The morality of money

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Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor
Rep. Darrell Issa (R-CA) proposed an interesting question last week in his hearing on a federal contraception mandate for employers, namely, “Has the Obama administration trampled on freedom of religion and freedom of conscience?”

Since this is America, one would assume that having two sides give their answers to that question would be part of the hearing, as would allowing testimony from a female law student. But Issa said the woman lacked the proper credentials, leaving five religious men to share their feelings on what contraception means to them. While Issa allowed two women to speak on Thursday, I think all parties can agree that this image of the panel isn't doing the GOP any favors with their moderate women voters, nor did a crude comment from a Rick Santorum backer about women keeping their knees together.

The comments section on the McKnight's site has lit up with feelings on both sides about the Obama's administration's contraception proposal. While we take out comments involving curse words or hate speech in the comments, everything else is fair game. We aim to allow our readers to talk about what the issue means for long-term care.

Reasonable people can disagree about the government's role in birth control, or whether it violates an employer's religious freedom to allow someone else to make a choice about taking contraception. But in a world of business news, I'm more interested in what this mandate might mean for the long-term care workforce financially.

At last count, the majority of caregivers in this workforce were women. There's a disturbing idea that it's easy for all women to afford birth control, that there are plenty of free or low-cost options available at every turn, or that the co-pays are low enough for anyone to afford. While there are many sliding scales available for low-income women at many clinics, there are also women who struggle to make ends meet and decide that birth control is a luxury, especially during a recession. A 2009 study of low- and middle-income sexually active women found that while three-fourths said they couldn't afford to have a baby, a third had put off a gynecology or birth control visit to save money, and a fourth said they saved money through inconsistent use of birth control.

Who are these women? Some of them work for you, and will neither be testifying at a congressional hearing nor lurking in the McKnight's comments sections because they're on their feet providing direct patient care, making meals, doing laundry or answering the phones. 

Neither the GOP nor the Obama administration has dwelled on the cost-benefit analysis of making birth control free. Yet the estimated costs of direct medical costs of unintended pregnancies was $5 billion in 2002, while the direct medical cost savings due to contraceptive use is about $19 billion.

As an employer, what is the cost to you when an unintended pregnancy develops — not just in the substantial health insurance costs but also in the cost of disruption to your workforce? How likely is it that your pregnant employee will be able to lift a resident? How likely is that she'll need to take time off for prenatal visits? How much time would that employee need to take off, not just when she has the baby, but in the years that follow? How likely is it that she'll finish her bachelor's degree in nursing and become a long-term care leader?

Whether one believes it's immoral for a Catholic nursing home to have to provide free birth control, or whether one believes it's immoral not to allow a woman the option, you can argue that it's wrong to consider money. After all, nonprofits have a higher purpose. Yet as I've often heard, “No margin, no mission.” My advice would be to choose to support what makes economic sense.

Feel free to disagree (or agree) in the comments below. After all, at McKnights.com you can always testify, even if you're of the opposite sex.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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