Who Pays for the Pill? (I)
The clash between reproductive freedom and religious conscience
Oct 2, 2000, Vol. 6, No. 03 • By JOE LOCONTE
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."
If mandates like this become universal, they will affect a staggering number of church-based institutions. Nationwide there are over 21,000 religious schools, plus hundreds of seminaries and religious colleges and universities. Catholic Charities supports 165 diocesan agencies, while nearly 1,000 Catholic hospitals and nursing facilities provide about 16 percent of all hospital beds. The National Association of Evangelicals boasts a member list of over 5,000 religious nonprofits. To that must be added countless doctors, pharmacists, and assorted individual employers who personally oppose birth control and abortifacients.
Catholic leaders have fought the laws in state capitols and helped craft more expansive conscience clauses in places like Maryland and Connecticut. But they have received little help. Pro-life groups, focusing on the fight against abortion, avoid the contraception debate. Rank-and-file Catholics largely disregard church teaching on birth control, while evangelical Christians mostly fail to address the issue.
"Our people don't even think about it," admits Richard Cizik, vice president of governmental affairs for the National Association of Evangelicals. "They don't fully realize the long-term agenda." Michael O'Dea, executive director of the Christus Medicus Foundation, which helps Catholic archdioceses set up health insurance plans, agrees. He sees widespread confusion and complacency about health care policies. "It's routine now for insurance companies to cover contraception, sterilization, and abortion," he says. "Many Catholic organizations don't really know what they're subsidizing." Says Myers of Ave Maria Law School, "This stuff is creeping in through the back door."
Political pressures to universalize abortion coverage, however, could easily spark a backlash. Pro-life activists note growing demands on health insurers to cover abortion-inducing drugs such as the "morning after" pill, already available by prescription, and RU-486, still awaiting federal approval. At the same time, frustration deepens with government tax policies that favor work-based insurance, making it burdensome for families to buy alternative plans that uphold their moral beliefs.
Oddly, both sides in this debate see themselves as defending freedom against heavy-handed social engineers. Says Richard Doerflinger, of the National Conference of Catholic Bishops, "It's as if we were just arms of the government. It's the idea that there is no such thing as private health care or private conscience." On the contrary, insist pro-choice leaders, employers have no right to impose a religious restriction on their workers' health insurance. "Whose conscience counts?" asked Gloria Feldt on a recent Crossfire. "What about the conscience of the individual who feels that it's very important to plan and space having children until you're ready to take care of them?"
Never mind that inexpensive birth control is available at the corner pharmacy. For many pro-choicers, anything that reduces the convenience of contraception or abortion is a transgression against women. Planned Parenthood, for example, has launched an effort to prevent mergers between Catholic and secular hospitals -- even when they are the only means of keeping facilities open. As the organization's "MergerWatch" director Lois Uttley warned in Redbook, "This is one of the most serious threats to women's reproductive health care today."
Threats abound, to be sure, but not from organized religion. Pro-choice activists claim a social concern to make health services available to women, particularly the poor. Yet they are alienating the very health care providers who do the most to reach the neediest -- religious hospitals, clinics, charities, and shelters. They demand these agencies offer services without discrimination, while they themselves discriminate against groups whose belief in God sustains their caregiving. They welcome religious duty as long as it serves their notion of the public good, even as they advance policies that confine faith to a private ghetto.
"The mask of choice is falling off," says Susan Orr, a policy expert with the Family Research Council. "It's not about choice. It's not about health care. It's about making everyone collaborators with the culture of death." A little hyperbolic? Perhaps, but it's no foible to be troubled when deeply held beliefs are publicly disparaged. It is no whimsy to worry when people are forced to bankroll whatever reproductive practices are in vogue -- today chemical abortion, tomorrow cloning.
And tomorrow is fast approaching. In June, the American Medical Association considered a plan that would have required hospitals receiving federal money -- virtually all hospitals -- to offer "a full range" of reproductive services, including abortion. It took the unprecedented intervention of Cardinal Francis George of Chicago to persuade AMA delegates to defeat the measure. In August, the National Institutes of Health approved federal funding for research on human embryos. For anyone still serious about bedrock American notions of freedom, it would be foolhardy not to ask where all this leads.
Joe Loconte is the William E. Simon fellow in religion and a free society at the Heritage Foundation and a commentator on religion for National Public Radio.