Anti-Obamacare conservatives are chuckling over an exchange from the House's grilling of Health and Human Services Secretary Kathleen Sebelius last week, in which Rep. Renee Ellmers, R-N.C., challenged Sebelius to explain why men should have to pay for maternity coverage in their health insurance plans.
"To the best of your knowledge, has a man ever delivered a baby?" Ellmers asked. Ellmers and her cheering section seem to think this was hilarious, a conclusive, slam-dunk, let-me-hear-a-rimshot punch line. "Ellmers was on her 'A' game," the deep thinkers over at Breitbart decided.
The reality is, of course, that Ellmers' question revealed only her profound ignorance about how health insurance works, and her lack of desire to learn. And that goes for everyone else who thought this was a smart, telling blow.
Let's examine why maternity care is written into all insurance policies under the Affordable Care Act. The reasons fall into three categories. In ascending order of importance, they are:
1. It takes two to tango. It's true, as Ellmers observed, no man has ever given birth to a baby. It's also true that no baby has ever been born without a man being involved somewhere along the line. Limit maternity coverage only to women of childbearing age, and you're giving many of these guys a free pass.
2. Society has a vested interest in healthy babies and mothers. And that's all society, because unhealthy babies and mothers impose a cost on everybody -- in the expense of caring for them as wards of the public, and in the waste of social resources that comes from children unable to reach their full potential as members of society because of injuries or illnesses caused by poor prenatal and postnatal health.
Child mortality rates are among the most important indicators of a nation's overall health profile, and the U.S. rate stinks compared with the rest of the industrialized world's -- at seven deaths of children under age 5 per 1,000 live births, it's worse than Israel's, South Korea's, Japan's and every Western European nation's. That's why maternity and newborn care and pediatric services are among the 10 health benefits that Obamacare requires to be part of every health plan.
Some of these benefits are so important, they're required to be among the free benefits of catastrophic health plans that may be sold to individuals under the age of 30. They include anemia screening for pregnant women and folic acid supplements for women of childbearing age.
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The most important reason is this one:
3. Universal coverage is the only way to make maternity coverage affordable.
Up to now -- before Obamacare's rules kick in Jan. 1 -- only 12 percent of policies in the individual insurance market offered maternity coverage. Those that offered the coverage often did so as separate riders imposing huge deductibles for maternity care alone -- $5,000 for maternity services, according to a 2010 survey by the House Committee on Energy and Commerce, and limits on benefits of only a few thousand dollars. The cost of maternity and newborn care is the principal reason that, pre-Obamacare, women were systematically charged more for health insurance than men.
Because insurers pitched maternity coverage in the individual market only to buyers of childbearing age, the premiums were high and they still made almost no money on them.
One company internal memo reviewed by the committee stated that its loss on maternity riders came to 90 percent of income, "a money-losing ratio," the memo said.
But that's what happens when you sell an insurance benefit to a narrowly defined market. Without the cross-subsidies inherent in a large pool of insured people, no single coverage is affordable to those who specifically need it.
That's the principle of universal coverage inherent in Obamacare, after all. Once you start segmenting the market so that only those vulnerable to a specific condition can buy coverage for that condition, the cost of that coverage soars into outer space.
These cross-subsidies are common throughout the Affordable Care Act mandate. Younger people subsidize older people (and will be subsidized themselves, when they grow older). Women subsidize men - for some reason, imposing the cost of prostate cancer screening and treatment on women never seems to be part of the conversation. Childless people subsidize the cost of children's health coverage. Men subsidize women in other particulars too: breast cancer treatment, for example.
Cross-subsidies like this are an inextricable part of life in a society, and by no means limited to health insurance. The cost of public education is embedded in the state tax rate paid by families with three kids in school as well as those whose kids graduated 20 years ago, or who educated their kids privately, or who never had kids. That's because education is a social good, like health. Everybody pays for highways, even those who don't drive, because one way or another they get the benefit. You don't like it, you're welcome to live by yourself on a desert island, but you may be giving up a few benefits of civilization to do so.
The focus by Ellmers and her cheering section on pregnancy benefits is profoundly cynical. In fact, it's a fair bet that her ignorance is only a pose. She surely knows why men have to pay for pregnancy coverage, because none of the points above is new or secret or, for that matter, very hard to understand. She's making an ideological argument, not a logical or, indeed, an intelligent one. And if Obamacare's critics want to be taken seriously, they should move on.