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Contriving Controversy

By Dr. Sachin D. Shah
. 1 Comment(s)

The Obama administration’s rule mandating coverage of oral contraception by most employers at no additional charge to their employees has been a lightning rod for controversy in recent weeks. It shouldn’t come as a surprise in an election year that an issue like this, uniting such powder keg topics as abortion, religious liberty, and President Obama’s hallmark legislative achievement, the Affordable Care Act (ACA), has become a signature cause for Republicans trying to rally their conservative base.

That this is a manufactured debate seems more likely given the status of contraceptive coverage before the recent outrage over the ACA provision.  In reality, most employers have been required to provide contraceptive coverage as part of their health plans since December 2000, when the federal Equal Employment Opportunity Commission (EEOC) ruled that failure to provide such coverage violates the 1978 Pregnancy Discrimination Act.  That law was an amendment to Title VII of the 1964 Civil Rights Act, which outlawed, among other things, discrimination based on gender.

Moreover, greater than half the states have similar “contraceptive equity” laws in place, many with religious exceptions similar or identical to the one included in the Obama administration’s regulation, which was modeled after state laws in New York, California, and Oregon.

If the contraception coverage provision of the ACA violates the First Amendment, as Senate Minority Leader Mitch McConnell claims, then there’s quite a legislative precedent in place supporting such blatant Constitutional disregard.

This debate is not about whether or not women should have access to birth control. As a nation, we’ve definitively agreed that it’s an essential part of women’s health and public health in general, and have passed laws that clearly state as much.

The only thing the ACA has changed is that women will no longer be required to pay a co-pay or deductible to get the prescription contraceptives.  Is the provision of free access to a key part of preventive health really such a controversial notion?

Regardless of the specific legislative merits of this issue, it is of course serving as a surrogate for the larger issue of religious liberty for faith based employers.  The Obama administration’s subsequently announced accommodation’ -- for employers with religious objections to offering contraception as part of their health plans -- allows them to turn the responsibility over to insurance companies instead. The revision to the rule has mollified some originally opposed groups, but has failed to appease others, including Senator McConnell.

Perhaps the new accommodation is simply semantics. It’s certainly more about politics than religion or religious liberty, especially given the current rules on contraception and how long they’ve been in place without much protest.

Fundamentally, though, this whole firestorm again highlights the absurdity of our current, employer-based health insurance system.  Health insurance coverage should not be dependent on employment, plain and simple.  General Motors should be able to focus on making cars, not managing employee and retiree health insurance benefits.  Its employees, in turn, should not have to worry about losing their job and their health insurance in an economic downturn. 

Likewise, the Catholic Church should not be placed in a position to decide, on religious grounds, what constitutes acceptable health care benefits for its employees, especially those who are not Catholics.  As a matter of personal liberty, access to health care -- and what type of health care you are entitled to -- should not be determined by your employer. 

Until we move to finally decouple employment and health insurance with a genuine solution like a single payer model, we will continue to face these avoidable controversies.

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  1. Ron Pudlo

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    When I first heard a detailed discussion that pointed out that the only issue here was whether there was a copay or not I was dumbfounded; that an incredibly petty and forced argument was creating such a fury. This note hits the nail on the head. Thank you.

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