CHICAGO, February 8, 2012—On January 20th, Secretary of Health and Human Services Kathleen Sebelius issued a mandate requiring that employers provide female workers access to free preventive care services, including contraceptives.
The rule includes an exemption for churches and houses of worship, but not religious institutions such as hospitals, universities and charities that may carry the church’s name or carry out its mission.
The mandate implements provisions of the Affordable Care Act, also known as Obamacare, and Republican and church leaders are speaking out against the mandate.
The administration’s theory is that birth control is less expensive than an unplanned pregnancy or an abortion. They claim that the cost will be approximately $30 per month, per employee, a figure which seems low.
According to Planned Parenthood (2010), the cost of birth control pills is $15 to $50 a month, depending on the type of pill. On an annual basis, that means the pill costs between $180 and $600, plus doctor visits. Other forms of birth control carry varying costs: For example, Depo-Provera shots cost up to $600 per year, and a diaphragm costs from $60 to $100 per year, plus office visits. The cost of condoms is dependent on useage, but at an average cost of $2.50 times two per week, they would typically cost $250.00 per year.
Abstinance is still free.
All employers, including religiously affiliated institutions, would be required to provide insurance coverage for contraceptives and birth control procedures, with no deductibles or co-pays paid by the insured employee.
Most health insurers cover contraception. They charge co-pays or deductibles, as they do for any other medication and procedure the insured may need.
This fiat is generating a firestorm in the Catholic Church. Other religious groups, pro-life organizations, and even some atheists are opposing it. Their rhetoric is harsh and fierce. Republicans, conservatives, and presidential candidates are accusing the President and his administration of waging war on religion.
The administration is seeking a way out of this mess that won’t offend Catholic or women voters. Those opposed to the mandate are using religious freedom, conscience, and morality as the basis for their protest.
They are only making one argument. If they added another, more potent argument, they could get a majority of people across the whole religious, political and ideological spectrum behind them.
This issue should not be framed by critics of the mandate just around religious freedom, conscience, morals and theology. It should be framed as one of equal treatment.
It’s about that fairness business President Obama keeps talking about.
The rule mandates that contraception, an elective treatment, be provided for free, while the provision of medically necessary, even life-saving, prescriptions and procedures will still require that people pay for them in the form of co-pay or deductible.
Health insurance normally does not cover elective or choice-based procedures and medications, but it does often cover Viagra (only 30% of insurers are reported to NOT cover erectile dysfunction medicine).
When insurers cover birth control and fertility treatments, there are co-pays and deductibles. It should be noted that this varies amongst the assorted providers.
Medically necessary pharmaceuticals and procedures are not free.
Even medically necessary birth control, where pregnancy is high risk for the mother or child, and other medical conditions, such treatment for endometriosis, require co-pays and deductibles.
Contraception is a personal choice, as is procreation. People seeking fertility treatments, drugs, and procedures should pay deductibles and co-pays.
There is no question that birth control, like fertility treatments, should be readily accessible, but the solution is not to tax employers to pay for these treatments, but to realign the insurance companies.
People should have the right to choose the birth control, or high blood pressure medicine, they prefer. And these choices should be subject to the same co-pays and deductibles as any other prescription medication or procedures.
There is no absolute entitlement to free elective prescriptions and procedures, especially if medically necessary prescriptions and procedures must be partially paid for.
Maintenance drugs that prevent health problems from worsening, such as insulin, cholesterol drugs, allergy, asthma, and high blood pressure medications, are subject to co-pays and deductibles.
Medications prescribed to keep people with acute or catastrophic diseases alive are subject to co-pays and deductibles.
These drugs are medically necessary for health maintenance, disease control, or preservation of life itself. Some people must take these drugs over the course of their lifetimes.
Even erectile dysfunction prescriptions have co-pays and deductibles. Sexual activity is a choice, not a medical necessity, so the insurance companies tell us.
For all its obsession with fairness, the Obama Administration is creating an unequal, indeed unfair, situation.
So let us not confuse rights with entitlement.
We all have a right to safe, effective medication, whether it is medically necessary or elective, over the counter or prescription. We elect to use birth control, patches to help us stop smoking, and cosmetic medical procedures.
And to elective procedures, we should not assume entitlement.
If a patient with acute heart disease has to pay a deductible or co-pay for expensive life saving drugs, people who elect to prevent pregnancy should pay the same - fair - deductible and co-pay.
This birth-control mandate could open up a Pandora’s box of unintended consequences:
- Diabetics could rightfully demand an end to all co-pays and deductibles for insulin, for example;
- There could be a cascading domino effect of people with chronic or acute conditions demanding medically necessary drugs or procedures for free;
- If the government took these claims seriously and mandated an end to all co-pays and deductibles, the cost of health insurance would be prohibitive. No one would be able to afford health insurance under the so-called Affordable Care Act;
- Employers, particularly part-time employers, may look more favorably upon male job applicants than on females of reproductive age, who could carry an additional $360 - $600 or more in cost per year.
Using the argument of equality demonstrates the new mandate’s negative impact on everyone who must pay for their necessary medications and procedures.
It shows this administration does not practice what they preach when it comes to their so-called principles of fairness and equality.
Peter V. Bella is a retired Chicago Police Officer, freelance writer and photographer, cook, and raconteur. He likes to be the sharp stick that pokes, prods, and annoys. His opinions are his and his alone.
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