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A broad religious exemption for contraceptive coverage would go too far, depriving millions of women of an important health benefit. Instead of expanding exemptions, we should be expanding access to affordable care.

Written by Jessica Arons for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

This article is cross-posted with permission from ThinkProgress Health.



As the Obama Administration debates whether to expand an exemption to  a new health insurance requirement to cover all FDA-approved methods of  contraception, there are some important facts to keep in mind:


– The average woman spends five years pregnant, postpartum, or trying to get pregnant, and at least 30 years trying to avoid pregnancy.

More than 99 percent of women of reproductive age who have had sexual intercourse have used at least one method of family planning.

– Contraception is the most commonly prescribed medication for women ages 18 to 44

Eighty-eight percent of voters support access to birth control

– Approximately three-quarters of Americans agree that insurance should cover contraception

Fifty-eight percent of pill users rely on oral contraception at least in part for non-contraceptive reasons

Eighteen percent of women on the pill reported inconsistent use, such as skipping doses, as a cost-cutting measure



Under the Affordable Care Act, or the ACA, women will benefit from  greatly expanded access to contraception—which has been shown to improve  health.  But this important consumer protection is at risk of being  undermined by an unreasonably expansive religious exemption.

Congress recognized that cost was a major barrier for women in accessing care.  In response, it passed the Women’s Health Amendment,  which required health plans to cover preventive services for women with  no cost-sharing such as co-pays.  Contraception was included among the comprehensive list of services deemed preventive based on an assessment of their effectiveness by the  Institute of Medicine, an independent body of experts that issues  unbiased, evidence-based guidance on matters of importance to public  health.

Indeed, the Department of Health and Human Services asked the IOM to  determine which services should be covered so that there would be no  question of political interference.  HHS then adopted the IOM’s recommendations in full—but with one important exception.   HHS exempted from the contraceptive-coverage requirement those  organizations whose purpose is to promote religious values, who  primarily employ and serve persons who share their religious tenets, and  who qualify for a religiously-related non-profit tax status—in sum,  churches and other houses of worship, church conventions, and the  religious activities of religious orders.

But this exemption was not enough for anti-contraception forces.   They went on the attack and pushed for a much wider exception that would  include universities, hospitals, social service organizations, and  potentially any religiously-affiliated non-profit organization.

While a main purpose of the ACA was to ensure that everyone has the  same guarantee of a baseline set of health care services, the number of  people who work for an institution that meets the proposed exemption is  relatively small.  The same cannot be said, however, for the numerous  religiously-affiliated organizations in our society that employ people  from many different faiths, as well as those with no faith, and serve  the general public.  Almost 800,000 people work in Catholic hospitals alone.  Religious universities employ and teach around 2 million.   Then there are the hospices, nursing homes, and non-profits that help  victims of trafficking, people living with AIDS, children in need of  adoption, and people struggling with addiction—fields that employ high  numbers of women.

All of these workers, students, and their dependents would be  affected by an expanded religious exemption.  Millions of women could  have their consciences—that tell them using birth control is the morally  right thing to do—overridden by those who privilege an institution’s  tenets over an individual’s.  These institutions may be guided by  sincere, religiously-informed principles, but they engage in secular  activities, such as providing an academic education or long-term care  services, and they are sought out for those services, not for religious  teachings.

It is for these reasons that the proposed HHS exemption mirrors the most common exemption in the 28 states that already require employers to offer contraceptive coverage if they  cover other prescription drugs and devices.  And it is for those reasons  that courts have upheld challenges to those laws, finding that a neutral, generally applicable  law not targeted at religion does not burden the right to free exercise  of religion.  In fact, there is the possibility that a broader exemption  would violate the law.  The Equal Employment Opportunity Commission has  found that the exclusion of prescription contraception from an  employer-sponsored health plan constitutes sex discrimination because it only burdens women.

The small minority in this country that opposes contraception is  entitled to its opinion and should be free to preach it as often as it  wants.  But this very dispute belies the fact that only a fraction of  followers practices what is being preached.  Only 2 percent of sexually active Catholic women, for instance, have not used some  form of modern contraception.  Contraception opponents are resorting to  coercion where persuasion has failed.

Freedom of conscience is a bedrock American principle and religious  exemptions can be a useful way to protect conscience, but they must be  employed judiciously.  Otherwise, issues of conscience become  trivialized and turn into excuses for discrimination.  If religious  employers are allowed to object to contraceptive coverage now, will they  one day be able to opt out of covering HIV services, HPV tests, health  care for transgendered people, blood transfusions, or end-of-life care?   If we are not careful, claims of religious liberty could be exploited  by religious organizations to justify noncompliance with laws they  prefer to ignore.

President George W. Bush tried to adopt an overly expansive  “conscience clause” right before he left office.  The Obama  Administration wisely rescinded most of that rule, “based on concerns  expressed that it had the potential to negatively impact patient access  to contraception and certain other medical services….”  This should not  be an occasion to reverse course.  The pending regulation is the first  to interpret and implement the Women’s Health Amendment and will  establish an important precedent.  Imagine where a more conservative  Administration would go if we start with an expansive loophole that  waters down the ACA’s important protections.

Most of us want to live in a world where all children are wanted,  nurtured, and adequately cared for.  Birth control enables women to plan  their pregnancies and avoid being placed in the difficult position of  having to decide whether to continue or end a pregnancy for which they  feel unprepared.  Family planning also results in better health outcomes  for women and their children—a woman who has a planned pregnancy is  more likely to be in better health when she gets pregnant and more  likely to seek prenatal care, and children who are born at least two  years apart are healthier, and possibly smarter.

A broad religious exemption for contraceptive coverage would go too  far, depriving millions of women of an important health benefit.   Instead of expanding exemptions, we should be expanding access to  affordable care.

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