FAQ: The Supreme Court's Contraception Ruling

[mikesimon]

The Supreme Court's recent decision in the Hobby Lobby case[1] allows for-profit businesses to assert a religious objection to the contraception coverage requirement mandated under the Affordable Care Act (ACA). Wondering how this decision will affect patient care? Here's our guide to everything you need to know about the clinical implications.

Q: What does the contraception mandate require under the ACA, and how will it affect women's health?

The ACA mandate requires every health plan to cover the full range of FDA-approved contraceptives without a copayment. "Houses of worship are exempt, and religiously affiliated nonprofits get an accommodation, meaning the organization does not have to pay for the coverage but the insurance company has to make sure the employees get this coverage," says Judy Waxman, Vice President for Health Reproductive Rights at the National Women's Law Center.

What is exciting about the ACA, says Jeanne A. Conry, MD, PhD, Immediate Past President of the American Congress of Obstetricians and Gynecologists (ACOG), is that it provides the mandate for preventive healthcare, including contraception, as a covered benefit. "We're very good at providing the best care and best contraception option, and we're at the stage where long-acting reversible contraception is gaining hold and offers a better opportunity to not worry about contraceptive failure," she says.

Dr. Conry says the need for access to contraceptives and reducing contraceptive failure is highlighted by the fact that 50% of the pregnancies in the United States are unplanned.[2] In addition, she notes that over the past 10-15 years, maternal mortality has doubled in the United States and is now comparable to some developing countries.[3] This indicates that women in the United States are not planning pregnancies and are not getting the best healthcare prior to conceiving, she says.

Q: What was the main issue that the Supreme Court weighed in their recent ruling on the Hobby Lobby case?

Hobby Lobby, a craft store chain, sued the US Department of Health and Human Services over the ACA mandate, specifically objecting to the requirement to cover 4 types of contraception (2 types of intrauterine devices [IUDs] and 2 types of morning-after pills) deemed abortifacients by the store owners.[4]

The main issue the Supreme Court weighed was whether for-profit companies must comply with the ACA mandate. Citing the Religious Freedom Restoration Act, passed in 1993, "the Court held that closely held family-owned companies that have a sincerely held religious belief do not have to cover contraceptives for their employees," Ms. Waxman says. "The Court implied that the same accommodation afforded nonprofit organizations could work for these for-profit companies."

Q: What are the larger implications of these decisions?

Although the Supreme Court says the ruling is a very narrow decision, there are many controversial issues in women's health that potentially could be considered by certain companies as violating religious beliefs, Dr. Conry says.

A good example of this, she says, is the human papillomavirus vaccine. The scientific evidence behind the importance of this vaccine for preventive health is overwhelming, yet there are ill-informed people who believe that the vaccine promotes sexual promiscuity or who are against vaccines for other reasons. Dr. Conry asks, if someone who owned a company had these views and based them on a religious belief, would religion then trump science in this situation too?

The larger implication, therefore, is the potential for companies to ask for exemptions regarding other types of healthcare because of religious beliefs, such as mental health services, AIDS drugs, or vaccines. This also could open the door to companies seeking religious exemption in providing healthcare to certain populations, such as gay people, Ms. Waxman says.

Q: Where does the medical community stand on this issue?

Various medical societies have responded negatively to the ruling, including ACOG, the American Medical Association, the American Nurses Association, and the American Academy of Family Physicians. These societies contend that the decision has a negative impact on women's health and calls up the larger issue of employer intrusion on the physician-patient relationship.[5] In its position statement, ACOG says access to contraception is essential for women's healthcare, and emphasizes the impact of contraception on reducing maternal and child morbidity and mortality as well as unintended pregnancies.[6]

Q: Will this have a significant effect on patients?

Although there is uncertainty about the number of patients affected by the ruling, what is certain is that women employed by a business that claims the exemption will have to pay for their own contraception if they use it. This may be prohibitive in many women who can't afford to pay, for example, the $600 or so for an IUD, Dr. Conry says. According to Dr. Conry, for women in whom hormonal birth control is contraindicated, such as those with diabetes and hypertension, and for whom an IUD is the best option, the lack of access to an IUD because of cost would mean offering suboptimal care and increasing the risk for morbidity.

Q: What can be done to provide all patients access to different types of birth control?

Women who are affected by this ruling -- that is, employees of for-profit businesses that are granted the exemption -- will need to either pay for coverage out of pocket or seek assistance from several private and state resources to help defray the cost of contraception.[7]

In order to change things on the policy level, Congress would need to enact legislation that would override the ruling on the Hobby Lobby case. The first attempt to do this was the Protect Women's Health From Corporate Interference Act bill, which was voted down in the Senate on July 16. Senate Majority Leader Harry Reid has said that another attempt to override the ruling will be made before the end of the year.[8]

http://www.medscape.com/viewarticle/829465

[mikesimon]

But Hobby had a sincere belief that they were abortifacients and that makes it okey-doke......constitutionally speaking, that is.

[desrt]

"....... if someone who owned a company had these views and based them on a religious belief, would religion then trump science in this situation too? "

Crux of the biscuit.
Three of the 4 methods Hobby Lobby 'believe' to be abortifacients simply aren't.

[Vance2335]

Women still have access to all birth controls.

[brice1967]

It might be interesting to wee what happens next.