Birth Control! Religion! The Sky Is Falling! Or Something.

OK, this is going to be one of these posts where I get all long-winded and pedantic. Feel free to quit reading whenever you feel like it. I’ll try to throw in some cuss words to keep it interesting but I may get boring in spite of myself.

So. If you’ve turned on the news in the past few weeks you’ve heard a LOT about birth control. Either  filthy slutty liberals are forcing God-fearing non-slutty Americans to pay for their sinful ways or woman-hating conservatives are lodging their Bibles directly up our collective vagina and opposing non-procreative sex, depending on whether you watch Fox or MSNBC. There’s a lot of visceral reacting to perceived threats against women’s rights and religious freedom but no one is telling the whole story. I’m going to try and connect a few of the dots for you.

It all starts with the Patient Protection and Affordable Care Act (PPACA). Or Obamacare, as it’s sometimes known. That massive bill addressed some issues in how insurance plans are structured to make them more beneficial to subscribers. One major function is to mandate that insurance plans cover preventive services with no patient co-pay.This includes many tests and screenings as well as some medications. For example, insurance plans must pay for mammograms without the patient having to pay an out-of-pocket share of the test. They still have to pay their premiums, of course, so it’s not really a free mammogram but it is a mammogram without any additional fees beyond premiums.

This effects employers because most Americans get their insurance from employers. The expanded slate of services that plans must offer may increase premium costs for employer who previously were able to pick and choose covered services to adjust plan costs. And employers with more than 50 employees who didn’t previously offer health plans ill now have to offer them in accordance with PPACA rules.

You still with me? Excellent.

One of the gray areas in the preventive care definition was birth control. Is it preventive health care in the same way a diabetes screening is? Or not? Hard to say. The Department of Health and Human Services wasn’t sure so they convened a panel of health experts to render a recommendation. That panel came to the conclusion that yes, birth control is preventive health care and therefore should be covered without co-pay under the provisions of PPACA. Secretary Sebillius and HHS accepted their recommendation. This all happened last spring, if I recall correctly, and it was met with great rejoicing from women who were happy to be done with prescription co-pays on birth control or with paying for it out of pocket if their plan didn’t cover it at all.

So, that’s the history. Congress says preventive health care needs to be part of insurance plans at no extra cost. HHS says birth control is preventive health care. It’s all the law of the land. Story over, right? Wrong.

There is a nice little exemption built into the ruling about birth control that allows religious institutions that employ members of their religion to opt out of the birth control coverage if it violates the tenets of their faith. So, a church that has primarily employees that are members of that faith, doesn’t have to include birth control in the preventive health coverage. Which is entirely reasonable. Where things got sticky was when that exemption didn’t apply to employers that are affiliated with a religion but are not technically religious organizations, such as Catholic colleges and universities. I already wrote about this at length and you can catch the details here. There was a hew and cry about it and rather than fight the battle, the Obama adminsitration ruled that the universities do have to add birth control to their plans for students and employees but instead of the school’s dollars paying for them, the insurers will eat the cost somehow using the magic of palliative accounting. Then Obama went back to trying to run the country.

And heads exploded all over the nation.

Some people saw this failure to exempt a very few employers from one single, relatively inexpensive provision of the largest health care reform law in US history as a full-scale condemnation on the beliefs that drove the leadership of these colleges and universities to ask for an exemption in the first place. Congressional Republicans, who know when an issue will fire up their base in an election year, took it and ran with it and started holding hearings and writing legislation to prove that birth control is not preventive care and certainly not everyone’s moral cup of tea and, therefore, anyone who doesn’t like it shouldn’t have to include it in their employee health insurance plan. Congressional Democrats, who also know when an issue will fire up their base in an election year, took note of what the Republicans were doing and pointed out that only Republican men were talking about an issue that primarily impacts women and framed it as a wholesale Republican attack on contraception and made it sound as if birth control pills were going to vanish from the market any second now.

I’m pretty sure the only outcome so far has been a fundraising bonanza on both sides of the aisle. No provisions of the PPACA have been changed. Birth control remains a preventive health care service that will be fully covered by all insurance plans except those offered by religious organizations such as churches.

Now, I’m not trying to minimize any of this, despite my glib tone. I full realize the gravity of the two arguments at play. When does the principle of religious freedom trump the law of the land? What responsibility to religious sensibilities do lawmakers have? When can the moral judgments of an employer come before the medical needs of a woman in consultation with her doctor? Is this a religious freedom issue? Or one of medical privacy? Where do the lines get drawn?

Damned if I know. I’m not a philosopher. I’m a blogger who deals in facts and opinions, not deep thoughts.

At the root of this argument is a decision that was arbitrary: that birth control is preventive health care. Not everyone believes this to be true. Certain religious persons object and would prefer not to have their insurance dollars being used for birth control. However, other groups of people feel that birth control should rightly be considered preventive care. Those groups include the medical establishment and women who use birth control.  And there are more of them than there are of the objecting group.

And in a democracy, majority rules.

It is arbitrary, it is unfair to the objectors, it breeds ill will among good but that is how the chips fell. I’m sorry if you are among their segments of the population who object to this set of decisions but you didn’t win this time. You were outvoted this time. That’s how it works sometimes. And I know the sting is doubly strong because you know that there is not opt out of paying for insurance under the PPACA’s coverage mandates. It sucks for you. You have a right to be angry. But you don’t have a right to expect that the situation will change. The only thing you are entitled to is outrage. At least until the election, when you’re entitled to vote. That, of course, can change everything.

For those of us who agree with the ruling that birth control should be a covered service, our job is to remain informed, and to hit the voting booth in November to vote for people who will uphold these laws. That’s what I’m going to do.