Zubrick and not understanding insurance

The Supreme Court requested the Zubrick attorneys to file a supplemental brief to explain how employees of religiously affiliated groups could receive no cost sharing contraceptive coverage without the religiously affiliated do jack shit.  The goal is to see if their precious fee-fees won’t be offended while offering their female employees contraceptive coverage.  The brief is here and it shows an amazing lack of understanding of insurance and Congressional intent in the ACA design.

There are many ways in which the employees of a petitioner with an insured plan could receive cost-free contraceptive coverage through the same insurance company that would not require further involvement by the petitioner, including the way described in the Court’s order. And each one of those ways is a less restrictive alternative that dooms the government’s ongoing effort to use the threat of massive penalties to compel petitioners to forsake their sincerely held religious beliefs. Moreover, so long as the coverage provided through these alternatives is truly independent of petitioners and their plans—i.e., provided through a separate policy, with a separate enrollment process, a separate insurance card, and a separate payment source, and offered to individuals through a separate communication—petitioners’ RFRA objections would be fully addressed….

If commercial insurance companies were to offer truly separate contraceptive only policies along the lines envisioned in this Court’s order, then the employees of petitioners who selfinsure or use self-insured church plans could enroll in those separate contraceptive-only insurance policies as well. Those policies would obviously be separate from the coverage provided by the self-insured employers or the church plans, and petitioners’ employees would be free to enroll in those policies if they choose. Accordingly, among the many less restrictive alternatives available to the government is to require or incentivize commercial insurance companies to make separate contraceptive coverage plans (of the kind contemplated by the Court’s order for petitioners with insured plans) available to the employees of petitioners that self-insure or use selfinsured church plans, without requiring petitioners to facilitate that process or threatening them with ruinous fines unless they do so.

I’ll let the lawyers take a whack at the legal argumentation as I’ll take a whack at the mechanics.

Contraception as a cost center is overwhelmingly focused on females who have some idea if they will want to use contraception at some point during the policy’s active period.  Men don’t have to pay for prescription contraception, and women over a certain age don’t either.  Individuals whose partner(s) have had permanant sterilization or medical infertility don’t need contraception either.  Contraception is a near perfect case example of an adverse selection problem when it is unbundled from a larger medical insurance policy.

Requiring women who work for religious organizations to buy separate contraception only policies transforms part of their compensation (second question are the women getting a pay raise to make them whole?) from participation in an insurance scheme to participation in a discount buyer’s club.  Almost everyone who would buy a separate policy with a twelve month coverage period for contraception only will use contraception.  There is no risk pool.  It is just a bulk buyers’ pool.

Congress in the ACA advanced a strong federal interest that there would be no gender discrimination in premiums offered to women.  This was expressed as a significant interest for well over a generation in the group market and it is an expressed interest in PPACA for the individual market.  Congress also has a strong interest in bending the cost curve.  One of the major theories of change to bend the cost curve is to increase the use of evidence based preventative care.  The means to increase birth control utilization is to reduce the cost of birth control.   If all of a sudden secondary policies have to be created the monetary and the hassle/friction costs go up significantly for the people who would benefit the most from increased access to this form of preventative care.

 
update 1 This is the oh so onerous and oppressive form that must be filled out under the current accommodation for their fee-fees:



Texas, Jake

 

ETA: Annnnnndddd….always read the fine print.  I was taken in by a fake news story at a parody site.  Mea culpa.

I’ll leave this up as (a) a warning to self not to be an idiot, and (b) as a reminder of how hard it is (at least for me), in this election year of our discontent, to tell the difference between what should be obvious parody, and what is.

***************

I’ll start by saying that no state could withstand a characterization drawn only from its most batsh*t crazy denizens.  So I apologize in advance for painting the great, diverse and fascinating state of Texas with a broad brush.

I’ll also note that it does matter a bit that so many of the most batsh*t insane Texans seem to end up in state government.  What this says about the too many of their fellow citizens* who put them there I’ll leave as an exercise for the reader.

Today’s Texan OMG S/HE SAID WUT???!!!! comes from TX state rep. Debbie Riddle (R-Planet Ten), who’s got a problem with the idea of one particular subset of her fellow double-X Americans doing their ladybusiness in public:

Rep. Debbie Riddle requested that the bill be modified to contain some conditions that not all mothers are going to like. Namely, the modified bill states, among other things, that “only women who possess the breast size C-cup or smaller shall be allowed to breastfeed in public areas.” Asked to comment on the discriminatory clause in the bill, Riddle simply stated, “Nature knows what it’s doing.”

I have to say that I really hope that this is somehow a hoax, that Riddle really didn’t say what she’s reported to said.  Because here’s where she is described as going next:

She also added, “It’s for the greater good. We already have more than enough distractions when walking the streets, and we don’t need this one as well.”

Lucas_Cranach_d.Ä._-_Madonna_mit_Kind_(Budapest)

You know that old line, “when you hit bottom, stop digging?”  Riddle apparently does not:

“…everybody knows what happens when a woman with a D-cup size breasts starts breastfeeding her child in the park or on the street. Everybody immediately stops and starts staring.

Riddle also added that“studies have shown that women with bigger breasts are not commonly associated with modest behavior.”

 

Alright.  If the Texan legislator really did say all that (and more! — check out the link!) I got nuthin.  Or perhaps, as our legal beagle friends might say, res ipsa loquitur.

Ladles and Jellyspoons, have at it.  For me, I despair of the Republic.  Or at least that part of it that gave us the Honorable Riddle.

*Somewhere Rousseau — and Jefferson — are weeping.

Image:  Lucas Cranach the Elder, The Virgin Giving Suck c. 1515

 



Open Thread: Hash-ley, Made Them Some

The old saw is that men don’t pay hookers for the sex, they pay them to go away after the sex. If the green-mailers/8chan-lulz-seekers who dumped all those Ashley Madison files are correct, Avid Life Media’s most reliable source of income was not introducing lonely guys to suspiciously compliant young ladies, it was assuring those guys that the details of their online fantasies could be wiped clean from the internet afterwards. Welcome to the new age of no privacy, dudes!

As explained at NYMag‘s ladyblog, The Cut:

On Tuesday a group calling itself Impact Team made good on its promise to release a huge cache of customer data stolen from Ashley Madison, a website for people looking to cheat on their spouses that claims to have 37 million members. Parent company Avid Life Media was hacked last month, and the New York Times reports that 9.7 gigabytes of data has been posted, including log-in details, email addresses, payment details, and encrypted passwords for members of Ashley Madison and its companion site Established Men. (A third site, Cougar Life, was hacked as well, but data on ladies seeking younger men was not included in the dump — so thank you, Impact Team?) The information first appeared on the dark web, which means its beyond the scope of your typical internet browser, but searchable databases have appeared online and are currently being combed for famous names.

Of course, the hackers argue their theft and privacy breach is completely justified. Impact Team demanded that Ashley Madison and Established Men be taken offline permanently, and the group objected in its initial statement to ALM’s claim that customers could have their profile erased completely. ALM charged $19 for the service, but it allegedly kept the customer information on file. “Too bad for those men, they’re cheating dirtbags and deserve no such discretion,” the hackers wrote last month. “Too bad for ALM, you promised secrecy but didn’t deliver.”…

The Washington Post‘s techno-blog helpfully explains “How to search the Ashley Madison leak” (until Avid Life Media can get the info taken down, at least). But a different Post reporter warns us, “Don’t gloat… It’s about way more than infidelity“:

… Within minutes of the alleged leak, people began combing the data for information and posting their findings. Journalists and security experts quickly noted that there were 15,000 .mil or .gov e-mail addresses among those used for the site.

Under military rules, philanderers can be punished by a year in confinement and a dishonorable discharge, which means losing their pension, Slate reported

But the Internet soon turned its ire on other suspected Ashley Madison members, such as university professors and other “SJWs,” a derogatory acronym for “social justice warriors,” or people who speak out publicly against discrimination… Read more



OTC Birth control beneficiaries

UPDATE 1 Thanks to commenter MJ_Oregon who actually read the relevant portion of the law:

First, birth control medications will NOT become OTC in Oregon and all insurance coverage still applies. Drum didn’t bother to check the legislation for what it actually says. HB 2879 allows PHARMACISTS to prescribe birth control medications to women over 18 after they fill out a health questionnaire and are counseled by the pharmacist. There are other safeguards built into the language of the bill as well. AND Section 2 of the legislation contains this language: “(3) All state and federal laws governing insurance coverage of contraceptive drugs, devices, products and services shall apply to hormonal contraceptive patches and self administered oral hormonal contraceptives prescribed by a pharmacist under this section.”

Okay, this is just a massive expansion of the allowed prescriber universe without touching the prescribed vs. non-prescribed categorization of hormonal birth control.  This is a net win for women with current insurance, and women who want birth control but can’t easily get to a prescribing doctor.  Very different story.

My bad for not reading the source documentation.

 

Kevin Drum is commenting on a recent decision by Oregon to allow hormonal birth control to be sold over the counter:

I know there’s some disagreement about this among progressives these days, since prescription birth control is covered by Obamacare and OTC birth control isn’t. But I assume Oregonians who want a prescription can still get one, and allowing contraceptives to be sold OTC as well is the right thing to do. That decision should be made solely on safety grounds, not on grounds of political convenience. This is the same argument we make against things like forced ultrasounds for abortion patients, and it’s the right one

For people who are lucky enough to have access to decent insurance, this is a muddled win.  For women without access to decent insurance, this is a significant improvement to the status quo.

It definately lowers the barriers to accessing birth control for some more women which is a win as they won’t have to see their ObGyn or PCP to get a prescription.  However, if the drugs are being sold over the counter, most insurance companies won’t pay for over the counter medication of any sort.  Further more, women can’t use their tax advantaged health savings dollars to spend on over the counter medication of any sort.  Reimbursement for OTC medications only occur when their is a prescription.  OTC medications will be more costly than zero cost-sharing birth control for women with health insurance.  Once we start factoring in a prescription is needed for reimbursement, the cost barrier that reimbursement knocks down is replaced by accessing a provider to write the scrip.

The real winners of this policy would be women without health insurance, so that increasingly means immigrant women. Increased access to birth control for this group is a win.

The political downside is that putting hormonal birth control OTC gives anti-choice, anti-contraceptive politicians another angle of attack against including contraception as a core, Essential Health Benefit in any and all insurance policies as it is available over the counter.  Senator Gardner (R-Co) used making birth control OTC as a dodge against all of his anti-contraception policy views in the last election.  Getting a policy victory at the cost of a political club is the downside of the deal.  But it is a policy victory that benefits marginal members of the community while not harming others.

The other part of the policy change that stretches a birth control prescription from once per quarter to one per year is a pure policy win on cost, effectiveness, barrier lowering and efficiency grounds.



I Raise My Glass To All Those Now Able To Celebrate Marriage — Filled With The Sweet, Sweet Liquor Of Scalia’s Tears

Via SCOTUSblog’s live blog of today’s decisions:

Scalia’s dissent has an awesome footnote on page 7 (note 22): he says, “If, even as the price to be paid for a fifth vote, I ever joined an opinion for the Court that began: ‘The Constitution promises liberty to all within its reach, a liberty that includes certain specific rights that allow persons, within a lawful realm, to define and express their identity,’ I would hide my head in a bag. The Supreme Court of the United States has descended from the disciplined legal reasoning of John Marshall and Joseph Story to the mystical aphorisms of the fortune cookie.” He is not happy with Justice Kennedy.

Do us all a favor, Antonius Obesus.

Italienischer_Maler_des_17._Jahrhunderts_001

Hide your head in bag anyway.

Image: attr. to Charles Mellin, Portrait of a Stout Man (Nearest I could get to a Baroque separated-at-birth portrait of the Honorable Scalia), c. 1630



Long Read: “Scary Movie About Sex-Trafficking Based on a True Story—Or Was It?”

(NSFW – no visuals, but many words liable to trip filters. Also, Trigger warning, for obvious reasons)

Women are chained to their sewing machines, young teenage migrants pick crops, but if you really want to massage American outrage glands you want to talk about sex. Or sexual abuse, which a great many people conflate with that loaded three-letter word. Weird but very worthwhile article by Jen Graves in Seattle’s The Stranger:

Eden is a 2012 film about a suburban teenage girl kidnapped from her hometown in New Mexico and taken into a warehouse outside Las Vegas, where she is forced into a factory of sex slaves headed by a crooked US Marshal. The girls live in punishing conditions. They’re lined up for mandatory pregnancy tests and mystery injections. Tracking cuffs are strapped to their ankles. Their clients come from every level of American society: businessmen, fraternity guys, politicians. Assigned the name Eden, the girl we follow is imprisoned, beaten, raped, whipped, and tortured. Her only route to escape is through the ultimate betrayal, convincing sex-trafficking ringleaders she is loyal to them by becoming their madam—selling other women to save herself.

As the movie makes clear, Eden’s story is based on the life of a real woman. She is Chong Kim, a noted crusader against sex trafficking. The movie premiered at the South by Southwest Film Festival, where it won the Audience Award, and then played the Seattle International Film Festival, where its star Jamie Chung won the Golden Space Needle Award for best actress. At a film festival in Milan, Edem‘s producers and its director also won awards. For Eden‘s official theatrical release in May 2013, SIFF hosted a sold-out screening at SIFF Cinema Uptown. The lights went down, and the very first words to appear on-screen were “BASED ON A TRUE STORY.”…

Chong Kim, the person the movie was based on, had shared her story in writing before. She was known in the anti-sex-trafficking world, and she is a regular speaker on being a human trafficking survivor, represented by the global speaker’s agency American Program Bureau. Two years before this screening, she had e-mailed James Barnes, founder of the nonprofit organization Breaking Out, whose mission is “to identify, investigate, and rescue victims of human trafficking,” according to its Facebook page. Kim was contacting Barnes, according to Barnes, to offer to help raise money for Breaking Out. Barnes describes himself as a private investigator who was first exposed to sex trafficking when he was investigating a missing child case, and then made sex trafficking his cause…

Barnes remembers Kim talking about books and movies she was involved with that would raise money for his cause. She was “really a hero to me,” Barnes said, “because I rescue people but I never get to see what happens to them.”

But soon, Barnes said, Kim actually started asking him for money so that she could travel—with the promise that she would publicize Breaking Out in her travels—”which is kind of one of our red flags.” Then Barnes began looking into Kim’s own story. “It kind of changed every time we talked, and things didn’t make sense.”…

Mistress Matisse, a professional dominatrix and longtime Stranger contributor… sent an e-mail to her editors here in late June referring to a potential lawsuit. “You’re getting this e-mail from me because I want some answers,” Matisse began. “I believe that Seattle filmmakers Colin Plank and Megan Griffiths”—the producer and the director—”have perpetrated a fraud in their movie called Eden. Allegations have been made, and it’s time for them to either double down—or fess up. And as The Stranger played a role in promoting the film, it’s appropriate that The Stranger play a part [in] the truth being told about it.”

The e-mail was signed “Mistress Matisse, endorsed by the members of the Sex Workers Outreach Project of Seattle.” She wrote that she was discussing with a lawyer “the possibility of a class-action lawsuit against the makers of Eden, although I’d want to wait on that until [Plank and Griffiths] have responded to the initial allegations.” The class in question would be sex workers. “Eden is prominently allied with anti-trafficking NGOs that deny that any form of consensual adult sex work even exists,” Matisse wrote. Read more



Middle class and white, it’s a bitch

Just noted this in passing while reading SCOTUS-Blog on the Supremes temporarily holding the Texas abortion harrassment regulations:

The seven clinics that were not affected by the new restrictions (and the eighth that is soon to open) were concentrated in the four largest metropolitan areas in the eastern part of the state. The lawyers had told the Court that, for the time being, there were no licensed facilities to provide abortions anywhere in the state south or west of San Antonio — “an area larger than most states.”

Texas officials had urged the Supreme Court not to block the new measures, arguing that they were necessary to protect the health of pregnant women in the state. They also argued that the challengers had exaggerated the practical impact of the new restrictions, and that most women would continue to have access to abortions within what they said was a reasonable driving distance.

Abortion will always be available for the upper and upper middle class as California, Canada or Sweden are within reasonable cost and time parameters.

The majority of abortions in this country are for women who under the age of 25.  Historically, this is a cohort that does not have the ability to fly out of state for an elective, common and safe medical procedure.  Nor is it a cohort that has bought into the dominant American car culture.  The odds of a 22 year old woman, much less an 18 year old having a car, and the financial resources to drive halfway across Texas and back without missing work is not particularly high.  It is unreasonable harrassment against female autonomy and reproductive control mingling with blatant classism.  And for this the government of the State of Texas wins the asshole of the week.