It’s not free, you’re paying for it

Jodi Jacobson at Rh reality check makes an excellent point about something that's been bugging me too. When describing the contraception benefit, it's not correct to say that it's free:

This is not the case, and it is misleading--and politically dangerous--to say so.

To get birth control without a co-pay means you have an insurance policy. No one can walk into any pharmacy today and get the pill without a prescription, which in any case first entails a visit to a doctor's office. No one without insurance can walk into a doctor's office and get an IUD for for free, nor any kind of contraception, unless they pay out of pocket or meet the means test for and are covered by Medicaid, an increasingly difficult enterprise in itself but the subject of a different article. Ten percent of women in the United States who work full time are currently uninsured and without coverage, they do not have access to "free" birth control. Nor do other women without insurance, or those whose plans are, for logistical reasons or because they were grand-fathered, not yet compliant with the ACA on preventive care. None of these women have "free" birth control now, and they will not later even if they get insurance. (See the National Women's Law Center Guide on what to do if you have questions about your insurance plan and contraception without co-pay.)

Why? Because if you have insurance, you pay for it, either by virtue of your labor or out of your own pocket, or, depending on the situation, both. And under the ACA, it is now mandated that your insurance plan cover certain benefits without a co-pay. This does not make them "free." It means that you are paying for that service as part of your premium. You earned it, you paid for it, it is yours. If you pay for it, you deserve to get it.

It's part of the required, preventive care package in everyone's insurance policy, a package that includes the following:

Children (0-17): Coverage includes regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.

Women (18-64): Coverage includes cancer screening such as pap smears for those ages 21 to 64, mammograms for those ages 50 to 64, and colonoscopy for those 50 to 64; recommended immunizations such as HPV vaccination for women ages 19 to 26, flu shots for all adults, and meningococcal and pneumococcal vaccinations for high-risk adults; healthy diet counseling and obesity screening; cholesterol and blood pressure screening; screening for sexually-transmitted infections and HIV; depression screening; and tobacco-use counseling. Starting in August 2012, additional preventive services specific to women, such as screening for gestational diabetes and contraception, will be covered by new health plans with no cost sharing.

Men (18-64): Coverage includes recommended immunizations such as flu shots for all adults and meningococcal and pneumococcal vaccinations for high-risk adults; cancer screening including colonoscopy for adults 50 to 64; healthy diet counseling and obesity screening; cholesterol and blood pressure screening; screening for HIV; depression screening; and tobacco-use counseling.

Some of those tests have been quite expensive for me in the last few years because I have a plan with an insanely high deductible since it's all I can afford. So this is a real benefit for me. And it's obviously a good benefit for women of child-bearing years because preventing unwanted pregnancy is extremely cost effective. That's why insurance companies didn't balk at the requirement.

But it's not free. You have to be insured to get the benefit (which is too bad, but that's another issue) and that means that you have paid for it one way or another.