15 December 2013

New England Journal of Medicine wants Hobby Lobby to lose

Where do the religious rights of a health insurance purchaser end? The New England Journal of Medicine brings up a point I've made before, not here but in conversation: If an employer is a Jehovah's Witness and thus objects to blood transfusions, then can they refuse to pay for health insurance coverage for an employee's blood transfusion? No, because it is objectively ridiculous to refuse blood transfusions. But, on a less ad hominem level, it seriously risks the health and life of an employee who may need a blood transfusion.

But more importantly, it's not your employer's decision whether you get a blood transfusion. It's not your employer's concern what you do with your body when it comes to your and your doctor's medical decisions. Because holy crap, why on god's green earth would you ever order your doctor to consult with your boss when you're about to bleed to death after a car crash or during complications from surgery?

In the Hobby Lobby case, an employer who religiously objects to contraception wants to refuse to pay for health insurance coverage for contraception. But why is this any different at all from an employer who may object to paying for blood transfusion coverage? The payor has a religious objection to something medical a third party wants to do. And there's a power differential, of course -- but it's not like a parent who has a real say (and duty) to oversee their child's medical care. So why is this literally a federal case?

Just like with a blood transfusion, it's a private medical decision that doesn't involve the employer at all. And just like with a blood transfusion, when patients get the contraception they ask for, then they're more healthy:
If the full panel of FDA-approved contraceptive services is made available to American women, the public health of the country will benefit. If a woman's religious beliefs compel her to decline such services, she has the right to do so. But to deny coverage for these vital public health services to women who want them but cannot afford them outside their employer-sponsored insurance would be a personal and public health tragedy.
To be absolutely clear, the only difference between not covering blood transfusions and not covering contraception is the gender of the patients who need it. Never mind the privacy issue, because if it were a privacy issue, then the case wouldn't have made it to the Supreme Court. Nobody would dream of allowing a "blood transfusion exception" to the health insurance coverage requirements of the Affordable Care Act, because it's completely absurd. No, this is squarely a gender discrimination issue. And NEJM puts it in terms of equal protection and full self-actualization:
[P]lanned pregnancy affords women and their children a better quality of life: it gives younger women the opportunity to complete school, start careers, and establish stable relationships, and older women the ability to add to their families only when they have the capacity to care for them.
Recall that this was what Justice Ginsburg said in 2007. Restrictions on access to reproductive healthcare prevent women from "enjoy[ing] equal citizenship stature" and deny them "autonomy to determine [their] life's course" (Gonzales v. Carhart, 550 U.S. 124, 172 (2007) (Ginsburg, J., dissenting) (PDF)). In this case, just as in anti-abortion cases, women risk losing full autonomy and citizenship. It's not a tax issue; it's not a privacy issue; and it's not an anti-President Obama issue. It's a woman's issue.

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