When the Affordable Care Act became law, American employers were for the first time ever obligated to offer their employees affordable health insurance. But not any insurance plan would do – the ACA also states that every American is entitled to a health insurance plan with certain essential health benefits, including emergency services, treatment for mental health and addiction problems, and prescription drugs. Mandatory essential health benefits also include preventative services: diet counseling, blood pressure screening and, for women, access to contraception.
Some employers, however, don’t want to pay for their female employees’ contraception – even if that payment is indirect, and even if it’s the law.
These anti-contraception employers say that because the pill and other modes of birth control are at odds with their religious beliefs, it would be a violation of religious freedom to pay for a health insurance plan providing contraception to the policyholder. Last month, the U.S. Supreme Court heard the case Burwell v. Hobby Lobby. Lawyers for arts and crafts outlet Hobby Lobby - a business owned by a family of Evangelical Christians - argued that the ACA employer mandate was violating the company’s ability to freely exercise its religion (a guaranteed right in the U.S. Constitution), and lawyers for the side of U.S Secretary of Health and Human Services, Sylvia Burwell responded with legal precedents preventing an employer from denying his employees statutory rights because of personal religious beliefs.
In the end, the Supreme Court ruled 5-4 in favor of Hobby Lobby. In its majority decision, the court wrote that requiring companies to provide some forms of contraception was restrictive of religious freedom, and that a less restrictive means of distributing that health service could be implemented instead. The ruling means that employers no longer have to offer their employees health plans with contraceptive benefits, and if the employer does choose a group health plan with birth control benefits, he won’t have to pay for that portion of the policy.
What does the Hobby Lobby case mean for American women? Many female employees won’t be affected by the Supreme Court’s decision – most employers will not claim their business to be a “closely-held” organization with strong religious values, and most women will therefore continue to access contraception as usual. However, if a company such as Hobby Lobby does successfully claim religious exemption from the birth control mandate, a female employee working for that company who wishes to purchase birth control will have to go around her workplace health insurance plan to do so. The federal government has promised that – in accordance with the ACA – a woman will be able to access affordable contraception whatever her employer’s religious beliefs: if birth control is not present on a workplace plan, she can request that benefit from the insurance company directly, and the insurer is legally bound to offer her that additional coverage.
The Supreme Court’s recent decision was in many ways based on an earlier ruling from the federal government related to birth control, the ACA and employer sponsored health insurance. In 2012, the Obama administration announced that religious, non-profit organizations such as churches, charities, universities and hospitals would not be required to directly pay for their employees’ birth control – or for any health service that violated the organization’s religious beliefs. That announcement was met with praise from religious groups, and skepticism from more progressive health care advocates, fearful that allowing one exemption would lead to further organizations requesting an out from providing their employees birth control.
On one side of the debate stands the right to religious freedom, and on the other side stands a woman’s right to a preventative health service – one that has been defined as essential by the Independent Institute of Medicine, a group that helps the federal government draft its health care policy. In their report on contraception as a preventative health service for women, the Independent Institute of Medicine found that by preventing unplanned pregnancies, birth control limits health harms to prenatal children. A woman unaware that she is pregnant is more likely to smoke, drink or engage in other risky behavior harmful to the fetus. Contraception reduces the number of children born with low birth weight or birth defects, because these ailments are much more likely to occur during unintended pregnancies.
Birth control is good for a healthier population of infants, and the Institute found that a woman’s health is likewise aided when she has the ability to be less pregnant less often. Contraception helps women space their pregnancies, reducing the risk of anemia, rupture of the uterine wall, genital inflammation and of course death: a woman’s risk of dying increases with every pregnancy and birth. Women can also experience non-pregnancy related health benefits from hormonal birth control, including lighter and more regular menstrual cycles, a reduction in cramps and other symptoms of PMS, a smaller risk of developing breast and ovarian cancer and a decline in acne.
Advocates for the Hobby Lobby and similar organizations say that despite the health benefits of contraception, hormonal birth control goes against the teachings of Evangelical Christianity – a religion that believes life begins at conception. Hobby Lobby has argued that it doesn’t want to fund any health care service that “has the potential to terminate a life.” Hormonal contraception is very different from an abortion pill in that it doesn’t kill an embryo but rather stops the ovaries from producing an egg altogether, but still – Hobby Lobby point to religiously-funded research showing that some birth control methods could stop a fertilized egg from implanting in a woman’s womb.
The Obama administration has demonstrated a huge commitment to improving health care for men and women, and the Affordable Care Act has gone a long way toward improving preventative health services for everyone. At the same time, free religious exercise is a right guaranteed in the constitution: access to health care is not. In the upcoming months, it will be interesting to see how the federal government responds to the Hobby Lobby ruling. Already, legislators have promised to keep contraception affordable and easy to get – whatever the religious beliefs of a woman’s employer – and insurance companies themselves are still required to offer contraception as part of every health plan’s minimum essential benefits. Still required, at least for now.