Do Conservatives Understand How the Female Body Works? The Myth Fueling the Right-Wing Freak-Out Over Birth Control
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Not only doesn't it cost companies a single penny to provide free contraceptives to their employees, studies show they actually save almost $100 per employee per year when they do so. Anyone with even a passing knowledge of women's health – of how human reproduction works – understands this.
That's why, in the real world, the Obama administration's “accomodation” with the Conference of Catholic Bishops over contraceptive coverage should be seen as a win-win proposition. Women get contraceptive coverage at no cost, religious institutions with superstitions against interfering with the will of the Gods get to keep their hands clean of the whole affair and the media reported the whole kerfuffle as if the bishops still had some moral authority from which to speak.
Of course, sound public policy has never stood in the way of a flood of conservative outrage being spewed at a Democratic administration. The right is up in arms, and Republicans in Congress have chosen to double-down on the issue. But their chosen narrative is unusually wrong; it in fact betrays a total lack of understanding of elementary biology.
Their gripe centers around the supposed “costs” of providing that coverage, and they're quite smug about it – as if they have a rare insight into some kind of shady scheme to get around religious objections. As the National Review's Hannah Smith put it, “religious employers would still ultimately be paying for these services against their conscience, with the costs spread through higher insurance premiums for their employees." That's totally inaccurate, but at Red State, Michael Hammond agreed, writing, "Catholic hospitals and universities would pay insurance companies premiums, which would pay for contraceptives.” He added, in 15th-century style, "Evil doesn't become good because it's laundered through a third party." Even Megan McCardle, the Atlantic's “business editor,” is woefully confused about this topic. "The insurers have to provide it 'at no cost',” she wrote, “which of course means the Church will still be paying for it."
This flies in the face of a large body of peer-reviewed data which show that, on net, providing universal contraceptive coverage to women is absolutely free of cost to insurers. As a Department of Health and Human Services analysis noted, “Evidence from well-documented prior expansions of contraceptive coverage indicates that the cost to issuers of including coverage for all FDA-approved contraceptive methods in insurance offered to an employed population is zero.”
And it's not difficult to understand why. Doctor Kelly Cullwell, a clinician and birth control expert at the UC Davis Center for Women's Health, told AlterNet that research into public health programs shows that “for every dollar spent on contraceptive coverage, you actually save close to four dollars in overall healthcare costs.” She added: “it's probably one of the most cost-effective preventive care interventions that we have.”
Studies from three actuarial firms – Buck Consultants, PriceWaterhouseCoopers, and the Actuarial Research Corporation – estimated the direct annual cost of the medication for insurers at between $21 and $41 per enrollee. In 2007, the average cost of giving birth to a child was $8,802, according to the Kaiser Family Foundation (PDF).
That math should be pretty obvious, but the costs aren't the same for planned and unintended pregnancies. According to the Department of Health and Human Services:
Medically, unintended pregnancies are serious in terms of the lost opportunity to prepare for an optimal pregnancy, the increased likelihood of infant and maternal illness, and the likelihood of abortion.…The mother is less likely to seek prenatal care in the first trimester and more likely not to obtain prenatal care at all... The child of such a pregnancy is at greater risk of low birth weight, dying in its first year, being abused, and not receiving sufficient resources for healthy development.
When those factors are accounted for, contraceptives aren't just free – they save money. According to a study by the Washington Business Group on Health and the employee benefits consulting firm William M. Mercer, “it costs employers 15–17 percent more to not provide contraceptive coverage in employee health plans than to provide such coverage”
And these analyses understate the savings, because they only weigh the costs of providing birth control against the costs of unplanned pregnancies (whether they end in a birth or an abortion). As HHS notes, “when indirect costs such as time away from work and productivity loss are considered, they further reduce the total cost to an employer.”
Global Health Outcomes developed a model that incorporates costs of contraception, costs of unintended pregnancy, and indirect costs. They find that it saves employers $97 per year per employee to offer a comprehensive contraceptive benefit. Similarly, the PwC actuaries state that after all effects are taken into account, providing contraceptive services is “cost-saving.”
Even this more comprehensive accounting still understates the savings that result from good family planning. As ABC news reported, an analysis of 30 years of research published in the Journal of the American Medical Association found that spacing out childbirths results in significant health benefits for both mothers and infants. “Women who space their pregnancies close together,” the study found, “are at an increased risk of giving birth prematurely, and having a baby with a low birth weight who's smaller.” What's more, “if the time between pregnancies was less than 18 months or more than five years, the babies born during the second pregnancy were at a higher risk of having difficulties early in life.”
Premature and underweight births run up really high bills. According to a report in BusinessWeek, “Corporations pay out nearly 15 times as much for babies born prematurely in their first year of life as for full-term babies, at an average cost of about $41,000 per child. For the earliest of the preemies, who are born in fewer than 28 weeks and spend up to three months in the hospital, the tab is higher.” Norman J. Waitzman, a professor of economics at the University of Utah, told BusinessWeek, "The million-dollar babies are there."
And there's yet another matter to consider: the use of birth-control pills to prevent or treat a variety of medical issues. While religious conservatives are offended by the idea of consequence-free sex, birth control pills are simply a hormonal therapy. “A lot of the women I see who require contraceptive methods are actually using them for non-contraceptive indications,” said UC Davis' Kelly Cullwell. “Some of those women can actually have life-threatening” conditions,” she added. Contraceptives are medicine, used to treat painful or irregular periods and the transition into menopause, and prevent bone loss and the development of non-cancerous cysts in the breasts, cervix and uterus.
All of this cuts down on overall healthcare costs, lost work days and decreased productivity. And that explains why even as conservative bloggers and the Atlantic's oft-mocked business editor are convinced that religious organizations will stealthily end up being stuck with some sort of “cost,” we haven't heard the insurance industry gripe about that aspect of the rule. It issued a statement decrying the “precedent” the administration set, but it's worth noting that its objections were non-economic, and seemed pretty mild.
And that's because the industry understands human biology. Corporations like saving money, and insurers know from actuarial studies and real-world experience that by providing cost-free contraception to working women, they'll do just that.