The Cheapest Shot Against Obamacare, and Why Men Should Pay for Maternity


Right wing Obamacare opponents have a rehashed talking point: the Affordable Care Act forces people to purchase coverage for things they do not need. This accusation comes from the fact that the ACA requires insurance plans to cover maternity and newborn care, and that is outrageous because men, who will never get pregnant, are being forced to pay for a policy that covers maternity care.

It's heartening to see the sudden Republican realization that men will never get pregnant; one only wishes they could apply such factual conviction to decisions about a pregnancy and let those who do get pregnant, rather than the government, determine whether to carry those pregnancies to term.

But I digress. Before the Affordable Care Act, insurance companies were free to charge women more for health insurance than men - essentially treating the fact of being female as a pre-existing condition - with the excuse that women could get pregnant, and thus they, and not those who couldn't be pregnant, should have to pay for the cost of childbearing.

This is one of the cheapest shots against Obamacare, and is probably adequately addressed by pointing out that while men do not get pregnant, they are the ones that get women pregnant, and therefore should have to pay part of the cost. After all, the law already recognizes men's responsibility to the product of a pregnancy, in that it requires men who do not share directly in the cost of raising their children to make childcare payments. Call the maternity care portion of men's health insurance liability insurance, if you will - in the same way your car's liability insurance helps pay for the cost of your actions.

In essence, what the Republican opponents of Obamacare are asking is for the law to permit men to be deadbeats and not have to pay for liability insurance for the pregnancies their actions directly cause. And they are asking for the law to go back to the days of gender discrimination in health insurance.

Still, it is not enough to simply point out that men get women pregnant, and thus need to share in the cost of maternity and newborn care or that gender discrimination in health insurance is wrong. As a man who will never get a woman pregnant, I can categorically say that the idea of separate coverage based on the likelihood of one's use of services is the status quo in health care, and that is what the Affordable Care Act aims to change - because the status quo is not working. The ACA's goal is to establish health care as a social good, which health insurance is the means of paying for.

Think about the implications of allowing health insurance charges on the likelihood of one's use of services. If I state in my living will that I do not wish to be kept alive by artificial means of life support, do I get to pay a smaller premium than those who do wish to be kept alive through life support? After all, there is no chance that I will use life support for an extended period of time, so I shouldn't have to pay for it, right? What would the Christian Right's response be to that? Should those who for religious reasons believe that life support should not be disconnected be penalized in their health insurance bills?

But that's a choice you say, and not a physical impossibility for me to use life support. Though it is a distinction without a difference due to the hypothetical living will, consider something simpler. If I have had a gallbladder operation or a tonsillectomy, should those who haven't be forced to pay a higher premium, since it would be physically impossible for me to ever again need care related to my tonsils or my gallbladder? Should fertile men and women have to pay more than women who have had a hysterectomy or are medically sterile or men who've had a vasectomy or are medically sterile?

Where does this stop? There is no way one can be logically consistent and oppose men having to pay for maternity care in their insurance policies and answer any of the above questions in the negative. And if the answers to the above are affirmative, then health insurance premiums, rather than the pursuit of happiness, is going to drive our decisions. Should it? Should a woman decide when she should stop having children based on health insurance premiums? Should individuals be financially forced to draw up living wills that deny themselves life support?

Of course not - and therein lies the point about the Affordable Care Act. It is designed to provide everyone with affordable coverage with minimum standards to prevent health insurance from becoming merely house insurance. Our health care premiums should not be decided based on our life decisions or our very beings. The Affordable Care Act is designed to regulate the insurance market in a way that makes affordable, comprehensive health care a right - not a privilege with the luxury to pick and choose based on anatomy or medical history or medical choices.

Health care is a social good, not an individual luxury, and so the way we pay for it must reflect that social good. The responsibility to contribute to that social good does not vary based on the possibility of one's use of that social good (or the things that comprise that social good). That is the bottom-line rationale for having a set of minimum coverage requirements, including maternity and newborn care. Pregnancy and child-rearing is as much men's responsibility as it is women's - not simply because men get women pregnant but because the care of a pregnant mother and an infant child is part of that social good.