Tuesday, May 21, 2013
The pill and the pauper
by Sara Michael
Ever since Margaret Sanger was escorted into a Black Maria some 90-odd years ago, reproductive rights have been at the center of an ongoing war between religious zealots, feminists and all those in between. Now that it's taken a headline in the 2012 elections, the conversation has turned political and vicious, ignoring perhaps the true issue at stake — the universal health needs of women.
President Barack Obama released a statement last Friday, Feb. 10, exempting religious hospitals and schools from directly providing birth control to their employees, without a co-pay. Instead, the insurance companies themselves will be required to supply the service.
All women working for these organizations would still have equal access to care. Houses of worship will be exempt from the requirement, as they were originally in the 2010 Patient Protection and Affordable Care Act. And abortions would not be included under the policy.
Still, religious leaders across the nation continued to fume. Bishop James D. Conley, of the Catholic Archdiocese of Denver, publicly denounced the Department of Health and Human Services announcement, calling it a "death knell for religious liberty."
"There's just really no place for religion in health care," counters Boulder physician Lila Rosenthal, M.D. "It's really important that people who go into health care and make health care policy remove their own religious filter from the discussion."
As long as women — all women — are getting their needs met, the government and medical field are doing their jobs, Rosenthal says. The statement explains not only her approval of Obama's "accommodation," but also her overall support for his health care reform and its guarantee that come Aug. 1, 2012, most women will have access to Food and Drug Administration-approved contraception at no added charge through their job-based insurance plans.
But it also explains why she believes it's not the be-all, end-all. There's still a demographic, she says, that has perhaps been overlooked by the government: the poor.
"It's never going to be a problem for middle- and upper-class women to get access to the highest-quality contraception or to pay for an abortion if they need one," she says. But Medicaid doesn't always cover higher-quality contraception, such as several intrauterine devices (IUDs), which she often recommends for patients.
"Poor women in America are the ones who lose out, every time."
Peak Vista Community Health Centers in Colorado Springs sees about 54,000 low-income medical patients annually, including female patients coming in with pregnancies, STDs and other sexual health issues. About 51 percent of its patients are on Medicaid, and a large portion of others pay on a sliding scale — which still includes co-pays. Many of them won't enjoy greater birth-control access under the new law.
Jeff McCutcheon, M.D., expresses more concern for "people who fall through the cracks," people who may work but don't qualify for Medicaid or are uninsured. As an obstetrician/gynecologist and clinical manager of Peak Vista's Women's Health Center, he says he also sees a number of undocumented patients who cannot qualify for government aid.
"It'd be nice to remove a roadblock for that," he says, "because there's not a lot of people out there that would like to see an explosion of unplanned births in that population."
Unplanned pregnancy can have immeasurable impacts, he says, and is "as individualized as the patient in that situation." More education, he says, would be the best way to prevent unplanned pregnancies. But, until those programs are expanded, he allows, providing co-pay-free, free birth control to a larger segment of the population is a realistic solution.
"Even being responsible patients," he says, "if they can't get birth control, they're not going to be able to afford to take care of a child."
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