The Supreme Court recently decided that “closely” owned for-profit companies like Hobby Lobby can refuse an Affordable Care Act mandate that requires all employer-based plans to cover, without cost-sharing, all Food and Drug Administration approved forms of contraception.
Basically, the company didn’t want to be required to pay for an element of coverage that it found morally objectionable.
The 5-4 Supreme Court decision — with the three female justices joined by Judge Stephen Breyer in dissent — came in one of several cases brought before the court by people fighting coverage of certain women’s health services, including birth control, the emergency morning after pill, and IUDs.
Victory in the Hobby Lobby case may inspire other groups to use their religious beliefs to try to limit or restrict coverage of contraceptive health, raising questions about the future of women’s health care.
Will employers have the right to deny employees and their dependents coverage for contraception? Do the religious beliefs of an entity, business, school or other force override elements of students or employees health care, effectively restricting it?
Hobby Lobby and Conestoga Woods seems to have convinced the Supreme Court that certain forms of contraception promote abortion and that, based on religious grounds, they should not be forced to cover such prescriptions. This includes two types of IUD’s, and two forms of the emergency morning after pill.
Medical science does not support the idea that either of these methods results in any type of abortion. But this was the grounds their argument was built on.
In this case, not all forms of contraception are barred from coverage.
But in a separate Supreme Court ruling, in a case brought by Wheaton College, it turns out that religious institutions might be exempt from coverage requirements for any form of contraception for employees.
So, is women’s health care becoming a privilege, rather than a right that is or isn’t granted based on the religious views of women’s bosses?
As a medical doctor, I have already witnessed the erosion of health care decision-making so that it resides in the hands of insurance companies that make decisions on preferred medications, coverage restrictions and more.
Often their decisions are not based on medical science, or even applied in a logical fashion, but the rationale is usually the same: Save money and restrict care.
The Supreme Court appears to be opening the door for such logic to apply to contraception too.
Based on this latest Supreme Court ruling, coverage that has been lauded by the Institute of Medicine’s evidence-based recommendations as essential to avoiding unwanted pregnancies and promoting better planning for optimal birth outcomes, is no longer necessary.
Employers, such as Hobby Lobby are given the right to refuse to cover employees’ birth control and other contraceptive services for women on the grounds that it violates their rights under the Religious Freedom Restoration Act signed in 1993 by President Bill Clinton.
For some very socially conservative people, these Supreme Court decisions are a launching pad. More colleges and faith-based universities are hoping to challenge the mandate for coverage. Wheaton College is one of more than 50 different institutions that have objected to the Affordable Care Act’s provision for birth control. (http://www.nwlc.org/sites/default/files/contraceptive_coverage_litigation_status_4-28-14_vf.pdf)
What might be next?
After all, Christian Scientists oppose all medical treatment by doctors. Should their organizations be allowed to oppose all insurance coverage entirely for employees?
Will businesses run by Jehovah’s Witnesses be allowed to refuse coverage for any type of testing that might be related to blood products, given their religious objections to transfusions?
Will members of religious groups that oppose vaccines refuse to cover their employees for scientifically avoidable diseases, thus endangering a much wider population with exposure?
Should all mental health services be disallowed by those practicing Scientology?
It has to stop somewhere.
One thing that the Affordable Care Act (ACA) attempted to do was to level the playing field for men and women, who have traditionally had different health insurance premiums because of the idea that women cost insurance companies more. (Some women do, others don’t.)
This provision was disallowed once the ACA was passed, as was a mandate that birth control and emergency contraception be provided at no cost to women as part of their health insurance coverage.
Slowly but surely the coverage gap is widening, and women are being left behind.
The lesbian, gay, bisexual and transgender population would be wise to monitor these developments in women’s health as their own rights for health care coverage may soon be attacked as well. It seems likely that certain people, based on their interpretation of their faith, might demanding exemptions for coverage of people in those communities.
It is a slippery slope.
Discrimination based on race, religion, gender, disability or sexual orientation is not legal in certain sectors, but if corporations are granted exemptions based on religious grounds, it can cause legalized discrimination in coverage.
We expect justice to be blind. We should expect the same of insurance companies, to avoid the sort of discrimination we no longer tolerate in the workplace. That way, we can keep the boss in the boardroom, not the bedroom — or the doctor’s office.
