President Obama says his administration has found a way to do what it always said it wanted to do: Provide access to birth control, free of charge, while respecting the wishes of religious employers who object to contraception in principle.
As ABC’s Jake Tapper was the first to report, the government will allow religious organizations to opt out of the requirement to include birth control coverage in their employee insurance plans. In those instances, the insurers themselves will offer contraception coverage to enrollees directly, at no additional cost.
The White House says this is possible because, overall, contraception saves money. That appears to be true. Independent analysts have found that the upfront costs of providing birth control are less than the long-term costs of prenatal and maternity care. In theory, this means insurers could handle the cost of contraception without drawing extra employer funds.
Theory and practice are different things, of course. Birth control may save money over the long run, but the drug makers and doctors providing it will still charge fees. How will insurers pay those fees? And what about self-insured institutions, who effectively pay all medical bills out of their own coffers? The Washington Post’s Sarah Kliff gets at the potential glitch here:
The catch here is that there’s a difference between “revenue neutral” and “free.” By one report’s measure, it costs about $21.40 to add birth control, IUDs and other contraceptives to an insurance plan. Those costs may be offset by a reduction in pregnancies. But unless drug manufacturers decide to start handing out free contraceptives, the money to buy them will have to come from somewhere.
Senior administration officials have told me that they are convinced, based on consultations, insurers can provide these benefits in accordance with the new policy. They said that insurers already make similar arrangements in some parts of the country where similar laws apply.
And what do the insurers say? The official response from America’s Health Insurance Plan was tepid, although it left open the possibility of finding a way to make the new rule work:
Health plans have long offered contraceptive coverage to employers as part of comprehensive, preventive benefits that aim to improve patient health and reduce health care cost growth. We are concerned about the precedent this proposed rule would set. As we learn more about how this rule would be operationalized, we will provide comments through the regulatory process.
(One possible workaround occurred to me, although I’m not aware of any administration or industry official who’s proposed or considered it: Employees generally pay premiums for health coverage, either directly or through explicit withholding. Those premiums are considerably larger than the upfront cost of contraception. Insurers administering plans could, therefore, pay doctors and pharmacists by drawing exclusively on money from employees. That would seem to satisfy the demands of religious leaders whose objection was to financing contraception explicitly with their own dollars or to playing some other active role in obtaining contraception coverage.)
If the new scheme works—still a big if, obviously—it would accomplish what’s seemed so elusive in the last few days: Pursuing the public interest in a way that makes reasonable accommodations of religious faith. Note that Planned Parenthood and the Catholic Hospital Association have issued statements supporting this arrangement. Sister Carol Keehan, president of CHA, said she was “very pleased” by the result.
Alas, not everybody is so happy. Shortly after Obama's press conference, the Conference of Catholic Bishops called the announcement a “first step in the right direction.” A few hours later, the Bishops issued a longer, more critical statement effectively rejecting the proposal. But, as I’ve said before, Catholic groups have split on these issues before, most memorably during the fight over the Affordable Care Act. When the administration proposed a compromise on funding for abortion, CHA embraced it while the Bishops said no. Sister Carol's support was instrumental in breaking a congressional impasse and making enactment possible.
This difference of opinion is not surprising. As a veteran health care operative once pointed out to me, health care is a reality for the nuns who run the hospitals. For the bishops, it's more of an abstraction. And so while the former think long and hard about how to improve access to care, for the sake of their institutions as well as their patients, the bishops tend to focus more on other imperatives, like the church’s declaration that contraception is a sin.
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