More risk-shifting: the Blunt proposal

Roy Blunt’s attempt to empower employers to deny any kind of health coverage based on a so-called conscience objective is typically framed as an extension of the religion-driven debate over coverage for contraception. Adam Serwer in MoJo has a good rundown here:

In their latest move in the battle over contraception coverage, top Republicans in Congress are going for broke: They’re now pushing a bill that would allow employers and insurance companies to pick and choose which health benefits to provide based simply on executives’ personal moral beliefs. Sen. Mitch McConnell (R-Ky.), the top GOPer in the Senate, has already endorsed the proposal, and it could come to a vote this week. The measure would make the religious exemptions to President Barack Obama’s health care bill so large they’d swallow it whole.

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Obama’s Affordable Care Act requires all health care plans to offer certain services and benefits, including birth control. Last week, Sen. Roy Blunt (R-Mo.) offered a “conscience amendment,” to the law, pitching it as a way to allay religious employers’ qualms about providing birth control to their employees.

But Blunt’s proposal doesn’t just apply to religious employers and birth control. Instead, it would allow any insurer or employer, religiously affiliated or otherwise, to opt out of providing any health care services required by federal law—everything from maternity care to screening for diabetes. Employers wouldn’t have to cite religious reasons for their decision; they could just say the treatment goes against their moral convictions. That exception could include almost anything—an employer could theoretically claim a “moral objection” to the cost of providing a given benefit. The bill would also allow employers to sue if state or federal regulators try to make them comply with the law.

If Republican leaders get their way and Blunt’s bill becomes law, a boss who regarded overweight people and smokers with moral disgust could exclude coverage of obesity and tobacco screening from his employees’ health plans. A Scientologist employer could deny its employees depression screening because Scientologists believe psychiatry is morally objectionable. A management team that thought HIV victims brought the disease upon themselves could excise HIV screening from its employees’ insurance coverage. Your boss’ personal prejudices, not science or medical expertise, would determine which procedures your insurance would cover for you and your kids.

It’s clear that this won’t become law, but if the past few years are any indication then I think it’s also clear that the operative modifier is “yet,” as once these ideas are on the table they tend to remain there. Taking it at face value raises the question of who in fact would count as “management” in the case of a large corporate employer – the umbrella HR department? Line managers? Would there be different levels of coverage for different operating units? How could an entire publicly traded company claim to have a single conscience-based objection to one kind of coverage?

The cynical (and obvious) conclusion is that in the longer term this will just be another way to pull a risk shift on employees, in this case by redrawing the boundaries of the insured risk pool. If companies can lower their insurance cost by excluding the items that make their policies expensive, and if they can claim some kind of safe harbor for doing it, then they surely will. And since their highest calling is supposed to be to shareholder value, well then, there’s the “conscience” part. I think back to my time in trying to manage our small company plan, and all of the times my insurance broker rather nauseatingly insisted that the driver of our rising costs was having women of childbearing age in the plan, and it doesn’t take Nostradamus to see where this would go.

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