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Healthy Separation of Church and State?

Matt Wuerker
© Matt Wuerker

Yes, the Supreme Court really did temporarily rule that employers can refuse to cover birth control in their health insurance plans based on religious beliefs. For now, the ruling only applies to a few Catholic groups involved in lawsuits challenging the ACA based on their claims that it infringes on their religious rights.

This is one I really don’t get. Nobody was forcing anyone to use birth control, so there is no violation of religious rights. And there is plenty of precedent that everyone must follow the law, even if it conflicts with their religious beliefs. After all, polygamy is illegal, even for Mormons who believe in it. And Rastafarians were never exempted from laws that made smoking marijuana a crime. As the comic points out, Christian Scientists don’t even believe in going to doctors, but they still have to provide health insurance to their employees.

I’m really surprised that conservatives are taking on this fight. They’ve been burned in the past by opposing birth control.

What makes this even more ironic is that conservatives are arguing that business owners can impose their religious beliefs on their employees, even employees who do not share their beliefs. Since when is it acceptable for an employer to tell their employees how to live their religious life?

UPDATE: It is worse than I thought. The specific lawsuit that prompted the Supreme Court injunction is from a group that is already exempt from providing contraception as part of their health insurance plan. What they don’t want to do is fill out the simple waiver form that exempts them as a religious organization. Why? Because if they do then it will allow their employees to get birth control elsewhere. So the group really is trying to control what their employees can do. If the Supreme Court rules in their favor, then the “religious freedom” of an employer will be placed above the religious freedom of real individual people.

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25 Comments

  1. Hassan wrote:

    And to make things more interesting, insurance is forbidden in Islam. So we could have (if wanted to, or perhaps individual muslim) ask for exemption from the Obamacare. But I am sure we are such a minority and have bigger issues in this country that this is not such a high priority.

    BTW, welfare state is encouraged as long as it does not overburden and stay just with rich.

    Friday, January 3, 2014 at 6:19 am | Permalink
  2. fodderwing wrote:

    “…everyone must follow the law, even if it conflicts with their religious beliefs.” I for one would prefer to see the government back down on this one. Just suppose that legislation is passed requiring all Americans to buy a Red Sox hat and bow down to a likeness of some government bigshot. “Everyone must follow the law, even if …”

    Please say that you really do get it. Rastas (a fairly recent phenom) were prohibited from an activity that was already illegal in the U.S. Hobby Lobby, privately owned, is not being prohibited from an activity, they are suddenly being forced, against their conscience, to partake in one. Big dif.

    Friday, January 3, 2014 at 7:19 am | Permalink
  3. ThatGuy wrote:

    Fodderwing, what you are suggesting is that every new law (or part of that law) could be rendered moot based on some segment of the population disagreeing with it. To counter your Red Sox or idol point, what if every company could force you to pray or (in this very real, actually happening example) decide whether or not you get access to certain types of healthcare just because the owners are ignorant of the non-contraceptive uses of birth control.

    Why should we (collectively, who put senators, reps, and a President in place to enact heathcare reform) accept the idea that actual tyranny by employers is better than a hypothetical dystopic America where everyone supports the best baseball club in America at gunpoint?

    To Hassan’s wonderful point, I would be shocked if there was not some prohibition in Christianity that directly or indirectly (i.e. insurance being very inaccessible to the poor) refers to insurance. I would love to see the uproar by Christian employees and the right to a Muslim employer using the logic of this USSC ruling to try to avoid getting healthcare for their employees. How quickly would everyone be talking about the tyranny of Islam and creeping Shariah or some such nonsense. Only a majority religion like Christianity in this country could get away with something so ludicrous as denying individual liberties to preserve an organization’s religious freedom.

    Friday, January 3, 2014 at 8:03 am | Permalink
  4. PATRIOTSGT wrote:

    “And there is plenty of precedent that everyone must follow the law” Really? Employer mandate delay, select individual mandate delays, this group is exempt, that group is exempt. And we are even debating that another group was granted a delay? I think you are targeting religion.

    It’s not even an exemption, it’s just a delay like the other 300 delays or whatever the number is.

    Friday, January 3, 2014 at 8:21 am | Permalink
  5. John G wrote:

    Why is it I feel that the same people who complain about adjustments to this sweeping massive change would complain if those adjustments weren’t happening? The complaint then would be about rigidity and inflexibility.

    Of course there will be adjustments, and those adjustments will be adjusted. We do all need to be treated equally under the law but a lot of details have to be worked out. Change is hard.

    Friday, January 3, 2014 at 8:32 am | Permalink
  6. Max wrote:

    “What makes this even more ironic is that conservatives are arguing that busines owners can impose their religious beliefs on their employees, even employees who do not share their beliefs. Since when is it acceptable for an employer to tell their employees how to live their religious life?”

    It’s the Golden Rule. (He who has the gold makes the rules).

    Friday, January 3, 2014 at 9:12 am | Permalink
  7. Michael wrote:

    If contraception were anything like a Red Sox hat, you might have a point, Fodderwing. However, last time I checked they had almost nothing in common, so your attempted analogy is beyond absurd.

    Furthermore, the claim that Hobby Lobby is being forced into an activity that goes against “their” conscience is a stretch. (To clarify for those who don’t know the details, Hobby Lobby’s suit is only about emergency contraception, not standard birth control pills.) First, it relies on the flawed claim that emergency contraception (EC) is abortion. On the contrary, EC functions in a manner similar to normal birth control pills–by suppressing ovulation and preventing fertilization. There is no scientific evidence whatsoever that EC pills allow for fertilization but prevent implantation. As such, there is no rational basis for opposing EC while allowing for normal birth control.

    Second, no one at Hobby Lobby is being forced to take EC pills. Sure, you can counter that with the charge that they are being forced to provide coverage, but that argument rests on a willful ignorance of how insurance billing works. It’s not like Hobby Lobby execs will receive a bill every time an employee gets EC. The purpose of insurance is to provide a blanket of coverage for standard medical practices, regardless of the individual services needed. If an employee gets EC or Tamiflu, the company has no knowledge, nor should they. Furthermore, how is insurance coverage any different than using one’s paycheck to buy the pills? In both cases, the money to pay for the pills came from Hobby Lobby. The only difference is whether or not the third-party insurance company must subsidize the costs.

    Third, the elephant in the room is whether or not Hobby Lobby–a chain of arts and crafts stores–can have a religious conscience. This is a dangerous precedent to set. Private, for-profit companies should never be granted the same set of rights as individuals. That’s the same line of reasoning that gave us Citizens United.

    Friday, January 3, 2014 at 9:17 am | Permalink
  8. fodderwing wrote:

    As to the ‘tyranny’ of employers, at present there probably is not an employer anywhere in the U.S. that can force someone to get an abortion or keep them from getting one. Same goes for the use of contraception. In the case of privately owned companies, it is the pocket of a private citizen that you are reaching into to pay for the ACA “insurance” benefits.

    THATGUY – I am happy for the Red Sox but do I really have to buy the hat? Before Obamacare there were many hundreds if not thousands of group and individual insurance plans, some covered one thing, some another. A vast market and a vast marketplace. Every citizen that purchased insurance could choose, even in most group policies, what coverages they would like and which ones they would rather forgo. In the Soviet Union it was one size fits all, but hey, they never knew what they were missing. The problem our government faces is that its citizens will know what they are missing.

    I certainly don’t mean to be contentious, but my background is in group health insurance and I am quite sure that those in government care nothing for an improved medical system; they have their eye on the billions in insurance premiums that are currently being handled by private companies and they want a piece of it. All of it, rather. Once they have it they will be able to reduce benefits across the board and create premium surpluses that they can use at their leisure. I understand that the ACA is a common topic here and appreciate everyone’s thoughtful comments, but I remain alarmed at the coming disaster to our country financially, quality of life-wise, constitutionally, socially, health-wise.

    Friday, January 3, 2014 at 10:43 am | Permalink
  9. jerry wrote:

    Fodderwing (#8 post):

    Do you have to buy that Red Sox hat? Yes. Why? Because your employer made the decision for you. That is what employer-based health insurance does. The employer picks the plan that is best for the company–and the employees pay the price as they have no say in the decision.

    Now the requirements have changed. What is/isn’t mandatorily covered by workplace insurance is the issue. And the problem is with employers, not employees. Employers are now required to offer coverage for services not previously desired by them–but the employer does not use the insurance. The employees do. And the employer is required to offer a broad coverage that would reasonably suit most employees. Choosing to NOT offer a particular coverage that is required by law means the employer is attempting to get a cost advantage over their competitors by offering LESS in compensation to employees as a result of a non-existent fact, which is the employer has no religious belief whatsoever. Who has ever seen a Hobby Lobby store in any church? And what happens when the current owners of Hobby Lobby die and the business is sold? Religious “conversion”? Or what?

    Friday, January 3, 2014 at 12:29 pm | Permalink
  10. ThatGuy wrote:

    Fodderwing, no one is suggesting the ACA is perfect. But anyone who thinks that the pre-ACA days were perfect must be joking. Americans pay more for their healthcare than any other developed country and get less for it while tens of millions of people didn’t even have access to it, and some of those who did had plans that were effectively useless. Reform was needed, and the ACA has made a lot of positive steps.

    This resistance from places like Hobby Lobby is just silly. As Michael points out, they won’t know the specifics of how employees are using their plans and they shouldn’t know that anyway. As the comic points out, allowing these exemptions on religious grounds sets a dangerous precedent, and unlike mandated Sox hats or idol worship, is something that people are currently trying to do.

    Thanks to Michael for pointing out my error regarding EC/birth control. I’m glad that the opposition to providing something in their insurance plans now seems a little less crazy.

    Friday, January 3, 2014 at 12:35 pm | Permalink
  11. Michael wrote:

    Glad I could help, Thatguy. I pointed it out because it was actually a misconception about their lawsuit that I had until recently. When I first learned about the distinction, I (like you) thought it made their suit seem less crazy. I don’t feel that way any more, though.

    I think opposing EC coverage while allowing coverage for standard pills is wholly irrational and has no scientific basis whatsoever. As I said above, both kinds of pills work identically by suppressing ovulation and making fertilization harder. Both also result in a thinning of the uterine lining, which (in theory) could make it more difficult for a fertilized embryo to implant, but there is no scientific data to validate this claim. Specifically, it is almost impossible (not to mention unethical) to do a randomized study where you can confirm fertilization without implantation. There is just no sound basis for opposing EC without also opposing normal pills, at least under the argument that one is an abortifacent. The only substantial differences between the two types of pills are (a) EC is a higher dosage and (b) you only take EC after having sex, rather than as a daily prescription.

    Note that their suit has nothing to do with a real abortifacent (RU486), because it is not part of the mandate. Hobby Lobby’s suit is just about bad science.

    Friday, January 3, 2014 at 2:53 pm | Permalink
  12. ebdoug wrote:

    “Once they have it they will be able to reduce benefits across the board and create premium surpluses that they can use at their leisure. I understand that the ACA is a common topic here and appreciate everyone’s thoughtful comments, but I remain alarmed at the coming disaster to our country financially, quality of life-wise, constitutionally, socially, health-wise.”
    There is a built in provision in ACA that 80% of Premiums. (not an accurate figure) must go to patient care. New York has had this for a couple of years with an oversight committee. Works well.

    Friday, January 3, 2014 at 5:24 pm | Permalink
  13. Iron Knee wrote:

    Good discussion. I especially thank Michael for giving information that (even) I didn’t know.

    Fodderwing, I am completely baffled at your claim (in comment #8) that the government wants a piece of the insurance premiums. That might be true of Medicare (which predates the ACA by many years), but has nothing to do with the ACA. The ACA has people buy insurance from private insurance companies. Not only that, but it requires those companies to spend most of the premiums on health care. The government gets no cut of this in the least.

    Just what are you thinking? Maybe you live in Colorado and are just stoned out of your mind!

    Friday, January 3, 2014 at 5:36 pm | Permalink
  14. David Freeman wrote:

    Just to be clear about how far the U. S. Conference of Catholic Bishops is taking this, it is important to understand just how picky this complaint stayed by Justice Sotomayor really is. This ruling isn’t about Hobby Lobby or any other group wanting to refuse contraceptive coverage for religious reasons. All the groups affected by this particular case already HAVE exemptions from the law. In this case the bishops are complaining that they have to fill out a form to receive this exemption:
    “Every single one of the plaintiffs in the Colorado case qualify for a religious exemption to the birth control rules — indeed, the federal government admits as much.
    In order to invoke that exemption, however, the plaintiffs need to fill out a form. That’s what the plaintiffs object to in this case. Not that they might be forced to provide medical care that goes against their personal beliefs, but that they have to inform the government that they wish to invoke their legal right by first filling out a form.” – Think Progress “Here’s What’s Really At StakeIn That Birth Control Case Involving The Colorado Nuns”

    Friday, January 3, 2014 at 6:00 pm | Permalink
  15. fodderwing wrote:

    Jerry – When Hobby Lobby is sold the new owners can do what they want. We should remember that no company, corporate or private, is required to provide health insurance for the employees, and businesses all over the U.S. are dropping coverage.

    ThatGuy – Neither am I suggesting that the situation pre-ACA was perfect. We have had a somewhat free insurance market operating side by side with a government market since the mid-sixties, with the greater expense of our system in comparison with others as a result. The mandated cost-shifting of medical care to young families and individuals from older folks who utilize medicine far more often, and sometimes extravagantly has driven the cost of a simple office visit beyond the reach of many people of marginal means. In my view, there were many options that could have been initiated, example: a simple expansion of Medicaid would have brought financial safety to the fifteen percent of Americans who could not afford insurance. Tort reform. Policies sold at group rates across State lines (currently not legal). Medicare utilization review that really works. Etc. None of these changes were waiting for the free market to bring them about. They were waiting on a government that refused to allow them, a government that had its eye on a significant cash cow and only needed opportunity. Next: your 401k.

    Friday, January 3, 2014 at 6:06 pm | Permalink
  16. fodderwing wrote:

    Hello IRON K. No, the only thing I am smoking is a Perdomo Reserve Champagne Noir, perfectly legal where I live. It appears that you do not share what I believe to be a safe assumption that the intention of those who delivered to us the ACA is to bring about a single-payer funding mechanism, a la Canada, UK, any small, homogenous northern European country. This may not unbaffle you, but if you can get hold of a Perdomo, I’m sure you’ll see how I came by this opinion.

    Friday, January 3, 2014 at 6:37 pm | Permalink
  17. Iron Knee wrote:

    Fodderwing, you claim to have a background in group health insurance, but you keep passing on some really pretty bad misconceptions. The employer mandate was delayed by a year, not eliminated. And the only reason that some small businesses are dropping coverage is because it is cheaper for their employees to get coverage on healthcare.gov. See http://www.nytimes.com/2013/12/12/business/smallbusiness/changing-the-health-insurance-equation-for-small-employers.html

    You claim “We have had a somewhat free insurance market operating side by side with a government market since the mid-sixties, with the greater expense of our system in comparison with others as a result.” That is utter nonsense. There are plenty of countries that have both a private market and a government market and yet they do not share our unique high cost and mediocre outcomes.

    If you are going to throw out wild statements, you need to back them up with actual evidence.

    Saturday, January 4, 2014 at 12:36 am | Permalink
  18. ebdoug wrote:

    Again the 1960s, I was working labor and delivery when a Dr recounted his wife needing medical care while they were on a trip to the UK. Free. Free health care. The Doctors were thrilled. Another 50 years has passed. Hillary Clinton tried 20 years ago and shot down the Republican plan in her dogmatic way. So President Obama adopted the Republican, Romney plan which should please all. And needs adjustment. He did what this country should have had 100 years ago.

    Saturday, January 4, 2014 at 5:19 am | Permalink
  19. fodderwing wrote:

    EBDOUG – UK hospitals are filthy, cancer patients are sent home, and there is no free lunch.

    IRON K – My “pretty bad misconception” on the employer mandate is given with the knowledge that employers will be penalized (taxed) if they do not provide coverage, but they are not required to provide coverage, and anyone who wants to talk about the ACA should know this. With the payment of a little baksheesh to those nice people in Washington any employer can get out of this.

    As to that wild statement about dual health care systems, the fact that other countries with dual systems do not experience such a high price for their medical needs does not mean that our own dual system is not the reason for our own high prices. [insert the name of some logical fallacy here]. Other nations did not experience the cost-shifting that I mentioned for a variety of reasons. Every situation is not the same, and we are not Bolivia. Or France, or Cuba, the UK, Sweden, etc. I don’t know of one of these countries that set up their social medical network the way Medicare was set up, and Seniors (who each spend most of their medical dollars in the last year of their lives) were not the only beneficiary in those systems as they were in Medicare. Much has been said lately about generational theft, which Medicare is, and other countries did not do this to their young. It remains that our dual system is precisely the main, but not only, reason for such high costs attendant with routine medical care in the U.S. Smoke that Perdomo.

    Saturday, January 4, 2014 at 1:54 pm | Permalink
  20. ThatGuy wrote:

    I’ve been to a UK hospital, and it was hardly any different from any US hospital I’ve visited [insert the name of some fallacy involving ridiculous generalizations here]. You also have to consider that the life expectancy of people in the UK is better, if marginally, than in the US. They can’t be doing that terrible a job if our system can’t even keep up.

    Your response to IK is similar to claiming that speeding isn’t illegal provided you’re willing to pay the tickets. I’d also imagine that these penalties (which at least double for next year) go into the pot for subsidies.

    Sunday, January 5, 2014 at 12:29 am | Permalink
  21. David Freeman wrote:

    My experience with receiving medical care as a tourist in Britain was very positive. I was seen quickly to fix a broken tooth. I offered my insurance card and they said no thanks. The few Canadians I know think their system is great and they have experience with both. Every system will have problems of some sort but I think most of what conservatives claim about Canada and European healthcare is Koch/Faux News type propaganda.
    My wife is a pediatrician. She spends at least 20% of her time arguing with insurance companies on her patients’ behalf. What a waste of her expertise. She’d prefer a single payer system but at least ACA gets almost everyone covered.

    Sunday, January 5, 2014 at 10:16 am | Permalink
  22. fodderwing wrote:

    DAVID FREEMAN – Salient points all. Unlike Canada, it seems to me that there are simply no waiting lines in the U.S., particularly for surgery, like the Canadians are accustomed to. They like their system. I don’t. Those who clamor for O’care in the U.S. seem heedless of the fact that, once truly nationalised, they will have the “health care” they thought they had a right to, but they will have given up the right to seek as much or as little health care of the type and quality that they may need or want. (Another seeming outlandish statement on my part, but that stipulation was spelled out in the original Hillarycare, and seeking additional coverage to national healthcare in many socialist countries is a crime. With the ACA it is only a matter of time as deperate measures are eventually sought to control costs).

    “20% of her time arguing with insurance companies…” I am sure that is a conservative estimate and it certainly is a problem. I remember when uniform hospital billing came in vogue in the 80′s, we (insurance people) were thrilled. I agree that the changes in store for Americans have some pluses, but I just think the minuses far more plenteous. In a single payer system, that is, nationalised health care, your wife will become essentially a government employee. Tell her to get ready, for she will spend a minimum of 20% of her time on nonsense she has not yet imagined.

    Sunday, January 5, 2014 at 8:13 pm | Permalink
  23. Iron Knee wrote:

    Fodderwing, I have lived in England, Canada, New Zealand, and (of course) the good old USA, and have had experiences with the medical system in all of them. In NZ, we shared a house with a nurse, and she would have strongly disagreed with your statement that in their single payer system that she was “essentially a government employee”. There are some government-run hospitals, but the majority were private, and doctors mostly work for themselves. And the level of paperwork was FAR less than what we put up with in the US.

    As for waiting lines, I have quite a few friends in Canada. The only waiting lines I have heard of are for elective surgery. And as someone who has had more than my share of surgery in the US, I can attest that there are definitely waiting lines here. It is not unusual to wait months for non-elective surgery here. I think the fact that doctors here do not differentiate between elective and non-elective surgery is a problem, not an advantage.

    And the waits are not just for surgery. In NZ I had to take my wife to the emergency room and as soon as she arrived she was treated in a few minutes. In the US, I have had to sit in an emergency room in extreme pain for hours, first filling out tons of paperwork and then waiting in line before they could get to me. Every single time I go to my doctor (or dentist for that matter) I have to fill out a bunch of paperwork (usually the same paperwork each time!) In NZ, I went to see a doctor for something (and I got an appointment for the morning after I called!) and there was absolutely no paperwork at all! For the emergency room visit, they had me fill out a 1/2 page form with my name and address, and that’s was it.

    Finally, I think you are conflating single payer insurance with government run health care. England has the latter, while Canada and NZ have the former. Personally, I am against the English system (although every survey shows that the British love their system). I think single payer (like Medicare) is the right system, but I am also open to Obamacare’s system of regulated private companies providing health insurance. You keep saying that with Obamacare it is “only a matter of time” before it turns into single payer. First of all, that is not true. Countries like Japan and Switzerland have systems similar to Obamacare that work fine and have not turned into single payer. Secondly, I think a system of Medicare for all would be just fine. But since you have finally told us that you are an “insurance people” I can see why you would be against that.

    Monday, January 6, 2014 at 2:06 am | Permalink
  24. fodderwing wrote:

    Thanks IRON K for your comments. Sounds like you have had favorable experiences. I am trying to let this go, but indulge me one more point. Yes, I have been an “insurance people” by trade, but also have been a consumer of medical care, and have family currently in med care. That’s enough to validate an opinion.

    Monday, January 6, 2014 at 7:26 am | Permalink
  25. Iron Knee wrote:

    Fodderwing, I will only only indulge you, I will encourage you. As someone famously said, I may disagree with your opinion, but I will defend to the death your right to have and express your opinion. I also appreciate that you acknowledged your conflict of interest.

    But I’d like to stop arguing on the basis of ideology and start thinking practically. I would gladly support our old system of health insurance if I thought it had any chance of actually working and not costing us a ton of extra money. But the only serious proposal I’ve seen from conservatives for fixing it was what became Romneycare and Obamacare. (I’m ignoring proposals like “tort reform” on purpose). And now their only serious proposal is to repeal the ACA. Sorry, no thanks.

    Even though I would favor Medicare for all (with hospitals/doctors remaining private, like in NZ), I’m willing to work with the idea of Obamacare (regulated insurance companies, but free market health care) and try to figure out ways to make it work well. As I’ve said, I believe in (actual) free markets and believe they should be at least tried as the default solution until they are shown to not work.

    Monday, January 6, 2014 at 1:49 pm | Permalink