Hobby Lobby vs. female patients and their doctors

On Monday the Supreme Court ruled in Burwell v. Hobby Lobby, in a 5-4 decision, that closely held for-profit businesses may opt out of the Affordable Care Act’s requirement to provide health insurance that covers all contraceptives approved by the Food and Drug Administration. The majority opinion, which none of the court’s female justices joined, claimed that the 1993 Religious Freedom Restoration Act protects the rights of such businesses’ owners to withhold coverage for birth control if they claim it violates their religious beliefs.

Meanwhile, women — particularly lower-income women — are left to struggle to pay for basic birth control that should, by all rights, be included in their employer-sponsored health insurance. It was left to Justice Ruth Bader Ginsburg’s scathing dissent to articulate the inequities women have faced in the health sphere and the very real health and economic challenges ignored by most of her male counterparts.

Let’s set aside that birth control should not be — and, except for a very vocal minority, is not —controversial in 2014; the court’s decision weakens the sanctity of medical practice. The gold standard of health care is medicine backed by science and rooted in patient need. This is what every patient wants, deserves and expects. 

The medical standards of care are uncontrovertibly clear: Birth control is crucial to women’s health. It is one of the most accepted aspects of comprehensive care worldwide and is used by more than 100 million American women. Every major U.S. and Western European medical academy supports accessible and affordable birth control. The federal government has used policies to protect and expand access to it for decades because it is essential to quality care for women.

The rationale behind medical insurance coverage should be health, not politics or ideology. Contraceptive coverage is good medical practice, and the body of evidence is immense. For more than five decades, access to family planning has allowed women to map out their lives and seek better economic futures. Properly spaced pregnancies allow a woman’s body to support healthy babies, reducing the likelihood of low birth weight and neonatal death. These reasons undergird the health law’s protections and were the very same reasons the nonpartisan Institute of Medicine recommended robust coverage when it was tasked with reviewing which preventive services are needed for well women’s health and should be covered. 

Contraception is responsible for far more than just family planning. For women living with serious chronic conditions, it can mean the difference between life and death. Heart disease is the nation’s No. 1 killer and can seriously damage a pregnant woman’s body. Women with lupus are 20 times more likely than other women to die during pregnancy. In these cases, contraception is not just about what happens in the bedroom but about being able to live without fear of premature death.

Yet in protecting the religious beliefs of for-profit business owners, the court overlooked the crucial role contraception plays and the dire situations that can result from lack of access.

Americans rely on health insurance to cover their costs because without it, health care is prohibitive for the average person. Ask any of the 99 percent of women who have used birth control at some point in their lives: Coverage is expensive.

In the days preceding the ACA, co-pays for birth control could set a woman back up to $600 a year. Working $50 into a monthly budget may be easy for the well off, but for the nearly two-thirds of minimum wage earners who are female, it can break the bank. This is why reliable contraception has been widely available for decades yet out of reach for many. 

These very real concerns about women’s health were dismissed by the all-male majority opinion. And the ramifications extend far beyond birth control.

In the coming years, as Ginsburg warned, we could see similar challenges against immunizations, anti-depressants and blood transfusions. Left unchecked, the precedent set by the Supreme Court threatens to send the nation back to the days of Conestoga wagons, when communicable diseases ravaged unvaccinated children, when anesthesia was considered unnecessary for African-Americans and when parents could object to their children’s receiving lifesaving blood transfusions. 

Ginsburg was right: The court has ventured into a minefield. Either the door is now open for all manner of challenges to American’s health care needs or the court is 20 years behind science and evidence and thinks that contraception is not basic to women’s health care.

Corporations must not be permitted to opt out of the social compact and the laws that govern the rest of the country. The result is an America where the rights of for-profit corporations, treated as full-fledged people, are respected but the rights of women are not.