Friday, October 24, 2014

Obamacare doesn't cover contraception for men

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Obamacare made great strides in improving women's access to reproductive services, but it doesn't do much to facilitate the same for men. In part, that's a logistical problem, given that men simply have fewer options when it comes to to birth control.

But there's one procedure the health law overlooks completely: vasectomies.

Under Obamacare, insurance plans have to cover women's tubal ligation without a co-pay. This is in addition to the standard birth control pills, IUDs, and emergency contraceptives that have been the primary focus of discourse provoked by the Hobby Lobby decision. Tubal ligation — better known as "having your tubes tied" — is a permanent form of sterilization where a woman's fallopian tubes are blocked, tied, or cut, interrupting eggs traveling from the ovaries to the uterus.

Vasectomies are basically the less expensive and less invasive male equivalent.

Vasectomies, which block or close the tubes that carry sperm, are actually safer than tubal ligation. The difference in risk isn't huge, but it's real. Women need to be put under general anesthesia to have their tubes tied, which always carries a chance of serious complications. Vasectomies, by contrast, only require local numbing.

They're also substantially less expensive than a woman having her tubes tied. The price of a vasectomy ranges between $350 to $1,000; female sterilization can cost up to six times as much. According to economists, vasectomies are actually one of the cheapest contraceptive methods, second only to nonhormonal IUDs.

Vasectomies are considered permanent because not all reversals are successful, so it's not for all men. But for some — those who don't want children, or who are confident that they're done having kids — a vasectomy serves as a guarantee against unplanned pregnancies. As a bonus, vasectomies could spare partners the daily hassle of taking birth control pills, which have hormones that can cause unpleasant side effects.

Insurers may already cover vasectomies, but high co-pays or deductibles could present a cost barrier. In a world where tubal ligation is covered without a co-pay and vasectomies aren't, a couple might opt for the riskier, more expensive procedure.

Giving women more control over their reproductive health is certainly important, especially since reversible forms of contraception (like the pill) are only available to women. Taking the opportunity to also give men more control over their reproductive capacity wouldn't diminish that — and it's not clear why Obamacare doesn't take that opportunity.

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