The firestorm rages on over the Obama Administration rule under which all employee health insurance plans, including ones at religiously affiliated institutions such as Catholic charities and schools, must include full coverage for birth control. A proposed compromise that would exempt such institutions from paying for such coverage but require insurers to extend it to their employees for free has not appeased critics. The battle has been framed as one of religious freedom versus reproductive rights. But it also illustrates two troubling phenomena unrelated to religion: intrusive micromanagement of insurance options under the new federal health care law, and the redefinition of contraception as a public good rather than a personal choice.
The stated purpose of health care reform was to address the problem of uninsured patients who either face bankruptcy due to exorbitant bills, or rely on the free emergency care hospitals must provide. But the Affordable Health Care Act (ACA) does far more than require Americans to be insured for catastrophic illness and other major medical expenses. To be approved under the ACA, an insurance policy must include extensive coverage for routine care.
In a sense, medical insurance is meant to mitigate life's unfair and arbitrary tragedies: Some people are plagued by chronic illness or struck by a devastating health crisis, and need costly care to prevent death or disability. Fertility, however, is a normal part of life and a healthy function of the human body. Contraception is arguably an essential personal need for many, especially women; to call it an essential medical need is a stretch, except where pregnancy would pose a grave health risk.
It is also not, for the vast majority, a financial burden. Defending the administration's decision to mandate birth control coverage with no copay or deductibles, Planned Parenthood official Kim Custer writes that without this benefit, "millions of women would pay $15 to $50 a month, making it a vital, but often cost-prohibitive expense for many women." Really? For low-income women, yes; but the poor can already get free contraceptives at any Planned Parenthood clinic. (Of course, plenty of women—at least those who are married or in steady relationships—also share birth control costs with their partners.)
As proof that the measure is needed, an article on the Center for American Progress website cites a 2009 survey by the Alan Guttmacher Institute . Eight percent of reproductive-age, sexually active women said they sometimes did not use birth control to save money; 18 percent of those taking the Pill reported "inconsistent use" for the same reason. (The last figure appears to be somewhat inflated: the definition of "inconsistent use" included "buying fewer pill packs at one time"—which would not diminish the Pill's effectiveness.)
But several caveats are in order. First of all, an accurate summary of the study would have specified "women with household income under $75,000 a year," to whom the survey pool was limited—excluding nearly a third of Americans. Obviously, birth control costs are not a concern for the affluent; but when the figures are reported as if they applied to the entire population, it gives the impression that the problem at lower income levels is more pervasive than it really is.
Secondly, many of the women who reported skimping on birth control were unemployed, which means that the problem would not be solved by requiring employer-provided insurance to cover birth control.
And finally, and most importantly: it is possible to give low-earning women access to affordable contraception without making free birth control a universal entitlement—even for those whose household income is well over $75,000.
Writing in The Huffington Post in praise of the Obama policy even before it was revised to exempt faith-based employers from paying directly for birth control coverage, Nancy Kaufman, CEO of the National Council of Jewish Women, invoked the slogan of pro-choice rallies: "Not the church, not the state, women will decide their fate!" But Kaufman's idea of female autonomy apparently includes having both the state and the church pay for women's reproductive choices. Is it really a feminist argument that women, and their male partners, should never be responsible for even part of the expense of controlling their fertility?
This question is especially relevant because much of the rhetoric surrounding the birth control coverage mandate treats contraception as a societal good, a way to lessen the costly burden of unwanted pregnancies. It is a mindset that has not very feminist overtones of treating women's bodies as public property. Will the prevention of unplanned pregnancies come to be seen as something akin to a civic duty?
Some of the "war on religion" rhetoric emanating from the right has been over the top. When religious institutions perform extensive secular functions—often with government subsidies—and serve nonbelievers, they inevitably surrender part of their religious autonomy. (A Catholic hospital, for instance, cannot require that all babies born in its maternity wards be baptized into the Catholic faith.)
The issue is where the line should be drawn; and, for many Americans, that line is crossed when Catholic institutions such as hospitals, schools and charities—with a narrow exemption for churches—are forced to buy employee insurance policies that cover services prohibited by Catholic teachings. Catholics who use contraception, and Protestants who have little sympathy for the Catholic Church's anti-birth-control stance, may still be offended by the state dictating to the church in such matters.
President Obama has picked the wrong fight. Rather than expand birth control options for women, this policy may undermine already shaky support for the health reform legislation. Suddenly, predictions that ObamaCare will result in less freedom and more bureaucratic authority do not seem so outlandish.
Contributing Editor Cathy Young is a columnist at RealClearPolitics, where a version of this article originally appeared.
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