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What rides on the rider

In their statement on the revised version of the HHS regulations, the U.S. bishops write that under the new terms, the mandate "would allow non-profit, religious employers to declare that they do not offer such coverage [of sterilization and contraception]. But the employee and insurer may separately agree to add that coverage. The employee would not have to pay any additional amount to obtain this coverage, and the coverage would be provided as a part of the employer's policy, not as a separate rider."This redfaced point, which as far as I know has not been contested in any of the descriptions of the regulations that are out there, seems to me to matter quite a bit. For in order for there to be a meaningful sense in which the HHS mandate doesn't require employers to provide insurance coverage for sterilization and the purchase of contraceptives, there needs to be a meaningful sense in which the insurance policy provided by the employer is different from the one that covers these things. Otherwise, we end up with a situation where, while an employer-sponsored policy may not cover sterilization and contraception at the moment that it is issued by the employer, once the employee requests the insurer to add such coverage that same (employer-sponsored) policy now does cover these things, and such coverage is integrated seamlessly with the rest of what the policy covers. It may be true that the default employer-sponsored policy does not pay for anything that the employer finds morally objectionable, but if the modified policy is also an employer-sponsored one, and coverage for sterilization and contraception is a part of it, then the employer has sponsored a policy that covers sterilization and contraception. And surely it will not matter that the employer did not have to tell the employee that there was an employer-sponsored plan available that covered these things, or that the insurer happens to be making it available to the employer at a reduced rate.By contrast, if coverage for these things is on the books as an additional rider that the employee is offered the opportunity to add for free, then -- so long as it really is free for the employer -- the force of this worry diminishes significantly. For then it strikes me the most accurate way to describe the situation would be as one where it must be in the terms of the employer-sponsored policy that it includes an option to add some separate policy that would bring with it some additional coverage, albeit of a sort the employer would rather not provide. I do not expect that everyone who is worried about the mandate's effects on religious liberty would be persuaded by this, but I think I might (though I would still oppose the mandate on other grounds). In any case it would go some way to addressing the concern about the "seamlessness" of employer-sponsored coverage as described in the paragraph above.I will now be shouted at in the comboxes. Please be charitable, as I am not in anyone's pocket here, and I have been thinking a lot about these questions and working hard to set my thoughts straight.

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Grant -- the "failure rate" you quote for condoms is because people don't use them often enough or correctly. That's like passing along the "failure rate" for a diet, without noting that virtually of the "failures" are because people stopped eating the diet and pigged out on ice cream instead.

Stuart, do you think anyone disputes that prescription contraception is more effective than condoms?Actually, don't answer that. Answer this: Are you capable of commenting here without being rude? If so, show me. If not, get lost.

Grant, Stuart is not the only one being rude.

John: You haven't been blogging here long enough to understand the scope of the problem. Everyone is permitted ill-tempered moments. And it would be one thing if he was intermittently nasty. But Stuart has taken a condescending, aggressive tone here for years. It's his default tone. He's been warned again and again. And I've had enough.

Grant, I merely have hewed to the tone set by several of the bloggers here, including yourself.

Yes, you've said that, and I'm sensitive to the criticism. That's why I've tried to do better. Yet you continue to spray insults all over the blog. I don't know why you can't make your points without resorting to ad hominem attacks on your interlocutors. No one wins arguments that way.

John Schwenkler: "Grant, Stuart is not the only one being rude."Does that qualify as a "tu quoque argument" or just a "everybody else is doing it so it's okay" argument?

Neither one, David -- it's only an observation, not meant to discredit claims about anyone else's rudeness (which is what a tu quoque would have done).

Maybe it's a "remove the log from thine eye" argument. Aaaaanyway, here's Mario Rizzo, economics professor at NYU, explaining why it makes no sense to object to the original (current) rule, but to be happy with the (as yet hypothetical) compromise:

http://thinkmarkets.wordpress.com/2012/02/12/morality-as-word-magic/Mora... as Word MagicFebruary 12, 2012by Mario RizzoI am disturbed by the Obama administrations revised rule regarding the provision of birth-control products and service under the new health insurance system they have created. The original rule required all employers, particularly for our purposes institutions affiliated with the Catholic Church, to provide insurance that covers birth control without copayment , coinsurance or deductible.The Church hierarchy and others protested that they should not have to provide insurance that reimburses or pays for activities they regard as immoral. So then after a politically troublesome firestorm, President Obama and Secretary of Health and Human Services Kathleen Sebelius announced a revised rule.The revised rule requires all employers, particularly for our purposes institutions affiliated with the Catholic Church, to provide insurance that covers birth control without copayment, coinsurance or deductible. What a relief.Re-read that sentence. It is exactly the same as the previous rule. Can it be?Previously, the Catholic institutions would have had to pay for the birth control coverage in the insurance. Now they have been relieved of that by their masters. The insurance companies will be required to provide the coverage free of charge.. . . But we need not worry about this. Secretary Kathleen Sebelius assures us that the coverage is costless. She said that experience tells us that the savings in child birth and child services will more than offset the costs of birth-control pills and sterilization. But, to be on the safe side, she said we shall just assume that it offsets the cost.But that was true (presumably) under the old rule. Under the old rule the Catholic institutions would be paying nothing extra for the coverage. Under the new rule the Catholic institutions will be paying nothing extra for the coverage. I am repeating myselfPerhaps there will be some different paperwork for reimbursement. Yes, I insist. The government could at least include that as a token of the difference between the two rules.What foolishness this is.But lets go back. Was the Catholic hierarchy wrong in objecting to the old rule because under the Sebelius actuarial calculus they would not have been paying (extra) for it all along?!Lets look more closely at that. Is the objection paying for coverage or providing access to coverage in the course of employment at a Catholic institution? The fact that I do not pay the provider of such services does not mean that I am not responsible for letting him on my property, so to speak. In any event, people need not take jobs at institutions whose values they do not share.There is more. Of course the institution is paying for the services. A woman gets a prescription for birth-control pills. She fills out a form for reimbursement. The insurance company goes into the pot of money into which the premiums have been paid and takes out the appropriate amount and pays her. Simple. The institution pays.It is true that the woman did not, in a counterfactual state of the world, seek reimbursement for birth services and child medical services. That is where the savings come in. But that is not what is happening. What is happening is that she is getting reimbursed for birth control out of the premiums paid by the institution.

It's a long post, and there's more at the link.

There is more. Of course the institution is paying for the services. A woman gets a prescription for birth-control pills. She fills out a form for reimbursement. The insurance company goes into the pot of money into which the premiums have been paid and takes out the appropriate amount and pays her. Simple. The institution pays.It is true that the woman did not, in a counterfactual state of the world, seek reimbursement for birth services and child medical services. That is where the savings come in. But that is not what is happening. What is happening is that she is getting reimbursed for birth control out of the premiums paid by the institution.Studebaker, that presentation is not factually correct.I've answered this claim several times in different posts here, so I'll be very brief. The employer buys a contract that excludes contraception. Whatever money it pays for the contract becomes the property of the insurance company. It goes into a bank account with about $14 billion dollars of other money that the insurance company collected in premiums that year (Aetna is the example). None of that money belongs to the people who paid Aetna. No employer has any conrol over how Aetna uses the money once it is paid in. Nor do they share in Aetna's profits or losses.

The employer buys a contract that excludes contraception. Why do you think that will have any meaning when the contract has an automatic accompaniment by an offer of "free" contraception? Clearly, the insurance company will charge the company the amount of money that is estimated to cover 1) all the expenses contemplated by the contract, and 2) all the "free" contraception covered by the automatic accompaniment. Even if that amount of money is the same or even lower than what the company would have been charged by excluding "free" contraception, the fact still remains that the employer is being charged for the estimated cost of contraception, and the insurance company is still paying out claims for contraception. And the coverage of contraception is made possible only by the employer's offer of health insurance in the first place. This doesn't and cannot make any difference to the moral calculation. If you objected to the original (i.e., current) rule, it doesn't make sense to let the proposed (and as yet hypothetical) modification off the hook.

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