Under the Affordable Care Act (ACA) or ObamaCare, contraception is a required covered benefit of the health care reform’s compliant coverage. Though contraception is always available with or without the law, the ACA requires insurance to cover its costs. Put in mind that having access to a birth control product is different from being required to buy insurance that offers such a product with no additional costs. This article explains more about the ObamaCare contraception mandate to give you a better understanding on this subject.
Federal Female Contraception Mandate Prior to the ACA
There are certain aspects of the contraception mandate did not start with the ObamaCare. In December 2000, it was ruled by the Equal Employment Opportunity Commission that companies providing prescription drugs to their workers, but do not offer birth control, violate Title VII of the 1964 Civil Rights Act—a law that prevents discrimination based on sex. This legislation, which has not been altered or withdrawn even with the then new George W. Bush administration took over a month after its enactment, is still in effect until today. As it relies on Title VII of the Civil Rights Act, it applies to all companies that have 15 or more employees. As of now, employers that choose not to offer prescription coverage or any type of health insurance at all are exempt, as they observe equal treatment between men and women, but the new mandate carried by the ACA requires prescription coverage.
ObamaCare Mandatory Coverage for Contraceptives
Except for houses of worship and churches, the ACA requires all employers and educational institutions to offer contraceptive coverage to all their employees, though the mandate itself is not included in the wording of the law passed by Congress. It applies to all new health insurance plans, which controversially includes those of Christian charities, Christian hospitals, Catholic schools and universities, and other establishments and facilities controlled or owned by religious organizations that are against contraception based on doctrinal grounds.
In January 2012, Kathleen Sebelius, former secretary of the Department of Health and Human Services, announced a final rule on health insurance coverage with no cost sharing for contraceptives and contraceptive services that are prescribed by doctors and approved by the Food and Drug Administration (FDA) for women of reproductive age. This is part of the guidelines for women’s preventive health services that are embraced by the Health Resources and Services Administration (HRSA) for the ObamaCare. Also, regulations created under the health care reform depend on the independent Institute of Medicine’s recommendations in its July 19, 2011 report titled “Clinical Preventive Services for Women: Closing the Gaps”, which concluded that birth control is medically necessary in ensuring the health and well-being of women.
Now, the Obama administration has allowed religious exemptions primarily for church organizations themselves, but these do not apply to affiliated non-profit organizations, such as hospitals, that do not mostly rely on religiously devoted individuals as employees.
In May this year, the administration required that, under the ObamaCare, at least 1 of all 18 contraception methods that are approved by the FDA should be covered without cost-sharing. These forms of birth control include surgical sterilization implant, sterilization surgery, copper intrauterine device, implantable rod, IUDs with progestin, oral contraceptives with estrogen and progestin, shot/injection, oral contraceptives with progestin only, vaginal contraceptive ring, the patch, diaphragm, cervical cap, sponge, spermicide, female condom, emergency contraception, and oral contraceptives that are known as continuous or extended use that delays menstruation. Take note that all male contraception methods are not included in the mandatory coverage under the ACA.
The Controversy Surrounding the ACA Contraception Mandate
For profit employers who offer coverage, the ObamaCare requires them to provide insurance benefits for contraception and other services related to reproductive health without co-pay. Now, several companies are equating some of the drugs covered, such as the “morning-after pill,” to abortion-inducing products, as well as IUDs, which are used by millions of American women. As religious beliefs are against abortion, businesses do not feel like they should be forced to pay for such method. On the other hand, those who are opposed to this opinion say that employers should not force their beliefs on their workers as well.
Opposition to the Contraceptive Mandate
In February of 2012, a huge political controversy has surfaced involving presidential candidates for the Republican nomination, as they view the contraceptive mandate as a direct attack on religious liberty. Taking the lead of the opposition was the United States Conference of Catholic Bishops, with Cardinal Cardinal Timothy M. Dolan stating that the regulation represents a compromise and a challenge of their religious liberty. Other organizations that oppose the mandate include active Christian evangelicals. On the other hand, it is supported by groups, such as Planned Parenthood.
Compromise by the Obama Administration
In response to the criticism on how contraception should be provided by the insurers without directly involving religious organizations, the Obama administration has proposed changes to the mandate. On March 16, 2012, regulations were issued to ensure coverage for employees of businesses that are controlled by religious organizations that self insure and to require coverage for those studying at educational institutions that are controlled by such organizations that purchase insurance. The federal government believes that it is impossible under the ACA to require contraception coverage for students at religious educational institutions that self insure.
The Hobby Lobby Case
Ruling 5-4 in favor of Hobby Lobby, the Supreme Court wrote, “Closely held for-profit corporations can opt out of the Affordable Care Act’s provisions for no-cost prescription coverage of contraception in most insurance plans.” Also, it ruled that the mandate is in violation of the Religious Freedom Restoration Act (RFRA), as it requires corporations to be involved in certain conducts that seriously violate the serious religious belief that life starts at conception. Lastly, the court states that if the government still seeks to provide better access to contraceptives, it should do it in a way that it will not violate religious freedom, such as making itself accountable to pay for the distribution itself.
Good Reason to Cover Contraceptives
According to research by the Guttmacher Institute, about 99% of women in the US between 15 and 44 of age have used contraception at some points in their lives, and more than half between 18 and 34 of age have struggled to pay for the services, raising the question on why women have to bear such heavy responsibility. Then again, there are employers that just have religious objections to financially supporting anything that prevents the making of life during conception.