The Obama administration has found the policy equivalent of
alchemy. Employees of religious organizations will receive
contraception coverage. And neither the individuals nor the groups
will have to pay for it. It’s magic.
Otherwise known as making the insurer pay.
On Friday the Department of Health and Human Services announced
its new rule mandating coverage of contraception. Responding to the
furor that the proposal first raised, HHS Secretary Kathleen
Sebelius proclaimed that the draft regulation would guarantee free
coverage “while respecting religious concerns.”
The latest iteration does clarify the exemption, expanding its
reach a bit, to some hospitals, social service groups, and
universities with religious affiliations. But there would be no
protection for other organizations, as well as employers or
employees in secular work who happen to be religious. As before,
freedom of conscience is sacrificed for the administration’s
ideological objectives.
Equally bad is the means of “protection.” Chiquita Brooks-LaSure
of HHS helped write the language and explained: “Under the proposed
rule, insurance companies — not churches or other religious
organizations — will cover contraceptive services.” Employees at a
religious institution could go to their group’s insurer and receive
a separate plan priced at zero dollars. Insurers cannot “impose any
premium, fee or other charge” for the coverage.
Thus we have policy alchemy. Uncle Sam mandates benefits.
Employers do not have to provide coverage for the benefits.
Employees do not have to pay for coverage for the benefits. The
insurers must provide coverage but cannot charge anyone
anything.
What’s not to like about this idea? Indeed, why not use this
model for health insurance generally?
Think about it. Congress could mandate a generous standard
medical plan for all of us. (Heck, legislators might as well
include people who aren’t working. Why let lack of employment get
in the way of such a great idea?) Not just generous, but
very generous. After all, we are entitled to
“Cadillac” care — every procedure at the finest facilities for as
long as we want.
Lest small-minded critics complain about the cost, the benefits,
all of them, would be FREE! Insurance companies would be required
to provide the necessary plans. But they would not be allowed to
“impose any premium, fee or other charge” for doing so. Just like
for the contraceptive benefits.
Then everyone in America would have comprehensive insurance at
no cost.
What could possibly go wrong with such a program?
Tragically, it appears that someone at HHS realized that there
ain’t no such thing as a free lunch, or insurance plan. So the
agency proposed allowing insurers to receive a credit against fees
they would owe for participating in state health insurance
exchanges. Which means the taxpayers would end up paying for the
coverage. For Uncle Sam would have to make up the difference
somehow — or borrow more money, which just means that future
taxpayers would end up paying.
The administration rule nicely demonstrates the fundamental
mistake that is Obamacare. It is ridiculous for Washington to
decide health care benefits for 315 million Americans.
First, the proposed rule has nothing to do with making “it clear
that your boss does not get to decide whether you can have birth
control,” as claimed by Planned Parenthood. Today everyone is free
to purchase contraception, which is affordable for most everyone.
The regulation actually is about subsidies, that is, forcing those
who don’t want or like birth control to pay for those who desire
birth control.
Second, there is no standard one-size-fits-all insurance package
that is appropriate for everyone. Just as it would make no sense to
mandate a particular standard for homeowner, auto, or life
insurance, it makes no sense to impose a set package for health
insurance. We all are different and prefer different mixes of risks
and benefits, as well as tradeoffs between health insurance and
other uses of our money.
Imagine telling a car owner that he or she also must pay for
motorcycle, racecar, and truck coverage. Never mind that the driver
doesn’t own any of them. Some far-sighted politician or bureaucrat
has decided that this coverage is “necessary” and all must pay.
Similar is requiring insurance coverage for maladies and procedures
irrespective of the insured’s desires.
Third, insurance for birth control is not insurance. The purpose
of insurance is to guard against unexpected and large, even
catastrophic, expenditures. That ain’t birth control. Not only is
it affordable, even for students who attend Georgetown Law School,
but its use is fully under the control of the insured. It is as if
auto insurance paid for gasoline fill-ups. Contraception coverage
is prepayment of expected medical expenses, expenses that you can
increase as much as you want.
Fourth, the push for mandatory coverage is ideological, not
medical. The vast majority of plans already cover birth control for
the simple reasons that it is widely desired and unplanned
pregnancies are expensive. Nor is contraception uniquely important
— more vital than mammograms, chemotherapy, colonoscopies, heart
bypass operations, and much, much more. If birth control should be
free, then surely everything else should be free as well. Why make
patients pay for any treatment?
Fifth, making contraceptive coverage truly “free” is impossible.
Someone has to pay. Contrary to the apparent assumption of many
policymakers, birth control products do not magically appear ex
nihilo. Someone has to create, produce, market, and sell them.
Which means that someone has to be paid by someone else. If not the
patient, then who?
The administration has shifted, not eliminated, costs. Thus,
everyone under a plan covering contraceptives will pay for the
benefit, even if they do not use them, never intend to use them,
and are morally opposed to using them. That may be a good deal for
the person who wants contraception, but not for the rest of us.
At least this makes more sense than the administration rule,
which says insurance companies have to pay for the coverage. If
they can’t charge specifically for birth control, they will treat
coverage like an administrative expense. Either all plans offered
to religious organizations or simply all plans for everyone (for
the sake of simplicity) will incorporate the cost. Then we all will
pay so Washington can satisfy the ideological preferences and
financial interests of clamorous political groups.
Sixth, requiring coverage of contraception (as well as
abortifacients and sterilization) is worse than other mandates
because it violates the conscience of some religious believers.
Requiring Catholics and some others to subsidize birth control is a
direct assault on their faith. One can argue about the rule’s
constitutionality — First Amendment jurisprudence is notoriously
complex — but the government should not challenge people’s
fundamental moral beliefs without a serious, even compelling
justification. There is none for relieving those having sex from
paying for contraception. Sex is good, but that doesn’t mean the
rest of us should have to pay for those using birth control while
engaging in sex.
In short, the administration rule is extraordinarily bad on
medical, policy, and moral grounds. It can only be explained as
being directed not for those who use birth control but against
those who oppose using birth control. It is about power and
control. That is, advocates want to force Catholics and others to
pay for contraception as a matter of (malign) principle. It makes
Schadenfreude the basis for the U.S. Code.
There is much to dislike about Obamacare. Top of the list should
be the arrogant presumption that Washington knows our treatment
needs better than the rest of us. Choosing our own medical
destinies should be our real “right” to health care.
Photo: UPI
