“Dear Mom,

Mitt Romney says he would repeal the Affordable Care Act. So here’s a quick question: Can I borrow $18,000 to help pay for my birth control? Thanks!”

-- E-card featured on President Obama’s campaign web site

This e-card falls in line with the Democratic claims of a supposed GOP “war on women.” Interestingly, it also plays into the Republican notion that Democrats want people to be dependent on government from cradle to grave, an issue that came up with the “Life of Julia” infographic that earned Three Pinocchios for President Obama’s campaign.

In this case, we have a presumably young woman asking her mom to lend a substantial sum of money for birth control. The idea is that she won’t be able to afford contraceptives without the national healthcare reform law.

Let’s take a deeper look at these issues to determine what’s going on with the $18,000 figure and what Ryan was talking about when he said, “It will be gone.”

The Facts

Before diving into the issue of costs and quotes, let’s review some background information on the so-called contraceptive mandate.

The rule came about as a result of the Affordable Care Act, which requires insurers to provide coverage for a long list of women’s preventive services -- determined by the Department of Health and Human Services -- without charging additional co-payments.

The Obama administration included contraception on that list but allowed an exemption for religious institutions such as churches. Administration officials have said they will also exempt religiously affiliated organizations such as Catholic schools and hospitals, but their insurance providers must still provide the coverage at no additional cost.

The Obama administration said in March that it will come up with an accommodation for religiously affiliated employers that self-insure, but it has not decided how to handle that yet.

GOP leaders have argued that the health-care law should exempt organizations that object on moral grounds to the birth-control mandate. House Majority Leader Eric Cantor (R-Va.) has gone so far as to say that the rule violates the constitutional right to free practice religion, an issue we covered in a previous column.

As for the $18,000 figure, it comes from Planned Parenthood, which has said “some women” could save that much on birth control “over a lifetime” through the Affordable Care Act’s contraception requirement.

Why just “some women”? Because Planned Parenthood estimated a range between $5,400 and $18,000 for birth control over a lifetime, depending on co-pays. That means women with the highest co-pays could spend $18,000, but others would pay far less.

Let’s assume these number are correct. One problem is that the e-card doesn’t tell readers it’s using a lifetime number. They could easily assume that the $18,000 represents just one year’s worth of co-payments for contraceptives.

Furthermore, the estimate assumes 30 years of birth-control use. So what we’re really talking about here is an annual cost of between $180 and $600, according to the Planned Parenthood figures.

That’s a burden, but it doesn’t sound as backbreaking as $18,000. It’s also doubtful that the average woman would need a parental loan to pay for annual birth-control costs beyond her college years and perhaps the start of her professional life.

Another problem is that the e-card cited only the high end of the estimate, giving readers the impression that all women would pay that much without the Affordable Care Act’s contraceptive provision. But some women would pay just $5,400 over a lifetime.

Finally, it’s striking that the daughter asked for the full lifetime amount, as in: Hey Mom, will you spot me some cash for a lifetime supply of birth control? This is an absurd request on multiple levels. For example, some women already cover their contraceptive co-payments without breaking the bank.

Overall, the e-card message implies that women couldn’t afford birth control without the health-care law. That may be true for some women, but certainly not all.

As it stands, greater than half of all states already require insurers to provide contraceptive coverage if they offer prescription-drug coverage at all, according to a report from the Guttmacher Institute, a non-profit group that advocates for women’s reproductive rights. On top of that, some insurers offer contraceptive coverage voluntarily.

We searched in vain for data on the number of women whose insurers provide contraceptive coverage and who don’t have help paying for birth control at all. Health-care experts told us there are no good sources for this information.

Nonetheless, a Guttmacher report based on 2002 data sheds some light on what kind of coverage employers are providing. The analysis noted that “almost every reversible and permanent contraceptive method available was covered by 89 percent or more of typical insurance plans, with similarly strong coverage of both the methods themselves and related services.”

Translation: the vast majority of employer-sponsored insurance plans already provide some level of coverage for birth control. That’s up from just 28 percent in 1993, according to the report.

What drove the massive increase? Guttmacher credited all those state laws requiring insurance plans to cover the full range of prescription contraceptives if they cover prescriptions at all.

In fact, a 2010 employer survey by the Kaiser Family Foundation found that that 85 percent of large firms (those with at least 200 workers) and 63 percent of firms overall provided coverage for prescription contraceptives. (See page 196 of the report).

We should also point out that the birth-control mandate doesn’t even affect some people until the start of next year or later, as the Post’s Wonkblog noted in August. That’s because the requirement kicks in when an insurance plan begins a new annual cycle, which is 2013 in some cases. The law also provides an exemption until 2014 for plans that existed before the free-birth-control mandate took effect.

With this in mind, we know that some women even to this day haven’t felt the benefits of the Affordable Care Act’s birth-control mandate, and they wouldn’t notice a difference in contraceptive coverage if the government repealed the law tomorrow. We find it difficult to fathom that many of these women have asked their mothers to cover a lifetime supply of birth-control.

None of this implies that contraceptive co-payments are inexpensive. The Guttmacher report estimated that out-of-pocket expenditures on a full year’s worth of birth-control pills amounted to 29 percent of women’s personal expenditures for all health services, with brand-name versions costing $49 per month with coverage and upwards of $60 per month without it.

As for Ryan’s remarks about the contraception mandate, they deserve some context. The quote comes from a Sept. 22 campaign event in which the vice presidential candidate fielded questions from the audience.

Here’s the exact question Ryan was answering: “Are you going to ask Joe Biden, during the debates, if he can reconcile his Democratic platform with his faith?”

Ryan argued that the contraception requirement violates religious liberty as it applies to the insurers of religion-affiliated employers. Here’s an excerpt of his remarks:

“You see, the federal government, through Obamacare believes that they can force religious institutions, churches, charities, schools, hospitals -- that they have to do things that violate their own conscious, their own religious teaching. This is the First Amendment to our Constitution, the freedom of conscious, religious liberty.

“Mitt Romney, on day one, will deal with this and we will respect religious liberty and we will not assault the First Amendment to religious freedom in this country and it will be gone. I can guarantee you that.”

So Ryan was talking about repealing the Affordable Care Act, and he argued that the birth-control requirement violates religious liberty. But he didn’t say that he personally opposes the rule as it applies to non-religious employers, and he never said women should not have coverage for contraceptives if they want it.

Granted, Ryan and running mate Mitt Romney have vowed to repeal the Affordable Care Act in its entirety, which would mean eliminating the contraceptive mandate. But the GOP presidential candidate has also said he would be open to reinstating popular aspects of the law.

Romney hasn’t provided many specifics on what he would restore from the Affordable Care Act except to say he wants to “make sure that those with pre-existing conditions can get coverage.” So there’s no guarantee that federal law would require insurers to provide no-pay birth control if he becomes president.

Either way, repealing the health-care law would not prohibit women from obtaining coverage for contraceptives. It would mean that some women have to pay out-of-pocket expenses to one extent or another, just as many do now.

Democrats have exhibited a disturbing pattern of taking birth-control rhetoric down a slippery slope in this election cycle, often suggesting that Republicans want to “ban” birth control. Another example: Obama's Twitter account on the day before the Republican National Convention circulated a line from a Women's Health Magazine article that said, “Crazy as it sounds, the fight to limit or even ban birth control is a key issue in the upcoming presidential election.” The problem here is that taking away the contraceptive mandate is not at all the same as banning birth control.

We also noticed that the head of Planned Parenthood, Cecile Richards, described Romney and Ryan during her speech at the Democratic National Convention as “two men who are committed to ending insurance coverage for birth control.” This is blatantly misleading. It implies that the two candidates want to prohibit insurance coverage for contraceptives, which is not true.  


The Pinocchio Test

The Obama campaign’s e-card cited Planned Parenthood’s high-end estimate for out-of-pocket birth-control costs without explaining what the low-end number could be or mentioning that the $18,000 figure refers to lifetime costs.

We question whether many young women have asked their parents to cover a lifetime’s worth of contraceptive co-payments before the coverage requirement took effect (it still hasn’t taken effect for some women), and it’s no more likely that they’ll do so if Republicans repeal the Affordable Care Act.

The Obama campaign tweet framed Ryan’s quote to suggest women shouldn’t have birth control coverage if they want it. Ryan didn’t say that, but instead argued that the rule violates First Amendment protections for free exercise of religion, which is an issue the courts are examining in a number of pending lawsuits. Furthermore, repealing the Affordable Care act wouldn’t suddenly prohibit women from having coverage for contraceptives — as though only the health-care law allows that choice. It would mean that some women would have to pay out-of-pocket costs to one extent or another.

The Obama campaign earns Three Pinocchios for its e-card and out-of-context tweet.

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