Confused about Contraception Coverage?

Dear Cheasty, I'm confused about the contraception regulation controversy that exploded in the news last week. I was under the impression that women already have access to birth control through their insurers. Is anything going to change with the compromise they reached on Friday?

Thanks,Confused about Contraception

Dear Confused, Join the club, friend. Last week’s contraception kerfuffle kicked up a lot of dust. With alarmist headlines and Catholic bishops sounding outraged, it looked like a five-alarm fire. And then Friday, after some sort of compromise, all was suddenly calm. Though the bishops themselves still have some concerns, the Catholic Health Association and Catholic Charities were on board, the Obama administration sounded pleased with the result, and even the president of Planned Parenthood approved of the deal. But it all happened so quickly, and let’s face it, the news media isn’t always that great at explaining the back story. So what happened, and where did we end up?

Well, the air is still clearing, and even health policy experts still have some unanswered questions, but I can at least clarify the basic facts and circumstances for you. Let’s start by addressing your first point.

You are mostly correct in your belief that women already are guaranteed access to contraception coverage through their insurer. Just like the Obamacare mandate, for a number of years now the state of Texas has had a law in place that requires any insurance plan that offers prescription drug coverage to also cover contraception. That includes all FDA-approved methods, from the birth control pill to diaphragms, to IUDs. (Not condoms, which are sold over the counter, but you get my drift.) Texas is one of 28 states that have such regulations, but even in states without the laws, this was fairly standard practice. The innovation here is that Obamacare promises women access to contraception with no additional co-pay – in other words, free.

But what was the big deal? Hasn’t this “no co-pay contraception” part of Obamacare been in the news for a while? Why, all of the sudden, were Catholic bishops on tv and radio complaining about government interference in their right to religious freedom?

In short, that’s a great question. First of all, the Obama administration did not, as it might appear from the dust-up, just release a regulation solely about contraception coverage. What we’re talking about here are the ACA’s regulations about preventive care. Preventive care includes everything from annual exams to mammograms, blood work, colonoscopies, and yes, contraception.

Anybody who is paying attention has known about these regulations for months.  But early last week, The Department of Health and Human Services released their final version of the regulations, and the Catholic bishops were ready for battle.

The original (pre-kerfuffle) regulations contained an exception for religious organizations. So if an organization’s primary purpose is the practice of religion (i.e., a church or diocese), then it doesn’t have to cover contraception through its insurance plan. However, if an organization is affiliated with a religion, but its primary purpose is not the practice of religion, (i.e., Seton Hospital or charities), then those institutions were not exempt.

The Catholic bishops were furious because, in essence, they felt the regulation was forcing Catholics to condone and pay for something that violated their religious beliefs. In an election year where conservatives seem to be grasping at straws, this generated a lot of political momentum.

Friday’s compromise quelled the hubbub by retaining the original exemption for churches, and by setting up a system that will work as follows. If Jane Doe works for XYZ Catholic University and XYZ doesn’t cover contraception, Jane Doe will call XYZ’s insurance company and say, “Hey insurance company, I need coverage for contraception.” The insurance company will then adjust Jane Doe’s policy to cover contraception. XYZ’s insurance plan will pay for it, but the cost will not come out of the plan’s premiums. This way, the employer need not know, nor must they pay.

Wait a second, you say. The insurance company will just eat the cost of contraception?

Essentially, yes. Obama wagered that insurance companies would be okay with this deal because it’s cost effective for them (birth control is way cheaper than an unintended pregnancy), and pretty much, he was right. They’ve issued a statement belly-aching about “setting a bad precedent,” but so far, so good. Churches and diocese and the like will still have the exemption they started with, but all the rest of us will have access to contraception at no additional co-pay, as originally promised in the law.

Disaster averted, it seems, for the time being. While the U.S. Bishops are still not satisfied, it appears most catholic voters support the policy.

Well, Confused about Contraception, I hope this helped clarify things for you about contraception. In short, you can rest easy. No matter where you work, or what your employer’s position on birth control is (unless you work for a Catholic church), your guaranteed access to contraception coverage is secure. It took some fancy footwork, but by Friday evening all seemed to have calmed down. What a roller coaster!

To a well and healthy Texas,

Cheasty Anderson Center for Public Policy Priorities