uncategorized by RH Reality Check

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

In 2011, the Department of Health and Human Services examined the issue of just how much it costs insurance companies to cover contraception. Based on data from a wide range of peer-reviewed medical and public health data, evidence-based research and actuarial studies as well as prior experience with insurance policies in which contraception is covered without a co-pay, the HHS analysis found that it costs more not to provide contraception than it does to provide it.  HHS concluded:

While the costs of contraceptives for individual women can be substantial and can influence choice of contraceptive methods, available data indicate that providing contraceptive coverage as part of a health insurance benefit does not add to the cost of providing insurance coverage.

HHS guidelines for including contraceptive care and supplies as part of the essential package of primary health care for women were based on this analysis as well as on recommendations to HHS from the Institute of Medicine, which conducted an extensive study, relying on independent physicians, nurses, scientists, and other experts as well as evidence-based research to draw conclusions and formulate its recommendations.

Here, in brief, is what the cost analysis said.

The Evidence

“Evidence from well-documented prior expansions of contraceptive coverage,” states the HHS issue brief, “indicates that the cost to issuers of including coverage for all FDA-approved contraceptive methods in insurance offered to an employed population is zero.”

In 1999, when Congress required the health plans in the Federal Employees Health Benefits (FEHB) program to cover the full range of FDA-approved contraceptive methods, premiums for 1999 had already been set when the legislation passed. The Office of Personnel Management (OPM), which administers the FEHB program, provided for a reconciliation process for insurers who found this requirement burdensome. But, HHS notes:

[T]here was no need to adjust premium levels because there was no cost increase as a result of providing coverage of contraceptive services.

In other words, no insurance company complained because they found it was to their advantage to provide the service.

This is critical because it is perhaps the best model for the nation in terms of what to expect. The FEHB program is the largest employer-sponsored health benefits program in the United States, and at the time, notes HHS, “it covered approximately 9 million Federal Employees, retirees and their family members and included approximately 300 health plans.”

Likewise a review of a similar mandate in Hawaii found no increase in insurance costs.  In 1999, Hawaii prohibited employer group health plans from excluding contraceptive services or supplies from coverage, requiring them to include FDA-approved contraceptive drugs or devices to prevent unintended pregnancy.

A report on this experience by the Insurance Commissioner of Hawaii concludes that the mandate did not appear to increase insurance costs in any of the four surveyed health plans in Hawaii servicing employer groups.

What do reviews of actuarial data show?

The direct costs of providing contraception as part of a health insurance plan are very low and do not add more than approximately 0.5 percent to the premium costs per adult enrollee, as per studies from three actuarial firms–Buck Consultants, PriceWaterhouseCoopers (PwC), and the Actuarial Research Corporation (ARC)–which estimated the direct costs of providing contraception coverage. 

More recent analysis of actuarial data conducted in July 2011 by the Actuarial Research Corporation and using data from 2010 estimated that contraceptive coverage without a co-pay costs roughly $26 per year per enrolled female.

However, notes HHS, “as indicated by the empirical evidence described above, these direct estimated costs overstate the total premium cost of providing contraceptive coverage.”

When medical costs associated with unintended pregnancies are taken into account, including costs of prenatal care, pregnancy complications, and deliveries, the net effect on premiums is close to zero. One study author concluded, “The message is simple: regardless of payment mechanism or contraceptive method, contraception saves money.

Counting indirect costs–such as time away from work and productivity losses–further reduces the total cost to an employer. 

A model developed by Global Health Outcomes that incorporates costs of contraception, costs of unintended pregnancy, and indirect costs found that covering contraception saves employers $97 per year per employee. Similarly, the PwC actuaries state that after all effects are taken into account, providing contraceptive services is “cost-saving.”

Does providing contraception through public programs also save costs?


As HHS notes:

Each year, public funding for family planning prevents about 1.94 million unintended pregnancies, including almost 400,000 teen pregnancies.  Preventing these pregnancies results in 860,000 fewer unintended births, 810,000 fewer abortions and 270,000 fewer miscarriages.  More than nine in 10 women receiving publicly-funded family planning services would be eligible for Medicaid-funded prenatal, delivery, and postpartum care services upon pregnancy.  Avoiding the significant costs associated with these unintended births saves taxpayers $4 for every $1 spent on family planning.

Evidence that expanding access to contraception through Medicaid is unequivocal: Increased access saves taxpayer money.

During the 1990s, HHS states:

…many states implemented Medicaid Section 1115 Family Planning Demonstrations.  An independent evaluation of the experience of six of these states found that all six Demonstrations yielded savings, with annual state savings ranging between $1.3 million in New Mexico and nearly $30 million in Arkansas.

As of August 1, 2010, 27 states, including States like Pennsylvania, Texas, Florida, and Virginia had expanded Medicaid eligibility for family planning services under waivers that stipulated that these expansions be budget neutral.  Based on this experience, the Congressional Budget Office has estimated that expanding family planning to all States would save $400 million over 10 years.

Why would insurance companies provide contraception without a co-pay to their female employees?  The answers are clear.


Why I Skipped Mass Today: A Practicing Catholic Objects to the Bishops’ Arguments Over Birth Control

10:47 am in Uncategorized by RH Reality Check

(image: ee382, photobucket)

(image: ee382, photobucket)

Written by Anonymous for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Reproductive health politics are controversial enough, but they are even more so for a family of practicing Catholics. My spouse begged me not to put my name on this, concerned about our son, who is scheduled to receive First Holy Communion in a few months. Certainly, neither of us want him to be hassled, or to have his standing jeopardized because of his parents’ dissent toward an increasingly politicized Church. So please excuse the anonymity of this editorial.

There is a really cool website called Bible Gateway that serves as a Google-style search engine for the Christian Bible. Any visitor can search for key words in 46 languages, and the English options includes 31 different versions representing a wide variety of religious traditions, from the 21st Century King James Version to Young’s Literal Translation. What kind of words can you look up? Anything, really. As a Catholic, my Bible Gateway is set to the New American Standard Bible, the same that is listed on the Vatican’s website. It’s interesting to note that, excluding articles, conjunctions, prepositions and other small words, the most common word in the Bible is Lord (6,726 times) and God is second (4,188 times). I have to admit that I was surprised that Jesus comes up only 990 times, but I am sure it’s a contextual thing.

The word love will get you 484 hits, and the results will direct you to excerpts from Genesis to Revelation. Some are passages you might expect to find, such as Jesus’ repeated instruction to “LOVE your neighbor as yourself” and there are some surprises, such as the rather chilling, “Outside are the dogs and the sorcerers and the immoral persons and the murderers and the idolaters, and everyone who LOVES and practices lying.” (Revelations 22:15). Yikes! Read the rest of this entry →

Pain and Shame: What Real Life Looks Like in a Religiously-Affiliated Non-Profit Without the Birth Control Mandate

9:53 am in Uncategorized by RH Reality Check

(image: miyagisan/flickr)

(image: miyagisan/flickr)

Written by the ACLU for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post. By “Dara:”  Due to concerns about job security the author of this post has chosen to write under a pseudonym.

Lately the water cooler conversations at my religiously-affiliated nonprofit social service agency have been focused on trying to understand the new HHS contraceptive mandate. My younger, female coworkers and enlightened male coworkers are giddy with anticipation. For as long as any of us have been working here, we haven’t been able to get coverage for our birth control and have even had to struggle to get our employer to cover contraception prescribed for conditions like polycystic fibrosis and dysmenorrhea.

When a coworker with a cancer-causing condition needed contraception, she didn’t know what to do. She couldn’t afford the medication out-of-pocket with her meager nonprofit salary. I called our HR Director on her behalf. It took weeks to get an answer. Meanwhile my coworker couldn’t fill her prescription and her condition got worse. Recently I found out that another coworker has been paying $90 a month out-of-pocket for the contraception she needs to treat her polycystic fibrosis.

HR then told us that we would have to ask permission of the agency’s CEO on a case-by-case basis. It reminded me of when I first got my period at age 12. My cramps were so bad that my pediatrician recommended low-dose contraception. My non-Catholic mother said that my very Catholic father might not allow it and that I would need to ask him for permission. The only difference here is that we are not young girls and the CEO is not our father.

I pursued my coworker’s issue with our agency’s lawyer. She acknowledged that the agency had to cover the contraception in this situation, and she finally intervened and informed HR that they needed to cover it. A year later, I too needed to get contraception for dysmenorrhea, so when I asked for coverage I ended up in battle with a male HR employee that knew nothing about the earlier situation. It was embarrassing to have to reveal my medical condition to him. The ground I thought I covered last year had been lost it seemed, making it a continuously frustrating battle.

When I finally got a clear answer, I requested that the agency develop a protocol and send it out to our thousands of staff throughout the city. They refused. Read the rest of this entry →

The White House’s Dangerous Dance With the Birth Control Mandate

8:16 am in Uncategorized by RH Reality Check

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

This week, on MSNBC’s Morning Joe, Obama campaign senior advisor David Axelrod signaled that the White House, having finally decided to include coverage of birth control as part of primary health care benefits under health reform after studying it for well over a year, is now “willing to compromise.”

Translation? The White House is considering “accommodations” to the policy.

Many of my colleagues disagree with my take on the situation. Many have pointed me to, and I have read, the so-called clarification on Tuesday by White House Press Secretary Jay Carney of what Axelrod really meant. I also read the further clarification made on Wednesday. I don’t find either very clarifying. In fact, I find them worrisome.

In Tuesday’s White House press conference, for example, ABC’s Jake Tapper asks Carney:

Is there a middle ground somewhere where perhaps some of these religious organizations that aren’t specifically houses of worship, but are Catholic or Jewish or Baptist hospitals, charities, of a smaller size could be — could receive the same exemption as the houses of worship?  We’re talking about people who think that some methods of birth control are murder, are a sin, and the Obama administration is forcing them to be party to that.  I mean, that’s the crux here.

And Carney responds:

Well, let’s be clear — and first of all, we understand the religious concerns here.  That is why this balance was sought. That’s why the process going forward includes a transition period where this discussion will continue to see if there can be ways found that ensure that women get access to these preventive services and that those services are covered — as they will be for all other women — and that also takes into account these religious concerns.  But let’s be clear, the rule does not require any individual or institution to provide contraception.  It requires coverage for women who work there of different faiths, or of any faith.

He continues: Read the rest of this entry →