Keep Your Leeches for Yourself

I spent a good part of the morning watching and listening to discussion of the Obama administration's new compromise position on contraception coverage in insurance plans offered by private religiously-affiliated institutions like hospitals and universities.

For those of you who missed it, under the new compromise religiously affiliated institutions that weren't already exempt from the regulation -- meaning, among other things, those that don't predominantly hire or serve people of their faith -- can continue to exclude contraception coverage from their insurance plans. But if they do, their insurance companies must reach out and offer -- for free -- a separate rider to female employees who would like to access contraception with no out-of-pocket cost.

To sum up: non-profit employers with a religious affiliation don't have to cover contraception, they don't have to pay for it, and they don't have to communicate with their female employees about it. In turn, women covered by private insurance still can access "free" birth control.

I suppose I shouldn't be surprised that almost all of the chatter on cable news has treated the announcement in purely political terms -- how many votes will this cost Obama? What do the Republican presidential candidates say?

They are missing the bigger story. This decision is not about the administration siding with or against different interest groups. It is about the administration siding with science, and with the right of all people to access health care that meets modern standards of appropriate care.

The point of insurance is to pool and minimize risk as much as possible. An insurance program that fails to cover services that meet the accepted standard of medical care is inadequate and unsafe; it is failing at its essential task. So, for example, even though there are religions that object to blood transfusions, vaccinations, and prescription drugs, we expect our insurance to cover these services because they reflect the best science has to get and keep us healthy.

The decision to use birth control is fundamentally a personal medical decision to protect the health and well-being of women and their children. This is why the vast percentage of women (including 98% of Catholic women) has chosen to use birth control for various reasons at various times in their lives. I outlined some of those reasons last week: to prevent premature births, to avoid harming a fetus or mother if a woman is struggling with a chronic condition, to allow women to make their own health care decisions, and to reduce the number of unwanted pregnancies and the social and financial costs associated with those pregnancies.

Contraception has been shown to have benefits beyond its ability to help plan pregnancies. Studies have shown that women with a family history of ovarian cancer are significantly less likely to get ovarian cancer if they take birth control pills.

If you are still not convinced, consider this: The benefits of contraception on the health and well-being of women and their families are so great that insurers will pick up the tab for employees whose religiously-affiliated employer chooses not to cover it. It is, in the words of Obama administration officials, "cost neutral." In fact, studies suggest that overall plan costs decrease 10-17 percent with full contraception coverage. I'm just sorry that women who work for religious institutions like churches that already were exempted from covering contraception aren't included in the new rule.

As for some of the rhetoric around the religious objections: The rule does not force anyone to prescribe birth control, and it does not force anyone to take it. Twenty-eight states already require employers to offer this coverage, eight of those states without any exemption at all for religious institutions -- and challenges to those laws have failed in courts.

Perhaps that is because the courts recognized that institutions that serve the general public and employ people of all religions (or no religion) really can't pick and choose which laws apply to them.

Or maybe it is because the courts understood that at the end of the day none of us want our employers to be able to tell us that we have to use leeches when there are better, safer, and more cost-effective options.