Up At The Supreme Court: Bosses Weigh In On Your Contraception

January 27, 2014 12:00 p.m.

What do a handful of businesses, bosses and bureaucrats have in common? Fierce and unrelenting opposition to the Affordable Care Act’s (ACA) birth control benefit.

The ACA established minimum standards for health insurance to ensure that individuals can get the health care they need to lead healthy and productive lives. Contraception was included in that coverage. What should be uncontroversial and common sense has met swift opposition from a small minority since the law pulled out of the station in 2010. And on March 25, that train arrives at the Supreme Court.

Businesses and bosses—including the owners of Hobby Lobby craft stores and Conestoga Wood Specialties manufacturers—are suing the federal government over the law. They argue that they should not be forced to include the full scope of Food and Drug Administration-approved contraceptives in their insurance plans, as required by the ACA.

In other words, these employers want the Supreme Court to allow them to effectively overrule their employees’ health-care needs. The case is not only novel in where it seeks to take the law; it is a fundamental affront to good medical care and public health.

The gold standard of health care is medicine backed by science and rooted in patient need. This is what every patient wants, deserves and expects to receive. These medical standards of care are uncontrovertibly clear: birth control is crucial to women’s health. Indeed, it is one of the most accepted aspects of comprehensive care and part of the daily lives of more than 100 million American women.

The bounty of evidence is immense. Access to family planning has paved the way for women to map out their lives and secure better economic futures. Proper spacing between pregnancies allows a woman’s body to support healthy babies. Planned pregnancies can diminish low infant birth weights and neonatal death. This is why the American Public Health Association has endorsed universal access to family planning for more than 30 years. And no wonder then that every major professional American and Western European medical academy includes family planning in women’s care.

Contraception is much more than just family planning. For millions of women it can mean the difference between life and death.

Nearly 6 percent of pregnant women are exposed to prescription drugs that are contraindicated during pregnancy and put fetuses at risk. Heart disease—the number-one killer in the U.S.—can wreak havoc on a woman’s body when coupled with the changes that happen during pregnancy. As a result, doctors sometimes counsel affected women to avoid pregnancy.

Women with diabetes—a condition that disproportionately affects African-Americans, Latinas and Asian-Americans—must take care not to become pregnant until their glucose levels are controlled. The risk of death for pregnant women with lupus is 20 times higher than for other women.

For these women, contraception is not about politics and ideology; it’s about health.

Left out of the polarized Obamacare debate is cost. Health care is expensive. No one debates that. It is not surprising then that one of the biggest roadblocks to tackling unplanned pregnancy is the lack of contraception use. Cost has always kept some of the most effective methods out of reach. Because of this, the ACA requires that insurance plans cover contraception without out-of-pocket costs.

Before the law, co-pays alone could set a woman back up to $600 a year, or $50 a month. Fifty dollars may be pocket change for the well heeled, but for the two-thirds of working women who earn only minimum wage it is anything but. That extra $20, $40, even $60–cost varies widely depending on brands—adds up. Even a mere $10 co-pay for generic contraception can strain a financially struggling woman’s bottom line. And when the budget gets tight, something has to give.

Tight finances along with a host of other factors impeding access to care are why women of color continue to experience some of the highest unintended pregnancy rates.

Remarkably, the business owners taking their cases all the way to the Supreme Court would have us believe the government has waded into an entirely new arena. Nothing could be further from the truth.

The ACA comes on the heels of similar requirements in the Federal Employee’s Health Benefit’s Program, which covers more than 8 million workers; health coverage offered to millions of military members and their families; and the more than 60 million Americans on Medicaid—America’s largest insurer.

Claiming that contraception coverage is a “new thing” is patently wrong. These programs have long recognized that requiring contraceptive coverage is a core tenant of equality and consistent with good medical practice. Instead, the opposition ignores decades of settled policy trying to ameliorate the health and economic toll that unplanned pregnancy takes on American women.

What is new, however, is asking the Supreme Court to allow an arts-and-craft chain or cabinetmaker to dictate the health-care needs of employees and their families.

Hobby Lobby’s owners claim that certain contraceptives, such as IUDs, cause abortions—an assertion flatly contradicted by science. Conestoga Wood’s owners would like to impose their personal views on their employees by claiming federal overreach.

Both are free to believe what they want to believe. Neither should be allowed to impose their ideology on their workers.

What is at stake in these cases is an entirely new America, one where employers would have unprecedented say in workers’ personal lives and jeopardize women’s health.

A woman must be able to make her own health-care decisions without interference or input from her bosses. Asserting otherwise puts American workers in a perilous position and takes women back to another century.

Susan Berke Fogel is director of reproductive health at the National Health Law Program.

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