"Cost neutral and saves money?" "What the hell does that mean?" asks the Disease Management Care Blog.
How can a White House Fact Sheet simultaneously assert that an insurance mandate simultaneously costs nothing and also reduces health care costs? Is this cognitive dissonance? Clever obfuscation? Insurance amateurism?
The physician DMCB fully understands the importance of contraception in women's health.
The logical DMCB knows someone has to eventually pay for birth control pills and doesn't understand the material difference between a mandate for buying contraceptive coverage versus buying mandated insurer coverage of contraceptives.
The accommodating DMCB wonders if religious leaders could compromise by agreeing to cover birth control pills with a "100% co-pay."
But the blogging DMCB couldn't resist looking at the of real world difficulty of reconciling today's insurer hard costs and tomorrow's savings. Over the years, it has learned it's never that easy.
Read on and see why that rule holds here.
So, just what is the evidence on birth control pills (BCPs)?
While BCPs' $15 to $50 a month retail cost contrasts with the average $13,000 to $17,000 total charge for childbirth, it's not that simple. Add up the additional cost of thousands of BCP prescriptions, their associated provider visits plus unnecessary testing, a 15% failure rate and a low but appreciable rate of side effects, its very possible that the aggregate costs of BCPs could exceed any savings from a fewer number of unwanted pregnancies.
The WH Fact Sheet addresses this by saying that prior studies show.....
"...there was no increase in premiums when contraception was added to the Federal Employees Health Benefit System and required of non-religious employers in Hawaii. One study found that covering contraception saved employees $97 per year, per employee."
As far as "Hawaii" goes, the DMCB discovered that White House is quoting "empirical evidence" from a 2001 study from the state's Insurance Commissioner. It describes the experience of four commercial health plans (anonymously named A, B, C and D) that went through a state-imposed contraceptive mandate. "A" already covered it, "B" saw a 14 cents per member cost of "contraceptive services and supplies" and "no material changes in eligible charges for maternity related services," "C" had a $1.50 increase in "contraceptive costs" and an approximate $7 decrease in maternity costs per 1000 members (which the Commissioner summarizes as of "little effect"), and "D" which had an 11.5% increase in pregnant members as the contraceptive mandate was implemented.
And where does the Fact Sheet's "$97" savings figure come from? The DMCB suspects the number comes from Table 4 of a 2000 CDC and Washington Business Group on Health Report here which quotes scenario economic modeling of $562 vs. $659 per employee per year with and without a contraceptive benefit, respectively.
While it was thinking about the topic of economic modeling, the DMCB found this interesting 1996 study of the cost-effectiveness of family planning services for the British National Health Service. Based on a cost of £39 and "0.82" avoided pregnancies per year, the authors estimate that the NHS saved £754 "per avoided pregnancy." The DMCB suspects the White House would probably prefer to not quote this one.
The DMCB's conclusion: there is no real world evidence that oral contraceptives save any money by reducing claims expense. Any evidence that there are savings are based on methodologically suspect economic modeling and actuarial studies. While the good news is that BCPs probably won't increase insurance costs, the bad news is that it does little to tame health care inflation. That's probably why this small recent survey of U.S. health insurers indicates that they don't believe it will save money either.
Two other DMCB points:
Given the experience in Europe, even if the mandate for contraceptive coverage wins this round, it will remain vulnerable to political and economic meddling... probably forever. Women's health deserves better.
BCPs are easy to prescribe. Given the likelihood of not enough PCPs to meet demand,it can be argued a physician office visit is unnecessary - which would further lower costs. It has also been argued that BCPs should be made available without a prescription, which begs the question of why this should be an "insurance benefit" in the first place.
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When BCP become non-prescription medications, THEN you might make an argument that BCP shouldn't be an insurance benefit in the first place. But you are putting cart before horse. Because, here's the FIRST place. Women need to get a prescription for BCP now. That is a common prescription, because family planning shouldn't be seen as an optional or recreational activity. It's fundamental to many women's basic preventive healthcare. So, it's not outrageous for women to want to have the prescriptions they get from their doctor covered by the health insurance that they are paying for.
You can't argue that BCP should not be covered just because some other people think that the availability of BCP should be SO ready that no prescription should be required.
Look, I don't have to have a prescription to buy crutches. I can buy crutches for fun if I want to! But, if I break my leg and a doctor recommends that I use crutches, it's not unreasonable to expect that the cost of those crutches be shared by my insurance company.
Even if BCP becomes available as OTC medication, it will still not be unreasonable for women to expect their insurance to help pay for BCP, especially if that medication comes recommended by their physicians. Right?
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