News Contraception

They Are Coming for Your Birth Control: “Obama Wants To Kill You With Hormonal Steroids”

Robin Marty

They found him out!  Obamacare is all about killing off women!

Note: Think that anti-choice politicians and activists aren’t trying to outlaw contraception?  Think again.  Follow along in an ongoing series that proves beyond a doubt that they really are coming for your birth control.

All of those claims that the Affordable Care Act has been beneficial to women?  They are all lies. The real truth? Obamacare is an insidious plot to kill women. Proof? Why else would he be offering birth control with no co-pay, unless it was because he wants every woman to die of cancer?

Karen Malec, president of the Coalition on Abortion/Breast Cancer said, “It is ludicrous to suggest that women will have more freedom and will be ’empowered’ by taking cancer-causing hormonal steroids, i.e. birth control pills, injections, vaginal rings, skin patches and some IUDs.

“Real empowerment of women means being free from the risks associated with taking these hormonal steroids, which can include not only cancer, but heart attacks, strokes, blood clots, gall bladder disease, urinary tract infections, bone mineral density loss and increased susceptibility to HIV/AIDS. [1] Fifty-three of 69 epidemiological studies link induced abortion with increased breast cancer risk. [2]

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“With its mandate from the U.S. Department of Health and Human Services requiring insurers to provide women with free health-damaging hormonal steroids, but not free life-saving chemotherapy, ObamaCare represents not only an attack on the rights to religious freedom and conscience, but also a grave attack on women’s health.”

In actuality, the risk of cancer is quite minimal, in some cases may lower risks for certain cancers, and the elevated risk returns to normal after you discontinue using hormonal contraception.

But remember, they just want to protect women and keep them healthy.  It’s not like they are coming for your birth control.

Commentary Law and Policy

Here’s What You Need to Know About Your Birth Control Access Post-Supreme Court Ruling

Bridgette Dunlap

Yes, the Zubik v. Burwell case challenged the Affordable Care Act's contraceptive coverage mandate. But that shouldn't stop you from getting your reproductive health needs met—without a co-payment.

In May, the Supreme Court issued a sort of non-decision in Zubik v. Burwell, the consolidated case challenging the Affordable Care Act’s mandate that employers provide contraceptive coverage. The ruling leaves some very important legal questions unanswered, but it is imperative that criticism of the Court for “punting” or leaving women in “limbo” not obscure the practical reality: that the vast majority of people with insurance are currently entitled to contraception without a co-payment—that includes people, for the most part, who work for religiously affiliated organizations.

Two years ago, hyperbole in response to the Court’s decision in Burwell v. Hobby Lobby—that, for example, the Court had ruled your boss can block your birth control—led too many people to believe the contraceptive coverage requirement was struck down. It wasn’t. The Zubik decision provides a good opportunity to make sure that is understood.

If people think they don’t have birth control coverage, they won’t use it. And if they don’t know what coverage is legally required, they won’t know when their plans are not in compliance with the law and overcharging them for contraceptives or other covered services, perhaps unintentionally. The point of the contraceptive coverage rule is to make it as easy as possible to access contraceptives—studies show seemingly small obstacles prevent consistent use of the most effective contraceptives. Eliminating financial barriers isn’t enough if informational ones undermine the goal.

The most important thing to know is that most health plans are currently required to cover reproductive health services without a co-payment, including:

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  • One version of every kind of FDA-approved contraception—that is, only the generic or the brand-name version of the contraceptive could be covered, but at least one must be. So you shouldn’t be paying a co-payment whether you use the pill, the patch, the shot, or want long-acting reversible contraception (LARC) like an IUD, which is more expensive, but most effective.
  • Screening for HIV and high-risk strains of HPV
  • An annual well-woman visit
  • Breastfeeding counseling and supplies like pumps

There are exceptions, but most plans should be covering these services without a co-payment. Don’t assume that because you work for Hobby Lobby or Notre Dame—or any other religiously affiliated employer—that you don’t currently have coverage.

The original contraceptive coverage rule had an “exemption” for church-type groups (on the somewhat dubious theory that such groups primarily employ individuals who would share their employers’ objection to contraception). When other kinds of organizations, which had religious affiliations but didn’t primarily employ individuals of that same religion, objected to providing contraceptive coverage, the Obama administration came up with a plan to accommodate them while still making sure women get contraceptive coverage.

This “accommodation” is a workaround that transfers the responsibility to provide contraceptive coverage from the employer to the insurance company. After the employer fills out a form noting it objects to providing contraception, the insurance company must reach out to the employee and provide separate coverage that the objecting organization doesn’t pay for or arrange.

This accommodation was originally available only to nonprofit organizations. But dozens of for-profits, like Hobby Lobby, sued under the Religious Freedom Restoration Act (RFRA)—arguing that their owners were religious people whose beliefs were also burdened by the company having to provide coverage.

The Hobby Lobby decision did not say your boss’s religious belief trumps your right to a quality health plan. What the Court did was point to the existence of the accommodation for nonprofits as proof that the government could achieve its goals of ensuring coverage of contraception through a workaround already in place to give greater protection to objectors. Basically, the Court told the government to give the for-profits the same treatment as the nonprofits.

The Hobby Lobby decision states explicitly that the effect of this on women should be “precisely zero.” The Obama administration subsequently amended the contraceptive regulations, making coverage available to employees of companies like Hobby Lobby available through the accommodation. Hobby Lobby added some headaches for administrators and patients, but it did not eliminate the contraceptive coverage rule.

Next, however, the nonprofits went on to argue to the Supreme Court and the public that the accommodation the Court had seemed to bless in Hobby Lobby also violated RFRA—because having to fill out a form, which notified the government that they objected to contraceptive coverage and identifying their insurers, would substantially burden their religious beliefs.

Following oral arguments in Zubik, the eight-member Supreme Court issued a highly unusual order: It asked the parties to respond to its proposed modification of the accommodation, in which the government would not require objecting nonprofits to self-certify that they oppose contraception nor to identify their insurers. The government would take an organization’s decision to contract for a health plan that does not cover contraception to be notice of a religious objection and go ahead with requiring the insurer to provide it instead.

The petitioners’ response to the Court’s proposed solution was “Yes, but…” They said the Court’s plan would be fine so long as the employee had to opt into the coverage, use a separate insurance card, and jump through various other hoops—defeating the goal of providing “seamless” contraceptive coverage through the accommodation.

When the Court issued its decision in Zubik, it ignored the “but.” It characterized the parties as being in agreement and sent the cases back to the lower courts to work out the compromise.

The Court told the government it could consider itself on notice of the petitioners’ objections and move forward with getting separate contraceptive coverage to the petitioners’ employees, through the accommodation process, but without the self-certification form. How the government will change the accommodation process, and whether it will satisfy the petitioners, are open questions. The case could end up back at the Supreme Court if the petitioners won’t compromise and one of the lower courts rules for them again. But for prospective patients, the main takeaway is that the Court ruled the government can move forward now with requiring petitioners’ insurers to provide the coverage that the petitioners won’t.

So—if your plan isn’t grandfathered, and you don’t work for a church or an organization that has sued the government, your insurance should be covering birth control without a co-payment. (If your plan is grandfathered and your employer makes a change to that plan, then those formerly grandfathered plans would be subject to the same contraceptive coverage requirements.) If you do work for one of the nonprofit petitioners, the government should be making contraceptive coverage available even before the litigation is resolved. And in some cases, employees of the petitioners already have coverage. Notre Dame, for example, initially accepted the accommodation before being pressured by off-campus contraception opponents to sue, so its insurer is currently providing Notre Dame students and employees coverage.

Don’t despair about the Supreme Court’s gutting access to contraception. Assume that you have coverage. The National Women’s Law Center has great resources here for finding out if your plan is required to cover contraception and how to address it with your insurance plan if it isn’t in compliance, and a hotline to call if you need help. The fact that equitable coverage of women’s health care is the new status quo is a very big deal that can be lost in the news about the unprecedented litigation campaign to block access to birth control and attacks on Obamacare more generally. Seriously, tell your friends.

Analysis Law and Policy

Everything You Need to Know for the Supreme Court Birth Control Case

Jessica Mason Pieklo

The Supreme Court is set to hear the second direct challenge to the Affordable Care Act's birth control benefit Wednesday. Here's what to look out for during oral arguments.

The U.S. Supreme Court is set to hear arguments on March 23 in Zubik v. Burwell, the second direct challenge to the birth control benefit in the Affordable Care Act (ACA). This time, the plaintiffs are religiously affiliated businesses like universities, hospitals, and nursing homes: nonprofits that serve the general population, but have a corporate affiliation to a faith group. Those organizations argue that, like churches, synagogues, and other houses of worship, they should be fully exempt from the law’s requirement that employer-provided health insurance plans cover contraception as preventive care. The cases are part of conservatives’ longstanding attacks on the Affordable Care Act generally, and the birth control benefit specifically—objections to which began as soon as President Obama signed the ACA into law. 

There’s a lot on the line with these cases. Here are the key points law attorneys will be battling over during this week’s arguments, and why they matter.

First, Some Background 

A nonprofit claiming a religious objection to the birth control benefit has two ways to participate in the “accommodation process” and opt out of complying with the law. It can mail a short self-certification form to its health insurance company or third-party administrator, depending on the type of insurance it carries, declaring that the organization is a religiously affiliated nonprofit that “opposes providing coverage for some or all of any contraceptive services that would otherwise be required to be covered.” The nonprofit can also provide similar notice, along with the name and contact information of its insurer or third-party administrator, directly to the U.S. Department of Health and Human Services (HHS).

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Once either of those two things happens, the federal government will step in and direct insurance coverage for contraception as needed. The employer has nothing more to do with the process at all.

The plaintiffs in Zubik v. Burwell argue that taking either action “triggers” or “facilitates” the ability of their employees to get contraceptive coverage elsewhere. That, the organizations argue, makes them complicit in what they believe to be a sinful act: supporting contraception. They say such an act violates their rights under the Religious Freedom Restoration Act (RFRA).

Unlike in Burwell v. Hobby Lobby, the 2014 case that asked whether secular, for-profit businesses should also have the right to pursue a religious exemption from the birth control benefit, the Roberts Court in Zubik v. Burwell will try to answer the question of whether completing the paperwork required to obtain that religious exemption is itself a substantial burden on religious liberty. If the plaintiffs win in Zubik, it could not only spell the end of the ACA’s birth control benefit; it could further open the door to launching wide-scale religiously based objections to civil rights protections.

So, let’s get into it.

How Badly Does the Government Want to Keep This Fight Up?

The conservative majority ruled in Hobby Lobby that secular, for-profit companies could have access to the accommodation process now being challenged by conservatives in Zubik. In that decision, the Court “presumed without deciding” that the contraception benefit advances compelling government interests, a necessary requirement for laws being challenged in RFRA cases.

A presumption is not the same thing as a ruling, however, and has no value as precedent for future cases, including Zubik.

In Hobby Lobby, Kennedy stated in his controlling concurrence the benefit furthers “a compelling [government] interest in the health of female employees”; the four liberals agreed with the sentiment, though Justice Ruth Bader Ginsburg, in her dissent, took a much stronger stance in its favor. If Kennedy changes his mind in Zubik, he’s going to have to explain why.

Compelling government interest is only one part of the equation, however. To successfully defend the benefit, the Obama administration is also going to have to show that it is narrowly tailored to further that compelling government interest. In Hobby Lobby, Kennedy presumed that the very fact that the benefit has an accommodation process and religious exemptions shows that it is narrowly tailored.

Again, this is a presumption on Kennedy’s part. The Court did not rule that the benefit is narrowly tailored in Hobby Lobby, so it is not bound by that finding in Zubik. In terms of presumptions, though, it was a pretty big one, on which Kennedy hung much of the rest of his concurrence.

But if there is a prong of the analysis conservatives feel they stand a chance of winning, it is clearly this “narrowly tailored” one. They argue that if providing contraception coverage is so important to the federal government, it should just provide that coverage directly and not involve employers at all. Because the Court never definitively ruled in Hobby Lobby that the benefit is narrowly tailored, presenting a specific alternative in the form of direct coverage for contraception is a smart tactical move by the challengers.

Kennedy’s opinion in Hobby Lobby suggests he won’t bite. But considering, too, the earlier interim orders by the Roberts Court preventing the administration from enforcing penalties against nonprofits for not complying with the accommodation process, any open question presents a way for conservatives to take a whack at the benefit. And if they do so successfully, the Obama administration is going to have to decide if it wants to amend the benefit yet again to try and appease their objections, provide the contraception itself directly through some as-yet-undescribed accommodation-to-the-accommodation, or give up on the coverage all together.

Which option do you think conservatives are gunning for?

It’s Not Just Any Burden

In addition to answering the “compelling government interest” and “narrowly tailored” questions, the Court in Zubik will have to address the matter of “substantial burdens.”

RFRA’s provisions don’t apply to simply any burden on religious rights. They apply only to substantial burdens on religious rights. The nonprofits claiming a RFRA violation here insist that the question of whether or not a law places a substantial burden on religious rights is a subjective one for the religious objector to answer, not an objective one for the courts. As soon as an objector says a law-created burden counts as substantial, they argue, it is substantial—as long as the objector is sincere in that religious belief.

The federal courts largely have rejected this line of argument, and for good reason. If accepted, it would provide an enormous loophole for businesses to seek accommodations to other civil rights requirements, like not discriminating in pay on the basis of gender, or not refusing to work as a photographer at same-sex weddings. But before Hobby Lobby, federal courts largely had rejected claims that secular, for-profit businesses could even raise religious objections to the birth control benefit—and look how that turned out. In addition, at least one federal court is willing to consider organizations’ moral objections to the benefit as well as religious ones, threatening to render RFRA entirely meaningless except as a weapon for conservatives to use to try and thwart civil rights advancements.

The Women Justices Going in Hard for the Benefit

Like we saw earlier this month in Whole Woman’s Health v. Hellerstedthaving women on the bench makes a difference in the tone and tenor of the questions when reproductive rights are before the Court. The birth control cases have been no different.

In Hobby Lobby, Justice Ginsburg made it clear that if the conservative male justices were going to “presume without deciding” the government’s compelling interest in advancing contraception coverage, she was ready for whenever the question arose again with proof of the public good contraceptive access advances.

Writing for the dissenters, Ginsburg emphasized that “the Government has shown that the [benefit] furthers compelling interests in public health and women’s well-being. Those interests are concrete, specific, and demonstrated by a wealth of empirical evidence.” Ginsburg then provided a list of the myriad of benefits women derive from contraception access.

Just days after the Court issued its decision in Hobby Lobby, it ruled Wheaton College did not have to comply with the very accommodation process it had just extended to for-profits, in one of the first religious objector cases to land before the Court. It was a temporary ruling while the underlying litigation progressed, but produced a blistering dissent.

“Those who are bound by our decisions usually believe they can take us at our word,” Justice Sonia Sotomayor wrote for the dissent, joined by all three female justices. “Not so today. After expressly relying on the availability of the religious-nonprofit accommodation to hold that the contraceptive coverage requirement violates RFRA as applied to closely held for-profit corporations, the Court now, as the dissent in Hobby Lobby feared it might, retreats from that position,” wrote Sotomayor. “This action evinces disregard for even the newest of this Court’s precedents and undermines confidence in this institution.”

Sotomayor’s dissent reveals a lot about the split among the justices in Hobby Lobby. Much of Kennedy’s controlling opinion in Hobby Lobby was about bridging the gap between the conservative wing of the Court—willing to open the floodgates for nearly all types of corporations to pose religious objections to regulatory actions—and the dissenting liberal justices—who, rightly, saw the arguments in Hobby Lobby as a ruse for conservatives to expand their attacks on all forms of civil rights protections. Kennedy tried to assure the liberal justices it was a narrow decision. His decision to side with the conservatives a few days later in Wheaton College betrayed that assurance, as Sotomayor’s dissent makes clear.

With the Court now split 4 to 4, the tension along the fault line between the ruling in Hobby Lobby and the Court’s retreat in Wheaton College will likely be palpable in Zubik. The women on the Court, along with Justice Stephen Breyer, will keep the pressure on Kennedy to stand by his analysis in Hobby Lobby; the conservative justices will no doubt pressure him as well, leaning hard on his discomfort with government intrusions into religious belief, actual or perceived.

Will Kennedy listen to those directly affected by the challenges to the birth control benefit? Or will he buy the specious arguments made by conservative employers: that their religious rights include the right to block their students and employees from accessing contraception coverage under the law?

The Court likely won’t rule until this summer. With the battle to replace the late Justice Scalia only heating up, the possibility of a 4-4 split in Zubik is real. If the Court deadlocks, there will be no definitive ruling on the birth control benefit. Nor will there be any answers at all to the broader questions of whether contraceptive coverage furthers government interest, and the limit, if any, to how far conservatives are willing to stretch RFRA to try and stymie civil rights progress. Such a split would leave in place the appellate court rulings, which have almost unanimously supported the Obama administration and the accommodation process. Practically speaking, it would mean that, eventually, these cases would find their way before the Court again, when it has a full bench of nine members and can issue a definitive ruling.

There is also the possibility that the Court rules 5 to 3 in favor of the Obama administration and the accommodation process. As Kennedy’s opinion in Hobby Lobby demonstrates, he is quite capable of distinguishing real government intrusions into religious beliefs from imaginary ones.

Will the oral arguments offer any insight here? Maybe. But only if Kennedy tips his hand.