Editorial Board

Eliminating Contraceptive Copays Is in Insurers’ Interest: View

Should health insurance companies be required to cover the entire range of birth-control services, and do so in full -- no copayments, no deductibles?

A panel of the Institute of Medicine, an arm of the National Academy of Sciences, has recommended that the Department of Health and Human Services adopt this mandate. On Monday, Kathleen Sebelius, the HHS secretary, raised the ire of cultural conservatives and fiscal watchdogs by requiring insurers to fully cover contraceptives starting next August.

In an era of tight budgets, it’s fair to ask whether the expenditure is worth it. It is -- if you factor in the true costs. Contraception is one area of medicine where it is beneficial to invest fully in the upfront expenses to maximize the health-care savings later on.

Contraception prevents unwanted pregnancies, abortions and miscarriages -- all of which can result in fairly expensive medical procedures. In 2007, insurers spent $9,000 for the average live birth, according to calculations by James Trussell, a Princeton University economist. Treatment for a miscarriage or an induced abortion cost insurers more than $500.

There were more than 3 million unintended pregnancies in 2001, the last year for which the data are available. And in that year, when the costs of childbirth, abortion and miscarriage were less than in 2007, they added up to $5 billion, according to Trussell. Contraceptive use in 2001, he has found, saved $19 billion in direct medical costs.

Insurers’ Average Cost

Meanwhile, the average yearly cost to an insurer of providing full coverage for the entire range of contraceptive methods and counseling services (with no copays or deductibles) is about $40, according to actuarial figures compiled for the National Business Group on Health, a nonprofit association of large U.S. employers.

Why force insurers to foot the entire bill? Because in choosing a form of birth control, people are often guided by price. And, in general, the most effective forms come with the highest upfront costs.

Condoms are cheap, but because they’re not always used properly there is a 15 percent chance that they will not prevent pregnancy during the first year of typical use. Birth-control pills fail 9 percent of the time, as women sometimes forget to take their daily dose. But pills are a popular choice (28 percent of women using contraception take them) because they cost only $14 a month for the average woman with prescription-drug insurance coverage.

Effective but Expensive

The most effective forms of contraception, with failure rates at or below 1 percent, are sterilization, intrauterine devices and hormonal implants. These cost several hundred dollars, and although they may last for several years or more, the costs are all upfront. Even couples whose insurance companies foot most of the bill find it cheaper in the short run to choose birth-control pills or condoms.

While sterilization is surprisingly common -- among people who practice birth control, 27 percent opt for female sterilization and nearly 10 percent for vasectomies -- IUDs are used by only 5.5 percent, and hormonal implants by about 1 percent. If more couples used more reliable forms of contraception, that $19 billion in annual medical savings would rise.

Although Secretary Sebelius will take heat for her decision, there are strong economic arguments in her favor. The reason insurers should pay 100 percent is to take price out of the equation. Insurance companies would have to pay a little more for contraception, but it could still lower health-care costs for them, and for all of us.

    To contact the senior editor responsible for Bloomberg View’s editorials: David Shipley at davidshipley@bloomberg.net .

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