What to Do About Contraceptive Coverage

One of the hot topics in the forefront of current public debate concerns the Affordable Health Care Act's requirement that contraception must be covered in health plans.  See the Department of Health and Human Services summary here.  While religious bodies that object to contraception are allowed to exempt their ministry employees from this coverage, the Obama Administration has ruled that the Act requiresthat employees not directly involved in the ministry of the body, such as employees of a church-owned hospital, must be covered.  In order to keep such religious bodies from having to pay premiums for services they do not agree with, health insurers have said they will be happy to include the coverage free.  Insurance companies have not made this offer out of charity; it's because paying for birth control pills is a lot cheaper than paying for prenatal care, delivery and health care for a child.  But this has not satisfied all the objectors.  Let's take a look at the positions.

Opponents see the mandate as an egregious intrusion of government control into the realm of religious free choice.  The U.S. Conference of Catholic Bishops, for example, decries the requirement on its website under the heading "unconscionable to require citizens to buy contraceptives against their will."  They and others see First Amendment ramifications that threaten religious liberty.  The Blunt Amendment (Senator Roy Blunt, R-Missouri) to the Health Care Act, which passed the House but was defeated in the Senate, would have allowed any employer to opt out of the mandate on religious, moral or other personally-held grounds.

Supporters see the mandate as providing needed services used by most women, and as a part of the larger issue of women's freedom to make their own decisions.  A survey by the Public Religion Research Institute covered in the Washington Post shows the majority of Americans support the mandate, with Catholics supporting it more strongly than the population as a whole.  The story points to other findings that 99% of all women and 98% of Catholic women have used artificial contraception at some point in their lives.

Since there are strongly-held principles in apparent conflict here, where should the balance of rights and interests be drawn?  It seems to me that the outline of a reasonable and just solution is clear, and it lies in personal choice.  To deny a widespread pharmaceutical practice used by virtually every American woman due to the objections of religious bodies smacks not of freedom of religion but of establishment of religion prohibited under the same First Amendment.  The statement of the bishops that anyone will be made to "buy contraceptives against their will" is completely wrong.  First, the employer will not be buying them.  Second, no woman is required to ask for or take them.  Only women who ask their doctor for a prescription for birth control pills will get one.  The idea that anyone will be forced to ingest birth control pills against her will is a complete invention and red herring.

In this way, the decision is where it belongs: with the patient.  Make the coverage available to all.  If anyone has a religious or any other objection, she may decline to ask for contraception.  But the decision should not be up to her employer, her preacher, her husband or any other person.  These may give advice, but as with any other medical decision in a free country, the choice is up to the patient.  Picture the shoe on the other foot: Imagine how it would go over if a man had to get permission from his boss in order to buy a condom.  If a boss is a Jehovah's Witness should he have the authority to keep any of his employees from getting a blood transfusion when they are bleeding to death?  If the boss is a Christian Scientist should he or she be able to deny employees antibiotics when they contract an infection because the boss doesn't believe in them, regardless of what the sufferer believes?  Under what principle do we give a person's employer the power to make life and death medical decisions, rather than letting people choose for themselves?  When viewed in this light the issue clarifies itself.  The mandate to cover everyone and let them decide their own medical needs for themselves is better from a public health perspective and more in accord with American concepts of personal liberty, including religious liberty.