Contraception, the Affordable Care Act, and the Catholic Church

One of the key components of the Patient Protection and Affordable Care Act, the landmark health care reform package signed into law last year, was the requirement that private insurance plans cover a variety of preventive services for women at no additional cost.

Assuming that the constitutionality of the Affordable Care Act is upheld, starting in August 2012 insurance carriers will be expected to cover such services as well-women visits, additional screening and treatment for cervical cancer, screening and counseling for HIV and other sexually transmitted diseases, domestic violence counseling, and family planning and contraceptive services.

These new rules are based on recommendations by the non-partisan Institute of Medicine, and their logic is indisputable. In examining this issue of birth control, for example, the Institute of Medicine found that unfettered access to family planning and contraceptive services dramatically improves the health of women and their families.

Unintended pregnancy is associated with higher rates of clinical depression among mothers, and prematurity and low birth weight among children. Even for women who want children, timing is important; overly short birth intervals are also associated with adverse health outcomes like prematurity. Some women have acute or chronic conditions, such as diabetes or pulmonary hypertension, that put them at considerable risk during pregnancy. Finally, hormonal birth control methods provide many women with additional medical benefits, including prevention of migraines and treatment of endometriosis.

Despite this, the US Conference of Catholic Bishops is actively lobbying against this provision of the Affordable Care Act. Speaking at a hearing convened by the House Judiciary Subcommittee on the Constitution, Bishop William Lori argued that this contraception requirement — along with other mandates, such as requiring federally funded programs to help the victims of human trafficking to provide reproductive health services — violates their religious liberties.

Archbishop Timothy Dolan made a similar argument to President Obama during a private White House meeting last week. According to the Archbishop, the President was “very open to the sensitivities of the Catholic community.” I hope that the Archbishop is wrong.

I have a great deal of respect for the Church, and have worked closely with Catholic relief agencies in Africa and Asia. I am troubled, however, by the Conference of Catholic Bishops’ attempt to seek an exemption from the contraceptive requirements of the Affordable Care Act.

The Affordable Care Act already has an extensive conscience clause. Non-profit organizations that have a religious purpose, and that primarily employ and provide services to followers of that faith, are exempt from these requirements. The purpose of Catholic hospitals and colleges, however, is to provide health care and education. They do so without consideration of their patients’ and their students’ faith, and they employ a large number of both Catholic and non-Catholic workers. That is why they are not exempt, but this does not violate anyone’s religious liberties.

While the Catholic Church is opposed to all forms of artificial contraception, most US Catholics are not. One study found that 98% of sexually active Catholic women, and 99% of all sexually women in the US, have used some form of contraception banned by the Church. As Jodi Jacobson, Editor-in-Chief of the reproductive health and justice website RH Reality Check, further notes: nothing in the Affordable Care Act requires the Catholic Church to dispense birth control. Nor does it requires Catholic women to use birth control. It only requires that Catholic hospitals and institutions offer an insurance plan that covers it.

Women working at large Catholic institutions should be entitled to the same preventive health services as those working for a secular company like Boeing or Google, and the public seems to agree. According to a recent survey, 71% of all likely voters (and 77% of Catholic women voters) support the contraceptive coverage provision of the Affordable Care Act.

Despite this, Archbishop Nolan’s remark seems to suggests that President Obama is wavering on this issue. That would be a mistake, particularly for a President facing a tough re-election challenge.

It wouldn’t be the first time that President Obama and the Democrats have sacrificed women’s reproductive rights for political purposes. During tense budget negotiations in April, they allowed Republicans in Congress to bar officials in the District of Columbia from using local money to provide abortion services to poor women. At the time, President Obama reportedly told the Republican Speaker of the House, “John, I will give you DC abortion. I am not happy about it.”

This time, the stakes are higher. Some polls suggest that many moderate and progressive Americans who voted for President Obama in 2008, particularly women, do not currently support him. Failing to again support women’s reproductive rights itself will not drive those voters to waiting arms of the Republican Party, but it might be one more reason why they stay out of the voting booth in 2012.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on November 24, 2011. It is also available on the WAMC website.]


About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
This entry was posted in Health Care, Policy, Reproductive Rights, Women. Bookmark the permalink.

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