1. F EDERAL M ANDATE FOR I NSURANCE C OVERAGE OF C ONTRACEPTION Trever Pearson and Holly Szafarek PA 770 April 13, 2012

2. P ROBLEM I DENTIFICATION Benefits of Contraception Pregnancy Prevention Women in the Workplace Medical Benefits Prohibitive Cost Deficit Reduction Act (DRA) Half of all pregnancies unintended $12 Billion/yr Equal Protection Burden felt mostly by women

3. C RITERIA OF E VALUATION Economic Efficiency Distributional Equity Cultural/Political Acceptability

4. A LTERNATIVE 1 - S TATUS Q UO No Federal Intervention State Regulation Contraceptive Equity Laws 26 states have such laws http://knowledgecenter.csg.org/drupal/content/states-forefront-contraception-mandates

5. A LTERNATIVE 2 - F EDERAL M ANDATE Requires insurance coverage of preventive health services for women. Includes: Contraceptives Emergency contractive drugs Plan B and Ella Sterilization Excludes: Abortion pill RU-486 Exemption: Religious organizations such as churches

6. A LTERNATIVE 3 - F EDERAL M ANDATE W / B ROADENED E XEMPTIONS Same insurance requirement for contraceptives Broadened exemptions to include religiously- affiliated institutions that object to coverage Hospitals Universities Social Service Agencies

7. E VALUATIONS OF A LTERNATIVES C RITERIA 1 – E CONOMIC E FFICIENCY $1 of coverage saves $4.02 in Medicaid birth costs (Rose, 2009, p. 25) Contraception Services Saves $4.3 billion in Medicaid pregnancy costs Not including the costs of treatment for diseases prevented by birth control (p. 24) Unintended pregnancy costs nearly $10,000 each, a total of $12.1 billion in Medicaid and Children’s Health Insurance Programs and $103 million in abortion costs (Thomas & Monea, 2011, p. 3).

8. E VALUATIONS OF A LTERNATIVES C RITERIA 1 – E CONOMIC E FFICIENCY ( CONT ) Status Quo Inefficient and does nothing to reduce costs Mandate without Exemption Employer premium increase: 0.6% Failure to provide coverage for contraception could cost employer approx. 15-17% more (Chettiar, 2002, p. 1878) Mandate with Exemption Similar to without albeit a shift in cost from employer to insurance provider

9. E VALUATIONS OF A LTERNATIVES C RITERIA 2 – D ISTRIBUTIONAL E QUITY Equal Protection Rights Status quo creates a burden felt by women Federal mandate is intended to “eliminate discriminatory insurance practices that undermine the health and economic well-being of women” (Chettiar, 2002, p. 1877). Broadened religious exemptions may created a different equity issue First Amendment’s Establishment Clause

10. E VALUATIONS OF A LTERNATIVES C RITERIA 3 – C ULTURAL /P OLITICAL A CCEPTABILITY Highly divisive issue First Amendment Free Exercise Rights v. Equal Protection Rights Government responsibility to uphold equal protection rights Religious groups don’t want to pay for the health decisions of the immoral Economic Conservatives see mandate as an intrusion into private sector Status Quo – “War on Women”, Religious takeover of Government Mandate with no Exemption – “Attack on Religion”, Government takeover of Private Sector Mandate with Exemption – Government takeover of Private Sector

11. C OMPARISON OF RESULTS Alternatives Criteria Status Quo Insurance Mandate Mandate w/ Broadened Exemptions Economic Efficiency BadGood Distributional Equity BadGoodModerate Cultural/Political Acceptability Bad Not as Bad Score399 *Bad = 1, Not as Bad = 2, Moderate = 3, Good = 4

12. R ECOMMENDATION Federal mandate with broadened exemption