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Republican Over-Reach on Contraception

Posted by John McDonough  February 14, 2012 06:00 PM

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Last week, I provided some Massachusetts context to understand the dispute over mandatory coverage of contraceptives under the Affordable Care Act. The U.S. Conference of Catholic Bishops objected to a requirement that Catholic affiliated hospitals, universities, and other large employers (not including houses of worship) would have to provide free contraceptive coverage to their workers -- despite evidence that many such institutions, including Boston College, already do so.

The Obama Administration stepped back from the mushrooming controversy, freeing the institutions from providing coverage for contraceptives, though requiring their respective health insurers to do so.

After expressing initial approval, the Bishops pulled back and said the ruling did not satisfy their objections; various Republican Congressional leaders concurred, and took the matter a big step further. Last week, Freshman Senator Roy Blunt (R-MO) filed legislation to allow any employer, religiously affiliated or not, to refuse to cover any essential or preventive health service, not just contraceptives, based on the "religious belief or moral conviction" of the employer. Word from DC is that Blunt and allies will attempt to add the provision as an amendment to other legislation now moving through the Senate, perhaps as early as tomorrow.

Our own Senator Scott Brown (R-MA) has signed on as a co-sponsor of the Blunt legislation. Brown spokesperson John Donnelly has confirmed to the Washington Post that the Senator supports the Blunt legislation. So this is not an academic matter for Massachusetts voters.

The Blunt proposal goes well beyond contraception and freedom of religiously affiliated institutions. Indeed, "moral conviction" may have nothing to do with the exercise of religious beliefs, and is in no way defined in the legislative language. So any employer could stop offering any medical service otherwise required by law to be provided to workers by invoking "moral conviction."

Let's say you had me as your employer. Let's say I assumed all folks with substance abuse problems should join Alcoholics or Narcotics Anonymous, and that should be enough treatment. Under the Blunt-Brown proposal, I would be acting within my rights as your employer.

Here's another: regular readers of this column know that I'm vegan, in other words, I don't eat anything that has a mother. That's a health judgment on my part, and it's also a moral conviction. Under this proposed legislation, I would be within my rights as your employer to provide no coverage for any essential or preventive health benefit tied to Type II diabetes because I believe it's largely caused by our awful American diet. I guess no diabetic would want to work for me, and then I'd save a lot of money too. All potentially legal under the Blunt-Brown view of how things should be.

And, it's not just employers who would be permitted to discriminate. Health plans would be allowed to do so as well. By the way, existing Massachusetts insurance laws would still stand that prevent insurers from stopping required coverage to any individual or business that purchases a state-licensed insurance policy. Primarily affected by this proposal would be businesses large enough to "self-insure," affecting more than half of the privately insured market in Massachusetts and most other states.

So this issue goes well beyond birth control and women's health, though these concerns always seem to find their way to the hit list quite easily.

Back in 2002, Massachusetts State Senator Scott Brown voted for legislation that became law to require insurers to cover contraceptive services, and without an exemption for religiously affiliated institutions.

Why is U.S. Senator Scott Brown now associating himself with the antithesis of that policy, one that explicitly permits widespread employer discrimination in health benefits?

(Disclosure: I have contributed to Brown's Democratic opponent, Elizabeth Warren.)

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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