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?

Sonfield

"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.