Monday, November 30, 2015

Religious groups lead a new strike against Obamacare

A new battle wound inflicted on Obamacare stems from a legal claim of religious freedom based on opposition to contraceptives.

Religious groups lead a new strike against Obamacare


by Erica Cohen

A new battle wound inflicted on Obamacare stems from a legal claim of religious freedom based on opposition to contraceptives. It takes the form of an injunction issued by a federal judge that temporarily prevents the Obama administration from requiring that the world's largest privately held Christian publisher, Tyndale House Publishers, provide its employees with coverage for certain contraceptive care.

The dispute involves a provision of the Affordable Care Act that requires insurance plans to provide women with preventive care, including contraceptives, free-of-charge. This mandate has elicited significant opposition, particularly from religious groups and Republicans.

In this case, the contraceptives at issue are Plan B and intrauterine devices (IUDs). Tyndale alleges that they are morally equivalent to abortion. However, Plan B has no effect on a fertilized egg because it merely prevents fertilization of the egg, and IUDs mainly work by blocking sperm and may prevent a fertilized egg from implanting on the uterine wall. 

According the American College of Obstetricians and Gynecologists (ACOG), pregnancy does not begin until a fertilized egg implants into the wall of the uterus; however, the question has been debated by political and religious leaders for years. Federal policy has generally followed the ACOG definition and found that medications and devices that act before implantation of the egg to the uterine wall prevent, rather than terminate, a pregnancy. Under this definition, Plan B and IUDs would be preventive contraceptives.

Lawsuits against Obamacare are piling up, with the contraceptive care mandate challenge as one among several. While the Obama administration has made it clear that religious employers are not required to provide, pay for, or refer women for contraceptives, Catholic groups opposing the Act say the exemption is too narrow and is not a fair compromise.

Additionally, these groups allege that their money would indirectly subsidize contraceptive care, even if they are exempted from paying directly. When a religious employer is exempted, the insurer is required to provide the contraceptives to the employee as supplemental coverage at no charge.

The judge in the case, U.S. District Court Judge Reggie Walton, an appointee of President George W. Bush, admitted that the government has a broad, compelling interest in promoting public and women’s health; however, Walton questioned “whether the government has shown that the application of the contraceptive coverage mandate to the plaintiffs furthers those compelling interests.” He sought additional proof that it does.

IUDs and Plan B are important methods of contraception. IUDs are often more reliable than other forms such as birth control pills because they do not require the user to remember to take a pill daily. Plan B is essential when a woman has unprotected sex or fears that another form of contraception has failed. It may be the last resort to prevent unwanted pregnancy for a woman who would not be willing to have an abortion once pregnant. 

Although Walton granted a temporary injunction, other suits that have challenged the contraceptive mandate have so far been unsuccessful.

The contraceptive mandate helps protect women’s and children’s rights. The mandate protects children because babies resulting from unwanted pregnancies are at greater risk for low birth weight and are more likely to experience developmental delays. Children from unwanted pregnancies are also more likely to be abandoned or abused.

The contraceptive mandate also protects women’s autonomy by allowing them to control their own bodies and fertility. Lastly, the mandate helps combat sex-based inequality in health insurance because women disproportionately bear the cost of birth control and pregnancy.

The contraceptive mandate is a controversial, yet important, aspect of Obamacare. While it is clear that groups will continue to oppose it, the success of their efforts is yet to be determined.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, Drexel University Kline School of Law & Dornsife School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson College of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson College of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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