President Obama proposed a compromise in recent days to a rule unveiled by the Department of Health and Human Services last month requiring religious institutions – but not houses of worship – to offer contraceptive coverage at no cost to their employees. The rule put forth last month drew criticism from several quarters, including religiously-affiliated hospitals and universities, as well as advocates of religious liberty. While intended to offer a compromise acceptable to all sides, however, President Obama’s ‘solution’ merely offers a distinction without a difference.
Passed in 2010, the three-thousand-page Patient Protection and Affordable Care Act was a measure intended to address the cost and availability of health insurance to American citizens. This new law does several things, the most notable of which is establishing a requirement in federal law for nearly every American to own health insurance; often referred to as the individual mandate, this provision (and the law more broadly) has been the subject of legal challenges. Despite the ongoing court battles, however, some provisions of the law have gone into effect.
Among the new regulations introduced as part of the Affordable Care Act are a set of ‘Essential Benefits’ that each insurer must provide. While an executive order signed by President Obama following passage of the law has (theoretically) prohibited most or all funding of abortions under the new law, contraception is a very different issue. Female contraceptives along with maternity care coverage are among the essential benefits each policy holder (regardless of biological sex or sexual orientation) must have. Requiring all insurance plans to cover the costs of contraceptives is a move meant to ensure that women who want contraception are able to obtain it.
But, there’s a problem; some individuals and groups impacted by the complex new law oppose contraception. But, under the law as written, insurers must offer such coverage to everyone covered, even those who have moral objections. The Department of Health and Human Services initially intended to only exclude churches and other houses of worship from being forced to fund contraceptive care. This meant that religious organizations, such as hospitals or universities, would be required to offer and pay for contraceptive care for their employees. For example, Roman Catholic hospitals and universities would have had to offer to their employees health care of a manner which runs contrary to church doctrine.
Catholics cannot and should not be singled out in this regard, but they represent a large portion of the U.S. populace. Nor should the Catholic be regarded as some backward or antiquated institution; the Church supports efforts to combat pollution and climate change, as well as, somewhat contrarily, the proposed DREAM Act and other efforts aimed at the legalization or integration of people living unlawfully in the United States.
The proposal suggested at a news conference recently to allay the concerns of social conservatives, President Obama declared that insurers, rather than religious institutions, would have to pay for the contraception of policy holders through those religious institutions. Nonetheless, all this stated position seems to change is semantics; those insurers will recoup the costs of those expenses through the religious institution they serve anyway. Furthermore, some institutions with religious affiliations are self-insured, meaning that they are left paying for contraceptive care anyway. One would hope that either the President or Secretary Sebelius would have taken this into account when announcing the change, particularly given that the HHS secretary had been a state insurance commissioner prior to her governorship of Kansas.
To defend the symbolic adjustment of policy, President Obama cited the need to balance the reproductive health of American women with the concerns expressed by the objecting religious groups among others. He further contended that 28 states already have some form of contraceptive coverage mandate. The first contention is reasonable, but the second is irrelevant given that other policies supported by a majority of the states are not championed by his administration. Indeed, 28 states have statutory or constitutional prohibitions on same-sex marriages. If the correctness of a policy is determined by the number of states that have embraced that policy, then social conservatives would not be wrong in asking why President Obama no longer opposes same-sex marriage.
Similarly, cultural conservatives could ask why this administration has not pushed to make English the official language of the United States using exactly the same justification.
With regard to issues of female reproductive health, the administration has admirable concerns but faulty core assumptions. All women of reproductive age and capacity do have particular health needs regardless of their sexual orientation or moral philosophy; birth control is not one of them. The Roman Catholic nun has the same core health needs as the unattached female university student, but only one of the two likely has any need for birth control products. While for some women, the use of specific forms of birth control can improve aspects of certain biological functions, for many if not most, use of such products is not a necessity.
Truthfully, the recent controversy over contraceptive coverage is a symptom of a larger disease: an antiquated approach to public policy. For all the talk of change, President Obama and his team have embraced the same failed, centralized, and bureaucratic approaches to addressing modern challenges. Curiously, issues with the Affordable Care Act have failed to unite often disparate groups disserved by the law. Indeed, opposition to making certain groups fund reproductive services should not be interpreted as an effort to prohibit such products or services, but rather as a concern about imposing on all the views of some. Certainly, that is something to which advocates of cultural pluralism or same-sex marriage can relate.