Until today, I have had a difficult time making up my mind about the contraceptive controversy. On the one hand, it is simply having insurance pay for what a very large percentage of sexually active Catholics already practice. On the other hand, the Catholic Church is not a democracy. A few old men run the organization. Is the official religion represented by their pronouncements, or by the actual practices of the Church members? In a democracy, do we craft policy that protects the freedoms of church members, or of its leaders? I am not sure how to resolve that, but I dont think it matters. The Church will not be paying for contraceptives.
John Goodman provides a link to a study which looks at the costs of providing contraceptives. It turns out that insurance companies, and businesses save money when contraceptives are offered.
Unintended pregnancies result in substantial excess direct medical claims costs17 and indirect costs such as disability, employee replacement costs, lost productivity, and presenteeism.14
Providing coverage for contraceptive counseling and contraceptive medications and devices improves access and use, thereby avoiding the substantial direct and indirect costs associated with unintended pregnancies, abortions, and unwanted births. The average cost of a 1-year supply of prescription birth control pills is $240 to $300 (in year 2005 dollars) and the cost of a single prescription of emergency contraception is $20 to $150. These costs are lower than the “treatment” costs for an unintended pregnancy.7 For example, the average cost to employers of:
• A first term abortion is approximately $468 (in year 2003 dollars).7
• A normal vaginal delivery (without complications) is $7,340 (in year 2005 dollars).7
• A cesarean delivery (without complications) is $12,257 (in year 2005 dollars).7
• The delivery and first year care of a premature infant is $41,610 (in year 2001 dollars).18
Comprehensive contraceptive coverage is relatively inexpensive. The average total cost (including administrative costs) of adding coverage for all reversible methods of contraception is $25.31 per employee, per year.7 The added cost to employers of providing contraception coverage (assuming 20% employee cost sharing) is $1.69 per employee, per month (all figures from 1998, adjusted to year 2005 dollars using the NASA Inflation Calculator).7
In 2004, the private-sector cost of preventive medicine evaluation and management averaged $107 per session; approximately 95% of paid claims fell within the range of $45 to $165 per session.19
Treatment costs of an unintended pregnancy include the cost of termination ($428)7 or the cost of prenatal, delivery, and postpartum care and the ongoing cost of care for the infant. The cost of labor and delivery alone ranges from $7,3406 to $41,610 (figures in year 2003, 2005, 2001 dollars, respectively).18 The cost of prenatal care and ongoing infant/child care varies substantially, but it can be assumed to be significant if the child remains a beneficiary until 18 to 25 years of age.
Researchers estimate that over a 5-year period, employers can save $9,000 to $14,000 (in year 1993 dollars) by providing comprehensive contraceptive coverage.8 Experts suggest that employers may begin to see some savings in the first year of coverage.8
The Church, or observant Catholics will not be required to pay for contraceptives. They will be required to pay less in insurance premiums because their insurance will carry contraceptives. I can see how they might find this offensive, but I dont think the Church has a constitutional right to not be offended because they are paying less for insurance. We have already done the same thing for abortion. Insurance carriers are not allowed to reduce their rates when they carry coverage for abortion. It is unclear to me why (I understand the politics) a religious group can mandate a decreased salary on my part.**
I do think there is a way out of this. We know that employers compensate employees based upon their total compensation package. Those health care benefits are part of what an employer pays to maintain an employee. Every employee of the Catholic Church, or an observant Catholic, will therefore see less take home pay if contraceptives are not offered. The Church, or the observant Catholic employer, should make up the difference in take home pay if they choose to not have contraceptives included on their insurance plan. The employee will not suffer from having someone else’s religious beliefs resulting in their decreased income. The Church/employer will not have to offer contraceptives in their insurance offering.
** As an employer, I would note that delivery and child care costs make a large contribution to our insurance costs.