Federal Mandate for Insurance Coverage of Contraception

1. Federal Mandate forInsurance Coverage of Contraception Trever Pearson and Holly Szafarek PA 770 April 13, 2012

2. 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

3. Criteria of Evaluation Economic Efficiency Distributional Equity Cultural/Political Acceptability

4. 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

5. 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

6. 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

7. 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).

8. 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

9. 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

10. 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

11. Comparison of results *Bad = 1, Not as Bad = 2, Moderate = 3, Good = 4

12. Recommendation • Federal mandate with broadened exemption