Hanna

"I'm hard pressed to believe that insurance companies intentionally make decisions that negatively affect the bottom line."

The decisions might negatively affect the bottom line in and of themselves, but if they preserve customer or shareholder relations for the company at the same time, the company may come out ahead.

Here's an example of the phenomenon I'm talking about. Assume that insurance company research finds that they lose money on heart disease prevention for people with Type II diabetes -- it's cheaper when those folks die of heart attacks than when they live long enough to get kidney disease and need dialysis, amputations, etc. Even in the absence of government regulation, it would be public relations suicide for the company to stop covering statins and so on for that group. They'd be all over the news as the company that just lets Grandma die of a heart attack because it's cheaper. They'd lose the profitable healthy customers who can switch to another company. PR puts a constraint on insurers saving money this way.

But a policy imposed by the government gives the insurer an out. Any shareholder or customer dissatisfaction with a mandate is directed at the government, not the company, and it impacts all the competitors equally. I agree with Hunt that they may be staying neutral for just that reason...they don't want any share of the blame if a segment of the public gets angry about a certain policy.

claremarie

"The more foolish and short-sighted someone's decisions are, the easier I want it to be for her to choose highly effective birth control"

You don't get it. The more foolish and short-sighted a woman is, the LESS likely she is to "choose" birth control pills, AND use them correctly, because proper use requires a level of discipline and motivation that she simply does not possess. Her method of birth control is actually the least of her "choice" issues -- she is making lots of poor choices regarding education, employment, and sexual partners. And those problems won't be solved by forcing employers to provide birth control free of copays.

Pizzagirl

Absolutely not. If my doctor and I have decided the BCP is best for my contraceptive needs, then how dare you suggest that I should just content myself with the other options, which frankly are all inferior since they don't provide the non-contraceptive health benefits that the BCP does? No. See, just because I'm a woman doesn't mean my health care needs are optional or that I should settle for sloppy seconds. We wouldn't have this discussion about other ways of treating erectile dysfunction other than Viagra, that's for sure. No one suggests men "content themselves" with less effective treatments.

emeraldkity4

And those problems won't be solved by forcing employers to provide birth control free of copays.

Although, i would argue that even the least motivated woman may recognize that by using birth control that doesn't require a financial outlay, could limit the problems she is already dealing with in her life by not becoming pregnant (again)

Bay

Something else I'd like clarification on, is the evidence and expectation for the outcome of offering bcps at no co-pay (Btw, I think the official adjective is "cost-sharing," which implies that there is a cost involved). If it increases the use of bcps, is the expectation and desire that the US fertility rate decline lower than it currently is? It is already below replacement rate - is that something we as a society want?

Also, is there any actual evidence that free or cost-shared bcps will reduce the rate of abortions in the US? I ask because on another thread, we learned that Sweden's abortion rate is higher than the US, (something like 27% versus 23%), and they offer free contraception.

zoosermom

I would be delighted to suggest that very thing. In fact, I don't think anyone, including insurance, should pay for ED tablets except the person taking them. Just like I don't want the government or our mutual health insurance company to pay for my neighbor's chemical peel.

myturnnow

claremarie~You may not have meant it to be offensive, but I take offense at your use of "they" as representative of very poor women valuing cigarettes more than the health of their unborn child. what are you basing this statement on?

Hunt

Personally, I think we'd be better off with a somewhat smaller population. It would be less of drag on natural resources.

Onward

I also think we would be better off with a smaller population.

zoosermom

Gotta have workers to pay those pensions and social security.

Bay

It is not just pensions and social security. We with self-funded retirement savings are going to be up a financial creek when there are not enough young people to buy our investments that we expect to be living off of in our old age.

Hanna

"It is already below replacement rate - is that something we as a society want?"

IMHO, it's something that we don't want, but we also don't want a society where people are having the additional kids because they were careless, not because they really wanted a larger family. I think there are other, better ways of encouraging larger families, like greater support for paid parental leave, day care, and free health coverage for all children. That and comprehensive immigration reform that makes it easier for young workers to come here legally and raise their families.

claremarie

"I take offense at your use of "they" as representative of very poor women valuing cigarettes more than the health of their unborn child. what are you basing this statement on?"

On statistics demonstrating that low-income pregnant women have high smoking rates. Here is just one study, but a few minutes on Google will give you many more.

"This study used the Washington State First Steps Program Database to estimate the difference in maternal smoking prevalence between mothers whose prenatal or delivery care was Medicaid-funded and mothers whose care was not Medicaid-funded. We evaluated differences in maternal smoking prevalence between these two groups by marital status, race, adequacy of prenatal care, and age. Among the Medicaid-funded mothers, the age-adjusted maternal smoking prevalence was 44.4% versus 16.3% for those not Medicaid-funded."

Smoking prevalence during pregnancy fo... [Am J Prev Med. 1994 Mar-Apr] - PubMed - NCBI

claremarie

"Although, i would argue that even the least motivated woman may recognize that by using birth control that doesn't require a financial outlay, could limit the problems she is already dealing with in her life by not becoming pregnant (again)"

You might argue that, but pills are ALREADY available, at very low cost, at family planning clinics, and low-income/education women still decline to use them. http://www.cdc.gov/NCHS/data/series/sr_23/sr23_029.pdf And women who experience unintended pregnancies while not using contraception don't give "just could not afford it" as the reason for their non-use.

bclintonk

I don't think it's necessarily anyone's goal to reduce the national fertility rate, but it has been the goal of many public health officials for some time to reduce the rate of unintended and unwanted pregnancies.

Surveys show that about half of all pregnancies in the U.S. are unintended, and rates of unintended pregnancy are highest among sexually active teens (twice the national average), women aged 20 to 24 (twice the national average), women with less than a high school education (about 60% higher than the national average), and women living below the federal poverty level (nearly 3 times the national average). Rates of unwanted pregnancy drop sharply with increasing age, level of educational attainment, and income. Nearly half of unwanted pregnancies end in abortion; of those that end in live birth, Medicaid picks up the tab for about 2/3 of them.

Not coincidentally given these statistics, poor women have abortions at a rate well above the national average (52 per thousand, or more than double the national average).

Women who use birth control consistently and correctly account for only 5% of unwanted pregnancies. Those who use birth control inconsistently or incorrectly account for 43% of unwanted pregnancies. Women who don't use birth control at all account for 52% of unwanted pregnancies.

Facts on Unintended Pregnancy in the United States

To me this is a no-brainer. Making birth control available at no cost won't eliminate unwanted pregnancies, but it will reduce the rates of unwanted pregnancy, abortion, and unwanted children being born and then in most cases raised at taxpayer expense.