By Adam Sonfield
Senior Public Policy Associate
On March 25, the Supreme Court will hear oral arguments on two high-profile challenges to the Affordable Care Act’s contraceptive coverage guarantee, which requires most private health plans to cover the full range of women’s contraceptive methods and services, without patient out-of-pocket costs. These cases, Sebelius v. Hobby Lobby Stores and Conestoga Wood Specialties v. Sebelius, were initiated by for-profit corporations and their owners asserting religious objections to coverage of and counseling and education about specific contraception methods (emergency contraceptive pills and intrauterine devices) that they claim cause abortion.
The cases involve complex legal claims, including challenges under the First Amendment’s protection for religious exercise and the Religious Freedom Restoration Act of 1993. However, there are also central questions of fact—many of which may seem self-evident—that have been subject to misinterpretation and obfuscation. The Guttmacher Institute has written extensively about the policy and submitted an amicus brief laying out many of these facts. Notably:
- Contraception is not abortion. Numerous medical associations made this fact clear to the Court by describing the science of how pregnancies are established and the most up-to-date evidence of how contraception works. And indeed, evidence from the United States and abroad helps show the obvious: that by preventing unintended pregnancies, effective contraceptive use reduces the need for abortion. For example, publicly supported family planning services helped U.S. women prevent 760,000 abortions in 2010 alone; without such services, the U.S. abortion rate would have been two-thirds higher.
- Contraceptive use benefits women and families. The government has a strong interest in promoting contraceptive use because it enables women and couples to prevent unplanned pregnancies and to plan and space those they do want. That, in turn, has real health benefits: It decreases pregnancy-related illness, injury and death; reduces the chances of premature and low-birth-weight deliveries; and is linked to improved prenatal care and breast-feeding. Moreover, according to numerous studies and to women themselves, contraceptive use enables women to complete their education, get and keep a good job, support themselves and their families financially, and invest in their children’s future.
- Contraceptive methods are not interchangeable. Methods of contraception differ dramatically in their effectiveness. Moreover, women’s contraceptive needs and choices are influenced by concerns about side effects and drug interactions, how frequently they expect to have sex, their perceived risk of Sexually Transmitted Infections (STIs) and a host of other factors. Women who are not completely satisfied with their choice of a method are particularly likely to use it inconsistently or incorrectly, or to experience gaps in use. For these reasons, women need access to not just any method of contraception, but to the one most suitable for their individual needs and circumstances.
- Insurance coverage improves use. Cost is a substantial barrier to women’s ability to choose and use the best method for them. Highly effective methods, such as IUDs, implants and sterilization, are ultimately cost-effective, but entail high up-front costs. Even for the pill, uninsured women on average pay $370 for a full year’s supply; that is the equivalent of 51 hours of work for someone making the federal minimum wage of $7.25. So, it is no surprise that one-third of women would switch methods if they did not have to worry about cost. Removing cost barriers—as the federal policy requires, for contraception and dozens of other effective preventive care services—has been proven to make a substantial difference in facilitating access to and use of needed care.
- Counseling and education matter. In fact, the plaintiffs in these cases object not only to specific contraceptive methods but also to counseling and education involving those methods. Put into practice, that might mean a gag rule: a ban on talking with one’s doctor about the full range of contraception options, if the office visit is to receive any insurance reimbursement. That would undermine women’s ability to choose the method they will use most effectively. More broadly, it would have serious repercussions for the health provider-patient relationship and for women’s ability to give informed consent for their care.
In sum, the scientific evidence strongly supports the current federal policy on contraceptive coverage. Its benefits are tangible and substantial, and thus the employees and their family members who depend on these companies for their health insurance have a great deal to lose if their employers get their way.
Moreover, the Supreme Court’s decision could have consequences far beyond contraception. For example, there are many important coverage guarantees included in the Affordable Care Act and federal law more broadly. Employers might claim religious objections to coverage—for everyone or, for instance, for those who are young, unmarried or gay—of HPV vaccination, STI testing, breast-feeding equipment, maternity care, blood transfusions, HIV medication and mental health care.
So, it’s not only women and couples in need of contraceptive care who should be worrying about the outcome of these cases; new rights for employers that override the rights and needs of their employees should worry us all.
Adam Sonfield is senior public policy associate at the Guttmacher Institute