Author’s Note: I’m currently in the process of migrating old blog posts to this new system. That may mean some links, syntax highlighting, and other details are broken or missing temporarily. Sorry for the inconvenience!

Yesterday, it was announced that the U.S. Supreme Court had affirmed the right of Hobby Lobby to deny insurance coverage to its employees for Plan B and Intrauterine Devices, on the grounds that compelling the company to provide those services violated its owners’ religious freedom.

Let’s bypass a religious discussion, shall we?

I’m not interested in having a religious discussion, nor a discussion about what consistutes abortion, nor a discussion of a woman’s right to choose. If you’re looking for a flamewar on those topics, there are fields and fields of internet for you to battle over. I’m interested in something that I hadn’t realized prior to this case:

The Affordable Care Act mandates that women’s preventative health care (including contraception) must be made available without cost-sharing (i.e. no copays, deductibles, etc). [source]

This no-cost-sharing policy confuses me. I’m certainly all for providing coverage for women’s preventative care — mamograms, HPV testing, and yes, birth control. But prohibiting a copay on these treatments, when the requirement is not extended to other preventative health care, seems to be a confusion of values.

What do we want to cover?

It seems to me that social legislation, in its best form, should reflect our social values. I’m aware that legislation rarely gets passed without yielding a bit to third-party interests, but let’s be idealistic for a second:

Let’s say that we have decided we want to provide health care to our citizens. Note: “we”, not “the government” should. Even if it’s via employer mandates rather than taxes, we’re all risking our own earning potential when we elect to pass these laws.

Now, we can decide what treatments we want to favor: whether we want to incentivize preventative care, to reduce costly treatments down the road. Maybe we want to provide entirely free care to victims of sexual assault. Perhaps we want to ensure we offer the best care to children, so that they’re in the best of health when they enter the working world.

Here’s a big one for me: let’s provide the best incentives to the people with conditions outside of their control.

I have epilepsy, so ignore me…

I’m absolutely partisan in this discussion. But I have a chronic condition for which there is no cure. I will be on medication likely for the rest of my life, and I am paying prescription and neurologist copays out of my own pocket. I can’t drive, and that limits where I’m able to live while maintaining a good quality of life.

I’m fortunate in that I can take a generic drug, with a small copay. And the seizures that I have — while they prevent me from working, or even really getting out of bed for a few days — only happen about every two years. I’m fortunate to have a good job that allows me to work from home when necessary, and provides me with sufficient pay to treat my condition.

There are many people who aren’t so lucky. Chronic conditions like epilepsy, multiple sclerosis, Crohn’s disease, hypothyroidism… these are all conditions that are non-preventable. And treament/management can range wildly in cost. These are not copay-free treatments; Plan B is.

So why sex?

When we provide birth control without a copay, we are giving it favored status over other types of care. It’s true that birth control can be used to treat hormonal problems, like polycyctic ovary syndrome. It’s also used to treat acne. And, perhaps most commonly, it’s used for recreational sex.

If we’ve really decided that it’s more important to subsidize recreational sex than treat chronic conditions, then I guess that’s fine.

If only there were an abstinence option for seizures.