Tag: Hormonal contraception

Pills Is On Us

Hmmm. It is looking very likely that, under Obamacare, the government will mandate that birth control pills be covered at 100% by insurance companies.

This seems like a good idea on paper — it might prevent some unwanted pregnancies. But I’m kind of mixed on it. The more I think about it, the more I wonder if we’re going to see minimal benefit for significant imposition. Bear with me for a moment.

First, this is going to make health insurance more expensive. Yeah, I know — just passing a regulation does not make free birth control pills rain down from the sky. Liberals still have a huge lacuna on this concept. I discovered this in grad school, when students reacted with shock and outrage when they found out that covering BCP’s in the student insurance would raise rates by the cost of the pills. The cost increase will be minimal, but it’s not zero. Liberals always claim that birth control should save insurance companies money, but it’s not clear that is necessarily true. Children are, generally speaking, very profitable to insure. Preventative care can do a lot of things — saving money is not one of them.

Second, this marginally increases the discrimination in Obamacare. Congress already forbad insurance companies from charging women more for insurance just because they happen to use more healthcare. The cost of pills will therefore be split and shifted around so that everyone, from 60-year-old men to 53-year-old menopausal women, are still paying a little extra. In principal, that’s not so bad. Our government system already shifts money from the young to the old, from the rich to the poor and from the childless to the childed (is that a word? It should be).

Third, there’s a moral question. Because women getting BCP’s will not see their insurance rise, you are forcing everyone else to pay for their pills. There are a lot of people who have moral qualms about the pill. Is it right to force them to pay for it? We already do through birth control subsidies and Medicaid, of course. But this is a little different, requiring employers who may have an objection to pay for this anyway.

The gripping hand here is that this is very unlikely to produce the huge social benefit the liberals are hoping for. There are already subsidies for poor women to get pills and the poorer are on Medicaid. Moreover, I am unconvinced that the cost of pills is the limiting factor in unwanted pregnancies. Irresponsible behavior is far more insidious problem, one that money can not make go away (and frequently makes worse). The primary beneficiaries will be women who have the money to buy insurance or have jobs. These are, generally speaking, not women to whom a copay is the principle roadblock to birth control. This may buy votes from them, but it’s unclear that it will keep babies out of them.

For me, the critical argument is the first one I made — the increased cost of insurance. Birth control pills are small potatoes but we are setting a precedent for future mandates that will drive up the cost of insurance even further. Because once you’ve mandated 100% copay-free coverage for birth control, what’s to stop you from mandating mental health? Or cancer screenings? Or free physicals? Or free flu shots? Or any of a number of things that sound reasonable but add up to make insurance more expensive?

In the end, we will all be priced out into the Medicaid gulag.