Family Planning: Contraception under the Affordable Care Act

Abstract

The paper discusses the issues of contraception under the Affordable Care Act. The notion of contraception is tightly connected with this reform. It is the main subject of heated debates, which were conducted in the U.S. government lately. According to the new provision, starting from August 2012, women will receive eight health care benefits free of charge. Those benefits include contraception and contraceptive counseling, HIV counseling, sexually transmitted disease counseling and others. Due to this reform, approximately 47 million women will receive free contraception coverage. One should take into account that before the adoption of Affordable Care Act nearly half of the American women between ages of 19-64 years avoided visits to the doctors, as they could not afford it.

Introduction

Family planning is a relevant issue that is essentially important for all the women around the world. Every woman dreams about successful life with happy family, breathtaking career, loving husband and entertaining leisure. In order to achieve all these benefits a woman should be able to manage her time in a right way. Contraception is a useful tool in family planning. It gives women an opportunity to plan pregnancy, which is one of the most vital things in human life.

With the birth of the child, the life acquires specific meaning, but it also presupposes the change of the lifestyle and every day habits. Unfortunately, sometimes these changes turn out to be not so positive, as it seems at the first sight. The unexpected pregnancy affects the career, relationship with husband, and even the state of soul. The experience has shown that conscious approach to family planning is extremely important. It helps a woman to live and freely pursue her goals, to embody her creative and professional potential, and to devote herself to motherhood. Such rational approach to family planning is typical for women in the U.S. and modern contraception methods are vitally important for it.

Definition

While discussing the notion of family planning and contraception, one should take into account that contraception “entails the use of drugs, chemicals, devices, surgery or behavior that control fertility amongst sexually active heterosexual people” (Russell, Sobo & Thomson, 2000, p. 5). Contraceptive methods are the determining factors of sexual relations between the partners. The primary objective of modern society is the preservation of reproductive health and safe motherhood. According to the research conducted by Adam Thomas (2012) most of the unplanned pregnancies in the U.S. occur due to lack of motivation, which is necessary to avoid becoming pregnant, lack of information about contraceptives, and lack of access to contraceptives (p.4)

There are a number of methods that might be useful to avoid pregnancy. These are: surgical, physiological, hormonal, and barrier methods. The issue of contraception is related to family planning clinics and is important for both nursing and healthcare consumer.

It is essential to nursing, as it is directly related to the health issues. When the woman or a teen girl lives below poverty line than the government pays for her prenatal care. Besides, usually mothers of an unplanned child use alcohol and cigarettes during their pregnancy, which results in delivering sick and premature children. In such cases, the government is obliged to help. Public hospitals provide low-cost treatment to sick and premature babies, and public assistance programs help young mothers to cope with the situation. While discussing the health issues, it should be also pointed out that teen pregnancies are dangerous for them, as there exist a number of risk factors. Contraceptives should be used in order to avoid all these problems. Moreover, usage of contraceptives demands less costs than premature care, abortion, and treatment of various diseases.

Contraception is also essential to healthcare consumers, as it allows taking fertility control measures in order to avoid unplanned pregnancies. As a result of unplanned pregnancies young teenage girls drop schools in order to take care of their baby; they have less chances to get the higher education, and to find the proper job. Besides, the government is obliged to pay great sums of money to mothers in the form of child benefits.

History

The history of male and female contraception goes back to antiquity. The rudiments of modern methods of pregnancy prevention and pregnancy termination occurred centuries ago. Even in the ancient times people understood that unplanned pregnancy just disappoints future parents, and for that reason they tried to avoid it. American President Barack Obama understood the same thing when he suggested creation of health care reform.

When Barack Obama became the President of the United States, he made health care reform one of the key issues on agenda. This reform was the subject of heated debates, which were conducted in the government.

There was a great conflict between the Catholic Church and American President. The matter is that according to the health care reform, the Catholic schools and hospitals had to pay for the birth control measures. Forty three Catholic Institutes have sued the Obama administration. Catholic bishops called Affordable Care Act the unprecedented attack on religious liberty.

Besides, such politicians as Joe Manchin, Mitt Romney, John Boehner, and others supported the Catholic Church. Joe Manchin stated that this decision was the direct affront to religious freedom. John Boehner accused Obama administration of violating the First Amendment to the U.S. Constitution, which guarantees freedom of religion. Mitt Romney pointed out that Obama has declared war against religion.

As a result of all these accusations and lawsuits, Barack Obama stated that president’s administration will not demand the coverage for contraception from religious institutions. Under the new amendment to the reform, women will receive free contraceptives from an insurance company in case of employer’s denial because of his/her religious beliefs. On June 28, 2012 the reform was affirmed by the U.S. Supreme Court.

People

A. People Interested in Affordable Care Act

According to the new provision, starting from August 2012 woman will receive eight health care benefits free of charge. Those benefits include contraception and contraceptive counseling, HIV counseling, sexually transmitted disease counseling and others. Due to this reform, approximately 47 million women will receive free contraception coverage. One should take into account that, before the adoption of Affordable Care Act, nearly half of the American women between the ages of 19-64 years avoided visits to the doctors, as they could not afford it. This health care reform will change the situation.

The reform is extremely important for families living beyond the poverty line, young women, and teenagers, who cannot afford private insurances. According to the World Health Organization, approximately 16 million girls of teen age give birth to children each year. In most cases, pregnancy is unplanned, and it is associated with health risks. Minors should have “easy and confidential” access to contraceptive services (Weiss, 2012, p.4). When parental consent is required, the teen is threatened and avoids contraception. Due to this factor, the risk of unplanned pregnancies increases. It should be stated, that 80% of teen pregnancies in the USA are unplanned, and usage of contraception reduces the risk of becoming pregnant.

B. Impacted Parties

Insurance Companies

While discussing the ACA, one should take into account the viewpoint of insurance companies towards this reform. A number of people consider that this law is cost effective for the insurers. However, it is not so. After detailed investigation of the insurance companies’ profits, it becomes understandable that they gain money not from private insurances, but from the federal programs Medicare and Medicaid. The Affordable Care Act presupposes insuring a large number of people, who live beyond poverty line, free of charge. It means that all the expenses will be covered by the government. As a result of this reform, insurers will definitely flourish. A writer Wendell Potter discussed this topic in his article “Why Insurers Want ObamaCare’s Medicaid Business” states: “So don’t pay any attention to the votes and rhetoric coming out of Washington. Health care reform can turn out to be very profitable indeed for some of the GOP’s biggest benefactors – the giant insurance companies” (par.11).

Insurance companies will benefit from the ACA, as it is more profitable to provide people with contraceptives, than pay thousands of dollars for abortions prenatal care.

Medicaid

The Affordable Care Act will have a significant impact on the governmental health care program Medicaid. Starting from the 2012, it will definitely change the structure of Medicaid by making health care services, including family planning services, available to all layers of the population, regardless of their family status and income. It will provide insurance to all people, living below 138% of the federal poverty level. The family planning services are intended to reduce the number of abortions and unplanned pregnancies. One should take into account that approximately 5% of all pregnancies in the country are unplanned, and every child birth costs approximately $9,000. The program Medicaid funds nearly one third of all pregnancies, thus it is not difficult to calculate that it will reduce its expenses by providing contraception counseling and making contraceptives free. The national researches have shown that every dollar spent in Medicaid on family-planning saves approximately three dollars of the program’s expenses on prenatal care and abortions.

Policy

The notion of contraception is tightly connected with the Affordable Care Act. In March 2010 the health care reform, aiming at making healthcare insurance more effective and affordable, was adopted.

One should take into account that virtually every American President from Theodore Roosevelt to Bill Clinton, tried to create government public health insurance. Unfortunately, all the Presidents suffered defeats, and it was Barack Obama, who managed to make this dream come true. Moreover, President Obama made contraception the part of preventive medicine. The current U.S. President dared to make his suggestions, and to provide 32 million uninsured Americans with medical coverage. It is worth mentioning that adoption of Affordable Care Act is really costly, as American taxpayers will have to pay $1 trillion in the next 10 years. However, this act is necessary, as it will reduce the expenditures of the American families. The matter is that without this act, people spend approximately 10% of income on private medical insurance and 35% of the population remains uninsured.

It is understandable that adoption of this reform is problematic, but it is vital. Adam Sonfield in the article “New Federal Protections Expand Coverage Without Cost-Sharing of Contraceptives and Other Women’s Preventive Services” (2012) points out:

“An extensive body of research shows that contraceptive use helps woman avoid unintended pregnancy and improve birth spacing, resulting in substantial benefits for the health and well-being of women, infants, families and society” (p. 24).

The notion of contraception has a strong impact on public policies, as it presupposes coverage of the insurance without out-of-pocket costs. Contraceptive measures are also closely connected to healthcare system, as the latter provides a woman with a method of fertility control.

Resources

It was already mentioned that Affordable Care Act is a costly reform. According to the researchers conducted by the George Mason University, in the period from 2012 to 2022, the U.S. federal expenditures on the mentioned above reform will be approximately 1,15 trillion dollars. In March, the Office of Congressional Budget has published its own estimates concerning the cost of Affordable Care Act. According to the official data, this reform will cost 1,76 trillion dollars. It becomes understandable that this act involves comparative increase in health care costs in the next 10 years. However, the share of additional costs is less than 0,5% of GDP. That is why it might be supposed that this reform will not have a significant effect on the U.S. economy. People are better off because of this reform, because they should not pay extra costs for the contraception and some medical services.

Solution

One of the possible solutions to the above mentioned problems is governmental insurance, which helps American citizens to cover almost all preventive-health costs. Even when a person buys the contraceptives, those costs will be lesser than prenatal care costs.

“Nearly 1 million female clients – 217 000 aged 13 to 19 and 783000 aged 20 to 44 years – received contraceptive methods through Family PACT in 2003. Payments were made for oral contraceptives for about 449000 clients, condoms and other barrier methods as a primary method for 405000 clients, injectables for 162000 clients, and long-term methods for 22000 clients. Emergency contraceptives were dispensed without any other method to 37 000 clients” (448).

However, it is worth mentioning that religious employers object to paying the insurance that covers the preventive healthcare services. For that reason, “alternative ways to fulfill the contraceptive services” (ACA’s Contraceptive Services Coverage Mandate: Regulatory and Judicial Update, 2012, p. 2) are considered, and some optimal ways to satisfy the requirements of both sides are to be found. Unfortunately, as a result of those objections, ordinary workers suffer; a lot of them cannot afford qualified preventive health care without insurance that is covered by the employer.

Proposal

The best proposal in this situation is proceeding with adoption of this reform. It would be wise to make healthcare services free for all the people. Of course, at first sight this idea seems to be naive, however, close considerations show that it is not so. The matter is that when a low-income family or teenagers give birth to a child, than the government spends more funds on it than it could have spent on the birth control measures. Free contraceptives help to improve the health of the population. One should take into account that unwanted pregnancies impose burdens on women and their families. Authors of the article “Family Planning as a Cost-Saving Preventive Health Service” (2011) state:

“When provided with counseling and their choice of contraceptive method at no cost, 67% of eligible women chose an IUC or implant, as compared with less than 6% choosing these methods in the general population. This disparity probably reflects more than cost alone: lack of provider training in the use of these methods and lack of patient awareness of IUCs and implants are also barriers to their use” (p. 3).

According to this act, nearly all people have the access to health care. This reform helps to stop a number of sexually transmitted, as it makes medical counseling free of charge. It presupposes family promotion seminars. The matter is that teenagers are not children; they should be aware of all methods of birth control, and understand that a child should be born into a family. The educators from Planned Parenthood Association in Utah state that: “the more a teen knows the better decisions they will be able to make” (p. 2), and it is true.

Implementation of Solution

In order to proceed with ACA adoption, people should vote for President Barack Obama, who suggested it. One should not listen to the opponents, as human health is the most important thing. It is understandable that this reform presupposes a slight GDP increase; however, one should think about its aim. It was implemented to provide the insurance to thousands of American residents, who live below the poverty line. This one of the first steps, made to reduce the number of unplanned pregnancies, constant abortions, and sexually transmitted diseases.

Conclusion

In conclusion, it should be stated that contraception, as well as other health planning services, is a vital issue for a woman. American President Barack Obama understood it well. Most people in the U.S. cannot afford proper medical care, which they need. Affordable Care Act makes medical services to be available to all the layers of population. One should take into account that before adoption of this reform, the U.S. did not have free medicine. Medical services were paid by the insurance companies. Obama’s initiative was designed to reduce the cost of insurances and to make medical care AFFORDABLE.

Contraception available to all American people is one of the wisest things in this act. The opponents state that free usage of contraception violates the freedom of religion; however, high cost of contraceptives seem to be a violation of the right to choose. When a person cannot afford a thing, he/she does not think about it at all.

Finally, it should be mentioned that this reform is important because it will save thousands of human lives, human families, and human souls.