Friday, October 3, 2014

Pregnancy prevention: What about vasectomy?

While researching an upcoming story on preventive services,  I came across something perplexing:  Tubal sterilization for women is fully covered by insurance,  per the Affordable Care Act mandate,  while vasectomy for men is not.

The act mandates that specific preventive services be exempt from deductibles and other cost-sharing,  not only for policies bought through the ACA exchange but for employer-provided and other privately purchased health insurance  (grandfathered policies are the exception). The goal is making sure that money doesn't deter anyone from getting care that's likely to head off more serious medical issues and bigger bills.

The medical,  financial and societal benefits of preventing unwanted pregnancies seem clear.  So why not support men who are willing to step up?

"You hear that from everyone who looks at this. It doesn't make sense," says Adam Sonfield of the Guttmacher Institute, which focuses on reproductive issues and pushed for vasectomies to be included.

Early versions of the ACA incorporated preventive standards that were already in place from the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention. Eventually it grew to include children's services recommended by the American Academy for Pediatrics.

And the Department of Health and Human Services commissioned the Institute of Medicine to create a separate list of covered preventive services for women. That list includes FDA-approved contraceptive devices and sterilization techniques.  But there's no parallel provision for men.

"This position seems particularly short sighted, and insurers should consider covering these services without cost-sharing anyway,"  Sonfield,  a senior public policy associate with Guttmacher,  wrote in 2012.  "Vasectomy is less expensive and less invasive than female sterilization, so it benefits no one to provide economic incentives for couples to choose female sterilization.  Moreover, contraceptive methods used by men and by women offer the same benefits for women’s health,  stemming from the prevention of unplanned pregnancies and the ability to time and space planned ones."

With a growing number of insurance policies requiring consumers to pay bigger sums out of pocket,  the bill for a vasectomy could be significant.  Planned Parenthood lists the cost as $350 to $1,000.  A Southern California public radio station recently did a price check and found fees ranging from $500 to $1,750.

Sonfield said he thought insurance companies would choose to exempt vasectomies from cost-sharing to encourage a cheaper,  safer alternative to tubal sterilization,  but he hasn't seen that happen. Other avenues for change would be for HHS to add vasectomies to the list of covered women's services or for the USPS Task Force to add it to the overall adult list. 


Anonymous said...

Well, it's very clear the Administration and Democrats are waging a war on men if we follow the rhetoric from from the "free" birth control crowd. Furthermore, prostate cancer funding is half what breast cancer funding is despite nearly the same amount of deaths, another example of the "war" on men.

Wiley Coyote said...



Anonymous said...

Funny how people will spend $500-1000 on a TV or Christmas presents but if you ask them to do it on their health they freak out.

Bolyn McClung said...


Why should one insurance company pay to prevent another insurance company’s pay out? Paying for a little snip-snip only works if both man and woman are on the same insurance plan.

Nothing says it clearer that coverage is still a business and that healthcare is secondary.

Bolyn McClung

Ann Doss Helms said...

Bolyn and Wiley -- it's like old times on Your Schools!

Wiley Coyote said...

...good time....good times...

There is at least a connection here and to the school blog.

Government is screwing up both.

Anonymous said...

Why are we talking about a sterilization program when we are already having to pay reparations for another sterilation program? Will we have to pay future reparations for this one?? What do you mean "men who are willing to step up"? I don't understand.

Ann Doss Helms said...

The issue with eugenic sterilization is that people were often coerced or deceived into being sterilized. This isn't a sterilization "program." We're talking about people who choose to have a vasectomy (or tubal ligation) and how to pay for it.

Bolyn's right on target; for a stable couple who are done having children, it makes sense to weigh the risks and costs of vasectomy vs. tubal. But for an insurance company that's only focused on the man's coverage, there's no financial payoff for vasectomy.

Wiley Coyote said...

Anytime I see the word "vasectomy" in the title of an article I'm about to read, I immediately start cupping.

Then write my comment in Word so I can copy and past with one hand into the blog.

Somehow I don't want to get into the argument with women who feel their birth control/tube tying should be paid for at taxpayer expense and say "yeah, but what about those same insurance companies? Shouldn't they pay for our err...snip?"

Ann should get a Pulitzer for this.

Ann Doss Helms said...

Wiley, I'm a doctor's kid so I'm not very squeamish. And I like to include visuals in posts. But I did a quick Google image search in hopes of finding something innocuous and immediately had to turn away and close the screen.

Wiley Coyote said...

well...My Mother always said that the only time a man will ever know what it's like to give birth is for him to get a very large kidney stone (which I have had).

A woman will never know the chills a man gets talking about or imagining a snip.

Barbara Taušová said...

In my view it’s linked to couples’ awareness of the possibilities of contraception. In Western countries vasectomy is far more widespread than here, it’s a common method. However, in comparison with the situation roughly ten years ago, when vasectomy was practically never spoken about in this country, it’s now obviously far more in the public awareness these days