FEDERAL MANDATE FORINSURANCE COVERAGE OF CONTRACEPTION

Trever Pearson and Holly Szafarek

PA 770

April 13, 2012

PROBLEM IDENTIFICATION

Benefits of Contraception Pregnancy Prevention Women in the Workplace Medical Benefits

Prohibitive Cost Deficit Reduction Act (DRA) Half of all pregnancies unintended

$12 Billion/yr

Equal Protection Burden felt mostly by women

CRITERIA OF EVALUATION

Economic Efficiency

Distributional Equity

Cultural/Political Acceptability

ALTERNATIVE 1 - STATUS QUO No Federal

Intervention State Regulation

Contraceptive Equity Laws 26 states have such laws

http://knowledgecenter.csg.org/drupal/content/states-forefront-contraception-mandates

ALTERNATIVE 2 - FEDERAL MANDATE

Requires insurance coverage of preventive health services for women.

Includes: Contraceptives Emergency contractive drugs Plan B and Ella Sterilization

Excludes:Abortion pill RU-486

Exemption: Religious organizations such as churches

ALTERNATIVE 3 - FEDERAL MANDATE W/ BROADENED EXEMPTIONS

Same insurance requirement for contraceptives

Broadened exemptions to include religiously-affiliated institutions that object to coverage Hospitals Universities Social Service Agencies

EVALUATIONS OF ALTERNATIVESCRITERIA 1 – ECONOMIC EFFICIENCY

$1 of coverage saves $4.02 in Medicaid birth costs (Rose, 2009, p. 25)

Contraception Services Saves $4.3 billion in Medicaid pregnancy costs Not including the costs of treatment for diseases

prevented by birth control (p. 24) Unintended pregnancy costs nearly $10,000 each,

a total of $12.1 billion in Medicaid and Children’s Health Insurance Programs and $103 million in abortion costs (Thomas & Monea, 2011, p. 3).

EVALUATIONS OF ALTERNATIVESCRITERIA 1 – ECONOMIC EFFICIENCY (CONT)

Status Quo Inefficient and does nothing to reduce costs

Mandate without Exemption Employer premium increase: 0.6%

Failure to provide coverage for contraception could cost employer approx. 15-17% more (Chettiar, 2002, p. 1878)

Mandate with Exemption Similar to without albeit a shift in cost from

employer to insurance provider

EVALUATIONS OF ALTERNATIVESCRITERIA 2 – DISTRIBUTIONAL EQUITY

Equal Protection Rights

Status quo creates a burden felt by women

Federal mandate is intended to “eliminate discriminatory insurance practices that undermine the health and economic well-being of women” (Chettiar, 2002, p. 1877).

Broadened religious exemptions may created a different equity issue First Amendment’s Establishment Clause

EVALUATIONS OF ALTERNATIVESCRITERIA 3 – CULTURAL/POLITICAL ACCEPTABILITY Highly divisive issue

First Amendment Free Exercise Rights v. Equal Protection Rights Government responsibility to uphold equal protection rights Religious groups don’t want to pay for the health decisions

of the immoral Economic Conservatives see mandate as an intrusion into

private sector

Status Quo – “War on Women”, Religious takeover of Government

Mandate with no Exemption – “Attack on Religion”, Government takeover of Private Sector

Mandate with Exemption – Government takeover of Private Sector

COMPARISON OF RESULTS

Alternatives

Criteria Status Quo

Insurance Mandate

Mandate w/ Broadened Exemptions

Economic Efficiency

Bad Good Good

Distributional Equity

Bad Good Moderate

Cultural/Political Acceptability

Bad Bad Not as Bad

Score 3 9 9

*Bad = 1, Not as Bad = 2, Moderate = 3, Good = 4

RECOMMENDATION

Federal mandate with broadened exemption