SCOTUS Blog’s Lyle Denniston is reading the tea leaves of today’s post-Hobby Lobby Supreme Court conferences and concludes that the five assholes have decided that religion is a massive get out of providing health care to women while getting tax benefits for doing so instead of a limited one time use card to use for “abortificants.”
The Supreme Court sent a fairly strong signal on Tuesday that its ruling giving some for-profit businesses a right not to provide birth control services to their female workers goes beyond the specific methods at issue in that decision. It issued a series of orders on six cases, each of which involved owners who objected to all of the pregnancy-related services mandated under the new federal health care law.
The decision Monday in Burwell v. Hobby Lobby Stores, and a related case, involved religiously devout business owners who objected to only four contraceptives: the “morning-after” pills Ella and Plan B, and two intrauterine devices (IUDs).
The Affordable Care Act regulations issued by the federal government, however, required sixteen different preventive methods or services, including sterilization and pregnancy counseling. Depending upon how lower courts now interpret the Hobby Lobby decision, companies that fit within the Court’s “closely held company” bracket and offer religious objections could be spared from having to provide any of those services through their employee health plans.
My wife was asking if insurance companies would fight these ruling on the grounds of it being an administrative nightmare.
Unfortunately, from an equal rights perspective, this is a fairly simple piece of plumbing for insurance companies. My company could probably sell HobbyLobby compliant policies for August 1st start dates. September 1 start dates would be the absolute latest the modification would need.
If Mayhew Insurance was the third party administrator for Hobby Lobby, the way that we would make a Hobby Lobby compliant plan would be to create a rider to a common policy configuration. The rider would say that if a claim with the prodecure or pharmacetucial code is on a reference table, deny the claim initially. If the federal government offers Hobby Lobby the religious institution work-around where the third party administrator pays the claim and gets reimbursed later by the feds, then there would be a piece of logic attached to the rider that would say pay the claim out of Money Bucket B instead of Money Bucket A. The finance folks would then chase the feds for reimbursement.
Now the cases that the Supremes have sent back to the Circuit Courts for review are cases where the business owners/assholes don’t want to pay for any pregnancy related preventative care. Besides being a moral and legal mess (privileging an already privileged class plus enshrining significant religious exemptions into the public square), it is again fairly simple plumbing. The assholes who want to not cover anything would just get the current “Catholic” riders where any birth control procedure codes are denied.
Depending on how the Little Sisters of the Poor case goes, the assholes in black robes may decide that signing a form is too much of an infringement on the LSP religibious liberty and the work-around won’t work. If that is the case, then the plumbing is simple — deny claims. If the workaround goes through, the number of combinations on the reference table increases, but it is a simple matter of annual maitenance to say Group Y will pay for Pregnancy Related EHB 1,2,3 but not 8,9, and 15 so 1,2,3 get paid from Money Bucket A and 8,9, 15 gets paid from Money Bucket B while Group X will see all Pregnancy Related EHB claim lines get paid from Money Bucket B.
The plumbing is a simple kludge to appease assholes.
Suffern ACE
Will pre-natal care for out of wedlock births be next?
⚽️ Martin
Someone previously mentioned that the California mandate to cover contraceptives stands after the ruling, so you still need to write them a policy that works here.
And if ‘administrative nightmare’ were a hardship, insurance companies wouldn’t exist. There’s not a single goddamn thing about insurance that’s easy.
mike with a mic
I figure that forms of birth control with uses other than contraception (ie the pill) will eventually become an OTC drug with warnings. Then your doctor can simply point you in the direction of the right OTC drug for you after a consultation, and provide you a script for the other uses.
Shortstop
How cumbersome does the plumbing (I saw what you did there, btw) become if we have scores or hundreds of different companies requiring this or that procedure be excluded on various religious grounds? A standard Catholic rider won’t fit all if this “narrowly drawn” decision is extended as far as many are predicting it could be.
Omnes Omnibus (the first of his name)
@mike with a mic: It currently is that way in Romania. FWIW.
JPL
@mike with a mic: Several OTC medications are priced out of the range of the poor and working poor. It sounds like a good solution but one that hurts the needy the most. IUD’s are a great alternative for those who easily forget their medication or for other reasons can not take birth control pills.
Would Mayhew insurance have to cover Mr. Green’s little blue pills? Someone should ask the Green family about objections to those. I figure if god wanted them to get it up, they’d get it up.
boatboy_srq
Fascinating how to the Reichwing the hoops required to be jumped through to obtain state-issued photo ID is acceptable to enable voting, yet signing one form is sufficient hindrance to require exception from common-sense healthcare coverage.
Richard Mayhew
@Shortstop: Pain in the ass, but fairly simple. If there are 20 pregnancy related EHB categories, each one gets a check box, and each buying company gets a line of data with 20 checkboxes — if Buying Company 1 has a checked box, money Bucket A, if not, Money Bucket B etc.
It becomes a plumbing problem if the asshole company does not know what they want until after open enrollment is done, but the customization is fairly straightforward if somewhat time consuming and error prone.
Mayken
@mike with a mic: That solves the convenience problem (at least for hormonal birth control with say the exception of the under the skin inserts) for most women but it doesn’t solve the price problem. The whole point of covering preventative care at no copay was to make it both convenient to get (1 visit!) and at no extra cost. No way Pharma’s making the Pill or the Patch available OTC without jacking up the price.
ETA: studies have shown that if you don’t make it both convenient and cost effective, birth control use plummets.
EATA: or what JPL said
Richard Mayhew
@JPL: I think all of our pharmacy riders would cover either little blue pills or pills you take while you and your lover are sitting in bathtubs in the middle of the field. There might be a difference on the formularies for the brands, but those types of pills are covered.
Mayken
@boatboy_srq: Yup!
Matt McIrvin
Denying the workaround would be particularly horrible given that the existence of the workaround is explicitly part of the reasoning in Hobby Lobby.
srv
@boatboy_srq:
Obama should announce an Executive Edict, requiring a Faith Based test regime to be managed by IRS Cincinnati.
Mayken
@Matt McIrvin: Yeah, sadly I’m not holding my breath believing the Gang of 5 when they say it’s an acceptable work around in one case. I fully expect at this point that they will say it is too much of an imposition. I also don’t believe them when they say this cannot be used in other cases. Their ruling is not even remotely narrowly defined as they want us to believe.
srv
@Richard Mayhew: Will there be an actuarial post on the health care cost savings for holy corporations?
Shortstop
@Richard Mayhew: So we could ostensibly have a long list of no-no procedures, only some of them in the reproductive healthcare category, and it would be pretty easy to pull off among different employers. Interesting, but I suppose not surprising.
About those bathtubs: I’m fairly certain there’s no pill that can make a guy hard enough to drill through two walls of porcelain-coated cast iron. Maybe if they were using contemporary acrylic tubs…
Omnes Omnibus (the first of his name)
@Shortstop:
Yet another plumbing issue.
Ben Cisco
They really pulled a rake take on this one.
May this work for the GOP as well as Cooch’s efforts did in VA.
Mandalay
It’s a little vague to refer to those who ruled in favor of Hobby Lobby as assholes. “Male Catholic assholes” is more precise, and gets to the nub of the matter.
Richard Mayhew
@srv: not really, as I don’t have the knowledge base to write intelligently about it. The evidence shows that birth control (from an insurance company perspective) versus more pregnancies is roughly a break even proposition (depending on age/gender composition of a group of course). It is more of a moral and respect female autonomy issue than an acturial issue.
Trollhattan
@Mayken:
So very true.
Seanly
@⚽️ Martin:
Don’t a lot of states have requirements that insurance cover contraception?
Senyordave
I think the companies should also be required to make a reasonable accommodation. For example, Hobby Lobby should be require to cover all deductibles associated with childbirth, pay for child care for families that have unintended pregnancies at the very least. But I’m guessing that their concern ends with the birth of the “potential person”. I assume Hobby Lobby is so moral that they must check on the conditions of the employees in China who make their plastic Jesus’.
Shortstop
@Omnes Omnibus (the first of his name): What else is there, at bottom?
Sorry; I’ll just see myself out.
Roger Moore
@Matt McIrvin:
FTFY. Kind of like the way the solution to all the problems with dark money created by Citizens United were going to be solved by disclosure rules that didn’t exist and had no realistic chance of being created given the politics of the issue. The right wing block on the Supreme Court loves justifying things on grounds that don’t actually apply.
JPL
@Senyordave: Hobby lobby imports most of its crap from a country that mandates abortion. The religious right has never been good about hiding their hypocrisy.
@Omnes Omnibus (the first of his name): What would god say?
Higgs Boson's Mate
What is is it that I don’t understand about the Establishment clause? I know that it applies only to Congress, but I’d think that the Supremes would at least give a nod to the Founders.
Trollhattan
@Seanly:
California is one (for something like 15 years) and that’s about 12% of the country right there.
Omnes Omnibus (the first of his name)
@JPL:
Ring-ding-ding-ding-dingeringeding!
Gering-ding-ding-ding-dingeringeding!
Gering-ding-ding-ding-dingeringeding!
Belafon
@Higgs Boson’s Mate: It was ESTABLISHED that this country was for white male landowners. Everyone else has to deal with it.
— Scalia’s originalism
Belafon
Who would have thought that the Catholics we have had to worry about all these years are Republicans.
coloradoblue
I was really hoping that, at a minimum, Roberts and Kennedy would see the massive number of lawsuits, the awful complexity, the confusion and the downright horror of voting in favor of HL. Sadly those two have opened a Pandora’s box of a clusterf*ck that will in some cases outlive their term on SCOTUS and lead to pain, suffering and probably the deaths of innocent americans.
We’re all going to be paying the costs of this stupidity for decades and they just didn’t give a sh*t.
Mandalay
@JPL:
Indeed. And Hobby Lobby don’t use barcodes for pricing their products because of the religious beliefs of the owners.
It’s all fine and dandy for SCOTUS to agree that the owners of Hobby Lobby are sincere in their beliefs. But surely it is also relevant whether those beliefs are coherent, and consistent with their actions.
Omnes Omnibus (the first of his name)
@coloradoblue: Just elect a decent Congress and amend RFRA. It was a statutory interpretation issue. That is actually the only good thing about the decision.
CONGRATULATIONS!
@mike with a mic: So do I. It’ll be like my Prilosec or my old allergy medication once it went OTC: same shit at four times the price.
Heads they win, tails I lose.
mike with a mic
@JPL:
You’re missing the point. A script for the pill for reasons such as massive cramps and other issues would be covered, there would be no issue. The pill as a contraceptive choice would be one of the various OTC methods out now you’d have to pick from.
Many on the left want it covered due to reasons other than sex, and bring this up constantly. This makes the pill covered for reasons other than sexual activity. It also lumps it in with condoms and other items something people choose. It can also help force multiple generic versions to compete with it. There would also be nothing stopping free clinics from handing it out as well. Price issues are an income equality issue, that can be handled through other methods. It can also be covered under federal and state ACA plans individuals can take, or FSA/HSA items.
There are enough tools in place that access to the pill is a non issue and there’s really nothing Republicans can do about it. The larger issue is the carve out for religious beliefs.
mike with a mic
@CONGRATULATIONS!:
Again though, there are methods to address this.
JPL
I paid sixty dollars for frontline before it went over the counter and now I pay ninety. Since frontline is for animals, otc doesn’t mean what some people think it does.
Kay
I’m wondering if they can deny pregnancy care to unmarried women. I’m trying to think how they’d slice and dice that group from the rest of us. Peel that vulnerable group off from the herd and go after them.
The whole thing is just appalling. I cannot imagine how awful this “debate” will be when they really get rolling. I feel sorry for everyone, already.
Seanly
I know the main crux of the LSP lawsuit is that they didn’t want to do the single page of paperwork. However, isn’t part of the lawsuit that they don’t even want their non-Catholic employees to have the ability to do the very workaround that SCOTUS said was the fix for the Hobby Lobby problem?
Mnemosyne
@mike with a mic:
Actually, the Pill has always been covered for reasons other than sex. It was getting it covered just for sex that was the problem. So what you’re proposing is to return us to the pre-2009 status quo.
Trollhattan
@Mandalay:
Bacodes are De Debil’s work? Who knew? They provide so many opportunities for pricing fraud.
Omnes Omnibus (the first of his name)
@Trollhattan: Sign of the beast.
Tissue Thin Pseudonym (JMN)
My problem with this is more fundamental. The majority has decided that corporations are independent persons, except in this one narrow instance in which their existence as a separate legal entity disappears and they take on the characteristics of their owners. This decision relies upon the time honored principle that one’s principles should disappear whenever it is convenient. Ginsburg got this right in her dissent.
Kay
@Suffern ACE:
That will be determined on the sidewalk outside the clinic, by the “counselors”.
We might have a show of hands. Feel free to weigh in!
Roger Moore
@Omnes Omnibus (the first of his name):
That would solve an awful lot of problems.
Roger Moore
@Kay:
Can I show people my elbows and knees instead?
Omnes Omnibus (the first of his name)
@Roger Moore: Yeah, it would.
Kay
@Roger Moore:
There is no way this ends well. No set of circumstances where this was a good road to go down.
Bill Arnold
@Mandalay:
LOL. Is this the 666-barcode thing from the 1980s(?)?
And somebody really needs to make a proof-of-concept laser tattoo gun (that can arguably write “666”) to give renewed life to that old chain mail.
D58826
I love the smell of hypocrisy in the morning (or the evening)
Don’t real Christian Murkins hate Red China and its godless communists.
⚽️ Martin
@Seanly: About half.
cdg
Here’s the solution I’d like to see, an HHS reg allowing employee’s whose employers refuse to cover HHS-mandated healthcare to opt out. Give the employee agency, instead of just the employer. Once the employee opts out, the employer is on the hook for the yearly tax on the employee they aren’t covering and the employee is eligible for their local ACA exchange.
I think this kills 2 birds with 1 stone. Bullshit artists like the Greens can’t claim offense from the sins of their workers and they can’t claim the tax credit by providing substandard insurance. At the same time, it gives the employee control of their situation. There will likely be women who are perfectly fine with the 16 contraceptive methods available, and they can stick with the company’s plan. If not, opt out and go for the exchange. The employee makes the decision, not the employer.
encephalopath
Could congress decide that companies that don’t provide birth control in their healthcare plans should be stripped of their insurance tax break?
Pay for the birth control or the government will provide it to your employees and strip you of your tax deduction to cover the cost.
mike with a mic
@Mnemosyne:
If that’s the case than put me in the “I don’t give a rats ass” category. And consider me furious that I was lied to and mislead about this. Because I was lead to believe that the reason to get angry about this was women being denied the pill completely, even for non sexual reasons, due to Christian idiocy. Oddly, I have some wingers I need to apologize to now, they were right and I was wrong.
Omnes Omnibus (the first of his name)
@mike with a mic:
Noted for the record.
Mnemosyne
@mike with a mic:
Some women have been, and it was due to Christian idiocy — basically, if you had an idiot Christian doctor, s/he would refuse to prescribe the Pill to you even if you had a valid medical reason because then you might run out and have sex.
And, yes, at one point enough insurance companies refused to cover the Pill at all that states like California had to pass legislation saying they couldn’t refuse coverage if it was for valid medical reasons … but contraception was not considered a “valid medical reason.”
You can apologize to your right-wing friends if you want, but you’ll have to go into the whole explanation of why they were sometimes, in some circumstances, right, but completely wrong in others. Good luck explaining to them that they were only partially right, because what they’ll hear is Mike with a mic admits the Pill totally causes abortions!
Mnemosyne
Also, too…
@mike with a mic:
I assume that you are a gay man, then? Otherwise, I’m not sure why you wouldn’t give a rat’s ass about the health of your mother, sister(s), girlfriend/wife, and friends.
I guess not getting pregnant is the “woman’s job” and you’re not involved in the process at all, right?
mike with a mic
@Omnes Omnibus (the first of his name):
After the all the “but they are going to deny the pill to women who need it for non contraceptive reasons that’s why we need to fight” bullshit I got feed, yeah I don’t care anymore. And I really feel bad that I got lied to more by the people I agree with than the wingers about it.
I’ll never trust either side on this debate ever again. Pox on all houses, fire them into the sun, Bloomberg 4 life, and all that. On this issue going forward I’m just going to default to both sides being liars about what’s going on.
And really, it’s going to end up going OTC anyways so fuck it.
Mnemosyne
@mike with a mic:
Uh, no, the Hobby Lobby decision does deny the Pill to women who need it for non-contraceptive reasons. Are you just not paying sufficient attention to the details here?
Let’s start over: pre-PPACA, regulations in some states required insurance companies to cover the Pill if it was for non-contraceptive reasons.
The PPACA said it always needs to be covered as part of preventative care.
The Hobby Lobby decision says that some companies can say they have a religious exemption and refuse to cover the Pill even if it’s prescribed for medical reasons.
So where, exactly, is the bullshit?
mike with a mic
@Mnemosyne:
Not getting pregnant is everyone’s responsibility. I have no problems splitting the costs of contraceptives in a relationship, and I have no problems covering the cost of them for my own fun times. I have no issues if insurance plans cover them either. However I now realize that I was LIED TO FOR MONTHS about this. That the pill was going to be denied for uses other than birth control. I believed those lies, and I used them against other people. I’m pissed about this.
I’m jumping in the “both sides lie” wagon on this one.
Omnes Omnibus (the first of his name)
@mike with a mic: Before you accuse people of lying, do you stop to consider that they may simply have been wrong or were looking what they believed to be be the next step that the wingers were going to take? No, obviously not. But then you don’t really give a shit about this issue anyway, do you? It’s part of that social liberalism you believe is incompatible with economic liberalism.
ETA: And what exactly do you mean by “deny the pill.”
Mnemosyne
@mike with a mic:
Lied to about what? The Hobby Lobby decision does allow companies that claim to have a religious objection to deny the Pill to their female employees even if they have a non-contraceptive reason for using it.
What is the “lie” that you think you see?
Violet
@mike with a mic: It IS being denied for uses other than birth control. Hobby Lobby et al can deny it completely. What part of that didn’t you get?
Also, several years ago–pre-ACA–I had to take the pill for a non-birth control reason. It was not covered by my insurance. I paid something like $50 a month. I live in a red state. One data point, I know, but my insurance was good insurance so I figure that must have been pretty common in my state. I was shocked when I had to pay that much.
Sasha
I think the pill going OTC will solve some problems. While it might be more expensive at first, eventually it will drop in price; it is available as a generic so Walmart et al, would certainly sell a Great Value equivalent. There are still going to be women who do not have health insurance and paying for a visit to the doctor with the requisite lab tests makes the pill unaffordable. I am fairly certain that I read an article which stated that women in countries where the pill is OTC, have better usage rates. It’s just easier to pick up a box at a store than to make a doctor’s apt and make sure you call in the refills and then make sure you’re at the store during pharmacy hours.
I find it terribly ironic that here, in the Commonwealth of Virginia, birth control is the only form of Medicaid available to most childless adults. Plan First pays for the annual doctor’s visit and all the birth control you can use. Men are eligible too; they get the yearly visit and condoms.
Kay
@mike with a mic:
I never liked the argument that some women need contraceptives for reasons other than contraception.
I think it’s a misunderstanding of why contraception was included in the law.
They asked a group of experts (physicians groups and researchers) what would constitute a good, solid public health approach to preventative care that would be offered without additional out of pocket costs. Not “free” that’s of course nonsense, because insurance is just a form of payment.
Here’s the list for women:
https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=2
I don’t draw any special distinctions between contraception and the rest of the services on the list. To me (and to the experts who made the list, incidentally) it’s a public health list. Ordinary. Not extraordinary. That’s true too. Contraception IS ordinary. Here’s why women spend more than men on preventative care:
Kay
@mike with a mic:
I think the preventative care for kids is sort of exciting, even! :)
You know people were skimping on this stuff when money got tight. It’ll be interesting to see if it makes a difference, over time. It might! Supposedly the effects when they started testing eyesight in schools were big. They found all these kids who couldn’t see! Wandering around all blurry and head-achy, they were probably amazed when they put their glasses on.
https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=3
BBA
I’d call this an argument for ending employer-based health insurance and moving everyone to the exchanges, but the Republicans could cut off any form of coverage they don’t like a la the Hyde/Stupak Amendments, even if the ACA as a whole is too popular to kill. I’d call it an argument for single-payer, but the same caveat applies.
The price of everything is eternal vigilance.
gian
@mike with a mic:
did you see what you did there?
really? fuck it in a discussion about birth control?
smh
PhilbertDesanex
@Bill Arnold:
666 was my starting wage at the Post Office, I love telling wingnuts that
Also
Scalia, Sharia: hell, six of one, half-dozen of the other
gian
@encephalopath:
you won’t get the house and senate to agree. the house as it’s currently constituted would try and pass an extra tax on plans that provide birth control
something like a tax of $1500 a month per person on the plan would accomplish the goal
said tax to include infants and 60 year olds on policies
the senate would take up your concept but it would die in committee or filibuster at best.
Original Lee
I thought that the birth control exemption for religious organizations under Obamacare was handled by third party administrators, who were supposed to get reimbursed for providing contraceptives by the feds (i.e., if a woman worked for Catholic Charities, she could get coverage for her contraceptives through a TPA, separately from whatever insurance her employer provided). I saw something today about how the TPAs are really upset because now they’re on the hook for even more contraceptives that nobody has figured out how to get money from HHS to pay them for.
Mnemosyne
@Kay:
When talking to people not at this blog, I usually try to use the word “included” rather than “free.” Most people understand what it is to pay a single price and have X, Y, or Z included in that price.
Fred
Seems to me a corporation that is religious is a religious organization, so no problem.
Now all they need to do is put in some pews, call themselves a church and all the junk they sell is really just fund raising. The proof that it really isn’t a true business is that nobody would buy that junk because they really want it so it must be charity.