Readers be forewarned: this is a very long blog post.
About a week ago in this space, I criticized Grant Gallicho for saying, at the dotCommonweal blog, that the Obama administration’s recent “accommodation” of religious nonprofits under its HHS contraception mandate ought to satisfy its critics. After all, wrote Gallicho, “No arrangement proposed by HHS [under the latest proposed version of its policy] would oblige a Catholic institution to fund contraception coverage.”
And if critics, including the Catholic bishops, fell back on a claim that the Church’s educational and charitable ministries would be facilitating contraception coverage even if they didn’t pay for it, Gallicho was ready for that too: “The facilitation argument doesn’t withstand scrutiny.” He argued that even if an employer dropped all health insurance coverage (and got away with that), its employees would still have to buy insurance as individuals with the wages they were paid—insurance that “would certainly include contraception coverage,” presumably because no coverage lacking it would be available to them—and so it really made no difference if the employer paid for it in the first place.
While I offered some criticism of Gallicho’s sloppy description of the categories of employers either “exempt” from the policy, or “accommodated” under it (both of which, he wrongly said, could “opt out” of coverage for their employees, when that is true only of the first category), my main purpose was to explain why Gallicho was wrong to say that the “accommodated” employers will not be arranging and paying for their employees’ contraception coverage. I had previously explained this at Public Discourse, and I went over it again here, saying:
Perhaps the administration is as confused about the economic reality of insurance as Gallicho is, so I will not accuse it of a deliberate lie. But when it claims that the “free” contraceptive coverage can be afforded by the insurer because “cost-savings” will result from “improvements in women’s health and fewer childbirths,” the administration is admitting that the contraception is already being paid for by the employer, if its policy covers childbirth and women’s health in general. The insurer is not being told to lower its premiums because of the cost-savings on procedures and ailments already covered; it is being told that it can put the cost-savings toward the expense of providing contraception. The existing premiums, paid by the employer, will be the funding source.
A week later, Gallicho has now responded to me, with a useful tutorial on how insurance works. I beg the reader’s pardon for a long extract from Gallicho’s latest:
When a group like, say, EWTN pays monthly premiums to its insurance provider, the insurer does not take the money, deposit it in an account used only for the TV network’s premiums, and then pay EWTN employees’ medical bills out of that account. Rather, the insurer pools EWTN’s payments with those from other customers. So when an EWTN employee gets an X-ray, the money that pays the bill may or may not come from EWTN. It may come from a company whose insurance coverage includes abortion. The insurer’s risk assessment of its policyholders determines whose monies fill the pools. If the same insurer covers EWTN and NARAL, the two organization’s monies will be mingled. Indeed, it’s the pooling of premiums that provides the incentive for insurers to offer contraception at no cost to their customers. . . .
So, pace Franck, when it comes to determining who’s really funding contraception for employees of accommodated organizations, “the existing premiums, paid by the employer” will not “be the funding source.” It may be one of the funding sources. It may not. The point is, there’s really no way to know, because insurance companies are in the business of spreading risk.
Everything Gallicho says in this passage is true. But it proves my point rather than his. A week ago he was denying that employers in the category receiving an “accommodation” under the HHS mandate would be paying for (“funding,” in his word) the coverage their employees receive for contraception. Now he is affirming that they will be paying for it.
Follow the logic of his own description, and change “X-ray” in his example to “birth-control pills.” EWTN “pays monthly premiums to its insurance provider,” and the money goes into a common pool of funds for all employees in a multi-employer group of customers of that insurance provider. The provider is required by the arrangement to cover contraception costs for every customer’s employees, including EWTN. Then an EWTN employee gets birth-control pills, “free” under the plan. Who in his right mind would say that EWTN was not arranging and paying for the coverage?
When Gallicho writes that such an employer “may be one of the funding sources,” he gives the game away. He is one inch away from understanding the point he himself is trying to make, about the fungibility of money. All the employers paying premiums to one insurance provider are paying, in common, for the contraception coverage of all their employees. Another way to say it that is equally true is that each and every one of them is paying for contraception coverage, in a common “risk pool” (if that term applies accurately to a choice that has very little to do with risk), from which all their employees’ contraception is funded. All are paying; each is paying; if EWTN is one of the “all,” it is one of the “each.” It will be paying for contraception.
Gallicho may think he is still denying that the “accommodated” institutions will be funding the contraception coverage. But it is a curious kind of argument when one can only “deny” that someone is committing an act by affirming that everyone, including that someone, is committing it. That is the space Gallicho now occupies, and whether he knows it or not, he is now in agreement with me, and joins me in refuting the administration’s claim that “accommodated” institutions will not be paying for contraception coverage. Of course they will be, and they will also be contracting for it, when arranging their employees’ health care plans and choosing a provider.
It may indeed be very hard for employers to find insurance companies to do business with that don’t cover contraception for someone. If Employer A pays premiums into a common risk pool, but his employees get no contraception coverage, and Employer B pays premiums into the same pool and his employees do get the contraception coverage, then one can say that A’s premium payments, once submerged, cannot be said to be not paying for the contraception used by B’s employees. Likewise, if A’s employees get a more copious form of coverage for maternity care than B’s employees, then B cannot be said to be not paying for that too, if all claims are being paid out of common funds held by the insurer. Still, B is not responsible for what A’s employees get, and the reverse is true: A is not responsible for what B’s employees get.
But this is why it is vitally important that the government not dictate the provision of morally wrong forms of coverage to one’s employees. If I run “Carolina Catholic College” and sign a contract with Blue Cross, it may trouble me that Blue Cross is providing birth control pills to Duke employees, but in its contract with my college, it better not provide those pills to our employees. I am not culpable for the arrangement BC has with Duke. I am directing premiums to a common BC pool out of which funds pay for Duke employees’ birth control pills, but at least I have not created a triadic relationship in which BC, by virtue of its contract with us, provides those pills to Carolina Catholic employees.
The current HHS accommodation preserves exactly that triadic relationship, under a deception that the link is severed between employer’s actions and employees’ access to contraception. It is not severed. In addition to the moral problem of scandal, and damage to the witness of the institution, there is still real cooperation and agency in the transaction that brings about the access to contraception. I must still look at the situation, if I am one of these employers, and say “I am arranging and paying for my employees to have contraception in their health insurance coverage.” The “accommodation” does not change that.
If you doubt this, examine the HHS mandate with respect to employers like EWTN or Belmont Abbey College both before and after the new “accommodation” was formulated. Here is the situation before the “accommodation”:
1. The religiously affiliated nonprofit employer contracts with an insurance provider for group health insurance for its employees, for which it pays the premiums.
2. The employees’ health care, by virtue of this contract, includes coverage from this insurance provider, as “preventive care” for women, all FDA-approved prescription contraceptive drugs and devices, including abortifacient pharmaceuticals, as well as sterilization services.
3. The employer informs the employees of the terms of the coverage for which it is paying, including automatic contraception coverage. These terms are explained in materials prepared by the insurance provider that are provided to the employer and passed on by it to the employees.
Now examine the situation the Obama HHS has proposed to create for “accommodated” institutions:
1. The religiously affiliated nonprofit employer contracts with an insurance provider for group health insurance for its employees, for which it pays the premiums.
2. The employees’ health care, by virtue of this contract, includes coverage from this insurance provider, as “preventive care” for women, all FDA-approved prescription contraceptive drugs and devices, including abortifacient pharmaceuticals, as well as sterilization services.
3. The employer says nothing to the employees about their automatic health insurance coverage for contraception, and all materials given to the employer by the insurance provider omit mention of it. Instead, the insurance provider communicates directly with the employer’s female employees and dependents receiving the coverage, explaining the drugs, devices, and services covered and assuring them that it is “separate” coverage.
Nothing changes in any substantive way, in the transition from the case “before” to the case “after” the latest HHS proposal. Stages 1 and 2 in the scenarios above are identical. All that changes is the story that is told in stage 3 of the above descriptions. And, where that story is not an openly, knowingly uttered lie, it is at the least a culpable omission that amounts to a lie. Call it a deception, a prevarication, what you will. It is the willful retailing of a falsehood.
For Gallicho, this falsehood creates the “distance” between intention and action that rescues these “accommodated” employers from moral responsibility. But our moral norms cannot be so easily satisfied.
The funding issue is not the whole of it, or the heart of it. The fact that one is still paying for the contraception coverage in both cases “before” and “after” the HHS accommodation is relevant chiefly inasmuch as it is a token or sign of the unchanged involvement of the employer in the provision of the morally wrong coverage.
But now that Gallicho agrees with me that the “accommodated” employers will in fact be paying for contraception coverage, he has one more misplaced argument to make, in the immediate sequel to the passage I quote above:
It would be like trying to determine whether any of Matthew Franck’s federal tax dollars ended up paying for an abortion for a rape victim. Once he’s paid taxes, that money is no longer his. It’s collected with other people’s money and dispensed by someone else. He’s not on the hook for what’s done with that money unless he’s willed something evil.
Gallicho’s conclusions are right about the morality of cooperation where taxing and public spending are concerned. But does he really mean to assimilate the business of contracting for insurance coverage—a free market transaction between employers and insurance providers—to the situation that obtains between taxpayers and the state? I know that many conservatives have observed that ObamaCare converts health insurance providers into public utilities. Gallicho would go further, seeing them as public agencies, or the moral equivalent thereof.
But consider Gallicho’s argument a little more carefully, for one might say he proves too much.
When we pay taxes, we do so as a civic duty, and we do so under coercion. If we are liable for taxes, we have a duty to pay them as members of the community. Because the state must be able to compel payment, we are subject to coercion if we don’t pay. But we share responsibility for the good or evil our government does, and we owe one another our best persuasive efforts, and the action of our votes, to see to it that the government does good and avoids evil.
The reason we are “not on the hook” individually for any evils on which our tax dollars are spent is not that the money is “no longer ours” when it is poured into the common treasury. The reason is that the state acts as the representative of all of us citizens in common (this is true in every state, and literally so in a democracy), and the evils (if any) that it commits are our collective (not individual) responsibility whether we pay any taxes or not.
Take the federal Hyde Amendment. This law forbids, with some exceptions, the spending of Medicaid funds on abortions. The law is not a salve for the consciences of that portion of the taxpaying public that objects to abortion. It is instead a federal policy predicated on the judgment that abortion is an evil for which the whole community should generally refrain from paying, even if it is an individual choice permitted under the law.
Come back now to the HHS mandate. If the policy of the government were to provide these contraceptive services to all women at public expense, we would all be individually “off the hook” as taxpayers. But the state—meaning all of us whom it represents, collectively—would be right back “on the hook,” and we could struggle democratically over whether this coverage is a good to be funded by taxpayers or an evil to remain unfunded by the federal budget.
That would be a fight in the open, at least. But the HHS mandate is something else again, entailing layer on layer of coercion, deception, and moral thuggery. In one category of employers, the “religious employers” are entitled to believe and to act on the conviction that contraception, abortifacients, and sterilization are evils to be avoided—not contracted for, not paid for, and not provided to their employees. In the second category, “religiously conscientious” nonprofits are entitled to believe that these are evils to be avoided, but they are not permitted to act on that conviction. They are encouraged rather to deceive themselves and their employees that they are avoiding these evils, when they are up to their necks in them. In the third category, of nonprofits with no religious identity and of for-profit businesses, the employers can believe what they like, but they are not invited to the table of self-deception. They must look their complicity with evil full in the face.
So the government’s new policy is to tell the first and third categories of employers the truth about their situation (even while violating the religious freedom of the third category). For the second category, the government’s policy is to lie to them, and to require their complicity in a lie, while also forcing them to do the very evil the lie is meant to cover up.
Some “accommodation.”
Remember, the Obama administration itself recognizes there is a genuine religious freedom claim here, overriding any “compelling interest” in the employer provision of contraception coverage, when it wholly exempts one class of employers. The existing exemption amounts to a recognition that the fullest expression of religiously conscientious opposition is fulfilled by the ability to purchase coverage that really does not include (and is not merely said not to include) contraception coverage for any of one’s employees. (Notice that in this corner of the market, there actually is such a thing as a policy with no contraception coverage. Where does government get the power to forbid others to purchase it?)
There is no good argument for not exempting every other party seeking an identical exemption on religious freedom grounds—those like Belmont Abbey College and those like Hobby Lobby. All, as I have previously argued, are identically situated where their religious freedom is concerned. Why does the Obama administration think it is within its power to parcel out full religious freedom in one place, less of it in a second, and none at all in a third? And why does it have any defenders among those who wish religious freedom well?
February 17th, 2013 | 1:53 pm
Absolutely not true for larger groups(about 500+)-most are actually self insured. Anthem/BC et al is often just an administrator of the plan(getting paid an administration fee)- the employers pays all the bills until their stop loss insurance kicks in. There is no common pool of money- it is strictly separate. If your insurance says TPA or something similar, your company self insurers.
February 17th, 2013 | 4:34 pm
There is no common pool of money- it is strictly separate. If your insurance says TPA or something similar, your company self insurers.
Mm,
Nothing in Matthew J. Franck’s analysis above deals with organizations that self-insure. He deals only with organizations that purchase insurance from insurance companies. So you have not confirmed anything in his argument.
February 17th, 2013 | 5:11 pm
A week ago he was denying that employers in the category receiving an “accommodation” under the HHS mandate would be paying for (“funding,” in his word) the coverage their employees receive for contraception. Now he is affirming that they will be paying for it.
What does paying for or funding actually mean? To simplify, let’s take individuals as policyholders (family policies) who pay their premiums in $1 bills on which they sign their names. Policyholders A and B each spend 10,000 marked $1 bill for their policies. A’s only claims for the year are $600 for an abortion and $900 for a vasectomy. B and his wife have a very premature baby and costs for the year are $50,000. Now, all the bills marked A and B have been thrown into a pot, and some of B’s bills just happen to be pulled out of the pot to pay for A’s abortion and vasectomy. Has B, who gets back more money from the insurance company than he paid in, “paid for” or “funded” A’s abortion and vasectomy because some bills marked B went to the abortionist and urologist? I don’t think many people would analyze it that way.
But suppose people do wish to analyze things that way or some other way. It is difficult to say they are simply wrong. And, it seems to me, it is unseemly to accuse those who would analyze a complicated and ambiguous situation differently from oneself as liars.
February 17th, 2013 | 6:37 pm
If a person, for Religious or moral reasons, desires to purchase Health Insurance from an Insurance Company that does not desire, for Religious or moral reasons, to be a contraception provider, it is not unjust discrimination, nor is it gender discrimination. The Obama Administration does not have the authority to mandate that every Insurance Company must provide contraception coverage, so that, as Father John Jenkins has stated, one is forced to either go without Health Insurance or violate one’s Faith and/or morals.
February 17th, 2013 | 7:59 pm
Dialogue is good for the soul.
February 18th, 2013 | 8:59 am
David- the point is most large Catholic groups DO self insure. As i clearly stated, most larger groups self insure and do not “purchase” coverage from an insurance company- they simply purchase management from the insurer. Therefore, the required birth control coverage etc is paid for directly by the Church or sponsoring organization. There is no outside pool of money that one can claim is paying for the coverage.
February 18th, 2013 | 10:56 am
“Gallicho may think he is still denying that the “accommodated” institutions will be funding the contraception coverage. But it is a curious kind of argument when one can only “deny” that someone is committing an act by affirming that everyone, including that someone, is committing it. That is the space Gallicho now occupies, and whether he knows it or not, he is now in agreement with me, and joins me in refuting the administration’s claim that “accommodated” institutions will not be paying for contraception coverage.”
Maybe he’ll take Kevin Drum’s word for it:
“In other words, money is fungible, a subject that liberals and conservatives alike treat with abandon depending on whether they happen to like the consequences. In this case, liberals are willing to accept the fiction that the money for contraceptive coverage is somehow “segregated,” and conservatives aren’t. When bailed-out bankers pay themselves big bonuses and swear that not one dime is coming from bailout funds, the roles are reversed. All good fun.”
http://www.motherjones.com/kevin-drum/2013/02/money-fungible-contraceptive-edition
Interesting that the link was posted in the comment thread on dotCommonweal; no response to it made.
February 18th, 2013 | 11:37 am
Ways insurance can produce ‘free coverage’. Note since I create this list from memory each time I offer it, it will vary slighly.
1. Cover something no one will actually use (i.e. if UFO’s burn down your home)
2. Change the use of insurance – covering insulin for diabetics mean fewer trips to the ER.
3. Change the risk pool –
3.1 Attract low use people.
3.2 Scare away sick people.
It is known that covering contraception does not increase total costs. The ‘common sense’ assertion is #2 since it certainly does seem covering a full childbirth costs a lot more than writing scrips for pills. I wouldn’t be surprised if #3 might also be a factor. If a young woman opts for a plan that’s full of old people because it covers birth control, then in a very real sense she is covering her own birth control and putting money into the pool for the older people to tap for their more chronic illnesses. Granted there’s a risk she may get cancer or some other disease but the law of large numbers says this is not going to happen if you get a lot of young people coming into a plan.
So it’s quite possible that contraception is indeed ‘free’ meaning that it costs employers nothing. If you want to strictly speak about a right of employers to have ‘clean hands’ when it comes to contraception, then what they should be doing is asking insurance companies to calculate how much savings they might see in their premiums each year from covering contraception and then they can voluntarily pay extra to the insurance company so as not to benefit from that.
February 18th, 2013 | 11:54 am
But it is a curious kind of argument when one can only “deny” that someone is committing an act by affirming that everyone, including that someone, is committing it.
Let me help out here. The analogy with regular pay gives the game away. EWTN pays its employees with money, there is nothing that prevents someone working at EWTN from taking her paycheck, cashing it and buying birth cnotrol. Correct? I mean ETWN does pay with money which is either US currency or in the form of a bank check which can be turned into US currency, right?
No doubt ETWN would respond that since the wages of their employee belongs to the employee, they can’t control how they spend it. Hence making payroll for them is not an immoral act *even though* there’s no dispute that a person can use their wages for immoral things.
But who is responsible for the immoral act here? Clearly it’s the person who has the decision making power. In other words, the person who cashed their paycheck and has money in their pocket to spend as they decide!
Ditto for health coverage. ETWN provides no contraception or prenatal services. ETWN provides no antibiotics or checkups. It provides coverage which its own employees decide how to use.
To make it even easier. Consider this analogy:
A. For your birthday I give your grandma the ‘adult novel’ 50 Shades of Grey.
B. For your birthday I give your grandma a $25 B&N card…which she uses to buy 50 Shades of Grey.
Clearly in case A. you’d consider my act somewhat creepy. But in case B you certainly may not approve of your grandmother’s action, but you’d hold me blameless. But why? Clearly out of the millions of books B&N has, there’s many you would consider at least morally questionable choices. Why do I not share any moral blame? Because clearly the person who has 100% of the power to decide what to purchase is…
February 18th, 2013 | 12:15 pm
And since we’re speaking of workers here….let me ask where has this supposed ‘moral concern’ ever been raised before? Specifically I mean if it is immoral for EWTN to buy insurance that covers abortion or contraception then why would not the same moral issue apply to every individual Catholic who has any type of health insurance?
Yet for decades insurance policies have covered both things and I have never heard it claimed that Catholics have a moral obligation to decline health insurance on those grounds. Am I wrong? Are Catholics who, say, work at Google or Ford under obligation to say no to coverage offered unless the employer offers an abortion and contraception free policy? If not why not?
February 18th, 2013 | 1:27 pm
David- the point is most large Catholic groups DO self insure. . . . Therefore, the required birth control coverage etc is paid for directly by the Church or sponsoring organization. There is no outside pool of money that one can claim is paying for the coverage.
Mm,
You are overlooking the fact that there are separate arrangements for organizations that self-insure. They do not pay the cost of contraceptive coverage. The money comes from elsewhere. Note the following:
February 18th, 2013 | 2:22 pm
Boonton- individuals can’t write the terms of their policy-but self insured groups can and do. Remember- “self insured” groups is a misnomer. Most such groups actually pay directly for health care expenses upto a limit, then a stop loss policy covers expenses that are unexpectedly high. They only have insurance to cover excessive costs- not the anticipated medical expense fir the covered population. Under Obamacare EWTN will be forced to pay for abortion etc if it continues to provide insurance for its employees-if they self insure it will be a direct payment for abortion.
February 18th, 2013 | 2:35 pm
In this case, liberals are willing to accept the fiction that the money for contraceptive coverage is somehow “segregated,” and conservatives aren’t.
Josh DeCuir,
This ignores one of the contentions of the Obama administration which it is difficult to prove or disprove: The insurance company may break even or come out ahead by providing “backdoor” coverage of contraception. If the costs of contraceptive coverage are zero or negative, there are no funds to be “segregated.”
While there is some truth to what Kevin Drum says, the “money is fungible” argument can lead to preposterous conclusions. When I pay my rent, am I really paying for my neighbor’s apartment and he’s paying for mine? Suppose I go to a store and buy only items on which the mark-up is low. Are people who buy high mark-up items there funding my purchases? Suppose I see a therapist who charges based on ability to pay. I am rich and pay $300 an hour, while a poor client pays only $30 an hour. Should I get some kind of charitable deduction for paying the poor person’s medical bills?
And of course there are very real situations, such as government aid to religious schools for non-religious purposes. If we really think of money as fungible, we can think of money given to pay for computers as being used to pay for religion classes, since it frees up money the school would have had to pay for computers. Those who support aid to religious school would never admit that computer money is fungible, yet they would try to get Planned Parenthood defunded, even though very careful accounting shows that government money does not go for abortions.
February 18th, 2013 | 6:04 pm
Why ignore the fact that one should be able to purchase Insurance from an Insurance Company that does not provide contraception coverage in any of its Insurance Plans?
February 18th, 2013 | 6:19 pm
David- “plans to offer” are hypotheticals that most Catholic organizations in good conscience cannot trust- the administration has hardly been a paragon of good faith in prior consultations with the Church leadership. The administration also claimed they would bend the cost curve down & everyone could keep their preexisting insurance(which won’t exist). There is little doubt that if push came to shove the administration will favor the beck and call of planned parenthood over the Church.
February 18th, 2013 | 6:57 pm
Mm
Boonton- individuals can’t write the terms of their policy-but self insured groups can and do.
You haven’t really addressed the problem with this argument. To keep from having to repeat it, I’ll abbreviate it as the Amazon.com Gift Card. If I give you a gift card, I’m not morally responsible if you use it for an immoral purcahse. That’s a world of difference between my buying something directly and giving it to you. In other words, call me when you can show me how Obamacare requires EWTN to hire on staff abortionists otherwise your beef is really EWTN may use their own pay in immoral ways.
This looks at giving a gift card as a gift, which the receiver has no property right claim too! If you’re giving someone a card as payment for their labor then this moral argument becomes even more absurd and unsustainable.
February 18th, 2013 | 7:00 pm
And if EWTN’s concern is immoral employees why don’t they just hire a better class of worker! Seriously, the SC ruled that just about any religious organization can define almost everyone as a ‘minister’. EWTN can simply assert as part of its employment contract that employees swear to abide by Catholic teaching on abortion and contraception.
Even if technically ‘covered’, employees couldn’t use it. This also would solve the cash problem since right now employees are free to cash their EWTN paychecks and head off to the abortion clinic or contraception dispensing pharmacy.
February 18th, 2013 | 8:12 pm
There is little doubt that if push came to shove the administration will favor the beck and call of planned parenthood over the Church.
MM,
You made an argument based on incorrect information—that is, that the self-insured religious organizations would be paying the cost of the coverage they object to. That is not what is in the proposed regulation, as I noted above. I think you have to address the proposed regulation and not fall back on the position that the government can’t be trusted. My understanding of the position of the USCCB is that the proposed regulation is not acceptable as it stands, not that they don’t trust the government to deliver on it. I understand (but do not agree with) the the USCCB’s objection to the proposal for those who purchase insurance policies. I don’t understand the objection to the proposal for the self-insured. If the bishops have a rational objection to the proposal for the self-insured, I would like to understand it. If the argument against the HHS regulations is, “You can’t trust the government to do what it says it will do,” that would apply even if the government says, “We’ll exempt everyone who wants to be exempted.” So I would like to hear what is wrong with the proposed regulation for the third-party administrator to absorb the cost of contraception coverage and be compensated by getting a discount from the government for exchange-related costs. It seems clear to me that the self-insured religious organizations will not be paying for anything they do not want to pay for. So what is the objection?
February 19th, 2013 | 10:02 am
“This ignores one of the contentions of the Obama administration which it is difficult to prove or disprove: The insurance company may break even or come out ahead by providing “backdoor” coverage of contraception. If the costs of contraceptive coverage are zero or negative, there are no funds to be “segregated.””
I had followed up the post (which didn’t get posted for some reason) with a response to Boonton by linking to a subsequent post by Drum who disputes the notion that in actuality contraception is a “freebie.” Mainly, Drum points out, if contraception were, in fact, such a homerun cost-savings, wouldn’t the insurance companies ALREADY be offering this coverage? Frum’s argument is dated 2.3.13.
Of course these arguments seem to me miss the essential question: is the burden being imposed justifiable in relation to the need being addressed? I am not convinced, as I don’t really think we have an epidemic in this country of unafforable birth control, & fail to see what the problem with the status quo was. Drum also makes this point as well. Until the proponents admit that they believe these institutions SHOULD be providing birth control, they will not convince those of us who doubt that the accomodation is sufficient.
February 19th, 2013 | 10:35 am
A proposal to propose is not exactly a policy
February 19th, 2013 | 11:34 am
Mainly, Drum points out, if contraception were, in fact, such a homerun cost-savings, wouldn’t the insurance companies ALREADY be offering this coverage? Frum’s argument is dated 2.3.13.
Granted I don’t work in insurance but I have never seen private corporate coverage that does not include contraception and even abortion. Remember contraception includes two things, there’s the drugs (covered or not under drug plan) and the doctor’s visit which is covered by the health plan. If one were to seriously say insurance should not cover contraception, then that would require the insurance company to examine every doctor’s appointment, find out if contraception was discussed and then demand the woman be billed a pro-rated portion of that visit. I would be very shocked if any health insurance plan did anything like that.
Until the proponents admit that they believe these institutions SHOULD be providing birth control, they will not convince those of us who doubt that the accomodation is sufficient
Whose providing birth control? EWTN? Are they keeping pills locked in a closet with an on site pharmacist? That’s kind of like saying I’m running a printing press if I give you a Amazon.com gift card.
February 19th, 2013 | 2:53 pm
A proposal to propose is not exactly a policy
Mm,
In this case, the “proposal to propose” is a Notice of Proposed Rulemaking. Wikipedia says:
In other words, what you call a “proposal to propose” is not a vague statement about what might be done, but rather, a formal step putting forth a planned regulation and inviting public comment. If one wishes to discuss the issues of the so-called “contraceptive mandate,” then the current Notice of Proposed Rulemaking is the only thing there really is to discuss. It is, in effect, HHS saying, “Here’s an outline of what we propose to do, and once we get all of your comments, we’ll take them into account and formulate the actual rule.”
February 19th, 2013 | 3:41 pm
“Granted I don’t work in insurance but I have never seen private corporate coverage that does not include contraception and even abortion.”
Drum states that most policies do not provide such coverage.
February 19th, 2013 | 8:07 pm
Drum states that most policies do not provide such coverage.
Josh DeCuir,
You need to provide a quote or a link. I think you are misinterpreting something Drum wrote. And if he said what you claim he said, he’s almost certainly wrong. This is from the National Conference of State Legislatures:
Also note the following, from the same source:
So most big companies include contraceptive coverage, and most states (28 out of 50) require it of insurance companies by law. Now, we don’t know how many of those large companies self-insure, so it is difficult to say for certain what insurance companies do, but I think it’s a safe bet (especially given the state mandates) that most insurers do cover contraception.
February 20th, 2013 | 12:56 pm
Yea I’m going to say that most insurance policies cover contraception. Remember two questions:
1. Health insurance covers doctors’ visits. I’m going to say that NO health policy declines contraception here as to do so you’d have to dig into what people actually do in their visit and pro-rate.
2. Drug insurance. I grant here that there no doubt are policies that exclude contraception. I don’t think they are standard policies but ones tailored to special requests by employers. The ‘norm’ I believe is coverage. Ancedotally I can confirm that but those with hard data are free to present it.
February 20th, 2013 | 1:09 pm
Happily:
“Unfortunately, I’m not sure I believe it. The main reason is simple: If this were true, insurance companies would routinely make contraceptive coverage a feature of all their group policies without even being asked. But they don’t. And since insurance companies tend to be fairly good at actuarial calculations, this suggests that contraceptive coverage isn’t, in fact, a freebie.”
http://www.motherjones.com/kevin-drum/2013/02/contraceptive-coverage-probably-not-freebie-insurance-companies
He clarifies certain things in the comment thread. I hardly agree with Drum on anything; but I would hesitate before I uniformly dismiss his claim as “certainly wrong.”
February 20th, 2013 | 2:33 pm
If this were true, insurance companies would routinely make contraceptive coverage a feature of all their group policies without even being asked. But they don’t.
Josh DeCuir,
Your statement was, “Drum states that most policies do not provide such coverage [contraception and abortion].” What Drum says above is that they do not make such coverage a feature of all their group policies without even being asked. It is not possible to draw the conclusion you do from what Drum said. Just because they do not provide the coverage in all their policies does not mean they do not supply it in most. And just because they do not supply it without being asked does not mean they don’t supply it.
I would hesitate before I uniformly dismiss his claim as “certainly wrong.”
Drum’s claim is no doubt true. It’s true if only, say, 5% of group policies don’t have contraceptive coverage unless it is requested. But saying “not all do” is quite different from saying “most don’t.” The information I gave above from the National Conference of State Legislators is much more suggestive of what insurance companies actually do most of the time than Drum’s statement, from which no significant conclusions can be drawn.
February 21st, 2013 | 1:07 pm
“It is not possible to draw the conclusion you do from what Drum said.”
It’s Drum’s conclusion, not mine. Drum is saying IF contraceptives were proven to be the cost-saver they are purported by the Administration to be, THEN one would expect them to be a more regular feature of coverage. Indeed, the very fact that Administration is mandating such coverage as part of the ACA belies that they are not a regular feature.
Indeed, he updates his post to state that, whatever the frequency of the coverage, the claim that these are huge cost-savers that pays for itself is not warranted by the existing evidence. So Drum’s (and my) claim is that there is no evidence that warrants the suggestion being made that people are not paying for this coverage because they pay for themselves. So we have distinct issues: whether they are included routinely in coverage, and whether, if they are, they prove to pay for themselves. Drum is addressing the second part, but mentions the first. You have staked your flag in the first to warrant the second.
I would think a bit more humility in the face of not-knowing would be a welcome addition to this dialgoue.
February 21st, 2013 | 4:17 pm
What we do know, is that it is not unjust discrimination, nor is it gender discrimination, to suggest that members of Religious Groups, which consist of Religious individuals, have a right to purchase Health Insurance that is Life-affirming and Life-sustaining from an Insurance Company that does not provide contraception coverage and thus does not condone the use of contraception, which is not Life-affirming or Life-sustaining, and in some cases, destroys Human Life, promotes promiscuity and the sexual objectification of the Human Person, “violates the Gift of Self, while closing off the Gift of Life”, does not serve the Common Good, and is thus not Good for our posterity or the prosperity of this Nation or The World.
February 21st, 2013 | 4:21 pm
What we do know, is that it is not unjust discrimination, nor is it gender discrimination, to suggest that members of Religious Groups, which consist of Religious individuals, have a right to purchase Health Insurance from an Insurance Company that does not condone the contraception mentality.
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