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placeholder  March 5, 2012   •   VOL. 50, NO. 5   •   Oakland, CA
Here are the facts about HHS mandate

WASHINGTON Exaggerations and outright misrepresentations about the Department of Health and Human Services' contraceptive mandate have been appearing in White House "fact sheets" and mainstream media. Here are some of the more frequently cited claims and the facts to counter them:

Myth: Self-insurance is a seldom-used method of providing health insurance to employers, used mainly by church organizations to avoid having to pay for abortions or birth control.

Fact: A majority of Americans who have private health insurance are in self-insured plans, according to separate reports by the Congressional Research Service and the Kaiser Family Foundation and Health Research & Educational Trust. The percentage was 44 percent in 1999, 55 percent in 2008 and had increased to 60 percent by 2011. Employees in large companies (those with 200 or more employees) were even more likely to be covered by a self-insured plan. Eighty-two percent of workers at large firms and 96 percent of those who work for a company with 5,000 or more workers were in a self-insured health plan.

There is no precise count of how many of the employees working for Catholic organizations or institutions are in self-insured plans, but the number is believed to mirror that of the general population. Myth: Twenty-eight states already require employers to cover contraceptives for their employees, so the situation in those states will not change.

Fact: Self-insured plans are excluded from state contraceptive mandates, but not from federal requirements. In addition, all but three states California, New York and Oregon include a broader religious exemption than the HHS one, which sets four criteria for an exemption: that an employer's purpose is to inculcate religious values, that it primarily hires and serves people who share its religious tenets, and that it is a nonprofit organization under certain sections of the tax code.

Twelve states do not require that the organization's purpose be the inculcation of religious values, 12 do not mention a requirement to hire people who share the organization's religious tenets and 13 states have no requirement that the exempt organization serve only those who share its religious tenets. Sixteen states do not mandate that the exempt organization meet the tax code criteria.

Eight states exempt virtually any religious employer with moral objections to providing coverage of contraceptives to its employees. Illinois and Missouri extend that exemption to nonreligious employers who object. Other states have passed laws that do not define what constitutes a religious organization or have declined to enforce existing laws.

Myth: Adding contraceptive coverage to health plans will be net cost-neutral, because those covered by the mandate will have fewer unintended pregnancies.

Fact: Pharmacy directors disagree. An online survey by New Jersey-based Reimbursement Intelligence of 15 pharmacy directors representing more than 100 million employees or their dependents found that nearly 50 percent thought the mandate would increase costs, 20 percent thought it would be cost-neutral and none predicted that it would save money. More than 30 percent said they didn't know what the effect would be.

Several respondents also raised the question of whether the mandate to provide contraceptives free of charge would require them to give away brand-name medications, even when generics are available.

In addition, the assumption that greater contraceptive use results in fewer pregnancies and fewer abortions has not been proved. A 2003 study in the journal International Family Planning Perspectives purported to show such a link, but found that levels of abortion and contraceptive use rose simultaneously in Cuba, Denmark, Netherlands, the United States, Singapore and South Korea. Abortions went down as contraceptive use increased in Kazakhstan, Kyrgyz Republic, Uzbekistan, Bulgaria, Turkey, Tunisia and Switzerland, the study found.

Myth: Ninety-eight percent of Catholic women have used contraceptives.

Fact:
The figure comes from an April 2011 Guttmacher Institute report based on the 2006-2008 National Survey of Family Growth. Twenty-five percent of the respondents to the survey self-identified as Catholics, but 40 percent of those said they never attended Mass or attended less frequently than once a month.

The survey looked at women between the ages of 15 and 44 and asked about contraceptive use only among those who had had sex in the three months prior to the survey and were not pregnant, postpartum or trying to get pregnant. Ninety percent of those women and 98 percent of the Catholic respondents said they had used some form of contraception at least once in their lives.

The survey did not ask the women about their current contraceptive usage.

 
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