Obama's Catholic hospital decision

[I spent the winter writing songs about getting better]

There needs to be a campaign making it very clear to people how a bunch of old men in funny hats are causing your premiums to rise, and how Obama fought to stop that.

[Torie]

Not for nothing, but more than a decade ago, the EEOC ruled that companies which offered health care plans to more than fifteen employees that provided prescription drugs but did not cover birth control medication stood in violation of title VII of the 1964 Civil Rights Act.  That ruling has been upheld by federal courts, in Erickson v. Bartell (2001) and several other cases.  All the initial Obama Administration decision did was to extend the same principle to companies with less than fifteen employees.  You can discriminate on religious grounds, but not on the basis of sex, which is what you are doing when it comes to drawing a line at medications related to pregnancy.  And that's been the practice long before PPACA and long before people were trying to kick up wedge bs for the 2012 election year.  Now you guys want to tell me that this is all about the insurance mandate, the sudden and immanent overthrow of the republic, and once again, the forced bankruptcy of insurance companies.  Yeah, ok.  I'm only sorry that the Obama people caved at all.

Oh well, 'tis the season for making mountains, so, by all means, carry on.

anvi, I  was unaware of this legal history, so thank you for bringing it up. I am confused however, as to why Catholic hospitals have not been subject to this legal ruling before, since no doubt they have more than 15 employees.

As an aside, paying for birth control medications is not really health insurance at all, unless you think paying for toothpaste is a matter for health insurance to cover. It is a predictable expense. Insurance should be for unpredictable expenses, and if one cannot pay for predictable expenses, that is why we have an income tax credit, medicaid, and so forth. The concept of insurance, and just paying for the necessities of life for the impecunious as part of the social safety net, are being conflated here.

Anyway, the fix over time, is to make medical insurance an individual matter, rather than employer driven. You do that, and all of these matters of conscience, just go away. Problem solved!

[Torie]

Surprise, not, the Catholic Church is unhappy with the Obama "compromise."  Among other things, they are offended that the plans they offer in effect still cover birth control and so forth, even if it's for "free" and not on their dime. And the term "abortifacients" is still in play, which is a particularly hot button item for the Catholic Bishops. What they really want is for anyone for reasons of conscience to be able to opt out of an insurance plan that has this coverage. So, with the SCOTUS decision, which seemed to have been ignored or something, and now this, and with confusion as to what Obama is really doing, and how he is doing it, what we have here is confusion. At least I am confused.

In the meantime of course, the issue is not going away. It's becoming a political football.

[Sbane]

I hope it becomes a political football. This is absolutely ridiculous. It's just birth control. Let them make this into a big deal, no ones going to care. And it can only backfire. At the same time you have racists speaking at CPAC and no one seems to be concerned about that. What a f'in joke.

Oh and plan B is not an abortifacient. It's not RU-486. These bunches of retards commenting on something they know nothing about is insane. The catholic church should stick to the bible.  They don't get to decide what is an abortifacient or what the mechanism of action of a drug is, medical professionals do.

[Brittain33]

Anyone who still cares now that Obama can claim both that he backed down and scored a victory for women's health advocates was already committed to voting Republican. This is not abortion where there is downside to Dems past a certain point. Obama looks to have won this round.

[Sbane]

Anyone who still cares now that Obama can claim both that he backed down and scored a victory for women's health advocates was already committed to voting Republican. This is not abortion where there is downside to Dems past a certain point. Obama looks to have won this round.

Seriously, if this goes on any longer, I would not feel even a little bad if some Super PAC starts running ads that the Republican nominee is against contraception. And hopefully they flood the internet with that message. Maybe then the bunch of idiots will learn their lesson.

[Torie]

As to the politics, it depends if Obama loses some Catholic and other voters over this, that he would otherwise have had. I don't think anybody is going to believe the GOP candidate is against contraception, no matter how many ads are run to that effect. It is a conscience issue, although I agree that most voters must consider the official Catholic position that contraception is some horrible moral crime as very odd indeed. As to the morning after pill thing, I defer to sbane on that one. I assume he knows what he is talking about, but are the Bishops really that confused, or being deliberately deceptive on that aspect?  That seems rather hard to believe too.

But these days, nothing is that surprising anymore is it?  We live in interesting times.

[Sbane]

To induce abortion you need implantation. Plan b can do nothing if implantation has already occurred unlike abortifacients such as RU-486.

In terms of politics, you can easily run ads targeting younger women voters stating Obama made it cheaper to get contraception and the republicans are against it. I suspect it will motivate as many voters as the policy turns off hardcore Catholics who were thinking of voting democrat. I suspect most in that category are Hispanics and I doubt they will be voting Republican.

[🐒Gods of Prosperity🔱🐲💸]

I hope it becomes a political football. This is absolutely ridiculous. It's just birth control. Let them make this into a big deal, no ones going to care. And it can only backfire. At the same time you have racists speaking at CPAC and no one seems to be concerned about that. What a f'in joke.

Oh and plan B is not an abortifacient. It's not RU-486. These bunches of retards commenting on something they know nothing about is insane. The catholic church should stick to the bible.  They don't get to decide what is an abortifacient or what the mechanism of action of a drug is, medical professionals do.

[Sbane]

I hope it becomes a political football. This is absolutely ridiculous. It's just birth control. Let them make this into a big deal, no ones going to care. And it can only backfire. At the same time you have racists speaking at CPAC and no one seems to be concerned about that. What a f'in joke.

Oh and plan B is not an abortifacient. It's not RU-486. These bunches of retards commenting on something they know nothing about is insane. The catholic church should stick to the bible. They don't get to decide what is an abortifacient or what the mechanism of action of a drug is, medical professionals do.

lol

[anvi]

As an aside, paying for birth control medications is not really health insurance at all, unless you think paying for toothpaste is a matter for health insurance to cover. It is a predictable expense. Insurance should be for unpredictable expenses, and if one cannot pay for predictable expenses, that is why we have an income tax credit, medicaid, and so forth. The concept of insurance, and just paying for the necessities of life for the impecunious as part of the social safety net, are being conflated here.

As far as I understand it, the rule under discussion here applies to prescriptive contraceptives, not to over-the-counter meds, so I'm not sure how the toothpaste analogy fits.  As has been mentioned above, certain medications that can also be used as contraceptives are also sometimes prescribed for other health-related purposes.  But even if we are talking about prescription medications being used for purposes of avoiding pregnancy, it seems to me that this is the very point of the EEOC and he courts finding CRA Title VII relevant.  Pregnancy is not an entirely predictable outcome of sexual activity (sometimes it happens, sometimes it doesn't and for a host of reasons), and if a woman in consultation with her physician decides certain prescriptive contraceptives are appropriate for her condition or her life plans, the employers' exlusion of them from the coverage they offer is a form of sexual discrimination (men don't get pregnant, last I checked).  I think one reason that many people are not aware of this legal history is that the courts that have decided such cases have not uniformly enforced it--but the results of the 2001 case have led to something like over 90% of plans, even at religiously affilliated institutions, covering prescription contraceptives already.  

Of course the bishops are unhappy; the bishops are unhappy that the U.S. and every other place on the planet does not follow the Vatican's moral directives.  But, as far as I'm concerned, I say: "no, this republic is not a religious state, Catholic bishops don't get to control what women do with their bodies in this society, whether those women happen to be Catholic or not, and if I have to protect their rights and their medical needs with federal law, I'm going to do it, and the bishops can bite me."  They can believe whatever they want, but they don't get to do whatever they want, especially when it comes to women being able to get medicines that their physicians have judged it appropriate for them to have.

[Torie]

Well, for most women, if having sex, taking birth control medications is a predictable expense, even if health related, be it a prescription drug or otherwise. One of the reasons I am unhappy with Obamacare, is that it does not focus enough on having universal medical insurance to cover unexpected catastrophic health issues, which is where it is really needed. The rest is not really an insurance issue, but an income redistribution issue, to cover the "necessities" of life, of which I agree contraception is certainly one such necessity, and it is in the national interest to avoid unwanted pregnancies obviously, particularly for women who do not have the resources to adequately care, raise, and educate their kids. I certainly stipulate to that. But then I am not Catholic, much less a faithful one. I just don't live on their planet as it were.

Anyway, I am a bit surprised that Obama didn't mention that the courts made him do this, or some such. That strikes me as a rather compelling card to play.

[anvi]

Yeah, neither Obama nor anyone in the White House made much of an attempt to defend themselves on the legal grounds.  I'd say that there are two main reasons for this.  The first one everyone has noticed; the president is, at times, a wuss, and I doubt, given the fact that it's an election year, this will be the last time this quality will manifest itself when faced with a wedge issue.  The second is that this White House seems unwilling, in the heat of a political fight, to make what would otherwise be a clear legal case for themselves.  They had a pretty solid legal basis for participation in the U.N. action in Libya, and they allowed themselves to get beat up over it for nothing.  Now there's this too.  It's very strange to me, because the president is a constitutional lawyer, and while I've no doubt at all there are better ones, I'm just as sure that he isn't the dumbest one on the block, so why he doesn't lean on that background when he needs to, and when it would otherwise serve him well, is silly.

[angus]

It's just birth control.

I guess that's really at the heart of the matter.  Is the federal government legitimately sovereign over medical insurance?  If you think it is then this is just birth control.  It really is just one of many services that the government can and should underwrite, or mandate, or regulate.  That's a respectable, intelligent position.  Just not one that everyone shares.

I think at this point our best bet is to win large GOP majorities in both chambers as well as the executive branch, and repeal the entire bill. 

[Wiz in Wis]

Lost in all this discussion of the federal government requiring religious hospitals and universities are a few key points that should really be addressed.

1) The vast majority of those who use birth control are women between 18-40. Do we really think that Barack Obama who won nearly 55-60% of this demographic in 2008, would fall back and risk pissing them off? Upsetting a few conservative Catholics who were already disinclined to vote for Obama is worth the benefit of looking like you care about a key constituency that has voted for you in the past. With the compromise, and the dramatically overblown GOP response (see McConnell today) these women know who has their back, and who wants to take away their yasmin.

2) The salience of this issue is very low. Yes, it got a lot of media coverage... in February, during a lull in the coverage of the GOP Primary. In the fall, this will not be an issue that comes up. Obama has proposed a reasonable compromise, and the GOP, like always, has overreached. Do you think Mitt Romney will want to talk about birth control in the fall? This won't move as many votes as last month's job report did... not even close.

3) While this is a politics board, I will say that the real issue here is the civil war in the Catholic Church. Conservative elements, under the direction of Rome, have spent the better part of the last decade taking a big juicy dump on the social justice wing of the Church. The result has been the mass aging of the general Catholic population, as hundreds of thousands of young people (look up the most recent ARIS study to see the age/religion shift) have abandoned the church... sometimes for more conservative evangelical churches, but more often for the church of I'll sleep in as late on Sunday as I damn well please. These people will not come back. I remember living in Milwaukee when Timothy Dolan was the Archbishop there. There were TV ads literally begging disaffected Catholics to come back to church... He was on there basically saying " PLEASE COME BACK... PLEASE! PLEASE! PLEASE!.  This issue will only further divide the church between the hardliners who just cant seem to enter the 21st century, and those who  are perfectly happy being a new Episcopalian or agnostic. Dolan has a lot more to lose here than Obama does.

[Beet]

At some point it seems that it became morally and politically fashionable to assume that it is the government's right and responsibility to ensure medical coverage to the masses.  I hold out slim hope that it was just a bad dream.

"At some point"? Please read this.

[True Federalist (진정한 연방 주의자)]

Yeah, neither Obama nor anyone in the White House made much of an attempt to defend themselves on the legal grounds.  I'd say that there are two main reasons for this.  The first one everyone has noticed; the president is, at times, a wuss, and I doubt, given the fact that it's an election year, this will be the last time this quality will manifest itself when faced with a wedge issue.  The second is that this White House seems unwilling, in the heat of a political fight, to make what would otherwise be a clear legal case for themselves.  They had a pretty solid legal basis for participation in the U.N. action in Libya, and they allowed themselves to get beat up over it for nothing.  Now there's this too.  It's very strange to me, because the president is a constitutional lawyer, and while I've no doubt at all there are better ones, I'm just as sure that he isn't the dumbest one on the block, so why he doesn't lean on that background when he needs to, and when it would otherwise serve him well, is silly.

Not strange at all.  A legalistic defense may work very well in a court of law, but it seldom works well in the court of public opinion.  The problems Obama faced on this issue were not legal, but political.  Indeed, if the administration were to make the legality of the actions you mentioned the focus of their response, it would hurt politically.  Better to respond with  forceful defense of the legality of their actions only when directly confronted with it.

[Beet]

It's very different with drugs and medical services.  Moreover, a building has no rights.  There is no guarantor that a building can say, "By god I'm an American building, and you cannot tell me how many doors I must have."  People are not buildings.  People have liberties.  Or, at least, they used to.

But one can say "By god" (somehow the god part is import), "I'm an American, and you cannot tell me how many doors my house can have."

Health insurance, too, has no rights. Like buildings, insurance policies are an artificial construction. Their existence is even more tenuous than that of a building; while buildings have a physical presence, insurance policies are only entries in a database somewhere, backed up by the force of law.

The supporters of universal health care have always wanted health care to be funded by the same pool run by the state, which is in turn funded by payroll taxes, just like Social Security. Such taxes would necessarily be compulsory. Compromises have forced the current situation, which attempts to get universal care, but leaves insurance out of the hands of the state and in the private sector. ACA would not have existed if it were not more palatable to political centrists than a single-payer system, modeled on Social Security. So to suggest that ACA is anything other than a less bold, timid version of Social Security for healthcare, (or less bold, timid version of Medicare for the young) is wrong.

In any case, Obama is bound by law to follow section 2713 of the ACA, which directs the executive branch as the authority on the preventative care rules. Even if Ron Paul had been President, he still would have been bound to follow the law, and if he were not, he would be in breach of his duties as President.

[angus]

It's a good point, Beet, that the campaign for universal, government-run medical care spans a century.  I was aware of that, as it gets mentioned quite often, but the fact that it has never come about--still hasn't, given the loopholes in the latest bill--testifies to the fact that this is something that we have rejected, time and time again.  And we may yet again.  As I said, all we need is control of the congress and the presidency to get it repealed.  It's not an impossible goal, and if we can rally the base around a decent candidate, it could happen.

[anvi]

I hear you, Ernest, and it's perhaps true that, as a general rule, that politicians don't sound good giving legal defenses of policies, especially when they're controversial.  But something simple, that articulated the grounds for the legal principle, might not be too hard a sell.  When challenged on the supposed unconstitutionality of U.S participation in the Libya operation absent consent from Congress, for instance, why not just say: "We are under a congressionally mandated treaty obligation with the United Nations, and the Constitution recognizes treaty obligations as the supreme law of the land."  Or, with this issue, why not just say: "failing to cover prescription contraceptive medication for women has been found by federal courts to violate a woman's civil rights, and the Affordable Care Act passed by Congress directs me to implement these provisions, and it's my job as president to faithfully execute the laws."  That way, you articulate a principle that you're following; the bishops' problem lies with the courts, not with the president, so it deflects the controversy and allows Obama to stand strong for the constituency of women.  Maybe he has to give other political justifications too, of course, but I don't see why saying these things would hurt his case.  The way he handled it just features him piecing together an incoherent solution, one that won't satisfy any of his critics, and placates only a few Senate Dems like Kerry and Casey (Senate Dems never waste an opportunity to muscle Obama around, and the more he lets them, the more they do it).  Why not stand for something, and find a way to look good doing it?  But, I realize all this is armchair quarterbacking on my part; I, after all, never got elected to any public office, and there are lots of good reasons that is true.

[angus]

"failing to cover prescription contraceptive medication for women has been found by federal courts to violate a woman's civil rights, and the Affordable Care Act passed by Congress directs me to implement these provisions, and it's my job as president to faithfully execute the laws."  

I think that'd be a reasonable answer to the charge being made by those specifically objecting to birth control as something special. 

Of course, to those of us who don't see birth control as any different than nose jobs or X-rays, and who think none of it should be in the purview of the federal government, the best solution is legislating an end to the very inappropriately-named Affordable Care Act, and all other acts dealing with medical care, and putting it back in the private sector where it belongs.

Birth control is a very good thing, make no mistake of it, and it is best liberally applied.  Government, on the other hand, is a necessary evil, and should be kept minimal.