The GMP on the affordable care act

How the times have changed. I remember being fed up with the GMP but more recently it seems there has been a paradigm shift and with Noah Brand (from NSWTM) as new editor in chief the site is certainly much better than before. So, there have been 2 interesting posts on the ACA recently:

For the first time ever, the U.S. government will expand access to preventive health services for women without requiring equivalent coverage for men. The U.S. Affordable Care Act (ACA), sometimes labeled by critics as “Obamacare,” will be rolled out using rules likely to deny men equal access to contraception, sterilization, sexually transmitted infection prevention, domestic violence screening and counseling, and even counseling for HIV-positive men.

[...]In a nutshell, women’s IUDs, contraceptive pills and implants, tubal ligations and birth control counseling must be provided without co-pays, doctor’s visit charges, or deductibles, while insurance companies will be free to charge men for vasectomies and contraceptive counseling. Women will universally receive free counseling if they test HIV-positive, but HIV-positive men will not. HPV can result in anal cancer and genital warts in men as well as cervical cancer in women, but no-cost HPV DNA testing will be added to free pap smears for women, while men pay for HPV tests or go without. The Centers for Disease Control found that 28.5 percent of men—over 40 million men—experience rape, physical violence, or stalking by an intimate partner. Those men, unlike women, will first have to ask for help and then pay out of pocket to receive it.

In contrast, a mental health service that men disproportionately need, is not a preventive health service under this Act or HHS guidelines. Men commit suicide at a rate nearly four times that of women. Young men are at particular risk: the National Institute of Mental Health reports that the suicide rate for young men during late adolescence is almost five times that of their female peers, and by their early twenties the rate rises to almost six to one. Reminiscent of Anatole France’s remark about the majestic equality of the law, suicide prevention services are excluded from the ACA / HHS no-cost-sharing package for both women and men.

[2nd Article starts here...] In effect, the sex-neutral insurance pricing required by the ACA already shifts some of the cost of future medical services consumed by women to men. The 2012 report cited above estimated the additional premium costs now borne by women to be over $1 billion a year. Thus, under the ACA, men can expect to bear at least half of those costs—half a billion dollars a year—for services consumed by women.

The theory behind these two fundamental health insurance payment changes wrought by the ACA, is that we are all in it together when it comes to healthcare. Until, in the case of men’s access to reproductive health services and preventive care for men’s diseases, we aren’t. [...]

Erin Gloria Ryan put it well in her recent Jezebel post: “When a woman consents to sex, she is not also consenting to pregnancy.” A woman in the U.S. has a constitutional right to terminate hosting a fetus and unilaterally end any obligation to support and raise a child. A precisely opposite legal regime applies to men. When a man has heterosexual sex he is presumed to have consented to paternity and a couple of decades of child support. To control their own fertility, straight men, unlike women, are entirely dependent on complete abstinence or the highly competent use of very limited and often ineffective birth control methods.[...]

The Federal decision to mandate no-cost preventive reproductive healthcare only for women must be viewed against the backdrop of 1) the sex discrimination prohibition in the ACA; 2) gender-neutral insurance pricing and the individual mandate under the ACA; 3) widespread lack of reproductive health and suicide prevention services for men; 4) the five-year life expectancy gap that disfavors U.S. men; and 5) the 50-year drought of public or private research funding for truly effective, reversible birth control for men. Any given man is some woman’s son or grandson, just as any given woman is some man’s daughter or granddaughter. Are we in this together, or aren’t we?

It is fantastic that women have reproductive rights and many contraceptive choices. No-cost preventive care addressing women’s unique health concerns is necessary. That is not the issue. The issue is that this administration and leading health organizations that purport to believe in widespread access to health care do not seem to hold men in equal regard to women when it comes to birth control, STI services, HIV counseling and screening and counseling for intimate partner violence.

When contacted by GMP, for example, Planned Parenthood was unable to cite anything it had done—or would do—with its impressive lobbying and public affairs operation to encourage HHS to provide men with equal access to reproductive health care under the ACA. [...]

The Guttmacher Institute’s last major review of men’s reproductive health needs and barriers to meeting those needs found the following barriers to addressing the reproductive health of men in their own right: Absence of political will to turn advocacy into action; Lack of funding; Logistical challenges of incorporating men’s services into existing programs; and Inadequate staff.

Men are carefully trained from infancy not to show pain, not to complain about hard knocks and not to seek help. Men are also inaccurately assumed to be omniscient about matters of sex and sexual health. Under these circumstances shouldn’t it be the duty of HHS officials, Members of Congress, public health school deans, medical school professors, public health advocates, the philanthropists and boards who direct major foundations, and maybe even a U.S. President, to demonstrate leadership on this issue?