Feb 3, 2011

Ensuring Real Reproductive Choice for All Women

The NY Times reports today that the Obama administration is trying to figure out a way to require health insurers under the new health care law to pay all birth control costs – that is, to eliminate co-pays and deductibles for birth control. This is another sign of what a terrifically pro-choice president we have right now: he not only wants to protect abortion rights but he also wants to ensure that all women have a truly robust set of choices they can make about reproduction.

There’s an interesting class dimension to this. The federal government already pays for low- or no-cost birth control services for low-income women through various programs that have been in place since the mid-1960s. Now the Obama Administration seems to be recognizing that adequate birth control can be cost-prohibitive even for women whose incomes aren’t low enough to qualify for the existing federal programs. 

At the same time, though, we’re faced with a Republican Party that is trying to eliminate all abortion coverage from private insurance plans by implementing tax penalties for any plans that continue their coverage. As David Waldman explains at Daily Kos, there is a bill pending in the House of Representatives that would eliminate the current tax-deductibility of any health insurance plan that covers abortion. Right now, if an individual or an employer pays for health insurance, that payment earns various tax credits and deductions. But if this legislation is enacted, any insurance plan that includes abortion coverage would no longer be eligible for those deductions. Since that would be a huge cost to individuals and to employers providing health benefits, the end result would be that those consumers would demand that insurance companies exclude abortion coverage in order to retain the tax-deductible status of their plans.

Moreover, the bill would write the Hyde Amendment into permanent law. This Amendment, which prevents Medicaid and other federal money from paying directly for abortion services and therefore has tremendous effects on poor women, has been on the books since 1977 but currently has to be renewed every year, which at least provides pro-choicers an opportunity to make their case. But the new law would end that yearly renewal and permanently forbid the federal government from spending money on abortion services.

I also worry about some aspects of this Obama Administration effort to end out-of-pocket costs for birth control. My basic concern is that people exaggerate the direct effects of making birth control widely available. As the Times says, about half of all pregnancies in America are unintended, but that has not changed substantially in a while, and it’s not clear from the past fifty years of experience that the broader availability of birth control alone reduces the incidence of unintended pregnancies. Helping women attain reproductive self-determination is a complex process that involves their educational attainment, economic prospects, sexual relationships, and status in society, which can't be accomplished with a daily pill, no matter how cheap that pill is.

Most importantly, the article concludes with a claim by a Brookings Institution scholar that “We have rigorous evidence that every dollar invested in family planning saves more than a dollar in welfare and social service costs for children that result from unintended births.” This claim is nearly fifty years old and was one of the main reasons that the federal government began to subsidize birth control services for poor women in the mid-1960s. In this case, it's entirely irrelevant since the proposed regulations have nothing to do with government expenditures, but instead are about how private insurance companies spend their money. The fact that it even came up in this context indicates how much we stigmatize poor women's (i.e. welfare recipients') reproduction and see it as a cause of our society's problems. 

I’m all for the universal accessibility of high-quality birth control and family planning care, but I worry a lot about seeing birth control as a panacea for very complex problems. Affordable, safe, and reliable birth control must be available to every American woman, but that is only a first step to ensuring that all women have reproductive autonomy. And it’s time to stop seeing women’s reproductive decisions as a component of fiscal policy. Whatever the effect on the government’s bottom line, access to high-quality family planning services is something we as a society should provide to all women.

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