On the HHS Contraception Mandate Debate

There has been some controversy lately about the new Department of Health and Human Services regulation which requires health plans to provide various women’s preventative care (including contraception and contraceptive counseling) without cost sharing (no copay or deductible).

Churches are exempt from the regulations, but church-affiliated employers like hospitals are not. The Catholic church opposes the new regulations because, in the words of Pope Paul VI, “the transmission of human life is a most serious role in which married people collaborate freely and responsibly with God the Creator.” Right. Other religious institutions are opposed to providing birth control as well. The Lutheran Church — Missouri Synod, for example, has spoken out against the regulation because it “objects to the use of drugs and procedures that are used to take the lives of unborn children, who are persons in the sight of God from the time of conception.”

Contraceptives as Social Good

The development and widespread availability of reliable contraceptives is one of humanity’s great triumphs over its own nature. No longer the slaves of our selfish genes, we can develop the social meaning of sex as we exploit its benefits while avoiding many of its risks.

Most significant is the role contraceptives play in the struggle for social equality. The risks of sex are not shared equally by both sexes; females are biologically more invested in reproduction than men. With that in view, an argument could be made that the males in an egalitarian society should bear most of the cost of contraceptives. Not that I could support an involuntary contraceptive tax on men, but it would be more justified than most taxes now levied, and the new HHS mandate may indeed work in that direction.

Obama’s Accommodation

On February 10 the president attempted to smooth things over by issuing an accommodation which would require insurance companies to cover contraception, for free (no cost sharing), if a religious organization chooses not to.

It’s not clear what the accommodation is trying to accomplish. It’s hard not to read it as the White House being a smart alec towards the Catholic church: “You won’t pay for these health plans? Okay, your insurance provider, who bills you, will pay for them instead.” As if there is any difference.

More confusing is the White House’s claim that “covering contraception is cost neutral since it saves money by keeping women healthy and preventing spending on other health services.” If that were true, wouldn’t insurance providers already offer free preventative contraception coverage to its customers? The White House press release goes on to claim that “one study found that covering contraception saved employees $97 per year, per employee,” but the study in question isn’t cited.

Most confusing of all to me is the idea that a mandate from the government could actually save non-minimum wage employees money on contraceptives. When health plans start including contraceptives with no cost sharing, what’s going to prevent employers from reducing compensation in other areas to keep real wages the same? And, as Peter Schweizer pointed out, the main effect of the mandate may be to drive up the price of name-brand pharmaceuticals. It’s not hard to imagine some users of pharmaceutical contraceptives ending up worse off due to the new mandate.

Better Solution

As usual a better solution seems to be to encourage competition by shortening or eliminating patents on pharmaceuticals (which is nearly the opposite of the Obama administration’s current solution). Finding a way to shift most of the cost of contraceptives and reproductive health to men would be ideal, though nothing practical comes to mind. And of course, dreaming of the future, eliminating the wage system would prevent owners from passing the costs of such well-intentioned plans back to their employees.

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