PHILADELPHIA — The recent Hobby Lobby U.S. Supreme Court decision is “a setback for both the ACA’s [Affordable Care Act] foundational goal of access to universal health care and for women’s health care,” say two University of Pennsylvania professors writing in the new issue of the New England Journal of Medicine.
In late June, the Supreme Court ruled that closely held private companies, including Hobby Lobby, a for-profit retailer selling arts and crafts supplies, can invoke religious objections in choosing whether to cover certain kinds of birth control in workers' health plans.
Authors of the article, “Money, Sex, and Religion — The Supreme Court’s ACA Sequel,” apply an interdisciplinary methodology to examine the Court’s 5-4 decision, which it characterizes as a “ruling in favor of idiosyncratic religious claims” over “basic health care entitlements.” The authors are Jennifer Prah Ruger, PhD, associate professor of Medical Ethics & Health Policy at Penn’s Perelman School of Medicine and Senior Fellow at the Leonard Davis Institute of Health Economics, Theodore Ruger, JD, deputy dean and professor of Law at Penn Law School, and George Annas, JD, of Boston University.
The team summarizes the choice facing the Court as “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.” A central goal of the ACA, they note, was to provide all Americans with the same access to certain basic services. However, with the recent decision, they argue that the Court has instead created an even greater divide in the health insurance system, and obstructed this critical health-policy goal.
The authors argue that it is “especially worrisome that abortion is again at the center of the continuing debate over the implementation of the ACA.” This has happened, they note, even despite arguments from medical experts that the four methods of contraception under scrutiny do not induce abortion, but rather prevent abortion by first preventing pregnancy.
“It’s clear that in weighing the competing beliefs about abortion and birth control, the Court focused on the religious claims of the corporation’s owners, and not the opinions or scientific facts presented by medical professionals,” said Prah Ruger.
The authors support Justice Ruth Bader Ginsburg’s comments questioning whether the court’s decision could allow some businesses to object to all contraceptives, not simply the four in question in the Hobby Lobby case. Additionally, they share her concerns that the decision could set a dangerous precedent for employers with any number of religious objections to protest the use of other medical services, in some cases life saving, such as “blood transfusions (Jehovah’s Witnesses); antidepressants (Scientologists); medications derived from pigs … (certain Muslims, Jews, and Hindus); and vaccinations (Christian Scientists, among others).”
“The decision has broad implications beyond abortion and birth control,” said Prah Ruger. “It opens the door for numerous corporations in this country to claim similar religious exemptions for any number of health care services, and allows corporate owners to have a say not only in how their employees receive medical care, but also in their own life decisions.”
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