Employer-Sponsored Reproduction

Abstract

This Article interrogates the current and future role of employer-sponsored health insurance in reproductive justice, revealing the impact that employers’ coverage choices have on access to reproductive care and the legal infrastructure that prioritizes employer choice over individual autonomy. Over half of the population depends on employers for health insurance. Laws regulating employer plans give employers exceptionally wide latitude to decide what reproductive care services to cover---including services like abortion, contraception, and infertility treatment. In their role as health care funders, employers pursue interests which often conflict with employees’ interests and the aims of reproductive justice: to enable autonomous decisions about whether and when to reproduce and to raise children in safe and supportive circumstances. Employers often balk at covering services related to conceiving and bearing children, which they view as costly to them both as employers and insurers. While some employers’ plans cover contraception and abortion, which may prevent the costs of pregnancy and additional dependents, many other employers object to covering these services. The legal infrastructure validates employers’ choices across this wide spectrum, subordinating individuals’ autonomy to their employer’s economic interests. Decoupling health care access from employment is necessary to bolster reproductive justice. But the most effective means of decoupling---public option and single-payer public benefits---raise tough questions about reproductive exceptionalism. The Hyde Amendment and decades of other compromises have excluded reproductive care from major reforms to expand public coverage. Shifting the third-party payment role from employers to governments does not truly remove the threat, so progressive health reform risks sacrificing reproductive justice to the cause of universal benefits. This Article illuminates how vigilantly centering reproductive justice in single-payer reform proposals can make those efforts more feasible and durable.

Keywords: Dobbs, abortion, reproductive rights, reproductive health care, reproductive freedom, employer health benefits, employer-sponsored insurance, health reform, single payer, universal health care, medicare for all, insurance reform

JEL Classification: K10, I13, I14, I18