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The contraception mandate makes financial sense

Staff Columnist

Published: Thursday, December 5, 2013

Updated: Thursday, December 5, 2013 22:12

The Supreme Court case Hobby Lobby Stores Inc. vs. Sibelius, currently underway has been positioned by its plaintiffs as a clarion call against religious tyranny; the plaintiffs, you see, are upset about the provision within the Affordable Care Act requiring employers to provide health insurance that covers, among other things, birth control measures for women. As devout Christians, the owners of the Hobby Lobby feel that they should not be compelled to offer birth control in violation of their belief that contraception is immoral.

Let’s leave aside the ludicrous assumption that a corporation ought to have constitutional protection of its religious freedom – this “corporate personhood” thing is really getting out of hand, isn’t it? – and focus, instead, on the less immediately exciting, but fundamental, question of insurability. My worthy colleague, who argues in his piece that the state of being a woman of childbearing age is a biological certainty and thereby uninsurable, is in the rare position of being against the contraception mandate for non-religious or otherwise bigoted reasons, and has put forth an argument actually worth engaging with.

I don’t need to tell you the function of insurance; by paying into a communal pot, a large group of people are able to pretty effectively pool the risk of catastrophic medical expense. Now, that is not to say this works all the time, and the past decade or so have seen a great deal of shady and irresponsible, if not downright immoral, manipulation by insurance companies in service of a bottom line, always a risk within a capitalist system with little regulation. The ACA, imperfect though it is, was introduced to combat this problem.

It is easy to see how a contraception mandate fits into the insurance system; maternity costs for an uninsured mother are exorbitant; The New York Times, in an article titled “The American Way of Birth: the Costliest in the World” reports that the cost of prenatal care alone can reach $45,000. An analysis commissioned by the Times, conducted by Truven Health Analytics, estimates an averaged cost of $30,000 dollars for a vaginal delivery, and a whopping $50,000 for a c-section. And this is before any of the possible complications. In actual fact, maternity care is the single greatest expenditure most insurance corporations face.

The reasons for this are multiple and complicated, but the good news is that the ACA managed to require maternity care for the estimated 62 percent of women not covered by employer insurance, or with private plans that do not offer maternity care. That’s great news for women who might otherwise have been driven into debt after giving birth, but it also presents a huge new strain on the system. The risk of a company having to pay for childbirth is thereby increased many times over.

Compare the above-mentioned costs with the yearly cost of contraception: about $1,200 a year, according to the Center for American Progress. The risk-reducing benefit of insured contraception should be immediately apparent; the cost of providing contraception for the duration of a woman’s natural fertility is dwarfed by the cost of even one baby, fully insured.

Now it is possible to complain that the miniscule raise in premiums going towards contraception for women that need it is an unfair rate increase, or a burden that shouldn’t be shared by those that don’t need it. I, for example, will probably never need to take a birth control pill (unless some effective solution is ever developed for men), so why should I have to pay for the pill for women? But then, it probably would make more sense to complain about the maternity coverage mandate, since the rate increase is bigger.

Of course, I may have a child someday, and will be glad to know that my spouse’s procedures are covered by insurance; my investment in the system would have paid off then, so it would still be reasonable to accept the rate increase for maternity and not for contraception. But what do we say to medically sterile women, or gay or lesbian people for whom this issue will never be raised? The possible list of exceptions grows with the absurdity of the original premise.

You just can’t call this sort of thing a “tax.” Besides being the moral thing to do – women need affordable, accessible birth control if they are ever going to break free of the socially imposed reproductive imperative – the contraception mandate just makes financial sense.


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