Why are we still fighting over birth control?

The Affordable Care Act aka Obamacare, included a provision for insurance to cover the cost of birth control.  After all, it has been estimated that 99% of all women use birth control at some point in their lives.  This is not just non-Catholic women.  Contraception is not cheap.  Without insurance, birth control pills can cost up to $100 a month.  Not affordable to lower income women who are also ones who can least afford to have unplanned children.  The pill is used for hormone regulation, not just birth control, a fact often ignored.

In fact, regardless of what the Pope and Cardinals and Archbishops in the United States think, Catholic women do use birth control.  I’m sorry, but no one has explained to me why a bunch of celibate men want to control women.  If you are against abortion, birth control would seem to be reasonable.  Of course, if you believe that life begins at the moment of conception, then some methods are problematic.  But we have no idea how many fertilized eggs just naturally abort, but I guess the distinction here is one is natural and the other has an artificial cause.  I should say that birth control also faces opposition from fundamentalist churches that are not Catholic.  The other thing that plays into the objection to birth control is that sex is to be reserved for marriage and for procreation.  There:   The objections to both birth control and gay marriage in one neat package.

The Obama administration has been twisting itself into knots to make sure that women who choose to use birth control have it covered under their health insurance.  The most recent proposal was outlined by the New York Times.

The Obama administration on Friday proposed yet another compromise to address strenuous objections from religious organizations about a policy requiring health insurance plans to provide free contraceptives, but the change did not end the political furor or legal fight over the issue.

The proposal could expand the number of groups that do not need to pay directly for birth control coverage, encompassing not only churches and other religious organizations, but also some religiously affiliated hospitals, universities and social service agencies. Health insurance companies would pay for the coverage.

The latest proposed change is the third in the last 15 months, all announced on Fridays, as President Obama has struggled to balance women’s rights, health care and religious liberty. Legal experts said the fight could end up in the Supreme Court

You can see the Department of Health and Human Services (HHS)  fact sheet here.

Religious groups dissatisfied with the new proposal want a broader, more explicit exemption for religious organizations and protection for secular businesses owned by people with religious objections to contraceptive coverage.

The tortured history of the rule has played out in several chapters. The Obama administration first issued standards requiring insurers to cover contraceptives for women in August 2011, less than a month after receiving recommendations to that effect from the National Academy of Sciences. In January 2012, the administration rejected a broad exemption sought by the Roman Catholic Church for insurance provided by Catholic hospitals, colleges and charities. After a firestorm of criticism from Catholic bishops and Republican lawmakers, the administration offered a possible compromise that February. But it left many questions unanswered and did not say how coverage would be provided for self-insured religious organizations.

Under the new proposal, churches and nonprofit religious organizations that object to providing birth control coverage on religious grounds would not have to pay for it.

Female employees could get free contraceptive coverage through a separate plan that would be provided by a health insurer. Institutions objecting to the coverage would not pay for the contraceptives.

Yesterday the Catholic Bishops weighed in

“The administration’s proposal maintains its inaccurate distinction among religious ministries,” said Cardinal Timothy M. Dolan of New York, the president of the United States Conference of Catholic Bishops. “It appears to offer second-class status to our first-class institutions in Catholic health care, Catholic education and Catholic charities. The Department of Health and Human Services offers what it calls an ‘accommodation,’ rather than accepting the fact that these ministries are integral to our church and worthy of the same exemption as our Catholic churches.”

The bishops’ statement, issued after they had reviewed President Obama’s proposal for six days, was more moderate and measured than their criticisms of the original rule issued by the White House early last year. Cardinal Dolan said the bishops wanted to work with the administration to find a solution.

The administration had no immediate reaction to the bishops’ statement, other than to say it was not a surprise.

One thing is clear, the Obama administration does not want to start saying the private business owners can opt out of paying for insurance that covers things they find objectionable.  What if we go from birth control to vaccinations to flu shots?

The birth control issue will end up in court and probably the Supreme Court.  For people who say they don’t want the ACA because they don’t want government controlling their health care, this the ultimate irony.  In case they haven’t noticed.  The Supreme Court is a branch of government.

So until the courts decide, Emily Douglas at the Nation has prepared this handy chart for you.

How to pay for your bith control

I guess I sound bitter, but I thought we already had this fight 40 years ago.  Contraception is supposed to be a routine option for women’s health care.

The War on Women: Part 2012

I have a book from 1996 on my shelf  “The Republican War on Women” by Tanya Melich.  Melich outlines the Republican strategy to outlaw abortion, curb contraception, cut funding for child care programs and otherwise control women’s choices by limiting them.  This was the start of the culture wars, code for a war on women and the poor.  Now it is 2012 and the war is heating up again.  There is the Komen Foundation v. Planned Parenthood.  And you have Affordable Health Care and the President v. the Catholic Bishops and all the Republican Presidential Candidates.  Rick Santorum who just won three primary contests is the culture war candidate who thinks the contraception is evil and would do away with it all together.  All of this is being framed as an assault on regligious freedom. by the President.

Zack Beauchamp writing in the Daily Dish put it this way

2012’s great birth control debate is far from over. The Catholic Church is threatening all-out war against the Obama Administration until it caves on the decision to require contraceptives without co-pays. One popular framing of the debate is religious liberty versus women’s health, but that’s not quite right. The Administration’s requirement isn’t a threat to liberty, religious or otherwise. It’s a sally in an ongoing debate about the character of liberal rights – and one on the right side, to boot.

We usually think of religious liberty as an individual believer’s right to worship and practice freely. That’s of course not at issue here – the feds aren’t marching into Catholic bedrooms and making everyone take Plan B on Sunday morning or requiring Catholic hospital administrators to pass out free birth control in the lobby. The regulations instead require they indirectly subsidize birth control use, which several faiths believe means being forced to participate in evil. But opponents worry about a much broader problem than religious freedom. Check this from Ross Douthat last week:

Critics of the administration’s policy are framing this as a religious liberty issue, and rightly so. But what’s at stake here is bigger even than religious freedom. The Obama White House’s decision is a threat to any kind of voluntary community that doesn’t share the moral sensibilities of whichever party controls the health care bureaucracy.

Ross is arguing that government regulations “crowd out” private associations that perform valuable societal functions. Forcing members of those associations to adhere to legal rules they find repugnant puts them in a devil’s choice: do something they believe fundamentally wrong or, more likely, get out of providing public services entirely. Government thus guts the ability of private, voluntary organizations to do good. See David Brooks and Kirsten Powers for similar arguments.

The problem with this argument is, as Beauchamp goes on to point out, we are not talking about voluntary organizations but employers – often large employers who employ many persons who are not Catholic.  The Guttmacher Institute posted a summary the other day.  It turns out that 28 states already require insurers to cover FDA approved contraceptives.  20 of those states have some form of opt-out provision ranging from just churches to broader provisions for church affiliated institutions like universities.  Interestingly among the twenty states that have exceptions those exemptions are extremely limited for hospitals. 

The latest polling supports the Obama Administration regulation.  The only group that does not are white evangelical.s

Finally, Think Progress has posted this story about DePaul University which offers contraception coverage.

“The employee health insurance plans include a prescription contraceptive benefit, in compliance with state and federal law,” DePaul University spokesperson Robin Florzak confirmed to ThinkProgress. “An optional insurance plan that covers such benefits is available to students, also due to previously established state and federal requirements.” The University notes, however, that it is disappointed with the Obama regulation and hopes to engage in an “effective national conversation on the appropriate conscience protections in our pluralistic country.” Other Catholic colleges and hospitals, including Georgetown and the six former Caritas Christi Catholic hospitals in Massachusetts, have also admitted to offering birth control benefits.

Notice that DePaul talks about conscience protections not doing away with the requirement all together. 

So who does this really hurt?  It hurts a woman’s ability to control her own body.   Here is Zack Beauchamp to sum up.

Birth control is for 98% of womenthe principal means of protecting a right central to their own liberty – the right to choose when to create a family. Chances are most women employed by Catholic universities and hospitals are part of the 98%. For these women, not having access to birth control renders a crucially important right meaningless.

Full insurance coverage is a critical part of the picture. Birth control is an expensive product – $81 a month is considered a steal with no contribution from your insurance, but that number still prices out many women. Even insurance plans that have copays can be prohibitively pricey. Cheaper alternatives like condoms have significant failure rates. Insurance, overwhelmingly provided by employers in the American system, that covers birth control with no copays is a woman’s best bet.

The Administration’s critics are saying that, in the currently existing health care system, protecting that right would create a grave threat  to equally important rights of free association. Seems like a classic rights conflict. However, churches and institutions that serve only co-religionists are exempt from the requirement. The only institutions covered by the birth control mandate have chosen to participate in the broader market, a zone of private life governed by political rules.

I think that the Catholic Bishops, the Republican Presidential Candidates and John Boehner are really the ones who want government to interfere in the lives of women.  Just because an insurer offers a benefit does not mean you have to take advantage of it.

Gail Collins puts it this way in today’s New York Times

The church is not a democracy and majority opinion really doesn’t matter. Catholic dogma holds that artificial contraception is against the law of God. The bishops have the right — a right guaranteed under the First Amendment — to preach that doctrine to the faithful. They have a right to preach it to everybody. Take out ads. Pass out leaflets. Put up billboards in the front yard.

The problem here is that they’re trying to get the government to do their work for them. They’ve lost the war at home, and they’re now demanding help from the outside.

And they don’t seem in the mood to compromise. Church leaders told The National Catholic Register that they regarded any deal that would allow them to avoid paying for contraceptives while directing their employees to other places where they could find the coverage as a nonstarter.

This new rule on contraceptive coverage is part of the health care reform law, which was designed to finally turn the United States into a country where everyone has basic health coverage. In a sane world, the government would be running the whole health care plan, the employers would be off the hook entirely and we would not be having this fight at all. But members of Congress — including many of the very same people who are howling and rending their garments over the bishops’ plight — deemed the current patchwork system untouchable.

The churches themselves don’t have to provide contraceptive coverage. Neither do organizations that are closely tied to a religion’s doctrinal mission. We are talking about places like hospitals and universities that rely heavily on government money and hire people from outside the faith.

And if you want to see what this is all about in a nutshell click on this link to the Ann Telnaes animated cartoon.

I hope the President sticks to his decision.