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February 05, 2013 10:11 AM The Cost of Contraception

By Mark Kleiman

I think Kevin Drum – about the smartest blogger, or journalist of any description, now working – makes a mistake from time to time just to keep the rest of us on our toes. He’s right that the latest Administration plan to deal with contraceptive coverage under employer-paid health insurance is a kludge, and he’s right that, since money is fungible, sayingthat insurance companies have to spend some money other than the employers’ money to cover it is gibberish. (That’s supposed to insulate the employers from the moral onus of allowing reproductive freedom rather than imposing their dogma on their employees. I forget who it was who Tweeted the question, “Should health insurance provided by a Jehovah’s Witness employer cover blood transfusion?”)

But what Kevin misses is that offering health insurance with contraceptive coverage is not in fact more expensive than offering health insurance without it, because if the woman gets pregnant the insurer will have to pay for prenatal care and delivery. You can cover a lot of $50 contraceptive-pill prescriptions with the avoided $10,000 cost of a single uncomplicated delivery.

As to the plan itself: looks to me like a perfect non-solution to a non-problem.

Update Kevin points out a complexity I’d missed. Yes, total health care costs go down with contraception. But if enough women without coverage pay out-of-pocket for the Pill, the insurance company could still come out ahead by stiffing them (while covering Viagra, of course). That leaves a factual question: if a big employer goes to a health insurer and asks for a quote for employee coverage, is the quote actually lower if contraception is excluded?

Second update Kevin produces a reasonable-sounding BOTEC suggesting some net cost to insurers. Which means he still owes the rest of us one mistake.

[Cross-posted at The Reality-based Community]

Mark Kleiman is a professor of public policy at the University of California Los Angeles.