Health Insurance Cannot Be A La Carte

Filed in National by on January 6, 2014

Health insurance only works if it covers your health care needs and mine.  It only works if the pool is big enough.  It really isn’t a case of priorities, because, if it were, then that numbers game would result in orphan diseases (very rare diseases that only affect a few) not being covered.

And, I sincerely doubt that those advocating for not covering birth control and maternity coverage would be fighting against coverage for Adrenoleukodystrophy and Landau Kleffner syndrome – let alone Viagra.  Know why?  Because the debate now raging isn’t about the ACA.  It’s, once again, about women and sex.  It’s just another branch of the war against women, and the men who love them.

The fact that Republicans, Conservatives and the Christian Right have chosen to focus on birth control and maternity coverage is no accident.  Altho… it is kind of strange that the “pro-life” crowd isn’t fighting for maternity coverage.  No… wait.  It isn’t strange at all when you consider what these two things have in common – controlling women.  Granted, they’re controlling them in different ways, and I’m having trouble making sense of it.  It seems they’re saying… Birth control is wrong/evil/sinful, so it shouldn’t be covered (because they believe it shouldn’t be covered, and that’s the only reason) which will lead to more unwanted pregnancies (that they also don’t feel should be included in the health insurance pool, because… I don’t know… penis?) which then leads to a demand for abortions – and we know they don’t want that covered.  What’s a woman to do?  Demand that any disorder/disease of male sex organs not be covered?  Why not, since that’s what those against covering birth control and maternity are demanding.

When I first took birth control pills, it wasn’t for sex.  I had ovarian cysts.  Later, it was because I didn’t want to get pregnant.  Both are 100% legitimate reasons.  One is not more legitimate than the other.  Go on and read that again.  And again, if necessary.  Birth control pills, etc. are part of woman’s/couple’s economy.  And the reason, any reason, for using them is nobody’s business.  But it seems like a lot of people want to put their sanctimonious noses into other people’s business.

I wrote this post for two reasons.  First, the Little Sisters of the Poor issue.  If you’re not familiar with their tactic of trying to force everyone to follow their religion (guess their message isn’t persuasive enough) here it is:

Does religious liberty extend to the right to not have to fill out paperwork? That’s the latest position religious organizations are taking against the Affordable Care Act (ACA). It’s crazy, yes. But, welcome to the future of “religious freedom” litigation.


The Little Sisters aren’t paying for contraception even through a third-party-secured insurance plan; they certainly aren’t being asked to distribute it, and Catholic nuns aren’t being force-fed birth control pills. They simply have to sign a piece of paper saying they’re a religious group, and then turn to a third party to negotiate all the details.

Their claim that even this accommodation violates their religious liberty is telling. These ACA-related “religious liberty” arguments aren’t actually about the freedom to exercise your own religion, or the right to be free of doing something that violates your conscience. These assertions are about an overwhelming sense of entitlement on behalf of religious organizations to force anyone within their reach to adhere to their beliefs.


The Little Sisters case is extra rich because, as it turns out, the Christian Brothers Trust insurance group can refuse to provide contraception and will face no fines or consequences. That’s because the Trust is a self-insured “church plan”, which means that the Little Sisters can designate the Christian Brothers as the third-party administrators, and if the Brothers still refuse to provide contraception coverage, the government can’t fine them (pdf). In other words: the Little Sisters can continue operating exactly as before, and nothing will happen.

Since certain religions look more like political activists it might be time to start taxing them.

The second reason I wrote this post had to do with a discussion on another thread.

It started with this comment from Dave (not trying to pick on you, Dave!):

I think we need people to comprehend that health insurance is not health care and vice versa. This has never been about health care. It’s about how families afford it and pay for it. Engaging in marginal fights over contraceptives when children can’t get treated for serious illness was and is silly and is a no win situation, especially when the public equates contraception with drug store rubbers and the implied purpose of the same. But let’s leave no stone unturned in the Sherman Williams approach (paint covering the world). By God, we are going get everything under the ACA umbrella, even if it affects the core purpose. Outstanding strategic planning and execution! (emphasis mine)

Let’s consider that comment.  I pointed out, that to women, contraceptives aren’t a marginal fight.  To the vast majority of women contraceptives are a daily occurrence.  They aren’t marginal, they are necessary if you don’t want to have 12 children.  And the public, at least those under 70, don’t equate drug store rubbers with contraception.  Yes, they are part of contraceptives, but not the only part and certainly not one that women control.  I was snarky in my reply to Dave, stating, “Leave it to a man to dismiss contraceptives as a marginal fight.”  But, come on!  What part of the public equates contraceptives as drug store rubbers?  Older men?  Certainly not Catholic, Protestant or Evangelical women.  Seriously, this is not a marginal issue.  Take a look at these tables:

Among women who have ever had sex, % that have ever used a contraceptive method other than natural family planning
All women Catholic Mainline Evangelical Other None
Yes 99 98 99 100 98 99
No 1 2 1 0 2 1
Population 53,195,675 13,365,042 12,295,740 13,507,644 4,869,328 9,157,921
Unpublished tabulations of the 2006-2008 National Survey of Family Growth.

Current contraceptive use among women at risk of unintended pregnancy,* by religious affiliation
All women Catholic Mainline Evangelical Other None
Highly effective methods 69 68 73 74 60 62
   Sterilization 33 32 34 41 23 26
   Pill or other hormonal 31 31 35 28 31 30
   IUD 5 5 4 4 6 6
Condom 14 15 13 10 25 17
Natural family planning 1 2 1 1 1 1
Other 5 4 4 6 5 7
No method 11 11 10 9 9 14
Population 42,711,521 10,635,049 10,017,708 10,992,501 3,744,769 7,321,494
*Refers to sexually active women who are not pregnant, post-partum or trying to get pregnant
Source: Jones RK and Dreweke J, Countering Conventional Wisdom: New Evidence on Religion and Contraceptive Use, New York: Guttmacher Institute, 2011 and unpublished tabulations of the 2006–2008 National Survey of Family Growth.


Obviously, the female public doesn’t equate condoms with contraceptives.  If they did, the number using condoms would be higher.  Know what is a high number?  The percentage of women who have used contraceptives.  Like Joanne said in that thread… we aren’t talking about sparse eyelashes here.  In fairness to Dave, he is a huge supporter of contraceptives.  He just seems to be saying we can’t have everything – that we should give up contraceptive coverage so we can treat sick children.  I called that a false choice, because if we really want to go down that path then we would be giving up a lot of health services in the name of children.  It’s Logan’s Run all over again!

When you don’t want or can’t afford having a baby birth control isn’t a marginal issue.  It’s economics 101.

In October 2012, I wrote a post on Joe Scarborough mainsplaining the economy to women.  Here’s the part where my head exploded:

But the comment that actually had me stopping in my tracks was this bit of mansplaining by Joe Scarborough.  Joe was scolding Mika, telling her how abortion wasn’t a big issue outside of Los Angelos and Manhattan, that most women are concerned about the economy.  Here’s who Joe cited to show how unimportant abortion is in this election:

“I talk about the waitresses.  I could talk about the single mom who’s a school teacher in Des Moines who’s raising three kids on her own.”

Take a good look at that example and ask yourself if maybe, just maybe, controlling whether or not she has a fourth child will effect her economy.  Right there – there’s the disconnect.  Access to birth control and abortion are economic issues to women.

Pregnancy and birth control are economic decisions – bigger than the price of gas at the pump.  Just sayin’.

And as I wrote this post another comment appeared on that thread which feeds into this debate.  A suggestion made by commenter, radef16, which states:  “Allow buyers to purchase only the coverage that they want or need.”  No, no, no!  That is not how insurance works.  Perhaps I should have written a post on how insurance works, because some people don’t get it.


Tags: , , ,

About the Author ()

A stay-at-home mom with an obsession for National politics.

Comments (18)

Trackback URL | Comments RSS Feed

  1. radef16 says:

    Insurance does work that way. For example with car insurance you can choose whether or not to have collision damage coverage, comprehensive coverage and also choose your liability limits. These choices do not affect the coverage pool. The same applies to homeowners insurance.

    Choice of coverage for a specific disease would not be practical. However, why would whether or not contraceptives or maternity are covered be an issue. The same can apply to prescription drug coverage, surgical coverage, eye exams etc etc. Why should anyone be forced to buy all of these coverages?

    With maternity coverage it becomes a straightforward economic issue. Should I have coverage or simply plan on paying for having a baby out of pocket? For some, the latter is the best choice.

  2. pandora says:

    “With maternity coverage it becomes a straightforward economic issue. Should I have coverage or simply plan on paying for having a baby out of pocket? For some, the latter is the best choice.”

    Are you psychic? Because that’s what you’re implying. You have no idea what the best choice is because many births have complications. No one can predict the best choice. So it’s not a straightforward economic issue, and you can take that from someone who had a normal pregnancy and ended up in the OR.

    One of the most important things the ACA did was define what health care is and what health insurance must cover to be labeled health insurance. You know, we get this when it comes to other things. You can’t label ground beef filet mignon and you can’t call anything health insurance.

    As far as the other insurance you cited… yes, you can upgrade (like the ACA), but the basic plan is consistent. States require basic auto insurance, most require liability insurance. Your upgrades are on top of the basic plan.

  3. cassandra_m says:

    For example with car insurance you can choose whether or not to have collision damage coverage, comprehensive coverage and also choose your liability limits.

    You can choose your liability limits as long as they are greater than the State’s mandatory minimums. If you have a loan on that car, your lender may also dictate how much insurance you have to carry.

  4. cassandra_m says:

    This is a great post, P. It is interesting how this new meme of breaking up insurance to coverage you want is passing through the right. None of them will stop to consider that it is no longer insurance if you start carving out what you don’t want to pay for. All my life I and my employer’s insurances have been paying for viagara and prostate treatments and tests that I’ll never need. Wonder if these “carve it out” folks will see that I get a refund on the insurance I did not use and never will.

  5. radef16 says:

    I fully agree that “basic” plan must be well defined. What I find unacceptable is that we, the consumers were never asked for input on this topic. It was decided entirely by regulators & the insurance companies. Many people are saying the same thing, they were happy with their low cost but limited coverage plans.

    Now cancelled junk plans that did not cover birth & delivery did usually cover complications of pregnancy.

    The Delaware exchange plans are pitiful. There is no way to get even 80% coverage for out of network care nor any plan that includes parity for Brand medications. What’s worse is that the networks have been reset to include far fewer choices. Don’t assume that your new plan includes the same providers that your old BCBSDE plan did.

    With the ACA’s minimum requirements, there is absolutely no reason that out of state plans cannot be made available in Delaware.

    Overall, the ACA is a start but definitely not an unqualified success.

  6. liberalgeek says:

    With the high price of pregnancy and birth, it seems to me that organizations that don’t want birth control should have to pay a higher amount than “normal” organizations. A 10% increase (or whatever the actuarial tables say) should cover it. I also wonder what would happen if the organization were to assume responsibility for any unwanted pregnancies and the resultant children for 5 years or something.

    Either way, I agree that it is an integral part of any insurance policy.

  7. puck says:

    “we, the consumers were never asked for input on this topic. It was decided entirely by regulators & the insurance companies”

    Sure they asked consumers. But Congress and Obama went against the polls and catered to the insurance companies instead (or to the right wing in the case of contraception). Remember the Democratic wing swallowing their disgust and saying “We’ll fix it later?” Well, it’s later.

  8. liberalgeek says:

    This is hardly “later”.

    The damn thing hasn’t even been implemented fully. But if you would like to propose single-payer in this Congress, have at it. I’ll wish you luck and proclaim your greatness if you get it passed.

  9. puck says:

    If we don’t fix it now, the Republicans will. It is only a matter of time before Republicans come up with an Obamacare “reform” package, which will pass with a bipartisan coalition including every Republican and Carper, Coons, and Carney.

  10. pandora says:

    Republicans won’t come up with a reform package – they’d like to keep the popular stuff while dropping the mandate, which means it won’t work this way. Their plan amounts to “keep bitching” (Also, it really hasn’t been later.)

    LG, love the idea of charging more to organizations that won’t cover birth control and making them contribute to the upkeep of an unplanned child. It’s time these people put their money where their mouth is.

  11. puck says:

    Republicans have already forced Obama to allow junk insurance, just because he misspoke about “if you like your plan, you can keep it.” That is just the beginning of their “reform” attempts.

  12. Dana says:

    The comparison being made here is kind of silly; no one who supports the PP&ACA is calling for a la carte insurance; it’s just that some people have religious or moral objections to artificial contraception. The Catholic Church was very much a strong supporter of universal health care coverage during the debates preceding its passage, and objects really only to this.

    And it’s kind of a silly place for the Administration to draw a line in the sand, because artificial contraception is simply not that expensive. Planned Parenthood’s website puts the cost of birth control pills at $15 to $50 per month.

    Now, for a woman who is paying cash for oral contraceptives, that means writing a check or using a debit card for $15.00 to $50.00, the cost of the prescription. The WalMart or Target or RiteAid pharmacies get their money, right away.

    But the Obama Administration wants to change that. The President and his minions want everybody to have health insurance, and they want all health insurance policies to cover contraception, without any patient copayments. If that is the case, no woman will pay cash for her pills; she’ll show her insurance card instead.

    And that means that the pharmacy will have to bill the woman’s insurance company. Rather than the quick cost of the cashier accepting the patient’s payment, the cashier will have to enter the insurance information, and someone — probably someone else — will then have to put together a bill to the insurance company. The insurance company will then have to process the bill, make certain that the expense is covered, and then make the payment to the pharmacy. All of those extra steps cost money!

    Back at the pharmacy, it has to wait for payment. Instead of having the cash on hand, in payment for the medication received at the time it was sold, there will be a period of time — which could be weeks — that the pharmacy will, in effect, have to finance between the sale of the medication and being paid for it.

    Well, someone has to pay those costs. The pharmacy will have to add their costs to the price of the medication, thus billing the insurance company for a higher amount. The insurance company, bearing an overhead cost of their own in processing the claims, will have to add that into the premium prices they charge.

    The simple economic truth: oral contraceptives will cost more, because the PP&ACA is adding expenses to the purchase.

    Of course, there’s still more. Oral contraceptives are fairly inexpensive, and there is some actual competition between brands for sales. When women pay cash for their birth patrol pills, there is an incentive for them to buy a less expensive brand if they have the option. But once price is removed as a consideration for the patient, there is no need for the patients to choose lower-priced generics or request their physicians to prescribe a lower cost pill. The PP&ACA requirement that contraceptives be completely covered, with no patient co-pays, removes the incentive for price competition concerning the patient.

    Pharmaceutical companies exist for only one purpose: to make money for their shareholders. Without an incentive to reduce prices to gain market share, since patients won’t be price shopping, the pharmaceutical companies will be able to charge higher prices. This factor could be held in check, if PP&ACA regulations required co-payments from patients for prices beyond the generic brands, but the current requirement is for no copayments.

    The government could start its own buying program, to buy the medication in bulk, but that would make the government the seller of medication, not the pharmaceutical companies. In theory, the government could get lower prices for the bulk purchases, but, in practice, government procurement of items has never been something which led to lower prices. Even if such a program were put in place, it adds additional overhead costs.

    This is not exactly PhD level economics; this is just a simple recitation of the reality of business. Anyone who knows anything about business would have been able to see this . . . which is probably why the government cannot.

  13. Davy says:

    Insurance for Dummies: You cannot insure against events that are either expected or certain to happen. Your deductible, which you pay out of pocket, covers expected and known costs. Your premium compensates your insurer for assuming the risk of an unexpected event happening.

    The ACA’s birth control mandate simply redistributes the cost of birth control from direct users to non- and indirect users. This raises two questions:

    (1) Should non-users bear part of the costs of birth control?

    (2) Should indirect users bear part of the costs of birth control?

    This is not about insurance AT ALL. This is about whether the government may force non- and indirect users of birth control to subsidize the cost of birth control and thus encourage its use.

    Non-users with religious objections have a viable claim under the RFRA.

  14. Joanne Christian says:

    Crimineeeee…….quit hanging all of healthcare on birth control. You totally play into the hand of wedge issues.

    And anyone who wants to compare auto insurance to health insurance really needs a beat down, and I’m gonna give it to you. When you BUY your car, you have control over price, make, model, etc.. Hence, you know that Benz is bigger premiums, higher labor costs etc.. When I was ISSUED my dang body, who knew I was gonna be female, get my tonsils out, have kids, have complications from having kids, break an ankle, drop a lung, get kicked by a cow, fall thru a window, or get a parasite in some 3rd world country? It’s all a crap shoot for any of us—-AND I’M CONSIDERED HEALTHY!!! What Americans need to be re-oriented to is health care costs money. What Americans have problems with is paying for anything that isn’t aligned to conspicuous consumption, and begrudge the fact that great healthcare comes with a price–for ALL OF US. So we need to suck it up, pay for healthcare in some equitable fashion across the board (of which the Joanne Christian program I am too tired to discuss), pool our resources, and then be darn grateful if we NEVER have to call upon those resources–choosing the attitude–Yup, I paid all that and never used it (that’s insurance), or I am so glad I had insurance when…..happened. Either way it’s a win, but you have to buy that lottery ticket gang, or it isn’t going to work as a nation. Sorry, there are no refunds. We just have to pay it forward to insure we are providing necessary healthcare at the quality of care I would want for me or my loved ones when, if, ever, or has already happened……..

  15. Davy says:

    Another thing: you CAN insure against any subset of unexpected events. In theory, I could buy insurance that pays for my care if I get cancer but pays for nothing if I get HIV. In other words, my insurance payouts in future state “A” but not in future state “B”.

    But this stymies redistribution. From old to young, from direct users of birth control to its non- and indirect users.

  16. V says:

    Just a clarification: oral BC with insurance is the $15 end of the Planned Parenthood spectrum. At least that’s a normal co-pay with decent insurance. With some insurance it can be as low as zero. Generic brand oral BC without insurance is $50. I would assume that brand name oral BC would be higher.

  17. Dana says:

    What really surprises me — OK, not really — is what was left out of the PP&ACA. Contraception is supposedly a standard health care item that everybody needs, but, even if you accept that logic, it’s needed only for about half of a woman’s life.

    More expensive, and more universally required, over a whole lifetime, is dental care, but that was wholly omitted. A couple will pay somewhere around that $15 a month just for toothpaste, toothbrushes (teethbrush?) and mouthwash, and the cost of the annual doctor’s visit for a new contraceptive prescription is (in most cases) going to be less than your every-six-months dentist appointment and cleaning.

  18. Dave says:

    Actually, dental care may well be an excellent non-wedge issue about which to have a discussion. Adequate dental care is at least important as things like vaccinations. Disregarding orthodontic procedures, why isn’t routine preventative and treatment dental care provided? I don’t mean toothpaste/toothbrushes but examinations and treatment.