2014
I’m back to my favorite pet peeve, the mandate to provide free contraception in health plans. Frankly, I don’t give a hoot who takes the pill or why, that’s their business. It’s like eating at Burger King every week, or spending $4.00 a day at Starbucks or $200 on a tattoo, not my business, that’s their money; who cares?
But wait, as much as proponents try to create the opposite impression, the pill issue is not about who uses it, but who pays for it and that I do care about. You see contraception is discretionary, highly affordable, even to poor women who already have coverage under many Medicaid programs. But even without health insurance, the cost is modest when you rank it among other things bought routinely on a voluntary basis.
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“Not My Boss’s Business?” Okay, it’s nobody’s business if you use contraceptives or not, but your boss is paying for what you choose to do and wouldn’t it seem that is the boss’s business? If it is somehow unfair, indeed discriminatory in the minds of some people, for women to pay for contraception, how is it fair for employers, fellow workers, insurance companies and other insured people to pay for this discretionary expense that is not health care?
Oh I know, the plans pay for a pregnancy so why not to prevent a pregnancy? The fact is, long before Obamacare, most health plans covered contraceptives the same as any other prescription drug and that’s fine if the plan chooses to do so. But there is no justification to pay 100% of the cost of a totally discretionary prescription when essential medications require a co-pay.
For the record here is a fairly standard definition of medically necessary health care:
• Necessary to meet the basic health needs of you or your covered dependents;
• Rendered in the most cost-efficient manner and type of setting appropriate for the delivery of the service or supply;
• Consistent in type, frequency, and duration of treatment with scientifically based guidelines of national medical, research, or health care coverage organizations or governmental agencies that are accepted by the claims administrator;
• Consistent with the diagnosis of the condition; 👀
• Required for reasons other than the convenience of you or your doctor;👀
• Demonstrated through prevailing peer-reviewed medical literature to be either:
— Safe and effective for treating or diagnosing the condition or sickness for which use is proposed; 👀 or
— Safe with promising efficacy:
— For treating a life-threatening* sickness or condition;
— In a clinically controlled research setting; and
— Using a specific research protocol that meets standards equivalent to those defined by the National Institutes of Health.* For the purpose of this definition, the term “life-threatening” is used to describe a sickness or condition that is likely to cause death within one year of the request for treatment.
The fact that a physician has performed or prescribed a procedure or treatment or the fact that it may be the only treatment for a particular injury, sickness, mental illness, or pregnancy, does not mean that it is “medically necessary” as defined above.
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QUINNSCOMMENTARY 
Sorry, no more, no less proscriptive than kids to age 26 – which could have been kids to age 28 (as in Ohio insurance) or kids to age 25 years 11 months and 16 days. Totally arbitrary. Why not contraceptives and colonoscopies?
The issue here is, was, and will continue to be … who gets to decide. And, Americans are in the mood, still, after 5+ years of discretionary rule by the current Administration, that they will continue to follow the golden rule … those with the gold, rule or just as accurately, those who get to rule on gold, decide. Whether it is in soliciting money from the privileged class, a la the recnt supreme court decision, or it is part of enacting a tax on higher income (note I did not say wealthy) Americans, those who rule on gold … get to decide.
I am not a libertarian, but we am being pushed, HARD, in that direction … by the assumption that other people should get to decide, other people know best, other people should have control. ……
In the past, the tax system encouraged employers to voluntarily adopt benefit plans, and the government believed it could then be proscriptive … what you must do to maintain the tax preferences. Subtle difference in how they treat individual insurance … in that the same tax preferences do not apply. That is, Congress believes they have the right or maybe the responsibility to ensure that valuable tax preferences are used in a way beneficial to society. Individual tax preferences (deductibility for costs > 10% of adjusted gross income, above the line deductions for HSA contributions, etc.), are similar but slightly different preferences – designed to encourage you, the individual to have coverage and help society minimize its burden to treat you when ill/injured. Today, we have now gone beyond that by saying whether or not you get the tax preference (group health), and whether or not you pay a penalty tax (requirement for minimum essential coverage), if you offer a health plan (if you purchase a health plan individually) it must include, no cost sharing contraceptives and colonscopies.
See the difference … it is subtle, but significant … The specific provision is NOT a condition to receive the tax preference, but a limit on your ability to purchase a specific good or service (or exclude a specific good or service) through insurance. Individual insurance must have the no cost sharing preventive services – there is no insurance policy without it (except for the few policies that remain grandfathered). And, you can’t offer a group health plan (self-insured), without the no cost sharing preventive services. (By the way, if I was a lawyer assigned to the case, that is what I would have attacked … this cannot be so compelling a need to mandate the cost sharing for these services where Congress intentionally exempted a whole class of Americans REGARDLESS of their needs – those in grandfathered plans).
Some would argue that this is little different than cars with mandatory seat belts, or the requirement for you to wear a helmet when operating or riding on a motor cycle. Again, the difference is subtle, in that health care is so personal, so unique, … not the result of some privilege bestowed by society (to operate a vehicle alongside others in society), but many would say a “God given” right as other freedoms enshrined in our Declaration of Independence.
How you view these changes says everything about how you react to the demonstrations. That is the reason why you end up with a similar emotional response as you do when youi see people on the same steps arguing over abortion. It is also why you have a slightly different feeling when you see people demonstrate over property rights, illegal immigration, etc.
Dick, thanks again for bringing this up and to our attention.
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Benefit Jack….Bravo, well said
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I don’t disagree with your comments, but I maintain the contraceptive issue is unique mainly because it is not health care, it was pushed by women’s rights groups, opposition was classified as a war on women and it stands alone as a politucal (votes) issue unlike the other health care mandates. The mandate to cover the pill is one thing and speaks to your comments, but to make it free alone among prescription drugs, is a separate issue in my mind. As I have said before on the blog, how can anyone accept the logic a thirty something working women should have free birth control, but a fifty-year old man or women of lesser means should pay a $30 co-pay for their heart medication?
Beyond your justified concerns overall is the blatant politics of this one item. You would not believe the criticism I have been barraged with via twitter by women who think I am against women’s rights or just women, just for asking why they should not pay $25 a month for the pill when most spend more than that on manicures. What good are free contraceptives without free ED medication? Hmmm, could that be age discrimination? LOL
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