“You Can’t Fix Stupid”: Birth Control Is Different Than Starbucks
The controversy over contraception has faded a bit. Congressional Republicans are rethinking efforts to overturn a requirement that would make birth control coverage a mandatory part of health insurance. Rush Limbaugh has stopped talking about the issue, at least for the moment.
But the issue hasn’t gone away entirely. The administration is still working on ways to accommodate the wishes of some large religious institutions opposed, for reasons of faith, to sponsoring employee benefits that cover contraception. (On Friday, it unveiled a few options and announced it was seeking public comment on them.) Conservatives, meanwhile, continue to press their case.
With that in mind, let’s talk about a conservative argument that isn’t simply about religion or the morality of birth control. It’s the suggestion that birth control coverage simply doesn’t belong in health insurance, because it’s not an expense that all of us should be subsidizing.
Among those making that argument recently was syndicated columnist Mona Charen. After arguing that contraception costs “less than the cost of a weekly trip to Starbucks” and that a variety of programs, public and private, make free contraception available to the poor, Charen draws a distinction between birth control and other types of drugs:
Contraceptives are not a matter of life and death. But even if they were, such as cancer drugs are, is that an argument for forcing insurance companies to provide them free? Why not force free distribution of all medicines? The mandate makes no economic, social or moral sense.
Actually, it makes economic, social and moral sense.
Let’s put aside the question of whether contraception coverage should be “free,” because that’s not really the issue anymore. Republican Senators Roy Blunt and Marco Rubio, along with the Conference of Catholic Bishops, have said they oppose any requirement that forces employers to cover contraception, regardless of whether such coverage requires out-of-pocket expenses.
And, one more time, let’s dispense with this notion that every woman can get birth control for less than the weekly cost of Starbucks. As noted here previously, the cheap drugs at Target, Walmart, and the other big chains are great if you take the standard combination hormonal pills, which combine estrogen and progestin. But some people cannot or should not take those pills. They’re not good for postpartum women who are breast-feeding, for example, and they cause side effects for many others. They may not be as effective, for some women, as methods like intrauterine devices, depo-provera, or surgical sterilization.
How many women fall into those categories? It’s a minority of the population, to be sure. But that’s always the story with health care and health insurance. At any one time, most people don’t require expensive medical care. Only a small number of people do. It’s precisely for the sake of that group – the ones who face high expenses, and could face financial or medical turmoil without assistance – that insurance exists.
Keep in mind that, at some point or another, pretty much everybody falls into that category. Maybe you’re not a woman who needs expensive birth control. You might still be a woman, or a man, who ends up with heart disease. Or allergies. Or a chronic gastro-intestinal problem. Or cancer. Insurance is there to take care of you, so why shouldn’t insurance be there to take care of a woman who needs more expensive forms of contraception?
No, birth control isn’t treatment for an acute condition. It’s routine, preventative care. But that hardly undermines the case for coverage. Think about eye exams for a moment. Or blood pressure checks. Both of these are widely available, for very low cost. In fact, if you do the math, over the course of a year either one would cost less than a year’s supply of even generic hormonal contraception. But insurance typically covers those costs and, under the Affordable Care Act, insurance must cover those costs – because this sort of care keeps people from getting serious medical conditions and, quite possibly, saves money in the long run.
The very same things are true of birth control. Pregnancy is a wonderful thing, but it’s also a serious medical condition that requires serious medical attention. (Those of you unfamiliar with what pregnancy entails might want to consult this page from the American Academy of Family Physicians – or ask a woman who has been pregnant.) Don’t forget, too, that some women take contraception to control their menstrual cycles or for reasons that aren’t really related to avoiding pregnancy.
Some critics insist there’s a difference between screening for hypertension or vision problems, on the one hand, and controlling the timing of pregnancy, on the other. Non-procreative sex, they say, is a purely voluntary act, for which others should not have to pay. “No one is touching your birth control, ladies,” conservative writer Amanda Carpenter tweeted on Friday. “We just don’t want to be forced to pay for it.” But, according to statistics from the Guttmacher Institute, 99 percent of women use birth control at times during their reproductive years. Based on that, I think it’s safe to assume that non-procreative sex is an activity in which virtually everybody engages, at some point or another, and for which a large majority will need birth control.
And so we’re back to the question that’s always been at the very heart of our health insurance debate: Do we think responsibility for medical expenses should lie primarily with individuals, even if that means some won’t be able to afford it? Or is it a burden we wish to spread more broadly, across society, so that everybody can get the care they need, at a price they can afford?
You know where I stand on that question.
P.S. When the administration announced its options for accommodating religious institutions on Friday, it also released a rule about health plans for college students – and, in so doing, revealed that, for legal reasons, it does not have the authority to regulate all the plans. Sarah Kliff has the story. It doesn’t sound like a huge deal, but, as she notes, it’s yet another reminder of how complex insurance regulation is in the U.S.
By: Jonathan Cohn, The New Republic, March 16, 2012
“Unlicensed Doctors”: Politicians Swinging Stethoscopes
Let’s take a look at sex and state legislatures.
Never a good combo. Lawmakers venture into murky waters when they attempt to deal with the mysteries of human reproduction. The results are generally short of scientific. Once, when I was covering the Connecticut House of Representatives, a bill introduced at the behest of professional musicians, “An Act Concerning Rhythm Machines,” was referred to the Public Health Committee under the assumption that it was about birth control.
That was a long time ago, but a definite high note. Normally when these matters come up in a state capitol, the result is not chuckles.
New Hampshire, for instance, seems to have developed a thing for linking sex and malignant disease. This week, the State House passed a bill that required that women who want to terminate a pregnancy be informed that abortions were linked to “an increased risk of breast cancer.”
As Terie Norelli, the minority leader, put it, the Legislature is attempting to make it a felony for a doctor “to not give a patient inaccurate information.”
And there’s more. One of the sponsors, Representative Jeanine Notter, recently asked a colleague whether he would be interested, “as a man,” to know that there was a study “that links the pill to prostate cancer.”
This was at a hearing on a bill to give employers a religious exemption from covering contraception in health care plans. The article Notter appeared to be referring to simply found that nations with high use of birth control pills among women also tended to have high rates of prostate cancer among men. Nobody claimed that this meant there was scientific evidence of a connection. You could also possibly discover that nations with the lowest per capita number of ferrets have a higher rate of prostate cancer.
Bringing the prostate into the fight was definitely a new wrinkle. But it’s getting very popular to try to legislate an abortion-breast cancer link. I suspect this is at least in part because politicians in some states are being forced to stretch to find new ways to torture women who want to end an unwanted pregnancy. It’s sort of like gun control — once your state already has guaranteed the right to wear concealed weapons into bars and churches, you’re going to have to start getting really creative to reaffirm a commitment to the Second Amendment.
Last year, South Dakota — which has a grand total of one abortion provider — instituted a 72-hour waiting period, plus a requirement that the woman undergo a lecture at one of the state’s anti-abortion pregnancy counseling centers.
This law is tied up by litigation. While they’re waiting, the legislators have improved upon their work, requiring the doctor to ask his patient — who may have already traveled for hours, waited for three days and gone through the counseling center harangue — questions including what her religious background is and how she thinks her family might react to the decision to end the pregnancy.
“South Dakota has taken the I.R.S. audit model and applied it to women’s reproduction,” said Ted Miller of Naral Pro-Choice America.
But about this cancer business.
“Now we’re seeing why legislatures getting into the practice of medicine is dangerous,” said Barbara Bollier, a Republican state representative in Kansas, where a bill requiring doctors to warn abortion patients about the breast cancer connection is pending.
Bollier is a retired anesthesiologist, who also formerly taught bioethics. If you wanted to have a résumé guaranteed to drive you crazy in the Kansas State Legislature, she’s got it.
We had a very interesting discussion over the phone about good science — what makes a reliable study, and how an early suggestion of a possible connection between abortions and breast cancer was overtaken by larger, better studies that showed no evidence of a link whatsoever. All of this has been shared with the Kansas Legislature, to no effect whatsoever.
Bollier has her finger on the moral to all this. When faced with a choice between scientific evidence and their personal and political preferences, legislators are not going to go with the statistics. I have warm memories of the committee of the Texas House of Representatives that last year rejected a bill to require that public school sex education classes be “medically accurate.”
Let’s refrain from discussing how the people who are preparing to legislate medical science are often the very same ones who scream about government overreach when health experts propose taxing sugary beverages.
Just try to envision yourself in a doctor’s office for a consult. Then imagine you’re joined by a state legislator. How many of you think the situation has been improved? Can I see a show of hands?
Thought so.
By: Gail Collins, Op-Ed Columnist, The New York Times, March 16, 2012
Arizona’s “20th Century Boss” In 2012: Using Birth Control? You’re Fired!
First, a bill that gives immunity to doctors who lie to couples about the results of their prenatal tests in order to prevent them from getting an abortion. Now, a bill that would give your boss the green light to fire you for using birth control. You think I am kidding? I wish. For a decade now, Arizona insurance companies have been required to provide coverage for contraception just like other prescriptions. But, because they saw an opening to score some political points, some politicians there are suddenly moving to take that coverage away from women and their families.
And we aren’t talking here just about exemptions for religiously affiliated employers like Catholic hospitals and universities. We are talking about authorizing secular, for-profit employers to deny a woman coverage for birth control if the employer doesn’t believe that she and her partner should be allowed to have sex without getting pregnant. Yup, that’s right. If the owner of the Taco Bell where you work opposes birth control, Arizona legislators want to give him a legal right to deny you insurance coverage for your pills.
Sadly, that isn’t even the half of it. You may want to sit down for this one. Arizona legislators know that whether or not her insurance covers it, a woman may get the prescription she needs to prevent an unintended pregnancy. They want to give her boss the right to control that too. The bill they are pushing would not only allow employers to take the insurance coverage away, but it would also make it easier for an employer who finds out that his employee uses birth control to fire her. You heard me right . . . to fire her. And I thought Rush Limbaugh’s comments were as low as you could go on this one.
The Arizona bill has, incredibly, already passed one house, but we can still stop it. We’ve seen what can happen if we make our voices heard. So, if you’ve had enough; if you think the decision about whether to have a child is one for you and your partner, not your boss and your senator, I urge you to speak up now. Tell the legislators in Arizona to stop playing politics with women’s health and put personal and private decisions back in the hands of a woman and her family.
By: Jennifer Dalven, Reproductive Freedom Project, ACLU Blog, March 12, 2012
Today’s Republican Party: “Grand, Old And Anti-Woman”
Senator Lisa Murkowski of Alaska got it half right on Tuesday when she told her Republican colleagues that their party was at risk of being painted as anti-woman. It would be more accurate to remove the hedges and say flat out that the G.O.P. is anti-woman.
There’s really no other conclusion to reach from the positions Republican lawmakers, and the contenders for the party’s presidential nomination, have taken on contraception, abortion and reproductive health services, including their obsession with putting Planned Parenthood out of business.
Republican opposition to reauthorizing the Violence Against Women Act certainly won’t help the party’s reputation. That law, which provides federal money to investigate and prosecute domestic violence, has had broad bipartisan support since it was enacted in 1994. Congress renewed it in 2000 and 2005 without struggle.
Senate Democrats have revised the law to include LGBT victims of domestic violence, dating violence and sexual assault. New provisions would also allow more immigrant victims to claim temporary visas. The latest version has five Republican co-sponsors, but it failed to garner a single Republican vote in the Judiciary Committee last month.
Despite what Republicans might say to the press, the Democrats did not dream up these changes to infuriate their opponents—they were responding to calls from groups that help victims of domestic violence. A 2010 report from the National Coalition of Anti-Violence Programs detailed a woeful shortage of services for LGBT violence victims – including scarce access to shelters. An expanded Violence Against Women Act would reflect the reality of American life in the 21st century – when gay men and lesbians actually get married and illegal immigrants cannot merely be deported or wished away.
Naturally, certain out-of-control right-wingers are eager to fight over this bill. Phyllis Schlafly said last month that it promoted “divorce, breakup of marriage and hatred of men.” Because, I guess, women whose husbands are beating them should stay in those relationships and just try to work it out. Or maybe because if we provide assistance to lesbian women whose girlfriends beat them up, straight women will hate their boyfriends. (Honestly, what is the logic here?)
But Congressional Republicans are scared of another tussle. They are bleating that it’s not fair to attach these provisions in an election year, because voting them down would make Republicans look bad. Senator Jeff Sessions, Republican of Alabama, put it this way: “I favor the Violence Against Women Act and have supported it at various points over the years, but there are matters put on that bill that almost seem to invite opposition,” he said.
They only invite opposition if you are ant-immigrant or homophobic.
Including same-sex couples in domestic violence programs would not diminish their value for couples of opposite genders in any conceivable way. And giving a battered illegal immigrant woman a temporary visa is not a threat to national security.
The real agenda here is obvious: If a federal bill recognizes that there is such a thing as domestic violence in same-sex families, then that implicitly recognizes the legitimacy of those couples and that could lead – gasp – to giving them actual rights.
By: Andrew Rosenthal, The Loyal Opposition, The New York Times, March 15, 2012
GOP “Ultracraziness”: Experts On “Lady Stuff”, Ultrasounds And Contraception
If the state of Arizona excels at one thing, it’s passing laws that make people angry. Today, an Arizona senate panel voted to give all employers the right to refuse coverage of birth control on their health-insurance plans. The bill is awaiting approval by the State Senate. Arizona Representative Debbie Lesko, a supporter of the bill, explained her rationale to the Arizona Star: “I believe that we live in America. We don’t live in the Soviet Union. So government shouldn’t be telling employers, Catholic organizations or mom-and-pop employers to do something that’s against their moral beliefs.”
In other contraception news, the controversial “Women’s Right to Know” Act, which would make it mandatory for women to have ultrasounds before getting abortions, made some more enemies today.
Republican Virginia State Senator Ryan McDougle, who backs the bill, received a barrage of posts on his Facebook page today from women who oppose the bill, asking McDougle for gynecological wisdom. One woman, complaining about her period, wrote, “frankly, I’ve had enough of this inconvenience — the costs of pads and pain reliever and all the mess — well YOU know how it is. You’re an expert on this lady stuff.” McDougle’s staff promptly removed the comments, but not before a screenshot was taken.
Pennsylvania Governor Tom Corbett also chimed in about the ultrasound bill. When asked if he thought it was going too far to make a woman look at her ultrasound before having an abortion, he replied: “You can’t make anybody watch, okay? Because you just have to close your eyes.” All in all, a rough day for Republicans and ladies.
By: Eliza Shapiro, Daily Intel, March 16, 2012
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