Among the tenets of the Affordable Care Act is the notion that basic preventive health care be covered by virtually all insurance policies, including employer-sponsored plans. That notion, when considered broadly, is relatively noncontroversial. Regardless of political stripes, most can agree that a proactive approach to health care – one that includes prevention – yields the best outcomes in terms of health and costs for people and providers. Once the term “preventive” is defined, though, division arises – primarily around access to contraception.
At issue is whether the provision requiring that insurance policies offer free contraception to women runs afoul of various organizations’ religious beliefs. The concern is a valid one, from a constitutional standpoint, in very limited circumstances: namely those involving churches and their employees. The Department of Health and Human Services has crafted exemptions for those institutions as well as provisions for religiously affiliated organizations such as universities and hospitals, which do not have to provide coverage including contraception; their employees can procure it directly from insurers.
But some private employers whose religious beliefs are violated by the contraception provision have tried to extend the exemption to the coverage they offer employees. As the 6th Circuit Court of Appeals ruled Tuesday, that claim goes a bit beyond the protections offered to churches and institutions with bona fide religious affiliations. The court made the right decision for a number of reasons.
First among them is the wholly innocuous nature of preventive contraception. It is reasonable to include that service along with other basic health-care offerings such as alcohol, tobacco, depression, cancer and HIV screening; immunizations including Hepatitis A and B, diphtheria, tetanus and pertussis; diet counseling, gestational diabetes and domestic violence screening as well as breast-feeding counseling and support. These are just a few of the preventive services insurers must provide and, in doing so, medical professionals believe, go a great distance in warding off more serious and costly medical conditions. It passes economic tests as well as public and personal health measures.
While churches have a constitutionally ensconced right to hold and exercise virtually all of their religious beliefs – and therefore extend those to their hiring practices – private business owners carry no such protection. That is as it should be. Employees should not have to make health-care choices based on their employers’ religious beliefs – requiring such could intrude on employees’ own religious beliefs pertaining to their own health care and, as such, could create a power imbalance over whose religious freedoms are protected.
There is much in the Affordable Care Act for reasonable people to disagree about, but providing contraception as part of a suite of preventive services should not be among the sources of contention – and certainly not for religious purposes. There have been reasonable exceptions and exemptions made on behalf of those institutions that meet a rigorous religious-affiliation test, and Tuesday’s ruling supports that balance.
The issue, though, is not likely resolved. The constitutional question of just how far religious freedom extends is not an easy one to answer and could be headed for the U.S. Supreme Court. In the meantime, private employers will have to separate their religious beliefs from the insurance coverage they offer.