Two years after the Supreme Court ruled in Burwell v. Hobby Lobby that closely held for-profit companies do not have to comply with the Affordable Care Act’s contraceptive coverage requirement if the company’s owners have moral or religious objections, this important health benefit is going back to the High Court.
On March 23rd the Supreme Court will hear Zubik v. Burwell, a challenge to the Obama administration’s accommodation for religiously affiliated nonprofit organizations that object to being required to providing contraceptive coverage for their employees. Under the accommodation, all they need to do is fill out a form stating their objection to opt out of having to provide coverage, and the insurance company provides the contraceptive coverage instead. But the groups challenging this accommodation argue that putting their objection in writing makes them party to something that goes against their beliefs.
Two years ago Hobby Lobby opened a dangerous door and now, with Zubik, these employers are trying to tear that door off its hinges—arguing the interests of employers far outweigh the health of their employees. Where do we draw the line between accommodating religious belief and protecting the health and rights of those impacted by such accommodation? With Zubik, some think they can erase the line. If the plaintiffs prevail, more women will lose their contraceptive coverage.
Plaintiffs argue that the accommodation is unacceptable because it is not the least restrictive means of furthering a compelling governmental interest. Plaintiffs have asserted that safety-net programs such as the Title X family planning program could simply step in to provide the coverage to which their employees are entitled by law. One of the nonprofit briefs even suggests redefining what it means to be “low-income” under Title X to include women who can’t get contraceptive coverage under their employer-based plan because their employer objects. That argument not only represents a misunderstanding of the program’s purpose and design, it’s foolhardy and dangerous.
Each year, 45% of all pregnancies in the United States are unintended. Regular use of contraception prevents unintended pregnancy, improves women’s health outcomes, and saves millions of dollars in health care costs. The Title X program was designed to meet the preventive health care needs of the millions of poor and low-income women and men who rely on it as their usual, and oftentimes sole, source of health care. In 2015 88% of clients at Kachemak Bay Family Planning Clinic were low-income, 38% were uninsured and 19% received Medicaid. In 2013 68% of clients were uninsured, we have worked diligently as Certified Application Counsellors to assist clients to enroll in Marketplace insurance and Medicaid.
While Kachemak Bay Family Planning Clinic provides care to anyone who comes through our doors, Title X was not designed nor is it funded to meet the contraceptive needs of women who otherwise have employer-based insurance coverage. Congress has never sufficiently funded the program to meet existing (and growing) need. At current funding levels, the program only serves about one third of the women in need of publicly funded family planning care in this country.
The Supreme Court should recognize that good reproductive health is only achieved when women are given full access to the family planning care and information they need to make the best decisions for themselves and the ones they love.
Catriona Reynolds is the clinic manager for the Kachemak Bay Family Planning Clinic in Homer.