Analysis Law and Policy

Death by 1,000 Cuts: The Right’s Legal Strategy to Undermine Health-Care Reform

Jessica Mason Pieklo

The hundreds of lawsuits challenging the birth control benefit in the Affordable Care Act fit into a larger picture of health-care reform opponents using the courts to undermine the success of the law.

Read more of our coverage on challenges to the Affordable Care Act’s birth control benefit here.

Attorneys representing Missouri Rep. Paul Wieland argued before the U.S. Eighth Circuit Court of Appeals this week that the three-term state representative’s religious objections to contraception should allow him to exclude birth control coverage for his wife and daughters from his state-provided health insurance without jeopardizing coverage or incurring any financial penalties for not complying with the Affordable Care Act.

Wieland’s lawsuit is among the more than 100 legal challenges filed against the contraception benefit in the ACA, but is the first to argue for an individual exemption from the benefit.

While cases like Hobby Lobby and Little Sisters of the Poor have dominated the coverage of the legal challenges to the contraception benefit, Wieland’s case represents an extension of a legal strategy by health-care reform opponents that is designed to destabilize and debilitate health-care reform broadly, ACA proponents argue.

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“I just can’t think of a better example of patriarchy than the man saying he wants to try and control the coverage that his wife and daughters get,” Brigitte Amiri, senior staff attorney for the American Civil Liberties Union, said in an interview with Rewire.

Judith Waxman, vice president for health and reproductive rights at the National Women’s Law Center, explained in an interview with Rewire that Wieland’s case undercuts the entire concept of group health insurance and the specific benefits built into the ACA to protect consumers from the outcome Wieland’s lawsuit seeks.

“The case takes this whole thing to a new level of absurdity,” Waxman said. “In the old individual market where companies had the choice to do that and sometimes they would say, ‘Well, you have a pulmonary system problem so we’ll cover you for everything other than your pulmonary system. That’s how it used to be in the olden-bad days. We got away from that by saying, ‘OK, everybody has the same basic plan, and preventive services are required, and we’re all in this together.’”

In other words, Wieland’s lawsuit effectively uses the contraception benefit as a Trojan Horse to argue for a return to the system in which insurance companies exclude some conditions from coverage.

“There are lawsuits like Halbig that try and directly put a stake through the heart of the ACA and then there are other ones that chip away at other important provisions in the act, like the cases challenging the contraception mandate,” Elizabeth Wydra, chief counsel of the Constitutional Accountability Center, told Rewire.

In Halbig, opponents to health-care reform argue that the ACA’s statutory language prevents the federal government from making subsidies available to those consumers who purchase health insurance through federal exchanges.

Conservative lawmakers who opposed health-care reform refused to set up their own state exchanges in 36 states, prompting the Obama administration to step in and provide health insurance to consumers through federal exchanges.

“The inception of the litigation strategy behind Halbig and the idea of taking these words out of context from the statute and playing ‘gotcha’ litigation is reflective of the right’s reaction to the Affordable Care Act in general, which is to try and kill it at any cost,” Wydra said. “I think given the lack of support that they are finding in the American public in their continued quest against the Affordable Care Act, they think their best hope is the conservative Roberts Court. That’s what they are betting on.”

While the right’s opposition to health-care reform is not confined simply to the law’s nondiscrimination provisions, opponents have found the most legal system success in those cases challenging the ACA’s birth control benefit.

Last summer’s Supreme Court decision in Hobby Lobby and its interim order in the Wheaton College case handed health-care reform opponents two important victories they are now looking to build upon in the federal appeals courts. Earlier this week, attorneys representing religiously affiliated nonprofit employers like the Little Sisters of the Poor told a federal appeals court that despite the Obama administration’s numerous attempts to accommodate religious objections to portions of the health-care law, they intended to press ahead with their legal challenges.

“What these plaintiffs want is a complete exemption from the requirement and so they want to be treated like the houses of worship,” Amiri said. “It’s not surprising that they don’t think the augmented accommodation doesn’t go far enough.”

In their legal briefs filed with the Tenth Circuit Court of Appeals, attorneys representing the Little Sisters of the Poor argued the administration’s attempts to provide a way for institutions that are religiously affiliated but not houses of worship to avoid providing contraception coverage for their employees and students amounted to religious discrimination because the administration is “picking and choosing” which institutions have “sufficient faith.”

But as Amiri notes, the question before the courts is not which institutions have substantial religious beliefs and which ones do not, but whether the administration’s coverage requirement and the process for opting out of that requirement unduly burdens those beliefs.

“Where the courts play a role is determining objectively whether there’s a substantial burden on those religious beliefs,” said Amiri.

“One of the real dangers of the Hobby Lobby decision is that it gives really short shrift to this question and makes it seems like it is very easy for a plaintiff to argue that there is a substantial burden on their religious beliefs because there wasn’t really much meat to the majority’s discussion of substantial burden in the Hobby Lobby decision,” said Amiri.

Indeed, in their brief to the Tenth Circuit, the Little Sisters state, “[T]he relevant question is only whether the Little Sisters sincerely believe they are forbidden from participating in the government’s system to promote and facilitate contraceptive access.”

Amiri said that to suggest all the court needs to do is accept the challengers at their word is misleading.

“Their [the challengers] arguments conflate sincerity of religious beliefs with the objective inquiry into whether there’s a substantial burden on those sincere religious beliefs,” Amiri said. “There still has to be some inquiry. It’s not like any plaintiff can just say, ‘I have a sincere religious objection to something the government is making me do,’ and that automatically means their religious beliefs are substantially burdened. It’s not a free pass just by a mere allegation of a sincere religious belief.”

But a free pass is apparently what the challengers are hoping for.

Attorneys for the Little Sisters of the Poor argued the case did not need to be returned to the lower court for a trial on the issue of whether or not the Obama administration’s latest birth control fix was sufficient and instead urged the federal appeals court to continue the preliminary injunction already in place. That would prevent the court from engaging in the very kind of objective inquiry Amiri described.

“Basically they are doing everything they can to withhold contraception coverage from their employees and it shouldn’t be permissible,” Amiri said.

With legal challenges to the federal government’s ability to subsidize insurance purchased on the federal exchanges and challenges by individuals, nonprofit employers, and for-profit employers to the ACA’s contraception benefit working their way through the federal courts, those defending the health-care law see no reason to think the challengers will quit trying to undo health-care reform anytime soon.

“We agree of course with Justice Ginsburg that the Hobby Lobby decision was going to open up the floodgates,” said Waxman, “and we are concerned that there is continuing litigation over the contraceptive requirement. But we’re also concerned about what’s coming next in terms of, ‘I don’t believe in immunizations for my employees, I don’t believe in mental health coverage for my employees, or whatever else it might be.’”

Analysis Law and Policy

Federal Court Says Trans Worker Can Be Fired Based on Owner’s Religious Beliefs

Jessica Mason Pieklo

“Plain and simple, this is just discrimination against a person because of who she is,” said John Knight, the director of the LGBT and HIV Project of the American Civil Liberties Union of Illinois, in an interview with Rewire.

When the U.S. Supreme Court ruled in 2014 in Burwell v. Hobby Lobby that the owners of secular for-profit businesses could challenge laws they believed infringed on their religious liberties, civil rights advocates warned that the decision was just the start of a new wave of litigation. On Thursday, those predictions came true: A federal district judge in Michigan ruled that a funeral home owner could fire a transgender worker simply for being transgender.

The language of the opinion is sweeping, even if the immediate effect of the decision is limited to the worker, Aimee Stephens, and her boss. And that has some court-watchers concerned.

“Plain and simple, this is just discrimination against a person because of who she is,” said John Knight, the director of the LGBT and HIV Project of the American Civil Liberties Union of Illinois, in an interview with Rewire.

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According to court documents, Stephens, an employee at Detroit’s R.G. & G.R. Funeral Homes, gave her boss—the business’ owner—a letter in 2013 explaining she was undergoing a gender transition. As part of her transition, she told her employer that she would soon start to present as a woman, including dressing in appropriate business attire at work that was consistent both with her identity and the company’s sex-segregated dress code policy.

Two weeks later, Stephens was fired after being told by her boss that what she was “proposing to do” was unacceptable and offensive to his religious beliefs.

In September 2014, the Equal Employment Opportunity Commission (EEOC) filed a lawsuit on behalf of Stephens, arguing the funeral home had violated Title VII of the federal Civil Rights Act, which prohibits employment discrimination. According to the EEOC, Stephens was unlawfully fired in violation of Title VII “because she is transgender, because she was transitioning from male to female, and/or because she did not conform to the employer’s gender-based expectations, preferences, or stereotypes.”

Title VII of the Civil Rights Act allows those employees who have been discriminated against in the workplace to collect money, known as civil damages. Those damages usually come in the form of lost wages, back pay, and funds to make up for—to some degree—the abuse the employee faced on the job. They are also designed to make employers more vigilant about their workplace culture. Losing an employment discrimination case for an employer can be expensive.

But attorneys representing Stephens’ employer argued that the Religious Freedom Restoration Act (RFRA) protected their client from legal liability for firing Stephens. On Thursday, a federal court agreed. It said that paying such damages for unlawfully discriminating against an employee could amount to a substantial burden on an employer’s religious beliefs. 

According to the court, despite the fact that Stephens’ boss admitted he fired her for transitioning, and despite the fact that the court found this admission to be direct evidence of employment discrimination, RFRA can be a defense against that direct discrimination. To use that defense, the court concluded, all the funeral home owner had to do was assert that his religious beliefs embraced LGBTQ discrimination. The funeral home had “met its initial burden of showing that enforcement of Title VII, and the body of sex-stereotyping case law that has developed under it, would impose a substantial burden on its ability to conduct business in accordance with its sincerely-held religious beliefs,” the court wrote.

In other words, Hobby Lobby provides employers a defense to discriminating against LGBTQ people on the basis of religious beliefs.

“The RFRA analysis is extremely troubling, and the implications of it [are] as well,” said Knight. “I believe this is the first case applying RFRA to a Title VII claim with respect to nonministerial employees.”

If the scope of the opinion were broader, Knight continued, “this would allow [employers in general] to evade and refuse to comply with uniform nondiscrimination law because of their religious views.”

This, Knight said, is what advocates were afraid of in the wake of Hobby Lobby: “It is the concern raised by all of the liberal justices in the dissent in Hobby Lobby, and it is what the majority in Hobby Lobby said the decision did not mean. [That majority] said it did not mean the end of enforcement of nondiscrimination laws.”

And yet that is exactly what we are seeing in this decision, Knight said.

According to court documents, Stephens’ boss has been a Christian for more than 65 years and testified that he believes “the Bible teaches that God creates people male or female,” that “the Bible teaches that a person’s sex is an immutable God-given gift, and that people should not deny or attempt to change their sex.” For Stephens’ former boss, Stephens’ transition to a woman was “denying” her sex. Stephens had to be fired, her boss testified, so that he would not be directly complicit in supporting the idea that “sex is a changeable social construct rather than an immutable God-given gift.”

If the “complicit in denying God’s will” sounds familiar, it should. It has been the exact argument used by businesses challenging the birth control benefit of the Affordable Care Act. Those business owners believe contraception is contrary to God’s will and that complying with federal law, which says birth control should be treated in insurance policies as any other preventive service, makes them complicit in sin. Thursday’s decision cites Hobby Lobby directly to support the court’s conclusion that complying with federal nondiscrimination law can be avoided by asserting a religious objection.

Think of the implications, should other courts follow this lead. Conservatives have, in the past, launched religious objections to child labor laws, the minimum wage, interracial marriage, and renting housing to single parents—to name a few. Those early legal challenges were unsuccessful, in part because they were based on constitutional claims. Hobby Lobby changed all that, opening the door for religious conservatives to launch all kinds of protests against laws they disagree with.

And though the complaint may be framed as religious objections to birth control, to LGBTQ people generally, and whatever other social issue that rankles conservatives, these cases are so much more than that. They are about corporate interests trying to evade regulations that both advance social equity and punish financially those businesses that refuse to follow the law. Thursday’s opinion represents the next, troubling evolution of that litigation.

CORRECTION: This article has been updated to clarify John Knight’s position with the American Civil Liberties Union of Illinois.

Commentary Politics

It’s Not Just Trump: The Right Wing’s Increasing Reliance on Violence and Intimidation as a Path to Power

Jodi Jacobson

Republicans have tried to pass Trump's most recent comments off as a joke because to accept the reality of that rhetoric would mean going to the core of their entire party platform and their strategies. The GOP would have to come to terms with the toll its power plays are taking on the country writ large.

This week, GOP presidential nominee Donald Trump stated that, if Hillary Clinton were elected and able to nominate justices to the Supreme Court, “Second Amendment people” might be able to do something about it. After blaming the media for “being dishonest” in reporting his statement, the Trump campaign has since tried to pass the comment off as a joke. However characterized, Trump’s statement is not only part of his own election strategy, but also a strategy that has become synonymous with those of candidates, legislators, and groups affiliated with the positions of the GOP.

To me, the phrase “Second Amendment people” translates to those reflexively opposed to any regulation of gun sales and ownership and who feel they need guns to arm themselves against the government. I’m not alone: The comment was widely perceived as an implicit threat of violence against the Democratic presidential nominee. Yet, GOP party leaders have failed to condemn his comment, with House Speaker Paul Ryan (R-WI) agreeing with the Trump campaign that it was “a joke gone bad.”

Republicans have tried to pass it off as a joke because to accept the reality of their rhetoric would mean going to the core of their entire party platform and their strategies. The GOP would have to come to terms with the toll its power plays are taking on the country writ large. The rhetoric is part of a longer and increasingly dangerous effort by the GOP, aided by corporate-funded right-wing organizations and talk show hosts, to de-legitimize the federal government, undermine confidence in our voting system, play on the fears held by a segment of the population about tyranny and the loss of liberty, and intimidate people Republican leaders see as political enemies.

Ironically, while GOP candidates and leaders decry the random violence of terrorist groups like Daeshitself an outgrowth of desperate circumstances, failed states, and a perceived or real loss of powerthey are perpetuating the idea of loss and desperation in the United States and inciting others to random violence against political opponents.

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Trump’s “Second Amendment” comment came after a week of efforts by the Trump campaign to de-legitimize the 2016 presidential election well before a single vote has been cast. On Monday, August 1, after polls showed Trump losing ground, he asserted in an Ohio campaign speech that “I’m afraid the election’s gonna be rigged, I have to be honest.”

Manufactured claims of widespread voter fraud—a problem that does not exist, as several analyses have shown—have nonetheless been repeatedly pushed by the GOP since the 2008 election. Using these disproven claims as support, GOP legislatures in 20 states have passed new voter restrictions since 2010, and still the GOP claims elections are suspect, stoking the fears of average voters seeking easy answers to complex problems and feeding the paranoia of separatist and white nationalist groups. Taking up arms against an illegitimate government is, after all, exactly what “Second Amendment remedies” are for.

Several days before Trump’s Ohio speech, Trump adviser Roger Stone suggested that the result of the election might be “illegitimate,” leading to “widespread civil disobedience” and a “bloodbath,” a term I personally find chilling.

Well before these comments were made, there was the hate-fest otherwise known as the Republican National Convention (RNC), during which both speakers and supporters variously called for Clinton to be imprisoned or shot, and during which New Jersey Gov. Chris Christie, a man not widely known for his high ethical standards or sense of accountability, led a mock trial of Hillary Clinton to chants from the crowd of “lock her up.” And that was the tame part.

The number of times Trump has called for or supported violence at his rallies is too long to catalogue here. His speeches are rife with threats to punch opponents; after the Democratic National Convention, he threatened to hit speakers who critiqued his policies “so hard their heads would spin.” He also famously promised to pay the legal fees of anyone who hurt protesters at his rallies and defended former campaign manager Corey Lewandowski after allegations surfaced that Lewandowski had assaulted a female Breitbart reporter.

A recent New York Times video compiled over a year of reporting at Trump rallies revealed the degree to which many of Trump’s supporters unapologetically express violence and hatred—for women, immigrants, and people of color. And Trump eschews any responsibility for what has transpired, repeatedly claiming he does not condone violence—his own rhetoric, that of his associates, and other evidence notwithstanding.

Still, to focus only on Trump is to ignore a broader and deeper acceptance, even encouragement of, incitement to violence by the GOP that began long before the 2016 campaign.

In 2008, in what may appear to be a now forgotten but eerily prescient peek at the 2016 RNC, then-GOP presidential nominee Sen. John McCain (R-AZ), and his running mate, former Alaska Gov. Sarah Palin, used race-baiting and hints at violence to gin up their crowds. First, Palin accused Obama of “palling around with terrorists,” a claim that became part of her stump speech. As a result, Frank Rich then wrote in the New York Times:

At McCain-Palin rallies, the raucous and insistent cries of “Treason!” and “Terrorist!” and “Kill him!” and “Off with his head!” as well as the uninhibited slinging of racial epithets, are actually something new in a campaign that has seen almost every conceivable twist. They are alarms. Doing nothing is not an option.

Nothing was in fact done. No price was paid by GOP candidates encouraging this kind of behavior.

In 2009, during congressional debates on the Affordable Care Act, opponents of the health-care law, who’d been fed a steady diet of misleading and sensationalist information, were encouraged by conservative groups like FreedomWorks and Right Principles, as well as talk show hosts such as Sean Hannity, to disrupt town hall meetings on the legislation held throughout the country. Protesters turned up at some town hall meetings armed with rifles with the apparent intention of intimidating those who, in supporting health reform, disagreed with them. In some cases, what began as nasty verbal attacks turned violent. As the New York Times then reported: “[M]embers of Congress have been shouted down, hanged in effigy and taunted by crowds. In several cities, noisy demonstrations have led to fistfights, arrests and hospitalizations.”

In 2010, as first reported by the Washington Post’s Greg Sargent, Tea Party candidate Sharron Angle, in an unsuccessful bid to unseat Senate Majority Leader Harry Reid (D-NV), suggested that armed insurrection would be the answer if “this Congress keeps going the way it is.” In response to a request for clarification by the host of the radio show on which she made her comments, Angle said:

You know, our Founding Fathers, they put that Second Amendment in there for a good reason and that was for the people to protect themselves against a tyrannical government. And in fact Thomas Jefferson said it’s good for a country to have a revolution every 20 years.

I hope that’s not where we’re going, but, you know, if this Congress keeps going the way it is, people are really looking toward those Second Amendment remedies and saying my goodness what can we do to turn this country around? I’ll tell you the first thing we need to do is take Harry Reid out.

Also in 2010, Palin, by then a failed vice-presidential candidate, created a map “targeting” congressional Democrats up for re-election, complete with crosshairs. Palin announced the map to her supporters with this exhortation: “Don’t retreat. Instead, reload!”

One of the congresspeople on that map was Arizona Democrat Gabby Giffords, who in the 2010 Congressional race was challenged by Jesse Kelly, a Palin-backed Tea Party candidate. Kelly’s campaign described an event this way:

Get on Target for Victory in November. Help remove Gabrielle Giffords from office. Shoot a fully automatic M16 with Jesse Kelly.

Someone took this literally. In January 2011, Jared Lee Loughner went on a shooting rampage in a Tuscon grocery store at which Giffords was meeting with constituents. Loughner killed six people and injured 13 others, including Giffords who, as a result of permanent disability resulting from the shooting, resigned from Congress. Investigators later found that Loughner had for months become obsessed with government conspiracy theories such as those spread by GOP and Tea Party candidates.

These events didn’t stop GOP candidates from fear-mongering and suggesting “remedies.”  To the contrary, the goading continued. As the Huffington Post‘s Sam Stein wrote in 2011:

Florida Senate candidate Mike McCalister, who is running against incumbent Sen. Bill Nelson (D-Fla.), offered a variation of the much-lampooned line during a speech before the Palms West Republican Club earlier this week.

“I get asked sometimes where do I stand on the Second and 10th Amendment, and I have a little saying,” he declared. “We need a sign at every harbor, every airport and every road entering our state: ‘You’re entering a 10th Amendment-owned and -operated state, and justice will be served with the Second Amendment.’” [Emphasis added.]

These kinds of threats by the GOP against other legislators and even the president have gone unpunished by the leadership of the party. Not a word has come from either House Speaker Paul Ryan or Senate Majority Leader Mitch McConnell decrying these statements, and the hyperbole and threats have only continued. Recently, for example, former Illinois GOP Congressman Joe Walsh tweeted and then deleted this threat to the president after the killing of five police officers in Dallas, Texas:

“3 Dallas cops killed, 7 wounded,” former congressman Joe Walsh, an Illinois Republican, wrote just before midnight in a tweet that is no longer on his profile. “This is now war. Watch out Obama. Watch out black lives matter punks. Real America is coming after you.”
Even after the outcry over his recent remarks, Trump has escalated the rhetoric against both President Obama and against Clinton, calling them the “founders of ISIS.” And again no word from the GOP leadership.
This rhetoric is part of a pattern used by the right wing within and outside elections. Anti-choice groups, for example, consistently misrepresent reproductive health care writ large, and abortion specifically. They “target” providers with public lists of names, addresses, and other personal information. They lie, intimidate, and make efforts to both vilify and stigmatize doctors. When this leads to violence, as David Cohen wrote in Rolling Stone this week, the anti-choice groups—and their GOP supporters—shrug off any responsibility.
Some gun rights groups also use this tactic of intimidation and targeting to silence critique. In 2011, for example, 40 men armed with semi-automatic weapons and other guns surrounded a restaurant in Arlington, Texas, in which a mothers’ group had gathered to discuss gun regulations. “Second Amendment people” have spit upon women arguing for gun regulation and threatened them with rape. In one case, a member of these groups waited in the dark at the home of an advocate and then sought to intimidate her as she approached in her wheelchair.
The growing resort to violence and intimidation in our country is a product of an environment in which leading politicians not only look the other way as their constituents and affiliated groups use such tactics to press a political point, but in which the leaders themselves are complicit.
These are dangerous games being played by a major political party in its own quest for power. Whether or not Donald Trump is the most recent and most bombastic evidence of what has become of the GOP, it is the leadership and the elected officials of the party who are condoning and perpetuating an environment in which insinuations of violence will increasingly lead to acts of violence. The more that the right uses and suggests violence as a method of capturing, consolidating, and holding power, the more they become like the very terrorists they claim to be against.

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