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Joanna Weiss

Fifty Shades of Obamacare


I had three separate “Fifty Shades of Grey” sightings last weekend — one in a nail salon, one in a rental car line, one on an airplane from Philadelphia to Boston. The readers were women of different ages and races, and what struck me was that all of them held paperbacks: No shame.

When it first hit the public consciousness, “Fifty Shades” was described, not just as “mommy porn,” but also as the ultimate electronic reader fare. The bondage-lite tale of a virginal woman, courted by a billionaire who’s into whips and chains, was easy to hide from your husband or your mom or the judgmental women on the playground.


But these days, the book and its sequels are everywhere, in print, including on the racks in airport bookstores. It’s selling like mad, and trust me, it’s not for the sparkling prose. (Sample text: “His voice is warm and husky like dark melted chocolate fudge caramel . . . or something.”) Last week, a library system in Brevard County, Florida announced that it would restock 19 copies of “Fifty Shades of Grey” that it had pulled from its shelves. County officials had complained that the book was “semi-pornographic.” The public revolted, in favor of semi-porn.

This highlights a fact that is understood by marketers and any number of Hollywood executives, but often unacknowledged by politicians: Human beings, even Americans, like sex. And this bears repeating during the hard-to-kill debate over the women’s preventive services mandate in health care reform, which requires that, starting in August, all health plans have to offer contraception free of charge.

You might recall that, under some political pressure, the Obama administration issued a religious exemption. But Catholic organizations are still complaining, and pressing a lawsuit against the rule — therefore keeping the story in the news and the rhetoric at high pitch. And in some circles, the contraception rule has become a stand-in for the ills of Obamacare, a complaint issued with Victorian-era disdain: “Why should I have to pay for your recreational sex?”


But that’s a highly distorted way of looking at health insurance. We engage in all sorts of recreational pursuits that carry all sorts of consequences; if pregnancy is a potential outcome of recreational sex, then knee surgery is a potential outcome of recreational skiing.

And while people applying for individual health plans might have to answer questions about their lifestyle risks — do you ski? run? skydive? — a group insurance plan, issued by your employer, has no such filters. Susan Pisano, a spokeswoman for the trade group America’s Health Insurance Plans, told me that group policies don’t usually have exclusions based on how an injury happens. In the emergency room, no one’s going to question you, or shame you, if you hurt your knee on the slopes. And knee surgery is a lot more expensive than birth control pills.

But here’s the good news, for “Fifty Shades” readers and their friends: In real life, with a few notable exceptions, no one is going to give you a hard time over contraception, either. Yes, employees and students at some religious institutions face restrictions or bans. Still, even before Obamacare, things have been moving in the right direction.

Contraceptive coverage was low in the early 1990s, but by 2002, the five leading prescription methods of birth control were covered by 86 percent of health plans, according to a study from the Guttmacher Institute. A 2007 study of pharmacy benefits, by the consulting company Mercer, found that 77 percent of employer-sponsored health plans cover contraceptive drugs — not counting emergency contraceptives — with no limits or extra costs.


Yes, for some women, copayments and deductibles can still be burdensome. But it’s worth noting that contraceptives are far more broadly covered than Viagra: The Mercer study found that only 15 percent of health plans cover erectile dysfunction drugs without limits, and 31 percent exclude them altogether.

In part, the increase in contraceptive coverage has been driven by state mandates. But in part, the marketplace is taking care of it. Today, contraceptive benefits tend to be demanded by employers, Pisano said. And why not? Birth control decreases the chance of unplanned maternity leaves. It lowers the chance of abortion. Workers like it, too. Covering it simply requires some honesty about sex — something those “Fifty Shades” readers know, even if the politicians don’t.

Joanna Weiss can be reached at weiss@globe.com. Follow her on Twitter @JoannaWeiss.