qotd: Hobby Lobby unravels one more thread of our inequitable quilt

The New England Journal of Medicine
July 16, 2014
Money, Sex, and Religion — The Supreme Court's ACA Sequel
By George J. Annas, J.D., M.P.H., Theodore W. Ruger, J.D., and Jennifer
Prah Ruger, Ph.D., M.S.L.

The Supreme Court decision in the Hobby Lobby case is in many ways a
sequel to the Court's 2012 decision on the constitutionality of the
Affordable Care Act (ACA). Like the 2012 case, the decision was decided
by a 5-to-4 vote, but in the initial ACA decision, Chief Justice John
Roberts acted to "save" the ACA. Not this time. To simplify, the choice
facing the Court in the Hobby Lobby case was whether to favor the
exercise of religion by for-profit corporations (whose owners believe
contraceptives that may prevent fertilized eggs from implanting violate
their religious beliefs) over the federal government's attempt to create
a uniform set of health care insurance benefits.

(This article goes on to discuss the issues in the Hobby Lobby decision,
including the ACA and the Religious Freedom Restoration Act, religion
and birth control, and religion and women's health. The authors end with
the following section on medical care and the ACA.)

Medical Care and the ACA

In terms of health care, the reaction of the American College of
Obstetricians and Gynecologists (ACOG) to the Court's opinion seems just
about right to us: "This decision inappropriately allows employers to
interfere in women's health care decisions . . . [which] should be made
by a woman and her doctor, based on the patient's needs and her current
health." ACOG went on to underline that contraceptives and family
planning are mainstream medical care and should be treated as such. In
their words, "access to contraception is essential women's health care."

The Court's ruling can also be viewed as a direct consequence of our
fragmented health care system, in which fundamental duties are
incrementally delegated and imposed on a range of public and private
actors. The Court is correct on one dimension of its opinion: if
universal access to contraceptives is a compelling societal interest,
then the provision of such access ought to fall first and foremost on
the national government and only secondarily be transferred to private
parties. Our systemic reliance on health insurance that is based on
private employment provokes just this sort of clash between public and
private values.

Our incremental, fragmented, and incomplete health insurance system
means that different Americans have different access to health care on
the basis of their income, employment status, age, and sex. The decision
in Hobby Lobby unravels only one more thread, perhaps, but it tugs on a
quilt that is already inequitable and uneven. A central goal of the ACA
was to repair some of this incremental fragmentation by universalizing
certain basic health care entitlements. In ruling in favor of
idiosyncratic religious claims over such universality, the Court has
once again expressed its disagreement with this foundational
health-policy goal.

http://www.nejm.org/doi/full/10.1056/NEJMhle1408081?query=TOC#t=article

George Annas:
http://www.bu.edu/sph/profile/george-annas/

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Comment by Don McCanne

The last paragraph says it all:

"Our incremental, fragmented, and incomplete health insurance system
means that different Americans have different access to health care on
the basis of their income, employment status, age, and sex. The decision
in Hobby Lobby unravels only one more thread, perhaps, but it tugs on a
quilt that is already inequitable and uneven. A central goal of the ACA
was to repair some of this incremental fragmentation by universalizing
certain basic health care entitlements. In ruling in favor of
idiosyncratic religious claims over such universality, the Court has
once again expressed its disagreement with this foundational
health-policy goal."

Need we say, single payer?