Contraceptive Coverage Should Be the Rule, Not the Exception


Originally published by McClatchy. Published here with permission of the author.

Far too often, government policies tend to be at odds with reality when it comes to women’s reproductive health by ignoring the services that women need most. Which is why guidelines recently issued by the Department of Human Services requiring insurance coverage for contraception and other preventive services were so welcome. After all, virtually every woman of childbearing age practices some sort of contraception at some point.

Requiring coverage of FDA-approved contraceptives like birth control pills, implants and IUDs and other necessary preventive services would seem like a no-brainer. Unfortunately, when it comes to health care in America today, nothing is ever that simple.

Following the HHS announcement, some groups have objected to the contraception requirement on religious grounds. They want a wide range of employers to get a special exception so they can deny their employees birth control coverage. The HHS guidelines already propose to exempt churches, synagogues and other exclusively sectarian institutions. But critics of the policy say that’s not enough.

These groups want special exceptions to allow any religiously-affiliated institution, including hospitals that employ people of all faiths, to deny its employees insurance for birth control. If the critics had their way, the HHS guidelines would be meaningless for hundreds of thousands of women, who would lose the ability to determine which health services are best for them and their families and instead could be beholden to the religious beliefs of their employers.

Consider that Catholic hospitals alone employ over half a million people. The effects of broadening the exception would be sweeping.

While everyone is free to make personal decisions regarding whether and when to use birth control, it is wrong for employers to force this decision on their employees by denying them access to essential health services.

This isn’t the first time that religious groups have tried to impose their views on health policy. The U.S. Conference of Catholic Bishops tried to have contraception excluded from the guidelines altogether, denying these benefits to all women. Currently, the bishops are pushing an even more extreme measure that could allow employers to refuse to provide coverage for any service they oppose, leaving health care coverage for thousands of people of all belief systems to the influence of one particular faith.

This is completely contrary to our values of both personal and religious freedom.

Women need, demand and utilize contraceptive services. This is the reality of women’s health, and has been acknowledged and affirmed by the medical community and now by HHS. Those who oppose family planning cannot be permitted to allow their ideology to dictate others’ health care. To do otherwise would mark a dismaying retreat from rationality in women’s health policy.

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  • waterjoe

    “While everyone is free to make personal decisions regarding whether and when to use birth control, it is wrong for employers to force this decision on their employees .  . .”

    If true, then this would also be true:

    “While everyone is free to make personal decisions regarding whether and when to pay for birth control, it is wrong for government to force this decision on employers .  . .”

  • plume-assassine

    There are many things that people already pay for — mandated by the government — which they do not agree with, but which do not otherwise personally effect them. Think about everything that your taxes go toward now at this moment; one of the possibilities is that you are paying to fund the current wars. Why is birth control coverage in insurance plans considered more of an outrage than the fact that you are potentially funding war crimes committed by your government?

    It does not personally or bodily effect you if you are an employer and your female employees need birth control coverage in their insurance plan. Nobody is forcing you or anyone to use birth control or even to advocate for any type of family planning. That is entirely different from making secular businesses provide birth control coverage for their employees. Unfortunately, you seem to think that using birth control and providing coverage for birth control are exactly the same concepts, and they most certainly are not. 

    Let us also consider the fact that 99% of Americans will use birth control at some point in their life and that access to birth control reduces the number of unwanted pregnancies (and therefore reduces # of abortions). This is not a matter of “personal convenience,” but a serious matter of health for American women, who will have healthier pregnancies and healthier children if they are given the opportunity to plan for the optimal time to have children.

  • jennifer-starr

    As far as I can see, no one is forcing an employer to purchase and personally use contraception if they don’t wish to.  And why should it matter to an employer if their employees do use it?  I fail to see any conflict here. 

  • crowepps

    Fervently Catholic organization has 10 employees in-house, 9 men of various faiths and 1 women in her 50′s.  Organization provides standard health insurance policies without any special conditions.  One of the men is married and he and his Jewish wife use the policy to get birth control necessary because she has a weak heart.  Since the helath insurance is provided as a part of the man’s compensation, his entitlement to health coverage arises out of his work.  A demand by the employer that the man act as though he is Catholic is unreasonable, but a demand that his wife, who is NOT their employee, and NOT of their faith, be economically punished for using birth control necessary to her health is really excessive.  Not only is it inappropriate for the man’s employer to be sticking its snoopy nose into their sex life or having an opinion about whether they should have more children, but asserting a right because they employ him  to demand private, personal information about her health condition is way, way over the line.

    Many states already require this.  Catholic Charities took it to court in California in 2004, lost, took it the appeals court in 2009 and lost.  So far as I am aware, they obeyed the law and provided the coverage, there and in the other 20 states where it was required.

    http://www.christianitytoday.com/ct/2004/marchweb-only/3-1-22.0.html 

    http://www.cbsnews.com/stories/2004/03/02/health/main603571.shtml

    I honestly do understand the whole ‘we don’t want any connection, however tenuous, to anything WE find questionable’.  It’s a very familiar meme from reading about obsessive compulsives.  I don’t see any reason for the government to cater to it, however.  If the Catholic organization is willing to cut off its nose to spite its face, it can choose between closing down the organizations in question and allowing secular organizations to provide those services, or not providing health insurance at all and giving employees an allowance to buy their own insurance.

  • waterjoe

    la plume assassine: “Why is birth control coverage in insurance plans considered more of an outrage than the fact that you are potentially funding war crimes committed by your government?”

     

    The analogy fails.  We are not talking about taxes. We are talking about mandating purchase of something.  Suppose you owned a pharmaceutical company and opposed the death penalty.  As a condition of continuing to operate the government required you to produce the “cocktail” that would kill an inmate.  Or suppose you operated a small factory and the government mandated that ten percent of your business must be producing parts for nuclear weapons.  Otherwise, government officials will shut you down.  Those analogies are more on point.

     

    It does not personally . . . effect you.”

    You apparently do not understand the nature of conscientious objection.

     

    Jennifer Starr: “As far as I can see, no one is forcing an employer to purchase . . . contraception if they don’t wish to.”  Wrong. That is exactly what this will do.

     

    crowepps: “Many states already require this.”  Actually, just two to this extent.  The others have sufficient religious exemptions.  In any event, whether it is done and whether it is constitutional is not the point.

  • jennifer-starr

    So Waterjoe, you’re saying that you believe the state will force you to purchase and use contraception for yourself? I did say that no one is forcing an employer to PERSONALLY purchase and use contraception, after all. Personally means the employer.  As to whether the employees do, I really don’t see why that should be the employer’s concern. 

  • waterjoe

    But the employer is being forced to pay for it.

     

    It reminds me of when my brother was a kid and the police alleged that he had sprayed grafitti on a school building.  He didn’t, but he later admitted that he bought the spray paint and gave it to kids who did the actual paintiing.  Should my mother have excused his actions because he did not personally use the spray paint?

  • crowepps

    Employers are ‘forced’ to pay for other things as well.  For instance, employers are forced to pay for expensive Worker’s Compensation insurance policies, that pay if the workers get hurt.  Does that mean the employer is ‘promoting’ on the job injuries?  It’s possible none of the employees will ever use their insurance to obtain birth control at all, just as the insurance may cover lung cancer and if none of the workers smoke, it’s unlikely they’ll use insurance for that purpose.

    Birth control has been found to be ‘revenue neutral’, that is, over the entire pool, the cost of birth control is balanced by the cost of not paying for expensive deliveries and premature births, so birth control doesn’t raise the employer’s costs for insurance.  So far as I can tell, the only impact this rule will have on religious employers is to remind them that they are not omnipotent, and entitled to micromanage their employees’ lives.  While that may be traumatic for authoritarians who want to control every second of other people’s lives, it isn’t an idea the civil government should be encouraging.

  • crowepps

     In any event, whether it is done and whether it is constitutional is not the point.

    You truly want to argue that?  You truly want to put on the record that although the other people in this country owe their allegience to an IDEA, to the proposition that government should interfere only where it must, and that our shared spiritual value is that each person has the freedom of conscience to make their own moral decisions, you don’t agree but instead believe the Constitution should be abandoned and representatives of a foreign power given permission to establish a new Inquisition in its place?

    Considering the corruption that has been revealed among the heirarchy of that power, and the fact that the pronouncements about sex come from a cabal of elderly, mostly white, mostly virginal, mostly gay and misogynistic religious leaders, I find it hard to agree their little list of rules is realistic or should be forced on everyone else.  If you and the other members of Opus Dei and its ilk can’t tolerate the idea that the women have been freed from slavery and are now allowed to control their own lives, if you want to be a ‘citizen of the Vatican’ instead of an American, feel free to move to Rome and huddle in the compound with the rest of the men revolted by the vileness that is woman.  We’ll manage to struggle along without you.

  • waterjoe

    Talk about twisting words . . .

    No one said anything about abandoning the Constitution.  You argued that is was constitutional.  All I said was that even if that is true, it does not make it right to infringe on religious liberties or conscience.

    You keep making this about contraception and the Catholic Church.  It is not about either of those.  It is about whether we are going to allow the government to engage in an unprecedented infringement upon religious liberty.  If this is allowed, what next?  Will I be forced to make nuclear weapons?  Engage in waterboarding?  What if I am a physician?  Will the state make me participate in an execution to make sure it is “humane” as a condition of keeping my license?  Will they prohibit my church from helping the undocumented?

     

  • beenthere72

    Gay marriage:  what next?   Are people going to be allowed to marry their dog?

     

    Frankly, that’s how ridiculous your argument sounds.  

     

    Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.  A religious employer is one that:  (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization under Internal Revenue Code section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii).

     

    From: http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html

     

    An interim final rule was released alongside the women’s prevention guidelines to give religious organizations the choice of buying or sponsoring group health insurance that does not cover contraception if that is inconsistent with their tenets. This proposal is modeled on the most common exemption available in the 28 states that already require insurance companies to cover contraception. We invite the public to comment on this proposal as we work to strike the balance between providing access to proven prevention and respecting religious beliefs.

     

    I think you can calm your hysterics. 

  • jennifer-starr

    The fact that you equate providing contraception a health plan to being an accessory in a crime is troubling to say the very least.  You do realize that the vast majority of people don’t feel that way.  Preventing a pregnancy is not criminal. Why should an employer be able to dictate the reproductive choices of their employees and force them to follow religious rules that the employees may not believe in? 

  • waterjoe

    The narrow scope of the “exemption” is what we are talking about.  It redefines religious employers in a way unprecedented in federal law and more narrowly than most of the relevant state laws.  Put any spin you want on it and even support it, but the fact remains that the proposed rule mandates some employers to violate their religious beliefs.  

  • crowepps

    In the United States, employers have a right to hire people to do a job, and have a right to fire people if their off the job activities interfere with them doing a good job, as for instance if they are drinking to excess or smoking pot at home and then coming into work still stoned or intoxicated.

     

    In the United States, employers do NOT have a right to supervise their employees’ sex lives, or impose their own religious opinion about whether their employees should have children, or for that matter impose their own religious opinions on their employees in ANY way.  In a business which is run for secular purposes, they cannot require employees to join in their prayers, they cannot proselytize the employees after having been told it is unwelcome, and they cannot treat the employees who share their faith with a preference while stigmatizing and disadvantaging those who do not.

     

    It is profoundly unamerican to argue that the religious beliefs of employers are more important than the religious beliefs of their employees, or that employers in addition to supervising their employees’ work also get to supervise their employees’ morality.  It is way, WAY over the line for employers to feel entitled to impose on their employees the weird, unnatural rules of the employer’s fringe religion because employees are not the equivalent to slaves.  The reason religion has remained important to so many Americans is that we are entitled to CHOOSE our religion and to follow one which we can sincerely believe in rather than having someone else force their religion and their rules down our throats.  This is why we don’t HAVE a government that enforces religious beliefs for the Chruch, because the Church always, ALWAYS abuses that power and attempts to institute oppression.

  • crowepps

     It is about whether we are going to allow the government to engage in an unprecedented infringement upon religious liberty.

    Since the “religious liberty” you are touting is the “right” of employers to impose their own religion on their employees, in my personal opinion it needs to be infringed to the max.  Employees are not slaves.  They do not have to adopt the religion of their employer.  Employers do not get to self-appoint themselves God’s enforcer.  Employers, however religious, do not have the “right” to supervise their employees’ sex lives or reproduction OR to use the fact that they are contributing towards the premiums as an excuse to structure health insurance in such a way as to infringe on the employees’ right to make their own moral decisions.

    Employers are not going to be forced to use birth control themselves, this is instead about MONEY.   You are already forced to PAY FOR nuclear weapons and the people who guard them and the people who potentially will use them.  You are already forced to PAY FOR the government employees who engage in waterboarding in your name.  You are already forced to PAY FOR executions.  You are already forced to PAY FOR the agents and mechanisms which identify, arrest, harass, torment, try and deport the undocumented.  You even PAY FOR the salaries of our representatives in Iraq and Afghanistan who are gunning down children gathering wood and murdering entire families to cover up rapes.

    This isn’t the beginning of the slippery slope, because we’re all already far, far down, right at the bottom, paying for obscenities much much worse than women merely having sex while preventing pregnancy.

  • jennifer-starr

    If I’m working for a secular organization and my boss happens to be religious and anti-contraception, why should I have to suffer for that by being denied birth control coverage in my insurance? That’s discrimination against me–and I fail to see why my employer’s religious beliefs should trump mine. 

  • plume-assassine

    We are not talking about taxes.

    We are talking about what you are already paying for, taxes or otherwise.

    We are talking about mandating purchase of something.

    No, actually. Nobody is forcing you to purchase birth control for yourself or anyone else! It only requires businesses to supply coverage for birth control, which may or may not be used. This is very different from forcing you to actually purchase, hand out, and/or advocate for specific family planning methods.  This is not a difficult concept to grasp.

    As a condition of continuing to operate the government required you to produce the “cocktail” that would kill an inmate.  Or suppose you operated a small factory and the government mandated that ten percent of your business must be producing parts for nuclear weapons

    Oh my god. Are you actually suggesting that mandated coverage of birth control under insurance plans is analagous to forcing somebody to create a lethal substance used to kill another human being? Are you suggesting that using birth control is morally on par with creating nuclear weapons or killing people? Oh, yep, I think you are. What utter bullshit. What nonsense.

    Your “on point” analogies are ridiculous hyperbole. Try again.

    “It does not personally . . . effect you.”

    You apparently do not understand the nature of conscientious objection.

    You are already free from purchasing/distributing/using birth control for yourself or anyone else, based on your religious rights and bodily autonomy. Insurance coverage for birth control is not the same thing as buying birth control for others. It is no longer “conscientious objection” when you try to impose your religious beliefs on others by preventing them from having a specific type of health coverage which does not personally effect you in any way whatsoever.

     

    And since you seemed to miss this part of my last post:

    Let us also consider the fact that 99% of Americans will use birth control at some point in their life and that access to birth control reduces the number of unwanted pregnancies (and therefore reduces # of abortions). This is not a matter of “personal convenience,” but a serious matter of health for American women, who will have healthier pregnancies and healthier children if they are given the opportunity to plan for the optimal time to have children.

    Again, what’s the problem here?

  • plume-assassine

    What is most appalling to me is that people like waterjoe are more outraged by the mere future possibility of other people having insurance coverage to prevent pregnancy than they are outraged by the reality that they are currently funding torture and other war crimes against innocent civilians.

    And yet they then go on to compare birth control coverage with… state-sanctioned murder or the proliferation of nuclear weapons. I mean, seriously?

  • crowepps

    Conscientious objectors who based their refusal to serve on their moral beliefs had real and sometimes harsh consequences levied against them for doing so.  Some went to jail, some were assigned to the dangerous ambulance service, some were assigned to menial and demeaning tasks.  The one thing that a conscientious objector absolutely did NOT do was continue on in exactly the same manner as before, with the consequences of his objection imposed as penalties on other people.

     

    If, just as an example, the Catholic Church absolutely cannot tolerate a hospital associated with it providing care (or health insurance) in violation of its tenets, then the correct thing for the faithful to do is what Bishop Olmstead did in Phoenix: disassociate the Church from the hospital, withdraw the host, and allow the hospital to continue on without having the Church associated with its offenses.

     

    An individual religious individual who has a conversion experience and decides his business can no longer morally make a product that he has signed a contract to supply has to choose between selling the business to someone else who will fulfill the contract or failing to fulfill the contract and being financially punished for that.  He can’t just say ‘I’ve decided this part of the business isn’t moral and since it’s my conscience that caused that decision, your contract is worthless, you’re just out of luck, and you have no right to enforce the penalties in the contract.  My religious freedom allows me to break my word and if you object, you’re oppressing me.’

  • elburto

    I wish this was a rare argument, but it’s one I see astonishingly often.

    I’m British, I live in the UK, and as such participate in the prevailing collective view that if taking a little extra money from each person means that EVERY person can have healthcare, contraception, education and emergency services as a right, then that’s a good thing. British people who rant and froth about the “right to life” for foetuses are usually viewed as complete oddballs.

    Although medicine is publicly funded, personal medical decisions are seen as only between a doctor and their patient. We even have laws saying that anyone capable of understanding the implications of refusing/accepting a treatment can do so on their own, regardless of their age. So if a 14 year old needs an abortion, she can get one by going through the usual procedure that any other woman would. Parents have no right to be notified, she has the right to have control over use future of her own body, and the right to confidentiality. None of this “not until you’re [either] 18 or off my insurance” crap.

    So looking at certain Americans, almost invariably white men, spewing tirades about “preborn children” and “the rights of fathers” over the bodies of women, all I can do is laugh. It seems almost prehistoric, especially when they declare their objection to any universal health coverage by yelling “WHY SHOULD MY TAX DOLLARS HELP ANYONE BUT ME?”. Yet at the same time, they claim to be ‘pro-life’! So pro-fucking-life that the poor should be denied the right to control their reproduction, to be given lifesaving treatments, to get preventative care that could greatly increase the quality of life and productivity.

    It’s always people like this guy, raising objections to things that will never affect them, and showing such a blatant need to control the lives of others that the thought of losing a tiny bit of this perceived control makes them piss their pants in fury, like a two year old denied another sweetie from the jar.