See all our coverage of the Birth Control Mandate 2011 here.
According to a New York Times article today by Robert Pear, the White House has now publicly confirmed that President Obama is considering caving to demands by the United States Conference of Catholic Bishops (USCCB) and other far right religious groups that he “expand the exemptions” from the requirement that insurance plans under health reform cover birth control without a co-pay.
If he does so, the President will be trading the health, welfare, autonomy, and economic prospects of millions of women and the opinion of the entire medical and public health communities to curry favor with a very small minority of male-dominated religious right groups such as the USCCB which has found that it can not, on its own, force women to become and remain pregnant.
And as far as I am concerned, if the President does this, he will also forfeit the right to call himself “pro-choice” under any definition of the term as I understand it.
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What’s the problem here? Even the Times basically has it wrong, because the article continues to mis-characterize both the nature of contraceptive coverage (it is not “free of charge”) and of the current exemption, which not only “may” (as the Times suggest) but does exempt Churches from the requirement.
The basic problem here is this: The vast majority of women of reproductive age in the United States–99 percent–uses at least one modern form of birth control at some point in their lives. This includes Catholic women, Jewish women, Muslim women, Protestant women and the majority of women of every other religious persuasion and those who are not religiously identified, are atheists, agnostic or any other category I may be inadvertently failing to mention.
That women–Catholic women and other women–actually do control their fertility drives the Bishops and the rest of the religio-political patriarchy up a wall. And, this summer, the Administration drove them over the top of that wall.
In August, the Department of Health and Human Services (HHS) adopted the recommendations of the Institute of Medicine to include as part of the basic package of services an array of preventive health care services for women.
Expanding access to preventive care without cost-sharing (co-pays) was ostensibly a core principal of health reform. As HHS notes:
The Affordable Care Act – the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 – helps make prevention affordable and accessible for all Americans by requiring health plans to cover recommended preventive services without cost sharing.
“Before health reform,” states an HHS press advisory, “too many Americans didn’t get the preventive health care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs. Often because of cost, Americans used preventive services at about half the recommended rate.”
Yet chronic diseases – which are responsible for 7 of 10 deaths among Americans each year and account for 75% of the nation’s health spending – often are preventable. Cost sharing (including copayments, co-insurance, and deductibles) reduces the likelihood that preventive services will be used. Especially concerning for women are studies showing that even moderate copays for preventive services such as mammograms or pap smears deter patients from receiving services. [Emphasis added.]
The preventive care services to be covered without co-pay include well-woman visits, support for breastfeeding equipment, screening and counseling for gestational diabetes, cervical cancer, sexually transmitted infections, and domestic violence, and support and supplies for breastfeeding.
And, of course, IOM strongly recommended and HHS included coverage without co-pays of contraceptive counseling and supplies. The reasons why have been extensively documented in numerous articles including one here, here, here, and here.
The HHS mandate states:
Women will have access to all Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling. These recommendations do not include abortifacient drugs. Most workers in employer-sponsored plans are currently covered for contraceptives. Family planning services are an essential preventive service for women and critical to appropriately spacing and ensuring intended pregnancies, which results in improved maternal health and better birth outcomes. [Emphasis added].
HHS exempted from this mandate certain religious employers including those that define the inculcation of religious values as their primary purpose; that primarily employ persons who share its religious tenets; that primarily serve persons who share the organization’s religious tenets; and are non-profit organizations. Contrary to the Times story that churches may be exempt,” HHS made clear that their exemption absolutely includes churches, their integrated auxiliaries, and conventions or associations of churches, as well as exclusively religious activities of any religious order.
As HHS stated, the “interim final rule… is modeled on the most common exemption available in the 28 states that already require insurance companies to cover contraception.”
HHS, as is common practice, provided an ample comment period, during which religious right organizations went to work, claiming that their religious liberty would be infringed if they had to include in their employer-based health plans coverage of contraception for women, whether they be Catholic, Jewish, Hindu, Protestant, atheistic, agnostic or otherwise. In other words, as I have pointed out elsewhere, the only means through which the religious right can experience religious liberty is to rob everyone else of theirs.
This is not a trivial matter. Cost plays a major role in consistent access to and use fo contraception, most especially for low-income and middle class women. Access to birth control is a major factor in preventing unintended pregnancies, ostensibly a goal of this Administration. Moreover, it is the right of every woman to decide whether and when to bear a child and under what conditions. No religious figure has the right to “override” the fertility and health decisions of any woman.
Now, however, HHS is punting. I called the White House last week for comment on their policy, and two days later received a call back from someone at HHS who’d been asked by White House staff to call me. I was told by the HHS spokesperson that no decision had been made on when to finalize the policy and that technically the department could take until next summer to decide since the final rule does not go into effect until August. When I asked what more, on top of the weight of evidence already made public, was left to consider, I was told that the department was hearing from “all stakeholders.” Apparently, HHS considers the USCCB, the Family Research Council, Focus on the Family and other religious right organizations to be a stakeholders of your womb, because they are weighing heavily on this decision.
My question to you is this: How far do we allow an Administration to go on simply trading away the basic health and economic needs of millions of women before we call this a political foul?
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Follow Jodi Jacobson on Twitter: @jljacobson