Let’s Be Sure To Duck Right Wing Canards Claiming Women Get Free Birth Control

By Donald A. Collins | 26 September 2012
Church and State

Those pols and religious screamers who are talking about freedom and the horror of forcing their rich constituent religious institutions into paying for needed medical services for women employees have finally gotten a powerful salvo of fact from Jodi Jacobson, Editor of RH Reality Check. Let’s let her shed light on these vicious canards.

In her August 6, 2012 article, Why “Free Birth Control” is not free, she celebrated the fact that “August 1, 2012, was a momentous day for women, marking the official beginning of a process of ensuring that millions of women across the United States will — finally — have access to a full range of preventive health care services without a co-pay.”

While she amplified what really is involved, I wanted to replay this part of her article to emphasize that religious zealotism lies behind all the controversy and will continue to play a powerful role in keeping women from getting the essential services Jacobson articulates.

“These (services) include a wide range of services and interventions identified by the Institutes of Medicine as essential to women’s health and well-being, including breastfeeding support, supplies, and counseling; screening and counseling for interpersonal and domestic violence; screening for gestational diabetes; DNA testing for high-risk strains of HPV; counseling regarding sexually transmitted infections, including HIV; screening for HIV; contraceptive methods and counseling; and well-woman visits. Likewise, the ACA also ensures that plans must cover an array of services, vaccinations, and interventions, including those specifically needed by women, infants, children, and adolescents at different points in their lifecycle.”

So here we go again, to paraphrase Ronald Reagan, who by the way was a flip flopper on choice, favoring it as Governor of California and against it as President.

Jacobson notes what this web site is dedicated to unmasking, namely the consistent failure of our main stream media to identify the source of these anti women’s health men.

She says, “Unquestionably, due to the efforts of religious and political fundamentalists at the state and federal level to deny women access to reproductive health care of virtually every kind, the benefit that has gotten the most media attention is the one involving contraception without a co-pay. Many media outlets (see ABC, NBC, Grist, Shape.com) and some columnists, including our colleague Amanda Marcotte, have described the new birth control benefit as making contraception “free,” most frequently, for example, stating that now women will have access to birth control for free.”

“This,” she notes, “is not the case, and it is misleading — and politically dangerous — to say so.”

And this is why I think rerunning the substance of her article is so important.

She explains:

“To get birth control without a co-pay means you have an insurance policy. No one can walk into any pharmacy today and get the pill without a prescription, which in any case first entails a visit to a doctor’s office. No one without insurance can walk into a doctor’s office and get an IUD for free, nor any kind of contraception, unless they pay out of pocket or meet the means test for and are covered by Medicaid, an increasingly difficult enterprise in itself but the subject of a different article. Ten percent of women in the United States who work full time are currently uninsured and without coverage; they do not have access to “free” birth control. Nor do other women without insurance, or those whose plans are, for logistical reasons or because they were grand-fathered, not yet compliant with the ACA on preventive care. None of these women have “free” birth control now, and they will not later even if they get insurance. (See the National Women’s Law Center Guide on what to do if you have questions about your insurance plan and contraception without co-pay.)

Why? Because if you have insurance, you pay for it, either by virtue of your labor or out of your own pocket, or, depending on the situation, both. And under the ACA, it is now mandated that your insurance plan cover certain benefits without a co-pay. This does not make them “free.” It means that you are paying for that service as part of your premium. You earned it, you paid for it, it is yours. If you pay for it, you deserve to get it.”

We know that providing birth control free to any one who wants it is great public policy. The Guttmacher Institute, on whose founding board I served has published huge amounts of carefully compiled research. In one example of many, using California and Title X, which is under attack by the current Republican candidates, Guttmacher reports that:

“Title X of the Public Health Service Act is the sole federal program devoted entirely to family planning. Through Title X the federal government sets family planning policy, and its flexible grant funds not only subsidize direct client services, but are critical to putting family planning centers in communities and to supporting their ongoing infrastructure needs.

These services are vital: U.S. women who are not using contraceptives, or who are using them inconsistently, represent one-third of all women at risk of unintended pregnancy and account for 95% of the three million unintended pregnancies that occur every year. Unintended pregnancy, in turn, has been linked with numerous negative maternal and child health outcomes. More broadly, women’s ability to rely on contraception enables them to invest in higher education and to be full participants in the nation’s workforce.

Title X is central to helping women meet their reproductive health goals. In 2008, an estimated 7.1 million female contraceptive clients were served at publicly funded family planning centers, two-thirds of whom—4.7 million women—were served at sites supported by Title X. Contraceptive services at Title X–supported family planning centers helped women and couples avoid 973,000 unintended pregnancies, which would have resulted in 433,000 unplanned births and 406,000 abortions. Without these services, unintended pregnancy and abortion in the United States would be one-third higher. And by helping women avoid unintended pregnancies, Title X–supported centers saved taxpayers $3.4 billion in 2008, amounting to $3.74 saved for every $1 spent providing contraceptive care.”

And these anti birth control zealots, claiming to be so fiscally responsible, ready to cut government spending, are so fixated on their War on Women based ideology that saving $3.4 dollars for every dollar spent on family planning is deemed a loss of freedom.

Romney’s historic comment about 47% of Americans not paying income taxes and being dependent on government conclusively demonstrates how completely unconnected to reality their definition of “freedom” has become.

Having made my points of emphasis, I am pleased to let my readers read the rest of what is a superb article, detailing what birth control has been paid for over and over by her and women generally and is clearly NOT free, as these right wingers keep whining.

Jacobson recites her personal history in illuminating detail:

“My first “real job” after college came with health insurance benefits. I worked very hard in that job, and by extension for those benefits. I earned them through my work in the very same way I earned a matching benefit for my retirement account, the vacation time I got, my life and disability insurance, and the Social Security earnings paid to the government. None of these were a gift. I earned them.

Throughout my career, I have been employed in positions where my health insurance was either fully or partially covered by my employer; in the latter case, the employer share was part of my compensation package (and when I was hired, this was explicitly made clear) and I paid a portion of the insurance premium out of my salary. I was fortunate during much of that time in that I also earned generous health benefits for my children. More recently, I was self-employed for three years, and I paid my insurance premiums in full, out of my pocket, at considerable cost. And I earned every single penny I spent on health insurance and therefore every benefit I got from it.

Under the terms of various of my prior health policies, various medical services, such as well-baby and well-child exams, were covered without a co-pay and did not require me to meet a deductible. Other things, such as our endless visits for my kids’ ear infections, laboratory work, dental care, medical tests, and some doctors visits required co-pays, generally in the range of $15.00 to $50.00 a visit for the simple kinds, and more for the more complicated kinds. I was also often required me to meet a deductible before I could be reimbursed for certain other costs. Prescriptions for me and my kids have invariably cost from $5.00 to $50.00 in co-pays, which, though seemingly small amounts, really begin to add up, especially if you have kids or illness or both.

But those well-baby exams were not “free.” I paid for them with my premium. My insurance premium — paid for and earned by me, and pooled with hundreds of thousands or millions of other people — paid to cover those services. This is a basic principle of health economics and comes down to the old adage, “an ounce of prevention is worth a pound of cure.” Insurance companies don’t make huge profits for nothing. They know that offering certain kinds of preventive care and making that care more accessible to more people means that a small investment in the short-term will keep costs lower in the long term. An early abnormal pap smear leading to early treatment is a lot less expensive for them than is treatment for cervical cancer later on (and quite obviously better for the woman in question). An unwanted pregnancy averted through use of contraception is less expensive than an abortion. And so on.

What the Affordable Care Act does is help to begin making our insurance policies and premiums more equitable. As Jessica Arons points out in a comprehensive article, fewer working women than working men in this country have employer-based insurance; insurers have historically charged women more than men in a practice known as gender-rating; and for a very long time, women have paid more out-of-pocket for basic preventive health care services like pap smears and birth control.

The goals of the women’s health provisions in the Affordable Care Act were to begin addressing these disparities, by making women’s access to health care more equitable, and by dramatically reducing the higher costs women pay just because they are women. These changes unquestionably benefit women. But let’s face it, while these are all great things, the reason that lawmakers and insurance companies did this has to do largely with the cost-savings that will be realized: healthier women mean a healthier society and reduced economic and social costs.

Claiming that the services for which women are covered by virtue of their labor and their earnings are “free” feeds into a narrative persistently cultivated by the far right that taxpayers and the government are footing the bill to expand services “for free” to people who did not earn these. It simply is not true.

I fully support expanding government-funded programs to ensure that all women — those living in poverty, low-income women, and the working poor — have access to birth control and other preventive health services, because it makes sense in terms of public health and the economy, and because such access is a basic human right. But people who earn their insurance coverage pay for it, and they deserve the benefit for which they are paying. Moreover, even those who are eligible for government-subsidized access to care — whether reproductive health care or other kinds of care — also are paying at least a share of those costs through their tax contributions. No one is really getting anything here “for free.”

It is notable that the Obama Administration, which has been widely criticized for not doing enough to advertise or explain the many benefits in the Affordable Care Act, does not refer to the birth control benefit as “free contraception.”

Let’s call the birth control benefit what it is: Women’s hard-earned insurance coverage.

It’s ours. We earned it. We pay for it. We deserve it.”

Former US Navy officer, banker and venture capitalist, Donald A. Collins, a free lance writer living in Washington, DC., has spent over 40 years working for women’s reproductive health as a board member and/or officer of numerous family planning organizations including Planned Parenthood Federation of America, Guttmacher Institute, Family Health International and Ipas. Yale under graduate, NYU MBA. He is the author of From the Dissident Left: A Collection of Essays 2004-2013.

From the Dissident Left: A Collection of Essays 2004-2013

By Donald A. Collins
Publisher: Church and State Press (July 30, 2014)
ASIN: B00MA40TVE
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