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The Sacramento Bee


Should Birth Control Be Considered An 'Essential Benefit' In Health Plans?

March 01, 2012

By Ben Boychuk

THE ISSUE: A federal mandate requiring health insurance providers to cover contraception without out-of-pocket costs among their offerings has become a major political controversy this election year. The U.S. Conference of Catholic Bishops, among others, believes the rule violates its religious liberties.

Ben Boychuk: No

If the federal government is going to mandate something, there’d better be a mighty compelling reason for it. At bottom, there is no compelling government interest in making contraception an "essential benefit" of health insurance under the Affordable Care Act — certainly not at the expense of religious liberty.

Health and Human Services Secretary Kathleen Sebelius argued recently in the pages of USA Today that the Obama administration is "working to strike the right balance between respecting religious beliefs and increasing women’s access to critical preventive health services."

Funny. When it comes to hilltop crosses, courthouse monuments and a two-word clause in the Pledge of Allegiance, religious liberty is bedrock principle. But when the liberal sacrament of government health care is at stake, the First Amendment is just another one of those competing interests that the feds need to "balance."

Contrary to Sebelius, access isn’t the problem.

This isn’t 1965. Contraception is cheap and readily available right now.

And most insurers — nearly nine out of 10 — offer some sort of birth control coverage, often with a co-pay or some form of coinsurance.

Mandate proponents complain such cost-sharing can cost women "up to $600 a year," under the worst-case scenario. That works out to $1.64 a day — again, in the extreme case — or less than half the price of a caramel macchiato at Starbucks.

Pro-mandate partisans also say that cost-sharing hits poor patients hardest, pointing to a 2010 study by the Robert Wood Johnson Foundation that does indeed show that low-income people would forego preventive care if they were saddled with co-pays.

One problem: That report focused on services such as Pap tests, mammograms and colorectal cancer screenings, as well as people with chronic illnesses. Birth control wasn’t part of the study.

So what are we really arguing about here?

Given just how readily available birth control and abortifacients are nowadays, we’re arguing about compelling a fraction of providers to cast their consciences aside and abandon their beliefs — or go out of business.

The Obama administration’s "accommodation" allows an objecting employer to declare they don’t offer coverage for contraception, but still requires insurers to offer the coverage "free of charge." That’s only possible if the baseline cost of everyone’s insurance goes up — objectors and non-objectors alike.

Confronted by some irate constituents this week, New York Congresswoman Kathy Hochul admitted: "Basically, we’re not looking to the Constitution on that aspect of (the mandate)."

Try telling that to the Supreme Court. "Congress shall make no law respecting the establishment of religion or prohibiting the free exercise thereof." This mandate has got to go.

Pia Lopez: Yes

The federal health insurance law signed by President Barack Obama in March 2010 emphasized preventive care — to help halt escalating health care costs and improve health outcomes. So health plans have to cover a range of preventive services without charging out-of-pocket costs, including colonoscopies, blood pressure checks, flu vaccines — and contraceptives.

Clearly, teens and women of childbearing age have unique health care needs — from birth control to prenatal care — that should be covered by health insurance.

With patchwork health insurance plans, some women bear disproportionate out-of-pocket costs. Ben blithely dismisses the $30 to $60 a month cost for pill, patch or ring, not to mention the cost of a visit to a doctor. Longer-acting contraceptive methods, such as an intrauterine device, can cost hundreds of dollars up front.

Requiring contraceptive coverage as an essential preventive measure builds on existing public and private-sector coverage — and state insurance requirements since the late 1990s.

The National Business Group on Health recommends that employers include contraceptive coverage in employee health benefits.

The Federal Employees Health Benefits Plan, Medicaid and TRICARE (for the military) cover contraceptives.

A majority of states — 28, including California — require private insurance plans to cover contraceptives.

Contraceptive coverage is supported by the American Medical Association, the American Congress of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Public Health Association.

Ben does not mention that church organizations are exempt if their primary purpose is "inculcation of religious values," and they primarily employ and serve people of that religion. That’s as it should be under the First Amendment.

But employers that hire people of other faiths — including Catholic-affiliated hospitals and universities — should have to offer that essential coverage, just like any other employer. And they already do, from sea to shining sea — including the University of San Diego, University of San Francisco, Catholic Healthcare West and Daughters of Charity hospitals in California.

Thus, Ben’s alarmism about having to "cast their consciences aside" or "go out of business" — is nonsense. As is his worry about cost. It is more cost-effective to cover prevention than the cost of unintended pregnancy and newborn care.

Catholic bishops have a right to counsel Catholics against birth control. But they have no constitutional right to impose their faith tenets against contraception on non-Catholics any more than Jehovah’s Witnesses have a right to impose their faith tenets against blood transfusion on people of other faiths.

This kerfuffle should not distract from the aim of assuring insurance coverage of essential preventive benefits — including contraception.

Original Source:



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