The Magazine

Who Pays for the Pill? (I)

The clash between reproductive freedom and religious conscience

Oct 2, 2000, Vol. 6, No. 03 • By JOE LOCONTE
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AFTER an embittered and byzantine debate last July, the Washington, D.C., city council unanimously approved a bill requiring health insurance plans sold in the District to cover contraceptives. Every religious employer in the city -- not exempting the National Conference of Catholic Bishops or even churches -- would have been required to comply. The bill earned a pocket veto from the mayor, but a version of it is expected to resurface this fall.

It is a sign of things to come. In the last two years, 13 states have begun requiring health policies that cover prescription drugs to add contraception, including abortion-inducing drugs and devices. The laws are forcing employers -- such as religious hospitals, schools, and charities -- to subsidize practices they find morally offensive. So-called "conscience clause" exemptions are too narrowly written to offer much protection. The dogma of sexual liberation is quietly insinuating itself into the very definition of health insurance.

A noisy and litigious clash of values is inevitable: The right to reproductive freedom, minted during the sexual revolution, is on a collision course with the free exercise of religion, enshrined in the Bill of Rights as the capstone of American liberty. Planned Parenthood president Gloria Feldt calls opposition to contraception mandates "blatant sex discrimination against women." Richard Myers, professor of law at Ave Maria School of Law in Ann Arbor, Mich., demurs: Requiring birth-control coverage "is an assault on religious institutions at their core. It takes away their ability to define themselves and the nature of their operations."

The contest can only intensify. In October 1998, Congress imposed a contraception mandate on the health insurance system for federal employees, the first and only time specific benefits have been required in the system's 40-year history. At least a dozen more states are debating similar laws. Last July, Planned Parenthood filed a discrimination lawsuit against the Bartell Drug Company for failing to include birth control in its employees' health plan. If successful, the suit could shake up the entire industry.

The majority of states with mandates include protections for religious groups, but most of these are turning out to be a sham. As the Alan Guttmacher Institute, an affiliate of Planned Parenthood, frankly admits, "the goal is to craft as narrow an exemption as possible." Under California's law -- a model for other states -- only a "religious employer" can qualify, and only by meeting several criteria: It must (1) make the teaching of religious values its primary purpose, (2) employ primarily persons who share its religious beliefs, and (3) serve persons of the same religious background. That probably limits protection to houses of worship.

Meanwhile, private entities ranging from colleges to health clinics are vulnerable to the regulations. Insurance companies decide who qualifies for an exemption, while state agencies monitor compliance by insurers and HMOs. Critics argue this puts religious freedom at the mercy of bureaucrats. "These are conscience clauses without a conscience," says C. Ben Mitchell, of the Ethics and Religious Liberty Commission of the Southern Baptist Convention. "It's a threat to every religious institution." Catholic Charities of Sacramento already has filed suit against the state of California. Warns executive director Jim Rodgers, "The effect of this new legislation would be to secularize us."

The Catholic Church is at special risk. The 1968 Papal Encyclical "Humanae Vitae" reiterated the church's condemnation of artificial birth control, and the National Conference of Catholic Bishops has told Catholic health care agencies they may not "promote or condone contraceptive practices." Church institutions typically omit contraception coverage for employees. The original D.C. bill, which allowed no exemptions, would have brought every Catholic organization under its purview. Says Sister Carol Keehan, president of D.C.'s Providence Hospital: "We're talking about profound issues that concern life, not what kind of pictures we can hand on the wall."