‘The Health Needs and Rights of Women Are Expendable’.

On July 8, the US Supreme Court ruled that employers can opt out of providing insurance that covers birth control based on religious or moral beliefs.

Under the Affordable Care Act, insurance coverage through employers had to cover contraception—and other preventative health care—except in the case of some religious employers such as churches. The Court ruled in favor of the Little Sisters of the Poor (an order of Catholic nuns) and the Trump administration in expanding the exemption to any employer who claimed religious or moral objections to contraception.

After the ruling, two School of Public Health experts weighed in on the Court’s decision:

Wendy Mariner, Edward R. Utley Professor of health law, ethics & human rights:

Five Justices make clear that they will allow religious or moral beliefs to prevent American women from accessing medical care. Today’s decision turns on the power of an administrative agency to require or deny insurance coverage under the Affordable Care Act, but the underlying sentiment is clear: The health needs and rights of women as human beings are expendable.

“The Department of Health and Human Services or Congress can correct this. Women are on notice that their access to health care depends on how they vote.

Nicole Huberfeld, professor of health law, ethics & human rights:

Today’s Little Sisters of the Poor decision shows the Supreme Court doesn’t understand that contraception is preventive care, and must be covered by insurers without copays under the ACA.

The Court also doesn’t acknowledge that the Trump administration’s allowance for ‘moral objections’ by employers creates a much, much broader exemption from copayment-free preventive care. Abuse of this exemption by employers will occur not because they found ‘morals.’ Rather, employers of all stripes, including large publicly held corporations, will claim this exemption for economic reasons. But, this is a false financial loophole, because pregnancy and children are much more expensive than contraceptive coverage.

Additionally, the Court’s critique of Congress’s reliance on the Health Resources & Services Administration (HRSA) to guide coverage requirements indicates no understanding that the role of HRSA is evidence-based health. HRSA did not randomly choose contraceptives as a form of preventive care; this is well-established, evidence-based medicine. Justice Alito’s opinion in particular questions whether contraceptive coverage is a compelling governmental goal, and this is a troubling shift away from his opinion in the first major case on this question, in which he assumed that contraceptive coverage was a compelling purpose.