During the debate over Ryancare/Trumpcare/AHCA/Robin-Hood-in-Reverse scheme (or whatever else people are calling it these days), Republican Representative John Shimkus of Illinois asked why men must pay for prenatal care (i.e. , care received from a health care provider during pregnancy).
Here is that moment of glory.
Shimkus is not alone in asking whether men should have to pay for costs involving childbearing. In 2013, Representative Renee Ellmers from North Carolina used maternity coverage as an example of a benefit that the ACA was forcing on many Americans. Arguing that men would never need maternity coverage, Ellmers asked then-HHS Secretary Kathleen Sebelius: “To the best of your knowledge, has a man ever delivered a baby?”
Should men have to pay for prenatal/maternal care? The answer should unambiguously be “Yes.” Here is why:
- In my middle-school biology class, we learned that a baby was created when a sperm met an egg and they liked each other enough to stick with each other for a while. In that version of the story, the sperm always came from a man and the egg from a woman. Its always possible that Shimkus and Ellmers have different statistics about who produces what in the baby-making process, but I am going to continue to believe my version of human biology purely out of loyalty to my middle school. So this means that some man’s sperm would usually have to take some degree of responsibility for any given baby (irrespective of whether the baby in question is ultimately raised by biological or adoptive, single or multiple, same-sex or opposite-sex parents). Why then must we make only the woman pay the medical costs for childbearing? Childbearing already involves many other costs for women, whether in terms of health risks, lost earnings and time, physical inconvenience, and all-too-often, future earnings and career opportunities. Some of these costs cannot be easily allocated to others, but medical costs sure can. So they should be. (I did once have a conversation about this with a male former colleague, who said dismissively “Maybe you are different, but my wife LOVED being pregnant.” Perhaps his wife is the only person on earth for whom the joys of pregnancy fully paid for the entire experience. And yes, I guess I AM different).
- Childbearing (i.e., the continuation of the human race) and the health of both children and childbearing mothers are, at least in part, public goods. We all benefit from them as a society, so we must all pay to some extent. And lest anyone ever tells you otherwise – we already pay for plenty of public goods (e.g, infrastructure, military service, clean air, etc). So the resistance of some on this issue is really more about their attitudes towards the childbearing role of women (“That’s what nature intended, so shut up and do your evolutionary duty”) than about whether its fundamentally fair to have to pay for something that you don’t directly experience or want. I paid for a war in Iraq that I most definitely did not want, and I certainly don’t remember getting a refund when we found out that the WMDs never existed.
- Finally, let’s talk about how insurance actually works, and why that matters. Last year, insurance expert Nancy Metcalf was asked the following question at issue here by a reader of Consumer Reports: “I’m a middle-aged man with no intention of having children. Why should I have to pay for maternity or pediatric dental coverage?”
Metcalf responded that health insurance, like other forms of insurance, worked by pooling risks. These health risks cover the full range of health care possibilities, from prenatal care for the mother to pediatric care for the newborn/infant/child all the way to hospice. While no individual is likely to need every kind of care covered in his or her plan, each individual will eventually need some form of care (or at least, expects to do so). If you slice and dice the risks too much – e.g.,middle-aged childless men don’t pay for maternal care, while 30-year-old women refuse to pay for Viagra, prostate cancer tests, or costs related to various cardiac conditions that older men are much more likely to suffer from – eventually the whole idea of a risk pool, and insurance itself, falls apart.
Metcalf also noted that a la carte pricing for maternity care has already been shown not to work. Before the ACA took effect, insurers could and did exclude maternity coverage from individual plans. Women could sometimes buy a maternity “rider” on their policy, which were supplements to individual plans when maternity coverage was not included in the plan. However, the rider was typically very expensive. Why? Because insurers knew that the only people who bought maternity coverage were people who were planning to have a baby and priced to this target group accordingly. Therefore, maternity “coverage” – even when it existed – often cost just about as much as paying cash for having a baby.
You can see some of the data for yourself in this 2012 study by the National Women’s Law Center (NWLC), which was prepared before the ACA came into effect. The numbers are pretty staggering – for instance, NWLC examined over 3000 individual health insurance policies offered to 30-year-old women across the country and found that only 6% of plans provided maternity coverage in states where such coverage was not mandated at the time. If you included states that mandated maternity coverage at the time, the percentage only increased to 12% – i.e., from the overall national perspective, the mandates did not do that much. In fact, only 9 states required all insurers on the individual market to cover maternity care. As for maternity “riders,” they were available in only 7% of plans, were often prohibitively expensive (e.g., several times more expensive than the plan itself), and sometimes included waiting periods of one or two years before the coverage took effect.
So yeah, like I was saying, men should absolutely pay.