The Religious Exemption To Contraceptive Coverage In Obamacare

This note has to do with today's (Friday, June 28, 2013) ruling by the U.S. Department of Health and Human Services regarding the mandate for employers to provide coverage for contraception and the limited religious exemption as reported in this article from Bloomberg and the actual ruling, which is linked in the Bloomberg article.

First of all, why did it take so long for the HHS to make a final ruling, especially since they were ordered by the court to stop stalling and make a ruling?  I think it is because of the timing of the renewal of insurance policies, specifically those that renew during the summer (July 1 and August 1 come to mind) and the employers not having a sufficient amount of time to self-certify that they are an eligible employer to opt out of providing the coverage.  Their failure to self-certify in the first year of the law might even be used against them if they try to self-certify at a later date.

Secondly, it seems that there was no compromise on the definition of a religious employer as promised by the HHS.  The actual ruling states "Based on their review of these comments, the Departments are finalizing without change the definition of religious employer in the proposed regulations."

Thirdly, what insurance law allows for an insurance company to provide a coverage to the policyholders without collecting anything for the coverage?  I cannot think of any insurance company or state department of insurance that would approve of doing what is stated here:

"A nonprofit associated with a religious group that doesn’t want to pay for the coverage must inform its insurer or the company that administers its health plan, if it is self-insured, the government said. The insurer then pays for the services without using any money received from the nonprofit."

The actual ruling discusses this this in more detail.  It still does not appear to be actuarially sound on its own.  Rather, it relies on the cost savings in the insurance plan and allows the insurer to offset these payments with the cost savings.  This cost savings is only realized when one combines the payments for contraception coverage with the insurance policy that specifically excludes contraception coverage.  No matter what the ruling states about not using premiums from these policies to pay for contraception coverage, this is the only way the insurer can offset the losses for providing the contraception coverage free of charge.

If the federal government will be reimbursing third party administrators (TPA) of self-insured companies for this coverage, doesn't this mean the government is paying for it?  And how much will this reimbursement cost?  The government has no idea:

"Third-party administrators, who won’t financially benefit from reduced births, will be reimbursed for the coverage by the government. The administration offered no estimate of what those reimbursements would cost."

In regards to the first sentence of the quote in the last paragraph, why should the TPA's benefit from this?  TPA's contract with the self-insured companies.  The TPA gets their income simply for being the administrator and their fee is negotiated and spelled out in the contract.  The supposed savings would be for the self-insured company, not the TPA.

Keep in mind from where the HHS feels the cost savings will come:

"“We do strongly believe that the cost of contraceptive services will be absolutely cost-neutral and offset by improvements to women’s health as well as reduced pregnancies,” she (Chiquita Brooks-Lasure, deputy director of policy and regulation at the Center for Consumer Information and Insurance Oversight at HHS, which is implementing much of the Affordable Care Act.) said at a briefing with reporters."

The overall impact on women's health of providing contraception may actually increase costs.  Some forms of contraception actually have negative impacts on women's health, such as  increased risk of cancer, so that may cause a net increase.  As with the federal government, I am not providing estimates on this, but I will refer you to the National Cancer Institutes Fact Sheet on Oral Contraceptives and Cancer Risk.

If the offset is in reduced pregnancies, then we are in trouble as public policy is being made on the cost of one's life.  It may cost less to the government, an employer, an insurance carrier, and the family (or in some cases, just the woman) to not go through a pregnancy.  The family should be the one making the decision on whether they can afford another child before going through the act of doing something that could conceive a child.  This should NOT be a decision of the government, an employer, or an insurance carrier.  Using the reduced number of pregnancies resulting from providing another coverage is a dangerous precedent in public policy and can lead to the government making such decisions for all people.

And how is the federal government going to determine how much a company saved by providing contraception coverage for them even though it goes against the beliefs of the employer?  How deep into one's health insurance claims will they dig to determine the cost savings of an insurer providing this coverage?

Finally, there is no way for an individual working at some non-religious employer to opt out.  It is simply up to the employer to decide whether to even offer an option to opt out of having the contraception coverage provided.

This ruling was intentionally delayed to make it difficult for eligible employers opt out, did not compromise on what constitutes an eligible employer, forces insurance companies to pay for contraception coverage out of their own pocket while only offering to make this actuarially sound by violating this ruling, does not have an estimate in the cost to the federal government for reimbursing TPA's for providing this coverage, relies on reduced pregnancies to justify this requirement, and does not allow for all individuals to opt out of the coverage.

About that 98% Of Catholic Women That Use Contraception

I posted the following on my Facebook page on Monday, February 13.  Even though there are many comments about the 98% statistic being thrown around by now, I figured it wouldn't hurt if I posted mine as well.

Here is the study that is used to make the claim that 98% of Catholic women use contraception >>>  http://www.guttmacher.org/pubs/Religion-and-Contraceptive-Use.pdf.

The Guttmacher Institute was founded in 1968 as the "Center for Family Planning Program Development", a semi-autonomous division of ThePlanned Parenthood Federation of America.  Keep that in mind when reading their study and their motives for misleading people.

"This report was based on data from the 2006–2008 National Survey of Family Growth (NSFG). Designed and administered by the National Center for Health Statistics (NCHS), the NSFG produces national estimates of factors affecting pregnancy, including sexual activity and contraceptive use.  Data were gathered using in-person interviews with 7,356 women aged 15–44 between June 2006 and December 2008.  All data used for this analysis were weighted, and the findings are nationally representative."  Let us assume that the CDC did not have political motivations in collecting or massaging the data.  I have not found the exact data set used from  www.cdc.gov/nchs/nsfg.htm, but I have found a variety of studies with a different number of women included.  This ranges from near 7,356 (the amount in the Guttmacher study) to 61,561.  This makes me question if Guttmacher excluded women from their dataset or if they based their study on the CDC study, but conducted it themselves.  If the former is the case, an explanation on their part is needed as to why some were excluded (Please contact me if you have the actual data source Guttmacher used.)  If it is the latter, then there is clearly a sample bias.  How great the sample bias is depends on where and how (Planned Parenthood office, independent facility, over the phone, etc.) the interviews were conducted.

My understanding of polls is that many people do not like taking polls regarding sex.  Those most likely to take a poll regarding sex are those that are more likely to be engaged in the activity.  So there is a bias here too.  Depending on if Guttmacher used only CDC data or if they did their own study based on CDC's study, the degree of bias can be quite significant.

"A Religious affiliation is based on an item that asked women for their current affiliation."  One would hope that people would not lie on this question to skew the results.  This includes women who are Catholic by name and do not attend Mass and women who had contracepted and later converted to Catholicism without contracepting after conversion.  

The 98% figure of Catholic women using contraception is that they have had sex and that they contracepted at least once.  First, this excludes those who have not had sex!  That 98% number needs to come down.  Secondly, just using contraception once in their lifetime includes a respondent into 98% group.  The better question is whether they are currently using contraception when they have sex.

Some people have been errantly advised by a priest that contraception is not immoral.  This may have been an honest mistake by the priest or just opinion of theirs on what the church teaches.  Shame on the priest if it is the latter.  Regardless of why the errant advise was given, through no fault of the woman she did the immoral thing of using contraception.  Some even went as far as having a sterilization surgery, which is quite costly to reverse and might not even work.  Through no fault of these women, they are still contracepting.

The study excludes women outside of 15-44 years of age. While this might be useful in studies regarding contraception, to use that to make a statement about all women in a religious group would be erroneous.

In regards to the part of the study involving choice of contraception, they first make an unsubstantiated claim,"Most sexually active women who do not want to become pregnant...practice contraception."  The data is certainly available through the CDC to show this, but nothing is shown in this report (this is another reason I question how the data was collected).  The preference of contraception method is among those not trying to get pregnant.

The 98% figure is made out to be representative of all Catholic women.  It is representative of the lifelong sex choices that a specific age group of Catholic women that have had sex made at least once in their life have made rather than what all Catholic women are doing today.

In regard to the 98% being used to support forcing religious organization to go against their conscience, regardless of what the percentage of Catholic's who do not follow the teachings of the Church, there are some (probably a large majority) that follow the teachings of the Church in this regard.  By forcing the Church or any related organization to provide this coverage forces someone to do something against their moral conscience.  This applies with both religious and non-religious employers.  No matter how great the numer is, the government has no right to force someone to do something against their moral conscience!