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08.02.11

Obama’s Birth-Control Shakeup

Insurance companies will be required to provide contraception without a copay—and conservative opposition, while predictable, makes no sense. Amanda Marcotte asks: Don’t they want to save money?

Starting in 2013, the Department of Health and Human Services announced Monday, insurance companies will be compelled to cover a wide range of women’s health services, from testing for gestational diabetes to counseling about domestic violence, without requiring a copayment. But it was HHS’ inclusion of free contraception in the slate of services to be classified as preventive care that grabbed all the headlines.

The news comes shortly after the Institute of Medicine issued a report recommending what services should be offered without extra cost to female patients. Even those in the reproductive-health community who have long advocated for free birth control as common-sense policy were surprised at the haste with which HHS announced the adoption of the IOM’s recommendations. The idea of free birth control for all falls in the rarely acknowledged gray area between boring old medical regulations and the promise of unrestrained sexual ecstasies—or at least so I’m told by some of the angrier pundits on Fox News—and the department’s quick turnaround allowed it to sidestep an opposition that was just starting to heat up its arguments. Still, Bill O’Reilly did manage to squeeze in one memorable statement, claiming that free birth-control pills wouldn’t work because women who get pregnant are too drunk to use their birth control when they have sex. (No one on O’Reilly’s show bothered to correct his false assumption that you have to take the pill during sex for it to be effective.)

Conservative opposition to this new regulation may have been predictable—right-wing media outlets rarely miss a chance to rail about the evils of women having sexual intercourse too early—but it still makes no sense. Republican-driven political discourse of late has been about nothing but the importance of cutting spending and saving money, and so the GOP should be delighted with this simple and clear-cut promise of long-term savings by making contraception free. The IOM report indicated that the direct medical cost of unintended pregnancy in 2002 was $5 billion, with a savings from contraception that year estimated at $19.3 billion. With nearly half of U.S. pregnancies unintended, there’s quite a bit of room to save money with free contraception.

In all probability, costs related to unintended pregnancy have only risen since 2002, in part because health-care costs overall are rising, but also because the recession has had a tremendous impact on women’s plans for childbearing. In September 2009, the Guttmacher Institute reported that as a result of the recession, nearly half of American women surveyed indicated that they wished to delay pregnancy or limit the number of children they would bear. Despite that desire, they were skimping more on contraception than they had in the past because they didn’t have the money to pay for the well-woman visits and the birth control. Indeed, after a long decline over the years, the abortion rate rose slightly in 2008, an indication that economic pressures could be increasing the rate of unintended pregnancy.

These new contraception regulations will pay for themselves easily in the short term by reducing the insurance payouts that come along with unintended pregnancies, but insurance companies should expect long-term savings. When children are planned, children are cheaper. As the Guttmacher noted (PDF) in its testimony on these proposed regulations, improved contraception use means women space out their pregnancies more, and putting some time in between pregnancies leads to better birth outcomes with lower medical costs. In addition, women who plan their pregnancies tend to get better prenatal care and are more likely to breast-feed, two behaviors that improve children’s health outcomes and reduce overall long-term health-care costs.

These new contraception regulations will pay for themselves easily in the short term by reducing the insurance payouts that come along with unintended pregnancies.

Of course, insurance companies have come out against the new regulations, claiming they will have to raise premiums to cover the costs. This should be viewed as the political exploitation that it is, and not a direct response to real costs to insurers, as the IOM and HHS were very careful to document the mountains of evidence pointing to long-term savings from these measures. 

With all the enthusiasm for tricorner hats and shouting about the blood of patriots, I would ask our newly enthused Tea Partiers to consider an aphorism from Ben Franklin’s Poor Richard’s Almanack: “An ounce of prevention is worth a pound of cure.” I’m sure Franklin would be delighted to find that his ratios proved far too conservative, as a year’s worth of pills or a standard-size IUD hardly weighs an ounce at all, and it prevents an average of 30 pounds gained during a pregnancy. More important, when weighing the up-front costs of contraception against the long-term spending reductions that result from fewer unintended pregnancies, anyone with an eye toward saving money should offer full-throated support of these HHS regulations.