Posted by: Grandma LaLa | February 18, 2012

Thoughts on the contraception coverage controversy

Part of the latest political uproar involves the proposed requirement that employer-provided health insurance coverage must include access to contraception and birth control prescriptions.  There are knee-jerk reactions in the public discourse on this topic.  And I include myself in that extreme.  So I’m taking a few moments to think about my experiences and my convictions, hoping to find a more reasonable perspective on this for myself.

On any of these polarizing issues, I believe it’s helpful for each of us to examine the experiences that inform and shape our convictions.  Truth in advertising, in a sense.

From the standpoint of personal experience, I need to start from the beginning.  My beginning.  I was not a planned pregnancy.  Over the years, my parents gently joked about whether they were using contraceptives as a newlywed couple or my conception was just a fluke.  Either way, my mother was shocked to discover that she was pregnant one month after marrying my father.  Eventually happy, but initially shocked and disbelieving!  So my very existence was created by a failure of contraception … or possibly of choice for contraception.

As a young woman, I had severe problems with my menstrual cycle.  I had heavy hemorrhaging every month, severe cramping due to the bleeding, and a cycle of less than 28 days.  My health was at risk.  My physician put me on a low-dose form of birth control to try to reduce the debilitating blood loss every month.  I was not sexually active.  I needed the birth control prescription for other medical reasons, immediately related to my overall health.

In those days, health insurance coverage paid for perinatal care for expectant mothers, delivery of newborns, and vasectomies for men.  But it did not cover contraceptive prescriptions, not even on the grounds of protecting a woman’s health in my situation.  That seemed to me then … and it still seems to me now … hypocritical and inequitable.

I’m now past the point of my potential childbearing years.  So contraception is not an immediate issue for me personally.  Since two cancers intervened early in my marriage, it really wasn’t an issue for us as a couple either.  Even so, I care about the issue of contraception access as a health care coverage issue because it’s a question of equitable coverage.

This controversy isn’t arising from within the insurance industry, as far as I can tell.  After all, health insurers pay for much more expensive prescriptions and procedures than this!  So the controversy seems to be stemming from one core issue.  Why should I have to help pay for a prescription or a procedure that is not one I would choose … especially when that choice/refusal would be for religious or ethical reasons?

For more than three decades, most insurers have included contraceptive prescriptions in their formulary drug list.  So I question why everyone is so upset about this now.

I wonder whether some are upset because they worry that this is a precedent and a slippery slope to even more controversial required coverage.  For example, perhaps they worry that requiring insurers to allow contraception as a qualifying prescription would eventually lead to requiring insurers to allow abortion as a qualifying procedure.  If that’s the worry, I can empathize with the concern.  It’s not my view, but I can understand the concern.

The irony is that health insurance coverage already includes plenty of procedures that some Americans find objectionable on religious and ethical grounds.   And yet I/we help to pay for this.  Here are some examples.

  1. I am a non-smoker.  Insurance companies routinely allow and pay for treatments for lung cancer, spinal problems, and circulation complications that are directly attributable to smoking.
  2. It’s unusual for me to drink a beverage containing alcohol.  Insurance companies routinely allow and pay for treatment of liver diseases directly attributable to alcoholism, not to mention treatment of the addiction itself.
  3. When I drive or ride in a car, I wear a seat belt.  Always.  When I ride a motorcycle or a bicycle, I wear a helmet.  Always.  Insurance companies routinely cover head traumas and other injuries for people who do not wear seat belts or helmets, even when it’s the law to do so.
  4. A colleague of mine recently served as a juror on a medical malpractice case involving a woman who died from complications of a heart attack.  Her religious conviction forbids the blood transfusion that could have saved her life.  Insurance companies routinely cover blood transfusions, despite the fact that some people object to them on religious grounds.
  5. I find it abhorrent that health insurers will cover costs related to extreme life-saving measures, such as organ transplants, when so many American citizens do not have the basics of health care such as an annual physical exam.  My family knows that I would refuse an organ transplant on those grounds, even if my life depends upon it.

I’m not suggesting that we stop insuring for these conditions.  I’m simply suggesting that it’s already the case that health care insurance charges us for treatments that many of us find religiously and/or ethically objectionable.

When I explore my own rage over this controversy, it really targets the scarcely-disguised sexism in the conversation.

Are people really objecting to proposed coverage of contraceptive medications on religious grounds?  If so, then where is the uproar over insurance coverage for Cialis and Viagra?  These are also manufactured interventions, which could easily and consistently be interpreted as interfering with God’s plan for one’s reproductivity.  If so, then where is the uproar over a vasectomy and hysterectomy being an allowed medical expense?  These medical procedures interfere with reproductivity just as surely as does a contraceptive medication!  It’s hypocritical and inequitable to scream about contraception and remain silent on these other treatments related to reproduction and sexuality, especially since they are routinely more expensive.

So I’m forced to conclude that it’s not really religious conviction that is the core of this controversy.  It’s sexism.


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