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Women's health care: now without co-pays
August 1, 2011 8:37 AM   Subscribe

Effective January 1, 2013, United States insurers will now be required to make a variety of medical procedures and medications available without copay as part of President Barack Obama's Affordable Care Act. Although the availability of prescribed birth control without copay is likely to have the widest effect, the plan also includes breast pumps for nursing mothers, an annual well-woman examination, and testing for gestational diabetes and the virus that causes cervical cancer, as well as other services related to women's health.

The Institute of Medicine, the health component of the National Academy of Science, released a report on July 19 that recommended a variety of changes to current coverage of women's health care services by insurance plans. Health and Human Services Secretary Kathleen Sebelius incorporated most of the Institute's recommendations in the requirements announced today.

The plan includes a provision that will allow religious institutions to opt out of birth control coverage. The Family Research Council opposes the new provisions on grounds of religion and conscience, as well as abortion via mifepristone (Plan B).
posted by catlet (110 comments total) 20 users marked this as a favorite

 
Making sure women have healthy babies when they want to have healthy babies for free has pretty broad social import. I for one would have liked that to come direct from the feds rather than from costly health insurance, but you get what you pay for as taxes go.
posted by Apropos of Something at 8:40 AM on August 1, 2011 [1 favorite]


As a dad of a 15-year-old girl, I cannot applaud enough for this. Waiting until 2013 gives the government enough time to really mess it up, but I'd like to believe that people will come around and realize Healthcare Reform is all sorts of awesome for the USA.
posted by AzraelBrown at 8:43 AM on August 1, 2011 [4 favorites]


Yes!
posted by Nixy at 8:44 AM on August 1, 2011


Fantastic. This is just... awesome.
posted by rachaelfaith at 8:49 AM on August 1, 2011 [2 favorites]


About fucking time. (Please, please, please don't fuck it up, Congress.)
posted by kmz at 8:50 AM on August 1, 2011 [1 favorite]


..but I'd like to believe that people will come around and realize Healthcare Reform is all sorts of awesome for the USA.

...if the USA ever does get Healthcare Reform.

I realize that a reduction of $10-$30 per visit is nice, but when you have to have $1000/mo (or more) insurance in the first place, it's hardly a game-changer.
posted by DU at 8:51 AM on August 1, 2011 [7 favorites]


Lets hope short sighted cheap-assed anti tax fools can see this as an investment that will pay for itself in a couple decades
posted by Redhush at 8:53 AM on August 1, 2011


Hm, how many people do I know (who are conservative) who did not have access to actual healthcare for pregnancies without a lot of BIG PLANNING and figuring out how to game the system? A few. All I can say is the more that people who don't think this is necessary benefit from it, the more that we will, little by little, chip away at this idea that people shouldn't get healthcare unless they 'earn' it.
posted by Medieval Maven at 8:53 AM on August 1, 2011 [2 favorites]


One big problem, she says, is that requiring insurers to cover contraceptives violates the conscience rights of people who belong to religions that don't believe in artificial contraception.

Sorry, that's not how taxes work. You don't only get to pay for stuff that doesn't violate your conscience. I pay for war with my taxes and I'm not exactly happy about it personally, but you don't only get to pay taxes you personally support.
posted by melissam at 9:02 AM on August 1, 2011 [73 favorites]


I realize that a reduction of $10-$30 per visit is nice, but when you have to have $1000/mo (or more) insurance in the first place, it's hardly a game-changer.

There really isn't a reduction - the "lost" copays are just buried in an increased premium. In fact, I'd be shocked if the insurance companies are not making more with the new regulations, because now they assume whatever they want about how many women will take advantage of the new benefits, and raise rates accordingly. To the extent they over estimate that number, they profit.
posted by COD at 9:03 AM on August 1, 2011 [6 favorites]


Ack I meant that's not how things like taxes work, but these people are also opposed to taxes covering birth control too. Their argument is even more ridiculous when it comes to private insurance companies.
posted by melissam at 9:04 AM on August 1, 2011


I would be happy to pay co-pays on my birth control. If I get some insurance in the first place I would be happy to pay $10 instead of $70.
posted by bleep at 9:05 AM on August 1, 2011 [1 favorite]


I realize that a reduction of $10-$30 per visit is nice, but when you have to have $1000/mo (or more) insurance in the first place, it's hardly a game-changer.

I'm in a lot of pregnant person internet groups, and you'd be surprised by how many women have insurance, but have to pay $100+ or more for basic preventative testing during pregnancy. It's really depressing to hear people talk about not paying their electric bill so that they can get an important ultrasound.
posted by the young rope-rider at 9:08 AM on August 1, 2011 [7 favorites]


There really isn't a reduction - the "lost" copays are just buried in an increased premium.

Very true. But people don't think of it that way, much as they don't think that getting a "refund" on taxes is a sign of really bad financial planning.

It will probably encourage people to do things they might not otherwise do, so, on balance, a good thing.
posted by IndigoJones at 9:10 AM on August 1, 2011


Now if we could find a way to legislate away the obscene profit levels and overhead in health insurance, healthcare, medical devices, and pharmaceuticals. Good luck with that since legislation is written by those banking the profits! Healthcare is a right in a civilized first world country. A healthy populace makes our country stronger and wealthier as a whole. We're too shortsighted and greedy to realize it.
posted by Daddy-O at 9:11 AM on August 1, 2011 [6 favorites]


NATIONALIZE

INSURANCE
posted by shakespeherian at 9:16 AM on August 1, 2011 [19 favorites]


Plan B is a progestin-only emergency contraception pill. It is NOT mifepristone.
posted by nat at 9:17 AM on August 1, 2011 [9 favorites]


If these people understood and valued actual facts, they wouldn't be these people.
posted by the young rope-rider at 9:18 AM on August 1, 2011 [18 favorites]


...getting a "refund" on taxes is a sign of really bad financial planning.

Getting a refund on taxes is only bad financial planning if your financial planning goal is maximum gain. If your goal is minimum stress, a refund is really great planning.
posted by DU at 9:18 AM on August 1, 2011 [7 favorites]


There really isn't a reduction - the "lost" copays are just buried in an increased premium.

That doesn't make it a bad thing, though. There's a psychological benefit to insurance, over and above the actual risk-pooling aspect that you get with high-deductible catastrophic insurance. The benefit is that it eliminates the apparent upfront cost of a medication or procedure, therefore making people more likely to actually use it. (Of course that can be a double-edged sword; it can make people more likely to use expensive prescription drugs when cheaper OTC ones would work, for example.)

If someone has to pay out of pocket for an exam or prescription, they might be inclined to skip it in order to pocket the money if they're tight that month. But if they're paying for it anyway as part of their health insurance -- even if the financial outlay is exactly the same at the end of the year -- then they might be more likely to take advantage of it.

So it makes sense to require insurance companies to cover, without a copay, things that are in some way social goods or that we want everyone to take advantage of: preventative care and birth control are obvious, low-hanging fruit.
posted by Kadin2048 at 9:19 AM on August 1, 2011 [3 favorites]


Good luck with that since legislation is written by those banking the profits!

Sadly, this comment could be applied to almost any aspect of American life nowadays, including financial, defense, power production, and criminal justice, to name a few.

It should be a crime, but our country is being driven by the lobbyists, and has been for a while.
posted by quin at 9:20 AM on August 1, 2011 [2 favorites]


Whoops, my bad. Thanks for catching that, Nat - I had intended to write "mifepristone or Plan B" but ended up with the wrong thing and ended up with an FRC-worthy mis-statement.
posted by catlet at 9:21 AM on August 1, 2011


Yeah, I wouldn't be at all surprised if FRC has text saying they're equivalent. rope-rider is right too. Sigh.

In other news, I do wonder how people will feel about the health care bill once they start to realize more what its consequences are; thanks for the update here!
posted by nat at 9:24 AM on August 1, 2011


I realize that a reduction of $10-$30 per visit is nice, but when you have to have $1000/mo (or more) insurance in the first place, it's hardly a game-changer.

I was actually really surprised when my husband and I went to purchase private insurance. We were able to get a halfway decent policy -- not great, but definitely on a par with a lot of corporate insurance plans -- for under $400/mo for the two of us. Turns out that my state has a high-risk health insurance pool, which means that insurers are allowed to decline to cover you if you're too sick and haven't had previous coverage, at which point you become eligible for Medicare/Medicaid regardless of income. IOW: We have a frickin public option. (Of sorts.) And it makes everything better for everyone.

But, yes. You'd be startled as to how high a co-pay for imaging services can be, or for a "specialist" like an OB-GYN. And the breast pump thing is AWESOME.
posted by KathrynT at 9:26 AM on August 1, 2011


I realize that a reduction of $10-$30 per visit is nice, but when you have to have $1000/mo (or more) insurance in the first place, it's hardly a game-changer.

The bigger issue is that this requires insurers to cover things, not just without copays. The things covered on the legislation that insurers simply deny coverage for now. There's a lot of health insurance plans that don't cover wellness checkups at all, so you're talking $300 - $500 a year. Birth control copays can add up, too -- not every place has Wal-Mart's $4 copays, a lot of insurance doesn't cover patient-requested birth control at all, and not everybody has a Planned Parenthood nearby -- every month on an ongoing basis.

Now, the above addresses only denial of service and copays, not deductibles, so I agree, this isn't UK-levels of government-assisted healthcare, but I'm a glass-half-full guy, and if this helps thousands of people have better lives becausenow there's things covered by their already expensive healthcare, then I'm not going to complain that this isn't enough to be called real healthcare reform.
posted by AzraelBrown at 9:49 AM on August 1, 2011 [2 favorites]


Plan B is not the abortion pill, mifepristone! They are two different drugs, with two different purposes. It is common for pro-lifers to (intentionally?) confuse the two. It is sad to see this misinformation in a FPP on Metafilter.
posted by Philosopher Dirtbike at 9:50 AM on August 1, 2011 [4 favorites]


I think for the most part this is a good thing. Although there is some indication that some nominal co-pay is effective at reducing overall costs it's also apparent that the co-pays many Americans are paying are completely excessive. People shouldn't have to forgo procedures and medicine because they have to decide between a procedure and paying the rent.

I know the vast majority of Mefites (including myself) want a Single Payer system but if we can improve health care access and quality of care for Americans I think it's a good thing and an important incremental step forwards.
posted by vuron at 9:52 AM on August 1, 2011


This is definitely a step forward.
posted by zennie at 9:56 AM on August 1, 2011


"The plan includes a provision that will allow religious institutions to opt out of birth control coverage."

Does that mean employers with a religious affiliation will be able to choose for their employees that birth control is not covered for them, even though other people insured by the same insurance company, but with a different employer, are covered?
posted by jsturgill at 9:56 AM on August 1, 2011 [1 favorite]


Planned Parenthood Bombed Despite Lack of Abortion Provision
posted by homunculus at 10:01 AM on August 1, 2011


The other big point here is that by making it part of coverage, the cost gets spread around; It's no different from the way any health insurance cost is made cheaper by adding to the pool people who don't need it. That means that my premium costs (I'm a single, young, healthy male) will end up subsidizing the birth control of women in my big corporate group plan. Setting aside the insane fact that my health care is an employer-provided benefit in the first place, this is exactly how it would work if we had nationalized health care: My taxes would subsidize 'your' birth control. In other words, it won't be the same total cost per woman; it'll be the same total cost, but with some of the cost borne by people who don't need it. And since I'd rather live in a world where I'm simply taxed a little more so that everyone can have health care they need, I'm totally fine with this situation.
posted by Tomorrowful at 10:49 AM on August 1, 2011


@Tomorrowful: it's generally believed you'll pay less subsidising free contraceptive implants (basically all schoolgirls here are seen by a nurse who discusses contraception with them and recommends this if at all suitable - the only measure that finally saw our soaring teen pregnancy rate drop) than you will in taxes subsidising the large families of teen career mothers and their tearaway/criminal-career offspring (bit of stereotyping there but you know what i mean). If it makes you feel better. Plus we'll be subsidising you when you're old and abandoned by your family.
posted by maiamaia at 11:09 AM on August 1, 2011


Philosopher Dirtbike: according to the OP, it was a typo, not an intentional misstatement.
posted by epersonae at 11:12 AM on August 1, 2011 [1 favorite]


One big problem, she says, is that requiring insurers to cover contraceptives violates the conscience rights of people who belong to religions that don't believe in artificial contraception.
Sorry, that's not how taxes work. You don't only get to pay for stuff that doesn't violate your conscience. I pay for war with my taxes and I'm not exactly happy about it personally, but you don't only get to pay taxes you personally support.


True, that's not how taxes work, but this is not about taxes, it's about insurance and government mandated conditions on private economic transactions. It's like saying you can only buy a barbecue grill if you also buy hamburgers. Now hamburgers might be nice to things that the majority would like to have included, but if you're a Hindu who abstains from eating beef, you might want to be able to buy a barbecue grill without having to buy hamburgers.
posted by Jahaza at 11:15 AM on August 1, 2011 [3 favorites]


Grrr... "...might be nice things to have that the majority would like to have included, but ...
posted by Jahaza at 11:16 AM on August 1, 2011


Well, and if I don't have an autistic child, I might want to buy a policy that excludes therapy for autistic kids. and if I don't have cancer, I might want to buy a policy that excludes chemotherapy. And if I don't drink, I might want to buy a policy that excludes liver transplants. And if I'm not crazy, I might want to buy a policy that excludes mental health coverage.

That's not how risk pooling works, though.
posted by KathrynT at 11:23 AM on August 1, 2011 [10 favorites]


Plus, we have government mandated restrictions on private economic transactions all the time -- for example, you're required to buy the seatbelts when you buy a car, because of another silly government mandate.
posted by peacheater at 11:25 AM on August 1, 2011


I was promosed that Obamacare was nothing more than a giveaway to insurance companies. What is this?!!
posted by humanfont at 11:32 AM on August 1, 2011 [2 favorites]


Plus, we have government mandated restrictions on private economic transactions all the time -- for example, you're required to buy the seatbelts when you buy a car, because of another silly government mandate.

I'm not aware of any religion that objects to seatbelts.

Also, the requirement to purchase seat belts lessens the cost of a negative externality caused by car ownership itself... the risk of having a car accident.

Pregnancy is not a negative externality caused by having car insurance.
posted by Jahaza at 11:33 AM on August 1, 2011


Honey, you're baby was born fine due to all your previous health care.

Too bad you're divorced now, and your baby-daddy's late with the support. The kid's sick, you can't afford a doctor, but you better not stay home from work, and you damn well better not have sex because you'll pay full price for birth control, because you can't afford insurance.

Making sure women have healthy babies when they want to have healthy babies is a great idea. Too bad we do NOTHING to help women keep their babies healthy afterward.

I would love to believe this will help women and children more than it will help out insurance companies and the health industry. They're gaming the angle as we speak.


It's really depressing to hear people talk about not paying their electric bill so that they can get an important ultrasound.

Let me FTFY:
It's really depressing to hear people talk about being so far behind on their electric bill that they consider not going to a doctor AT ALL for the first and second trimesters.

I'm damn lucky. I have insurance. I'm behind on some medical bills, but they will get paid.
posted by BlueHorse at 11:34 AM on August 1, 2011 [1 favorite]


ARGH!
your baby

sarcasm screws with my typing
posted by BlueHorse at 11:35 AM on August 1, 2011


I'm not aware of any religion that objects to seatbelts.

There are religions that object to drinking, though. But Methodists and Mormons still pay premiums towards health insurance that covers rehab and liver transplants. Why is birth control in a special category of exemption? Because the crackpots who oppose it are particularly vocal?
posted by KathrynT at 11:41 AM on August 1, 2011 [7 favorites]


Healthcare is a right in a civilized first world country.

No it isn't. I happen to think it ought to be, but the fact is that you are not actually promised healthcare in law. This is a prime example of magical thinking: mistaking what you want for reality, and then being confused and angry when reality fails to deliver. In much the same fashion that Republicans push for a balanced-budget amendment, liberals need to start pushing for the idea of healthcare as a civil right, get to grips with the philosophical and practical difficulties of such a law, and come up with a convincing plan for how to pay for it (not the usual nonsense of 'tax the rich' or 'end all wars' which are about as grounded in reality as Republicans' 'end unnecessary government spending').

Universal healthcare is a great idea, with many economic virtues to recommend it. It's also difficult, and implementing it without going bankrupt means accepting compromise on things like sharing facilities, waiting lists, and priority for people who follow their doctors' advice and stop smoking/overeating/drinking etc. Also, get used to seeing individual healthcare outcomes become a huge political football, to the point where you almost wish it could be outsourced back to the private sector at times because your preferred party/political figure will be held personally responsible for anything that ever goes wrong inside a government-funded healthcare facility.

Effective political strategies: every time someone objects to being 'forced' to fund women's health, object (or even sue) over being 'forced' to subsidize Viagra prescriptions for men who can't get it up any more. Work for a ban on direct-to-consumer pharmaceutical advertising. Pursue patent reform, because flaws in the patent system are a major cost driver. Set up a women-only mutual insurance company, run solely by women, designed to cater to women's particular health problems. Someone else can do the same for men's particular health issues. Are these ideal solutions to existing problems? no. But they're more effective than the status quo. Idealistic solutions tend to generate more rhetoric than results.
posted by anigbrowl at 11:54 AM on August 1, 2011 [4 favorites]


Part of pushing for something is advocating for it. Like, you know, saying "healthcare is a right".

No one thinks that there is an amendment in the constitution that says that everyone gets healthcare.
posted by the young rope-rider at 11:58 AM on August 1, 2011 [1 favorite]


Pregnancy is not a negative externality caused by having car insurance.

You never went to prom, eh ?
posted by Pogo_Fuzzybutt at 11:58 AM on August 1, 2011 [2 favorites]


Well, jahaza, I don't believe in forcing women to carry pregnancies to term, so I don't want my health insurance to pay any OB/GYN unless they are willing to preform abortions.

I hope you can support me in this, because you're all about freedom of choice, right?
posted by the young rope-rider at 12:06 PM on August 1, 2011


Part of pushing for something is advocating for it. Like, you know, saying "healthcare is a right".

That's not advocacy, that's wishful thinking. There's something fundamentally immature about a strategy built upon the belief that repeating something often enough will make it true. Demand that healthcare be a right, yes. Assert that it already is, and you just sound deluded. Look at the history of effective civil rights movements: MLK didn't say that all people were already equal in the eyes of the law, he talked about his vision of what society could be like if they actually were, and railed against the fact that they weren't.

Words have meaning, nowhere more than in law. If you abandon accuracy and reality in this area, you've already put your cause at a huge disadvantage because everything else you say can be portrayed as similarly disconnected from reality.
posted by anigbrowl at 12:10 PM on August 1, 2011 [4 favorites]


We're not MLK, nor are we lawyers (for the most part), nor are we in a court of law.

If you think that "right" only refers to rights encoded in US law, that's fine for you, but most people have a broader understanding of the term.
posted by the young rope-rider at 12:13 PM on August 1, 2011 [3 favorites]


It's like saying you can only buy a barbecue grill if you also buy hamburgers. Now hamburgers might be nice to things that the majority would like to have included, but if you're a Hindu who abstains from eating beef, you might want to be able to buy a barbecue grill without having to buy hamburgers.

The first reason that's a terrible analogy is that hamburgers aren't important to anything, but contraception is an important part of women's health care, and health care is important. Requiring manufacturers of unimportant consumer goods to include other unimportant consumer goods might well be as silly as requiring grill manufacturers to include hamburgers. Requiring providers of vital functions such as health care to cover critical components of health care is not silly.

Further, the complaint doesn't really make any sense except as an attempt to make contraception harder to obtain for women who want it. While the law would require your health insurance plan to cover contraception, it would not force you to use contraception. It would not make you pay for someone else's contraception; it would make you pay for your health insurance coverage. It imposes absolutely nothing on anyone who would, for whatever reason, decline contraception. The lack of such a requirement, however, would make it harder for women who do want contraception to obtain it.
posted by ROU_Xenophobe at 12:31 PM on August 1, 2011 [3 favorites]


The lack of such a requirement, however, would make it harder for women who do want contraception to obtain it.

Yes, and that's pretty much the goal that's being carefully left unsaid. Not that it's likely to become overt, of course. No, instead we'll talk about religious rights or the ability of devout Hindus to buy stainless steel grills that don't explode & kill everyone when used to cook anything other than beef.
posted by aramaic at 12:43 PM on August 1, 2011


We're not MLK, nor are we lawyers (for the most part), nor are we in a court of law.

So how's your current approach to advocacy working out for you? It doesn't matter whether you're in a court of law or not. The counterfactual rhetorical approach of asserting desire as a matter of fact does not work very well in the court of public opinion. It's been trotted out a lot during the debt ceiling debate too, and hasn't improved the standing of politicians in DC one whit. The great majority of people find this style of argument facile and tiresome, so I'm suggesting you try something a little more substantive, and gave some examples above of campaigns that might be more effective than recycling existing tropes.

A recent article from the American Bar Association indicates that women's reproductive rights are under considerable pressure across the nation as a whole, because voters in red states tend to support laws and/or legislative candidates that considerably restrict women's freedom to make their own decisions. Relying on people's 'broad understanding' is not that good of a strategy, because such arguments quickly fall apart as soon as they are fielded in a legislative or electoral context. People also talk about 'a right to choose' and 'a right to privacy' a lot, but because these 'rights' are implicit rather than explicit their scope is subject to constant revision and erosion, with potentially dangerous consequences for those who rely upon their existence as a fact. All I'm saying is that the staple communication strategy has become obsolete and that it's time to change up.
posted by anigbrowl at 12:44 PM on August 1, 2011 [2 favorites]


It makes me sad that this is news. I've never understood the idea of co-pays and deductibles. About a year ago, my tooth started to hurt, so I went to a dentist I found via my insurer's website. He took a look and told me I needed to have a cavity filled. "Alright," I said, "You've got my insurance information, right? Let's go ahead and do it."

"Well," he told me, "We called your insurance company and they said they'll only pay for $150 of the procedure."

"How much does that leave?" I asked.

"About $500." I still have a cavity; it was bothering me just this morning, but alas, I don't have the money to get it fixed.

The same thing happened with my car's windshield; it's cracked, and even though I have glass coverage and having a cracked windshield is technically illegal in my state, I have to pay for the first $200 on my own.

Why am I paying for insurance when I end up having to pay for all the procedures out of pocket anyway? This sort of practice should be illegal.
posted by reductiondesign at 1:00 PM on August 1, 2011 [4 favorites]


Requiring providers of vital functions such as health care to cover critical components of health care is not silly.

Favorited.

The first reason that's a terrible analogy is that hamburgers aren't important to anything,
Whoa, whoa, waitaminute there.

From the Rovner piece: One big problem, she says, is that requiring insurers to cover contraceptives violates the conscience rights of people who belong to religions that don't believe in artificial contraception.
Aww, F'em.
Oh, wait, no. Don't.

From Hom's link: In other words, anti-choice protesters have stopped simply harassing women getting abortions, but have expanded toward harrassing women who want Pap smears and birth control pills, and probably some men looking for condoms and STD tests as well.

I do tend to use a lot of profanity. It's rare when I can think of nothing other than a profane response however.

How's our infant mortality rate btw? Still trailing behind Cuba and Guam? Yeah, that's swell. All about the kids. Fuck I want to hit something.
posted by Smedleyman at 1:03 PM on August 1, 2011 [1 favorite]


There are religions that object to drinking, though. But Methodists and Mormons still pay premiums towards health insurance that covers rehab and liver transplants.

This case is not analogous to the birth control case. Methodists and Mormons might seek not to be covered for rehab and liver transplants because they don't think they'll need these services, but that's just a case of trying to save money, not a case of trying to not pay for something you find morally objectionable. They don't consider the services to be immoral in and of themselves. That's why you have things like a Mormon rehab program.

The first reason that's a terrible analogy is that hamburgers aren't important to anything, but contraception is an important part of women's health care, and health care is important. ... Requiring providers of vital functions such as health care to cover critical components of health care is not silly.

It's not the best analogy, but it's the best one I could come up with quickly. However, your objection here just begs the question. Sure, if we all agreed that "contraception is an important part of women's health care" there'd be no objection.

Further, the complaint doesn't really make any sense except as an attempt to make contraception harder to obtain for women who want it. While the law would require your health insurance plan to cover contraception, it would not force you to use contraception. It would not make you pay for someone else's contraception; it would make you pay for your health insurance coverage.

Well... actually, we have recently instituted an employer mandate for health insurance. So if you then mandate that insurance cover contraception, you are mandating that the employer provide insurance coverage for contraception. From a Catholic perspective, providing such coverage is immoral, whether the employee chooses to take advantage of it or not.

There is sort of already a conscience exception... employers can pay the "penalty" instead of paying for the insurance. But, from a public policy perspective, it makes sense to include a broad conscience exception because the main public policy goal is not contraception and abortion coverage, it's heart attack coverage, preventive care coverage, car accident injury coverage, cancer coverage, end-of-life-care coverage, etc. and compared to these things, coverage for contraception and abortion is a relatively small piece of the pie.
posted by Jahaza at 1:11 PM on August 1, 2011


From a Catholic perspective, providing such coverage is immoral, whether the employee chooses to take advantage of it or not.

There's a distinction there: "providing such coverage" is the issue -- not the real-world statistics on actually using the birth control. 98% of Catholic women use birth control in some form, about the same percentage as other faiths. So, the question becomes: do we bend over for the Church's percieved expectation for Catholic women, or extend the required coverage to the 98% of Catholic women as we would any other American woman capable of making the choice would, regardless of their religion?
posted by AzraelBrown at 1:43 PM on August 1, 2011 [3 favorites]


Sure, if we all agreed that "contraception is an important part of women's health care" there'd be no objection.

It isn't a matter of agreement or disagreement any more than we could agree or disagree that the Earth is an oblate spheroid. Contraception has substantial effects on women's health, therefore it is, as a simple matter of fact, an important part of women's health care.

From a Catholic perspective, providing such coverage is immoral, whether the employee chooses to take advantage of it or not.

So the objection really is that other women might choose to use contraceptives, therefore they must not be covered.
posted by ROU_Xenophobe at 1:55 PM on August 1, 2011 [1 favorite]


AzraelBrown, providing the coverage is indeed the issue, because that's what the mandate does. It doesn't oblige anyone to use the services, but it does oblige people and organizations to pay for the services. Paying for the services is itself seen to be immoral.

If the main public policy goal is broader health care coverage and reducing of externalities related to health care costs, like when uninsured people end up in the emergency room, not the expansion of provision of family planning services, do we do what furthers that goal (conscience exceptions) or do we do something that impedes that goal (require coverage that may end up with organizations dropping their coverage and even taking a penalty to do so so as to not engage in what they view as immoral behavior.

If the expansion of family planning and abortion services is the policy hill the proponents want to die on, what does that say about their motivations in a debate where the other side is being accused of using the issue as a proxy for their views on family planning?

Of course, what people do or don't do is not decisive in deciding a moral or legislative question. We still have speed limits on roads even though the vast majority of people exceed them at some time or another.
posted by Jahaza at 1:56 PM on August 1, 2011


Sure, if we all agreed that "contraception is an important part of women's health care" there'd be no objection.
It isn't a matter of agreement or disagreement any more than we could agree or disagree that the Earth is an oblate spheroid. Contraception has substantial effects on women's health, therefore it is, as a simple matter of fact, an important part of women's health care.


That's not a good argument. Everything that has a substantial effect on women's health is not a part of women's health care. Preventing plane crashes has a substantial effect on women's health, but that doesn't mean that the air traffic control system is "an important part of women's health care."
posted by Jahaza at 2:09 PM on August 1, 2011


Preventing plane crashes has a substantial effect on women's health, but that doesn't mean that the air traffic control system is "an important part of women's health care."

I would agree with you if men could get pregnant, or have menstrual disorders. But they can't, so yes, contraception IS an important part of women's health care instead of being an important part of health care for all members of society.

I'm sure if men had a medical need for birth control, though, it would be approved and subsidized in the blink of an eye. That seems to be how things work in this country.
posted by palomar at 2:18 PM on August 1, 2011


The problem with saying that religious organizations can exclude coverage of birth control, is that means they are also denying coverage to women who take birth control pills for endometriosis, for example, or any of a number of other conditions it is prescribed for, other than contraception.

If a woman wants to use birth control, that is a matter for her and her doctor. Whether a woman commits a sin in using birth control is a matter between her and her clergy. The two should not be confused. 99% of all sexually active women use birth control at some point in their lives. The same is true of 98% of all Catholic women. Women should not be denied legal, effective, medical care because of their employer's religious beliefs.
posted by pbrim at 2:20 PM on August 1, 2011 [11 favorites]


Just going to drop in briefly to note that I've known at least one woman who took hormonal contraception in order to manage symptoms of severe PMS, not for birth control.
posted by epersonae at 2:20 PM on August 1, 2011 [2 favorites]


Or, what pbrim said.
posted by epersonae at 2:21 PM on August 1, 2011


I took birth control for a few years to manage symptoms of severe PMS -- every other month the hormones would kick in and cause extreme depression and suicidal ideation. Going on the pill helped fix that, an IUD proved to be a much better long-term solution, and as soon as I can find a doctor who will perform a tubal ligation on me and save up the necessary funds (since it's not covered by my insurance at all -- but two rounds of IVF is covered, as is male sterilization and Viagra), I plan to do that.

Family planning is not the only thing covered in this measure. Breast pumps for nursing moms are covered, annual "well woman" exams are covered, cancer and STD screenings are covered, and counseling for domestic violence is covered. But by all means, let's focus on the part that gets the religious wingnuts in a lather about their rights!
posted by palomar at 2:26 PM on August 1, 2011


I had to take it before gyn surgery to resolve pain that required narcotics and was severely limiting my life. But I guess that is not good enough because the amazing moral authority of the Catholic church knows all there is to know about women's health.
posted by the young rope-rider at 2:27 PM on August 1, 2011 [3 favorites]


The problem with saying that religious organizations can exclude coverage of birth control, is that means they are also denying coverage to women who take birth control pills for endometriosis, for example, or any of a number of other conditions it is prescribed for, other than contraception.

I don't think this kind of objection is a problem. Health insurance commonly makes this kind of distinction where the same drug has multiple uses. For instance, Medicare covers Botox for some purposes, but not for elective cosmetic reasons.
Preventing plane crashes has a substantial effect on women's health, but that doesn't mean that the air traffic control system is "an important part of women's health care."
I would agree with you if men could get pregnant, or have menstrual disorders. But they can't, so yes, contraception IS an important part of women's health care instead of being an important part of health care for all members of society.


Hmm. So you agree that the air traffic control system is an important part of health care? What isn't then? Wearing shoes prevents getting cuts on your feet. Should shoes be covered as an important medical device?
posted by Jahaza at 2:42 PM on August 1, 2011


Previously uninsured (as in, contract worker who was repeatedly denied get insurance due to a thyroid thing and a brain thing) I was just accepted for the PCIP and I will soon have health ins for the first time since I worked in the Big City during the dot comedies 10+ years ago; just in time for my first mammogram!! I had to pay out-of-pocket back in grad school when I had a precancerous cervical scare/biopsies/surgery. It was traumatic and expensive. Thank goodness some other women will soon have it a little better. Here's hoping this plan works out for all of us.
posted by tingting at 2:57 PM on August 1, 2011


coverage for contraception and abortion is a relatively small piece of the pie.

This is only true if you're not a woman of childbearing age. My pregnancies are easily the most expensive medical care I've ever consumed, upwards of $30K between them. And that's for two normal, uncomplicated vaginal deliveries. Premature babies (one big cause of prematurity is not getting prenatal care, of course) can cost hundreds of thousands if not millions of dollars in care before their first birthday.
posted by KathrynT at 3:00 PM on August 1, 2011


Hmm. So you agree that the air traffic control system is an important part of health care? What isn't then?

Oh, wow, you're serious. Either that or you're trolling hard with that ridiculous strawman argument, but okay, I'll play along.

No, Jahaza, I was responding with sarcasm to your air traffic controller argument. What you're claiming is that the argument that contraception is an important part of women's health is invalid, because you could also make the claim that air traffic controllers are an important part of women's health.

What I intended to say, via sarcasm, is that you could make that claim if both men and women could get pregnant or suffer from menstrual disorders. If both genders could suffer from those health issues, then the issue of contraception would be simply a health issue. To date, only women can carry a fetus inside their bodies, and to date, only women (or men who are biologically female and have not undergone a hysterectomy) can suffer from menstrual disorders. Therefore, the issue of contraception is a women's health issue.

An example of a men's health issue would be testicular or prostate cancers, as only biological males can have those particular forms of cancer.

(Yes, these issues affect all of society, not simply one gender. In a discussion about medical treatments, I feel it is fair to say that only one gender is affected, as only one gender can be prescribed medical treatments involving pregnancy, et cetera.)
posted by palomar at 3:13 PM on August 1, 2011 [1 favorite]


Nothing is free. Someone, somewhere, has to pay for it, whatever "it" is. The insurance companies will simply figure out a way to make people pay another way.

(The only insurance I have is aflac accident insurance, fwiw.)
posted by St. Alia of the Bunnies at 3:13 PM on August 1, 2011


palomar, it's the "health" part that's being disputed, not the "women's" part.
posted by Jahaza at 3:46 PM on August 1, 2011


Methodists and Mormons might seek not to be covered for rehab and liver transplants because they don't think they'll need these services, but that's just a case of trying to save money, not a case of trying to not pay for something you find morally objectionable.

Christian Scientists are against blood transfusions and organ transplants, but I'm fairly sure that health insurance companies are required to pay for them.
posted by empath at 3:55 PM on August 1, 2011 [3 favorites]


Yes, clearly, only the most blithering of idiots would suggest that pharmaceuticals that regulate the behavior of internal organs in order to prevent bodily harm are properly classified in "health care." Obviously they're really sporting goods, or perhaps cookware.
posted by ROU_Xenophobe at 3:56 PM on August 1, 2011 [4 favorites]


Association of denomination to infant mortality.
posted by zennie at 4:01 PM on August 1, 2011


it's the "health" part that's being disputed

You're joking, right?
posted by palomar at 4:24 PM on August 1, 2011 [1 favorite]


A few people have commented something along the lines that "the 'lost' copays are just buried in an increased premium." Kadin2048 addressed this a bit, but there's more to it. It's not a wash - eliminating copays reduces the marginal cost of care, which (as Kadin2048 noted) makes it more likely that an insured will seek the treatments once they are insured, and is likely to increase overall consumption of these preventive services. And that's the point. Yes, insurers will adjust their premiums (just as they always do in the face of changes in delivery costs). But the increase in premiums resulting from the shift from copays to premiums (without accounting for the change in consumption of services) is a wash to someone looking forward and deciding whether to carry insurance at all. And the penalty under the new law for not having insurance is likely high enough to counteract (on an individual level) the increased incentive not to carry insurance that may result from increased consumption of services (which may also drive up premiums slightly). So just as many people are likely to be insured, but they are more likely to get the medicines and services that no longer carry a copay - that is, a bunch of preventive measures to encourage people to avoid larger costs later.
posted by dilettanti at 4:25 PM on August 1, 2011


Please please please let this actually happen. I have spent so much money on birth control over the years, it's ridiculous. And I was originally prescribed it for medical conditions that have nothing to do with not being pregnant. I also believe that I have a right not to become pregnant, and I never want to be so. I appreciate that the Obama administration has taken this step to try to ensure BASIC women's healthcare for all of us.
posted by agregoli at 4:27 PM on August 1, 2011 [1 favorite]


Methodists and Mormons might seek not to be covered for rehab and liver transplants because they don't think they'll need these services, but that's just a case of trying to save money, not a case of trying to not pay for something you find morally objectionable. They don't consider the services to be immoral in and of themselves.
Scientologists consider psychiatry, including psychiatric medication, to be immoral, and yet there are mandates that require insurance to cover treatment for mental illness. I'm pretty sure that there are religions, such as Jainism, that would object to the use of pig and cow valves, which are sometimes the best choice for people who need to replace their heart valves, and yet insurance covers that.

If you don't want to use birth control (or antidepressants or porcine valves) because of your religion or for any other reason, then don't use it. But you're not going to convince me that your religion gives you the right to make it difficult for the rest of us to get appropriate medical care.
posted by craichead at 5:07 PM on August 1, 2011 [2 favorites]


reductiondesign : I've never understood the idea of co-pays and deductibles.

Simple - Let's say you have no copays or deductibles. You get the flu. You go to your doctor, who basically tells you to suck it up but gives you scripts for an antibiotic, high-dose ibuprofen (aka "placebos"), and some codeine cough medicine. You have them all filled and never even take the antibiotic, (and only a couple of the ibuprofen), sticking them in the fridge for five or so years "just in case", before throwing them away basically unused.

Now lets say you do have copays and deductibles. You don't go to the doctor for a cold or flu until you don't care if he cures or kills you as long as it ends the symptoms. When you have to pay $5 per script, you skip the obvious placebos and just get the palliative one.

Basically, copays and deductibles act as a disincentive to whiners and those who would abuse the system and thereby drive up all our rates.
posted by pla at 5:26 PM on August 1, 2011


You don't go to the doctor for a cold or flu until you don't care if he cures or kills you as long as it ends the symptoms.

Yes, thats a great idea. People should clearly wait until they need extreme intervention, instead of going when they first get sick and the treatment is easier and cheaper.

(I was on a PPO plan with no deductibles or copays and I didn't see any big difference in how often I and people I knew in the company went to the doctor vs. at companies with low deductibles/copays. I think you'd have to set them high to have an effect, and then you'd be in the situation I'm describing where people make things worse for themselves and the community (communicable diseases) by not going to the doctor when they should).
posted by wildcrdj at 5:41 PM on August 1, 2011 [4 favorites]


Socialism!

*spits on porch next to rifle butt*
posted by Fister Roboto at 5:48 PM on August 1, 2011


Nothing is free. Someone, somewhere, has to pay for it, whatever "it" is. The insurance companies will simply figure out a way to make people pay another way.

How about we keep paying for the healthcare, but just stop paying the parasites leaching off the healthcare system, and just pay for actual healthcare, (like other countries). That should halve the price right there, which to us, is like getting half your healthcare free, and it's still fully paid for! :)
posted by -harlequin- at 6:01 PM on August 1, 2011


Basically, copays and deductibles act as a disincentive to whiners and those who would abuse the system and thereby drive up all our rates.

A couple of years ago I had what the internet told me was gastroenteritis. It felt like my large intestine was a live snake thrashing in my abdomen for three days. Intense agony, unable to keep down anything.

I spent three days drinking water and then having it leave me every possible way, but I knew dehydration was what would kill me if I didn't keep hydrated.

I could have died. People do. But I couldn't afford three hundred dollars and a possible hospital visit, so I risked it.

Copays and deductibles can also kill people. I guess that's a small price to pay to make sure we don't let whiners and freeloaders get health care.
posted by winna at 7:41 PM on August 1, 2011 [7 favorites]


Basically, copays and deductibles act as a disincentive to whiners and those who would abuse the system and thereby drive up all our rates.

As someone who once worked for the Blues, that's somewhat of a fallacy; people don't choose to go to the doctor based on how cheap it is. They may decline to go to the doctor due to inability to pay, but they do not choose to go to the doctor simply because of low cost combined with a desire to do so. A large part of it is that people actively dislike going to the doctor, and avoid it regardless of cost, and most won't go unless they really think they need to simply because it's added work that they deem unnecessary.

Insurance companies who provide free wellness checkups don't see anywhere near 100% utilization; I think it's somewhere around 20% (it's late and I didn't find a source in the first few Google pages). People go to the doctor because of a perceived need, not due to the cheapness of the service. Yes, there are hypochondriacs and obsessive-compulsives, but they a small portion of insureds and are already likely to be utilizing those services regardless of cost. Copays and deductibles are to disincentivize claims for 'trivial' things so most claims cover catastrophic expenses -- it doesn't disincentivize going to the doctor, it disincentivizes the claim. If a person thinks they're sick enough to go to the doctor, they'll do it. Having a zero deductible and going in to the doctor doesn't encourage people to go to the doctor -- it enables people to go to the doctor who are otherwise unable to pay a copay and deductible. Lower deductibles and copays encourage people to get the care they need, not the other way around.
posted by AzraelBrown at 7:43 PM on August 1, 2011 [5 favorites]


Minimal copays can reduce over-consumption of scarce resources but in the case of preventative care it seems that the potential costs savings resulting from people seeking out the proper amount of preventative care far exceed the potential cost overruns associated with over-consumption.

In the case of pre-natal care, good lowcost pre-natal care can reduce the incidence of complications in utero. Further mothers with good pre-natal care are less likely to deliver low birth weight children or extremely low birth weight children. These children often have extremely high health care costs and often have significant developmental disadvantages down the road.

If making certain kinds of care "free" results in greater utilization of preventative medicine and less use of emergency medicine I think the end result is a net benefit and likely a cost savings.
posted by vuron at 8:34 PM on August 1, 2011


Jahaza writes "do we do what furthers that goal (conscience exceptions) or do we do something that impedes that goal (require coverage that may end up with organizations dropping their coverage and even taking a penalty to do so so as to not engage in what they view as immoral behavior."

This is of course one of the problems with the current implementation. Organizations shouldn't have been able to opt out of providing these services any more than they can opt out of hiring women.

palomar writes "I'm sure if men had a medical need for birth control, though, it would be approved and subsidized in the blink of an eye. That seems to be how things work in this country."

Obviously false on the face of it. Many health issues affecting men aren't covered or are covered in similar ways to female BC.

pla writes "let's say you have no copays or deductibles. You get the flu. You go to your doctor, who basically tells you to suck it up but gives you scripts for an antibiotic, high-dose ibuprofen (aka 'placebos'), and some codeine cough medicine. You have them all filled and never even take the antibiotic, (and only a couple of the ibuprofen), sticking them in the fridge for five or so years 'just in case', before throwing them away basically unused."

Ignoring the, uh, strangeness of the behaviour you are describing Ibuprofen is not a placebo. It reduces pain which may allow you to sleep and it reduces fever which may prevent your your brain from baking.

pla writes "Now lets say you do have copays and deductibles. You don't go to the doctor for a cold or flu until you don't care if he cures or kills you as long as it ends the symptoms. When you have to pay $5 per script, you skip the obvious placebos and just get the palliative one."

The "visit the ER when things get bad enough" system is pretty well The. Most. Expensive. Way. to provide care.
posted by Mitheral at 1:11 AM on August 2, 2011


Mitheral : Ibuprofen is not a placebo.

True, but getting it via two of the most expensive middle class professions in the US doesn't magically make it better when you get it through your insurance company rather than taking four regular-strength ones at a time (800mg = 4x200mg). Nor does it make it any better for your kidneys.


The "visit the ER when things get bad enough" system is pretty well The. Most. Expensive. Way. to provide care.

"Not going to your doctor at the first sniffle" doesn't mean "go to the ER".
posted by pla at 3:41 AM on August 2, 2011


You said that people shouldn't go to the doctor until the patient doesn't care if the treatment kills them as long as the pain was treated. That's pretty well a definition of ER health care delivery. Even if that care is being provided in distributed offices. A healthcare system that worked in that way would require doctor's offices to be equipped like ERs because they'd be dealing with problems that have deteriorated into emergencies.

pla writes "but getting it via two of the most expensive middle class professions in the US doesn't magically make it better when you get it through your insurance company rather than taking four regular-strength ones at a time (800mg = 4x200mg). Nor does it make it any better for your kidneys."

That is true. However getting it from your doctor allows for a more informed use than the packaging vis-à-vis kidney damage. As is often the case with engaging the services of a professional you aren't paying them for the action; you are paying them to provide knowledge of what action to provide. And to recognize the 1 in 100 case where your symptoms aren't simple flu.

And are pharmacists all that expensive? I'd be surprised if they cost anything near the top ten professionals. Heck I'd bet they lose out to some trades.
posted by Mitheral at 9:05 AM on August 2, 2011


Anecdata: My college roommate's parents were BOTH pharmacists (one industrial, one retail) and they both pulled down easily 100K or more a year. Apparently pharmacists are/were scarce?
posted by Medieval Maven at 10:45 AM on August 2, 2011


Most American pharmacists make about $100,000 a year. The middle 50 percent earn between about $90,000 and about $120,000. I don't know why being a pharmacist pays so well, but it does.

I guess I don't understand why a doctor has to prescribe a placebo. Why can't he or she just say "there's really no treatment for this other than to take some Advil and wait it out. Go home and do that, and give me a call if you don't get better in a week or if you have these symptoms"? It seems like bad medical practice, and condescending to boot, to prescribe unneeded medication because you don't want to tell the patient that.

I'd also be really interested to see data on how co-pays affect patients' willingness to go to the doctor. It seems unlikely that co-pays would cause patients to forgo unnecessary treatment but not to forgo necessary visits, but maybe that's true. Personally, I don't always feel like I have a good handle on what's doctor-worthy and what isn't, and the presence or absence of co-pays don't really help me make those decisions more wisely.
posted by craichead at 10:56 AM on August 2, 2011


The last time I went to the ER (walking pneumonia), I saw a doctor for less than 10 minutes, and she barely spoke to me--she just signed off on the head RN's diagnosis, wrote the prescription, and left again. The RN was the one who took the time to explain things to us, and I've generally found nurses to be exponentially more helpful than doctors.
Here in New Orleans (and I can't believe I'm about to use Louisiana as a good example) we have privately owned, walk-in urgent-care clinics. They don't do surgery, but they treat asthma, migraines, ear infections, staph, and broken bones, and if you're paying out of pocket, they charge about $90 for treating most infections. I'm betting urgent care centers become more common across the country--they fill a huge need.

The women's health bill is a big step in the right direction, and I appreciate it as a nice symbolic fuck-you to the anti-contraceptionists. These people are not anti-contraception because they love children, they're anti-contraception because they hate women. Or at least, they hate any woman who is sexually active outside of a procreating-within-marriage context.
posted by Nibbly Fang at 10:56 AM on August 2, 2011 [1 favorite]


My wife's cousin just graduated from pharmacy school a couple of years ago. Her first job, as your friendly neighborhood pharmacist, somewhere in rural Arkansas, paid over $100K a year, plus full benefits, plus some sort of sign on bonus.

Pharmacy is a 5 year degree in most places in the US, with lots and lots and lots of chemistry involved. Not many people can hack it, thus the pay grade.
posted by COD at 11:18 AM on August 2, 2011


Here's a list of top income salary jobs which unfortunately excludes the self employed. Pharmacists are at 15. Some of the groups above them are very large though like sales manager and General Operations Manager. No trades though the top paying trades jobs are in generally in management so it's possible they are lumped in with another group.

However as a service pharmacy isn't all that expensive. WAG: If a pharmacist making 100K annually sees say 100 clients per day the delivery cost per client is only a little over $4. Waiters make more than that at all but the cheapest establishments.
posted by Mitheral at 12:25 PM on August 2, 2011


Fox ‘Expert’ Blasts Expanding Access To Birth Control: ‘Are We Going To Do Pedicures And Manicures As Well?’
posted by homunculus at 1:08 PM on August 2, 2011


This is a very good thing.

That said, it's not obvious to me that birth control should be handled through the insurance system. There's not much risk to spread around, since essentially every woman will be on one of a handful of types of pills for several decades of her life. Insurance companies don't bring a lot of negotiating power, since most brands are generic and therefore dirt cheap to manufacture. And insurance companies are incredibly stingy -- a lot of plans won't cover an extra pack of birth control (so you literally have to get a new one on the exact day your last one expires), nor do many plans allow you to get more than one month's supply at a time. And I really don't see any value in requiring women to see a pharmacist once a month.

It would make more sense to treat birth control like immunizations, which are purchased under a single, national government contract and distributed directly to providers for nominal cost. The government could simply buy all the pills for the whole country from a couple of generic manufacturers. Your GYN could give you a full year's supply at each appointment, or perhaps schedule them to be mailed to you on a monthly basis. Insurance would have to get involved if you need unusual, non-generic types of birth control.
posted by miyabo at 1:46 PM on August 2, 2011 [1 favorite]


miyabo writes "a lot of plans won't cover an extra pack of birth control (so you literally have to get a new one on the exact day your last one expires), nor do many plans allow you to get more than one month's supply at a time. And I really don't see any value in requiring women to see a pharmacist once a month. "

These are idiotic implementation details designed to save insurance companies money by making the services you are paying for as painful as possible to actually get. Additional regulation is the solution. For example my insurance covers 90 days worth of pills, you can get the next prescription several weeks in advance and pharmacists here are allowed to sell a weeks worth or so of many recurring pills without a prescription if you happen to run out at the end of your script before you get in to your doctor. Also my doctor will write multiple scripts for medication so that even though my insurance will only fill any particular script for 90 days I only have to see my doctor every four months.
posted by Mitheral at 2:05 PM on August 2, 2011


I am so thankful for this. As a graduate student my health care is usually included in my funding one way or another, but that doesn't mean it's good. Just trying to understand how my coverage is changing AGAIN this fall was mind boggling; I am going to new insurance that charged a higher co-pay and a high deductible. My old insurance charged a cheaper rate for my birth control but wouldn't pay for more than one month of it at a time. I had to waste 10 or 15 minutes of some pharmacists' time figuring out if 1) there was a loophole to get the max refill before the changeover 2) would the new coverage take effect in time for me to get my next refill on time 3) if I would be able to afford my current Rx for Nuvaring on the new plan and 4) if I couldn't afford it anymore because I would be paying $50 out of pocket for it, would I have to go back, make a new appointment with the OBGYN and get a new Rx for something different?

This is completely ridiculous on multiple levels. I'm not even someone who qualifies as actually poor, but birth control has been at various times in my life a major expense and a major hassle. I intend to call my insurer and ask if they're going to "voluntarily comply" with this early, because I could use an extra $30-50/mo. That's high speed internet. That's days of groceries. A tank or two of gas in my car. And again, I'm not poor, just on the lower end of the income distribution.
posted by slow graffiti at 2:55 PM on August 2, 2011 [1 favorite]


miyabo, what qualifies as "non-standard"? I see the utility of your implementation but lots of girls go through lots of pills, and then end up on something else entirely (moi). Is an IUD non-standard? (Not in China or the UK, according to my understanding.) Who gets to decide who gets hassled? I mean, I only have to deal with it once every five years, so okay fine, but disparate treatment because standard birth control pills make me a head case is not really super okay with me.
posted by Medieval Maven at 3:03 PM on August 2, 2011


Obviously I'd prefer for the government to cover all forms of birth control, but providing generic hormonal BC would cover an awful lot of people at extremely low cost. Once you start getting into patented BC or IUDs, the costs rise from a few dollars a year to a few hundred.
posted by miyabo at 5:16 PM on August 2, 2011


miyabo - I'm not sure you're correct about the relative costs of IUDs vs pills. Even though the government could probably negotiate a relatively larger discount on generic pills vs IUDs which are more expensive to manufacture, it would need to be a pretty huge discount before it beat even the retail cost per year of an IUD, which usually works out to under $100. That's not even $10/mo.
posted by slow graffiti at 5:24 PM on August 2, 2011


relative costs of IUDs vs pills

When I started out on birth control I was on a pill that cost me $35 each month. $35 x 12 months = $420 annually, not counting any co-pays for doctor visits solely to get my prescription renewed. Four copays per year for visits like that, on my insurance at the time I was on the pill, would run me $120 (each copay was $30). So for one year, it used to cost me $540 to have birth control.

I switched to an IUD five years ago. The device plus "installation" fees, copay, etc., cost approximately $650. As I've incurred no other reproductive health costs in relation to my IUD, that makes the annual cost of my IUD $130.

$540 versus $130 is a pretty steep difference.
posted by palomar at 5:42 PM on August 2, 2011


$540 versus $130 is a pretty steep difference.

Well, and it's not surprising that in China, where for years they have a lot of people to provide contraception to on a limited budget, IUDs are the method of choice (or at least they were, as of a few years ago; I don't know if this is changing).

IUDs are exactly the sort of high-upfront / low-backend costs that it makes perfect sense to subsidize. It's not hard to imagine someone being interested in one, but staying on pills because of the high upfront costs, even though the pills will eventually cost them more.

That said, I'm not sure as a matter of policy that it's really a good idea to favor one birth control method over others, and you could make the same argument for subsidization about birth control generally, not just IUDs. There are huge costs, both social and economic, associated with unintended pregnancies, and in any sort of remotely rational world we'd provide all but the most exotic forms of birth control gratis just to reduce the number of unintended pregnancies and all their associated downstream costs.

The only reason why we don't do this, given that it would have an obvious return on investment in probably only a few months, is because there are a small-but-vocal core of anti-contraception hardliners who vote, and have managed to conflate the contraception issue -- which is really a "non-procreative sex" issue -- with abortion and a bunch of other controversial social issues.

Happily, virtually all evidence points to the anti-contraceptionists being on the wrong side of history, and this is certainly a step in the right direction, even if it's far short of where we ought to be.
posted by Kadin2048 at 6:58 AM on August 3, 2011


So, free condoms, right?
posted by gjc at 7:40 PM on August 3, 2011


Well, it'd certainly be a start.
posted by Kadin2048 at 9:47 PM on August 3, 2011


Medieval Maven : disparate treatment because standard birth control pills make me a head case is not really super okay with me.

"We've decided to make thing X available to you for free".

"But but but... I want more-expensive thing Y, what about that?"


gjc : So, free condoms, right?

C'mon, free birth control for males? Crazy talk, dude!


Or by the FDA's own reasoning FTA, "Since birth control is the most common drug prescribed to women, health plans should make sure it’s readily available". Okay, when do I get my free statins?

"Other preventive services covered include: [...] Screening for the virus that causes cervical cancer for women 30 and older." - And my free PSA testing starts when?

"Annual HIV counseling and screening for sexually active women." - Right, I keep forgetting that only women get HIV.

"Screening for and counseling about domestic violence." ... And abused.

"Annual counseling on sexually transmitted infections for sexually active women." ... And STDs in general.


For those who consider the above somewhat catty, I would point out that most STDs more easily pass from males to females than vice-versa. If you want to stop their spread, try treating the source of the problem.

I actually support the birth control part of this, because that affects everyone. But the rest of it? How the hell does this not have "blatant discrimination" written all over it?
posted by pla at 3:49 AM on August 4, 2011


pla, I was responding to a hypothetical. At this point, it seems it's just all covered without copay, which would mean that I don't have to pay the $50 device fee (I think). Which is equitable.

While you're blasting things you haven't researched, you could read this summary, which I found by using my great powers of google ("affordable care act" "preventative care") - which states among other things that HIV testing will be available to all adults at higher risk, as well as STI screening (including syphillis!). No, I don't know what "at higher risk" means, but it's there.

Now, I know, "What about the men?" is a really popular question here, but in my experience, I know very few men who've been on the phone trying to get routine labs covered, you know, to make sure they don't have cancer.
posted by Medieval Maven at 5:48 AM on August 4, 2011 [1 favorite]


Medieval Maven : While you're blasting things you haven't researched

I think you mistook my statement for sarcasm - I certainly meant it with a bit of vitriol, but not directed at you.

First, I would love to see real ubiquitous single-payer national healthcare. We currently pay more than other 1st-world countries with exactly that, just to get seniors and the poor something approaching a passable level of healthcare. That needs to go away ASAP.

Second, I in no way grudge women for getting any of the services of interest here. I don't, however, think that a piecemeal approach via reverse discrimination will ever accomplish the real goal.

I do, however, have a problem with saying "we'll give special interest group X this, but not offer everyone else the analogous coverage". When no analog exist, okay, fine; When an obvious 1:1 mapping exists (for example, STD testing), yeah, I have a problem with that.
posted by pla at 9:06 AM on August 4, 2011


Colbert: Obama is using your tax dollars to create an “army of flesh-thirsty young sluts”
posted by homunculus at 2:29 PM on August 4, 2011


Sex, birth control, and the far right social agenda
posted by homunculus at 2:00 PM on August 8, 2011


House GOP Revives Global War on Women's Health With "Gag Rule"
posted by homunculus at 10:34 PM on August 8, 2011


A Map Of Where You Can Use Your Insurance To Pay For An Abortion
posted by homunculus at 11:58 PM on August 22, 2011


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