For much of 2012, congressional Republicans have pushed back aggressively against the preventive care measures in the Affordable Care Act, driven entirely by the right’s opposition to contraception access. In the Senate, we saw the odious Blunt Amendment reach the floor, and in the House, GOP lawmakers vowed to block implementation of the provision.
At least, that was the case a few months ago. With the Obama administration’s rule set to take effect this week, Republicans’ interest in the issue has faded. GOP officials are still opposedto the birth-control measures of the ACA, but unlike in the Spring, there’s a limit as to how far Republican leaders are prepared to go with this.
There is, however, a parallel track involving the judiciary. While lawmakers on Capitol Hill have all but given up on blocking access to contraception, fearing a public backlash, opponents of the policy are pushing forward in the courts, and late on Friday, they even won a round — Irin Carmon reported that a federal judge issued an injunction exempting the Catholic owners of a Colorado company from the contraception requirement.
It was the first legal victory for conservative opponents of the Obama administration’s policy
Benen is stating that accurately. Republicans are pushing back against the preventive services requirements in the health care law. Big surprise. Republicans oppose regulation that applies to large employers.
During the contraception battle, when we saw the panel of male religious leaders who were invited to weigh in on contraception coverage for American women, this issue was presented by media and conservatives as very narrow. We were directed to stop whining because birth control pills are inexpensive, and the absolutely endless religious exception for large employers that Republicans and certain religious leaders are demanding would affect a very narrow portion of the population; women of child-bearing age, who of course are of no concern to the general population. Liberals countered that large employers could refuse to cover all sorts of medical treatments and services relying on religious objections. That’s true, and what’s more, it’s not some slippery-slope, wild-eyed theory. They’re litigating this and they just won one.
It’s so important to put this within the context of the health care law, and go back to the actual HHS rule on preventive services and large employers, because that’s what this is actually about :large employers and federal mandates on what they have to offer to meet the new rules under the PPACA. Understand that preventive services with no co-pay or meeting a deductible are an integral part of he health care law. This section of the health care law adds value to health insurance for ordinary people. Too, the preventive services are not “free” which is another lie conservatives and media are promoting in order to portray women as whiny, needy deadbeats. If you’re paying an insurance premium, and you will be on the exchanges under the health care law, you’re paying for these services. If insurance is part of your compensation package at work, you’re paying for these services. This is not a gift from the federal government, and it’s not a gift from your employer.
Here’s the list of preventive services that large employers must include in insurance policies to employees and that must be covered in health care plans offered on the exchanges. Look at this list and think about how many of these required services could be denied based on “religious objections”:
• Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
• Alcohol Misuse screening and counseling
• Aspirin use for men and women of certain ages
• Blood Pressure screening for all adults
• Cholesterol screening for adults of certain ages or at higher risk
• Colorectal Cancer screening for adults over 50
• Depression screening for adults
• Type 2 Diabetes screening for adults with high blood pressure
• Diet counseling for adults at higher risk for chronic disease
• HIV screening for all adults at higher risk
• Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
• Obesity screening and counseling for all adults
• Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
• Tobacco Use screening for all adults and cessation interventions for tobacco users
• Syphilis screening for all adults at higher risk
• Anemia screening on a routine basis for pregnant women
• Bacteriuria urinary tract or other infection screening for pregnant women
• BRCA counseling about genetic testing for women at higher risk
• Breast Cancer Mammography screenings every 1 to 2 years for women over 40
• Breast Cancer Chemoprevention counseling for women at higher risk
• Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*
• Cervical Cancer screening for sexually active women
• Chlamydia Infection screening for younger women and other women at higher risk
• Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*
• Domestic and interpersonal violence screening and counseling for all women*
• Folic Acid supplements for women who may become pregnant
• Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*
• Gonorrhea screening for all women at higher risk
• Hepatitis B screening for pregnant women at their first prenatal visit
• Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*
• Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older*
• Osteoporosis screening for women over age 60 depending on risk factors
• Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
• Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
• Sexually Transmitted Infections (STI) counseling for sexually active women*
• Syphilis screening for all pregnant women or other women at increased risk
• Well-woman visits to obtain recommended preventive services for women under 65*
• Alcohol and Drug Use assessments for adolescents
• Autism screening for children at 18 and 24 months
• Behavioral assessments for children of all ages
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
• Blood Pressure screening for children
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
• Cervical Dysplasia screening for sexually active females
• Congenital Hypothyroidism screening for newborns
• Depression screening for adolescents
• Developmental screening for children under age 3, and surveillance throughout childhood
• Dyslipidemia screening for children at higher risk of lipid disorders
Ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
• Fluoride Chemoprevention supplements for children without fluoride in their water source
• Gonorrhea preventive medication for the eyes of all newborns
• Hearing screening for all newborns
• Height, Weight and Body Mass Index measurements for children
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
• Hematocrit or Hemoglobin screening for children
• Hemoglobinopathies or sickle cell screening for newborns
• HIV screening for adolescents at higher risk
• Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
• Iron supplements for children ages 6 to 12 months at risk for anemia
• Lead screening for children at risk of exposure
• Medical History for all children throughout development
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
• Obesity screening and counseling
• Oral Health risk assessment for young children
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
• Phenylketonuria (PKU) screening for this genetic disorder in newborns
• Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
• Tuberculin testing for children at higher risk of tuberculosis
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
• Vision screening for all children
Republicans don’t want to talk about this anymore. Despite pundit predictions that singling out women and birth control would be a political winner for the GOP, it wasn’t. Republicans looked at the polling and decided it wasn’t an issue they wanted to pursue on the national political stage. But they’re pursuing it in court, outside the reach of political media, which is a very common tactic on the Right. They’re attacking the Voting Rights Act not in Congress, not out in the open, but in the courts. They do this a lot.
Look at that list of preventive services and tell me this isn’t an issue that affects every single person in the country. I can think of a religious objection that a large employer could put forth for every single one of the services on the list. Media and conservatives have presented this as “should women get free birth control?” which is an insulting and incredibly stupid analysis of this issue. It’s insulting to women and it’s insulting to the whole country, because it isn’t just about women and birth control, and it never was.
Republicans are opposing a regulation that applies to large businesses. That’s what Republicans do. They seized the contraception issue because they (mistakenly) believed women and birth control were an easily demonized target, they assumed women would immediately start apologizing for “demanding” inclusion of birth control in the list of preventive services that cover the whole population, they assumed we would slink off, shamed at having even considered asking to be treated like part of the general population with a preventive service that applies only to women of child-bearing age. They were wrong. Amazingly, women seem to feel they ARE part of the general population, so should be covered under “preventive services.” Who knew?
Mitt Romney needs to be asked about this. Does Mitt Romney support exclusion of any and all coverage based on religious objections by large employers? Because that’s endless, and it’s huge.
Ash Can
I can hear the answer now: “I won’t answer that until after I’m elected.”
a hip hop artist from Idaho (fka Bella Q)
And I was just gonna ask which answer he’d give as his first position, before it becomes inconvenient. But you’ve got the correct response – “I’ll announce that once I’m in my rightful position Being President.” The fuckwad.
Hunter Gathers
He’ll find a way to take both sides, and then blame the questioner for attacking his success.
Jay in Oregon
One oft-repeated comment during the whole Catholic bishop/birth control thing was “If employers were allowed to deny coverage for specific items due to religious objections, every CEO in the country would become Christian Scientists overnight.”
burnspbesq
Just so we’re clear: the district judge in Colorado entered a preliminary injunction. There has been no merits determination yet on any of plaintiffs’ claims.
And as Lyle Denniston notes over at SCOTUSBlog, these cases raise an issue that AFAIK has never been addressed: for purposes of the Exercise Clause, how exactly does a corporation engage in the free exercise of religion?
PeakVT
The courts can be unpredictable at times, but the Republicans know they’ve stacked them pretty well at the higher levels. So there’s no good reason they would stop when the legislature gets in the way. This also is also one of the few times that is accurate to say that both sides do it. Liberals have certainly had their share of successes in the courts, though not so much in recent years.
danimal
The argument for Catholic employers limiting birth control access to their employees is the same as a Scientologist employer limiting access to counseling for depression or a Jehovah’s Witness employer limiting access to blood transfusions.
To open this door is to effectively gut the minimum care standards.
Cassidy
It really is time for torches and guillotines.
Roger Moore
@Jay in Oregon:
This. Also, too, some religions object to insurance because they think it’s a form of gambling. Would they be allowed to opt out of paying for employee insurance without penalty because of their religious objection to the concept of insurance? What’s to stop somebody from claiming that overtime laws are against their religion because God said we’re supposed to earn our bread by the sweat of our brows? Once you allow people to opt out of obeying some laws because of their religious objections, there’s no logical stopping place.
amk
Shouldn’t that question be actually addressed to women ? If they are smart, then mittbot and the entire rw thugs will be toast, come november.
Cassidy
Honestly, we just need to ban this sick religion. I know that’s an uncomfortable thought, but these whackjobs won’t stop until people are actively dying for their cause. Ban the religion, take away their citizenship and deport these MFers to Somalia.
kay
@Jay in Oregon:
The preventive services part of the PPACA was intended to solve the problem of meeting a deductible for ordinary care. It is what makes a health insurance plan offered on the exchange truly “affordable” for middle class people. The plans lose value without the no co-pay/ no deductible provisions.
It’s huge. When “healthy people” buy these policies, they have to see some value. It’s yet another hit to the middle class, and it makes the exchanges much less appealing to an average person, who may see a doctor once a year. It’s good policy, but it’s also practical and immediate
Steve
The Colorado case is a little scary because it’s not a case about a religious employer like a Catholic hospital; it’s just a regular old business that happens to be run by devout Catholics.
While it’s just a preliminary injunction that doesn’t necessarily foretell the outcome, the decision is a little creepy in some ways. For example, the court actually took seriously the plaintiffs’ argument that a plausible alternative to requiring their company to provide coverage for contraception would be for the government to simply provide contraception for everyone in America. I’m just gobsmacked by that on so many levels.
Jennifer
They’re against activist judges, except when they’re for them.
MattR
@Roger Moore:
The Supreme Court seems to agree – Scalia quoted the 1878 case Reynolds v United States (related to polygamy) when issuing the majority decision in Employment Division v Smith in 1990 (related to unemployment benefits for people fired for using peyote during a religious ceremony)
So here, as a law of the organization of society under the exclusive dominion of the United States, it is provided that plural marriages shall not be allowed. Can a man excuse his practices to the contrary because of his religious belief? The permit this would be to make the professed doctrines of religious belief superior to the law of the land, and in effect to permit every citizen to become a law unto himself. Government could exist only in name under such circumstances….
Villago Delenda Est
To push against preventative care that will reduce costs in the long run is not sane.
Time to plan on constructing warrens of padded cells for these lost souls.
Waynski
The list of things Mitt fcking Romney needs to be asked about and isn’t is as long as the preventative care list you posted. I can’t believe (well I can actually) our feckless press is allowing this man not to be interviewed for the most important, most powerful position in the world. What a bunch of cowards.
Sentient Puddle
@burnspbesq:
Link for those who want it. Good summary read. Relevant issue raised by the judge:
To my non-lawyer mind, this one looks pretty easy to me. Is the corporation in question doing religious work? If so, then that could count as exercising religion. And HVAC does not strike me as being particularly religious.
Steve
@MattR: It’s important to remember that Congress passed RFRA in response to the Smith decision, which effectively imposes strict scrutiny upon all laws that burden an exercise of religion.
I don’t have a problem with RFRA, but the head-scratcher in all this is the idea that when an employer provides health coverage, there’s some kind of religious exercise occurring. Even if I am devoutly opposed to birth control, one of my employees using their health coverage to purchase birth control is no more a violation of my religion than the same person using their paycheck to purchase birth control. It’s their money, their health coverage, they decide what to use it on. So how does the employer’s religion have anything to do with it?
MikeJ
@burnspbesq:
Do corporations go to heaven?
Roger Moore
@Villago Delenda Est:
Unless your goal is to milk the system for as much money as possible. In that case, anything that increases spending is a good idea.
Kay
@Steve:
Right, which is exactly what liberals predicted would happen, and what did happen.
California tried an insurance exchange. It failed, because healthy people saw no value in purchasing a policy under the sort of public-spirited idea that they needed to join a pool to subsidize those who require more medical care. The plans had very little immediate value to them. They were still paying out of pocket for the ordinary care that healthy people use. Unsurprisingly, they didn’t rush to subsidize a group of people they don’t know when their own families wouldn’t benefit from the plans until there was a serious health issue. The preventive care w/no out of pocket is worth about a 1,000 dollars a year to a “healthy family”. In addition they get health coverage with no upper limit should something terrible happen, but they have to SEE some value, or this thing will fail.
California already tried the GOP approach. It failed. It will fail again, if they manage to gut regulation and make these plans less valuable to ordinary people.
Jennifer
@Steve: And if the government DID provide contraception for everyone in America, then they’d be bitching that THEIR tax dollars are going to fund something that violates their religious beliefs.
Rafer Janders
@burnspbesq:
Corporations are religions, my friend.
burnspbesq
@MikeJ:
Do corporations have souls?
I think we’re getting pretty close to the reductio ad absurdum of plaintiffs’ RFRA argument. It could be highly amusing to watch the district judge wrestle with this.
Jennifer
@Sentient Puddle: Easy litmus test: does the corporation tithe?
If not, it’s kinda hard to demonstrate any religious beliefs on the part of the corporation.
That’s setting aside the fact that non-living entities, by their very nature, can’t and don’t have beliefs, religious or otherwise.
Kristine
@burnspbesq:
But Mitt said that corporations are people.
This is going to get very weird very quickly.
Roger Moore
@burnspbesq:
Probably. They seem to be required to take the souls of their upper management. Unless you think they’re just discarding those souls, they probably have some around.
SenyorDave
•Vision screening for all children
WTF? I own a business and my religious beliefs say that if God meant for children to lose their sight, they should. I refuse to cover vison screening for children. Can I find a conservative goup to fund my challenge to the law?
a hip hop artist from Idaho (fka Bella Q)
@Roger Moore: But can corporation be baptized after dissolution? Whether they should be is of course a separate question.
La Gata Gris
Ha! Yes Mittens did declare ‘corporations are people my friend’. Therefor, does Mittens do baptisms for them in Mormon temples? (Indeed, this does get weird quickly).
Meanwhile, how shortsighted would Repubs have to be to not realize contraception is good ‘preventative medicine’. Simple economics – contraceptive pills/devices/procedures are less expensive than unintended pregnancies and delivery. Econ fail!
Also any CEO who went Christian Scientist to be free of health care costs should discover new long term problems – employees who are sicker, far less productive, and more likely to leave the company in search of a workplace with coverage. This would hurt CEO’s bidness. So much for foresight.
Ed Drone
@Roger Moore:
And if the slope weren’t slippery enough, the Republicants are adding oil AND Teflon.
Ed
Patricia Kayden
He’s already said that he supports the Blunt amendment, so I guess his answer would be yes.
Roger Moore
@Patricia Kayden:
You’re assuming that Romney is capable of maintaining a consistent position on anything, which is not a safe assumption. My guess is that his answer would depend on who he thought was listening.
KS in MA
@MikeJ: Win!
El Cid
Well, it’s not their fault that all those listed illnesses aren’t in the Bible.
shortstop
@Ed Drone:
Rule 34! Rule 34!
shortstop
Well, can’t we get some Christian Scientist employer to bring suit just to illustrate the problem? Who was that state legislator who snappily withdrew her support for religious-school vouchers after she found out madrassas would qualify? These people can never see past the next FOX commercial break.
Name
@Cassidy:
Why haven’t you thought of concentration camps and gas chambers? That’s the only really practical solution.