Friday, February 10, 2012
An alternative approach to the contraception coverage issue
I don't have an ethical problem with Romneycare's support for mandating birth control coverage by religiously-run institutions doing secular activities like running hospitals, with similar provisions in many states, or with similar provisions in Obamacare.
Another way to handle this issue though is to require the same total level of financial commitment from religious employers and then let them choose something additional to cover, to make up for their decision not to cover contraception. Their hospital employees can get breaks on plastic surgery, while other hospitals' employees get contraceptive coverage. No financial reward accrues to a religiously-based resistance to coverage, and secular employees can keep the coverage differential in mind when deciding which jobs to apply to.
This could be done even more broadly: rather than every insurance provider being required to cover the same standardized basket of services, just figure out how much that basket would cost for your average provider, and tell other providers that they can choose a different basket so long as that different basket, if paid for by the average provider, cost at least as much as the standardized basket. If they can then figure out a way to do things differently and cheaper, then more power to them.
I doubt these solutions are allowable currently, but maybe that could change someday. I generally prefer determining the fair cost approach for someone who wants to deviate from a standard, like requiring lifelong coma/quadraplegia insurance for motorcycle riders who don't want to wear helmets, rather than simply telling them what they can or can't do.
UPDATE: Apparently I should clarify. I was comparing replacement of contraceptive coverage with something trivial like plastic surgery not in order to indicate that contraceptive coverage is trivial, but that employers IMO are unnecessarily and significantly reducing the value they provide to employees if they really want to follow this unwise path.
UPDATE 2: Just like I don't have a problem with the original proposal, I don't have a problem with the new one. The cost issue is less than entirely clear to me - if it's really the case that it saves insurers money, then that's fine, but if the coverage costs money on net, then there's the question of who pays for it. And the Catholic Bishops want to exempt not just the religious charities but any business run by Catholics from the same obligations as other business, which is a real race to the bottom if the exemption saves them money. And there's self-insured Catholic charities, but they're getting ever further afield from religious service and being more like any other business entity in that case. I still think the best approach would be to develop a basic cost basket, and a clear, mandatory disclosure of when the insurer deviates to add and subtract from the standardized basket.
What the heck, UPDATE 3: my classmate Laura MacCleery battles it out on Fox News.