Whose conscience? Whose rights?


The Obama administration said this month that church-run hospitals, universities and charities, like other employers, must cover birth control in their health insurance plans, as an essential provision for women’s health care. Despite the protests of the Catholic hierarchy, this decision is the right thing to do.

The nation’s Catholic bishops say that the requirement for birth control coverage is a violation of religious freedom. Cardinal Daniel DiNardo, writing for the U.S. Conference of Catholic Bishops, insisted that, “Those who sponsor, purchase and issue health plans should not be forced to violate their deeply held moral and religious convictions in order to take part in the health care system or provide for the needs of their families or their employees.”

Religious freedom is not absolute. For example, Jehovah’s Witnesses have deep theological and moral objections to blood transfusions. Nonetheless, the law does not say that institutions owned by Jehovah’s Witnesses can require that health insurance policies  refuse to pay for blood transfusions for their employees. If a church owns a restaurant, it has to comply with food safety laws. If a church runs a hospital, it needs to follow rules about licensure for doctors and nurses. And if a church owns a hospital or university, it now needs to follow the rules on health insurance.

The Catholic Church’s exclusion of birth control from health insurance coverage has been a hardship for women employees and students. Those who use birth control, whether they are Catholic or non-Catholic, have had to pay the full costs of prescriptions out of pocket. Some, like a Georgetown student profiled in the New York Times, have been unable to get prescriptions even for non-birth control medical needs:

“One recent Georgetown law graduate, who asked not to be identified for reasons of medical privacy, said she had polycystic ovary syndrome, a condition for which her doctor prescribed birth control pills. She is gay and had no other reason to take the pills. Georgetown does not cover birth control for students, so she made sure her doctor noted the diagnosis on her prescription. Even so, coverage was denied several times. She finally gave up and paid out of pocket, more than $100 a month. After a few months she could no longer afford the pills. Within months she developed a large ovarian cyst that had to be removed surgically — along with her ovary.”

The policy change will not require that anyone use birth control in violation of their conscience. It only requires that health insurance cover birth control for those people, Catholic or non-Catholic, who choose to use it. Many employees of Catholic institutions and students at Catholic schools are not Catholic. Catholic or non-Catholic, they have their own deeply held moral and religious and moral convictions, which are not necessarily dictated by their employers or universities. Something like 98 percent of sexually active Catholic women have used contraception. A majority of U.S. Catholics agree that contraception should be covered by health insurance policies of church-owned hospitals, universities, etc. 

In point of fact, many Catholic universities and schools already offer full health care coverage, including birth control coverage, to their employees, which makes the bishops’ claim even less convincing. Katha Pollitt, writing in The Nation, calls the bishops’ insistence that Catholic institutions should be exempt from providing full health care coverage “nonsense.” 

“Are Quakers, Jehovah’s Witnesses and other pacifists exempt from taxes that pay for war and weapons? Can Scientologists, who abhor psychiatry, deduct the costs of the National Institute of Mental Health? As an atheist, a feminist, a progressive, I ante up for so much stuff that violates my conscience, the government should probably pay me damages. Why should the bishops be exempt from the costs of living in a pluralistic society?”

While Republican candidates are unanimous in denouncing the move as an Obama assault on Christianity, Catholics disagree. “Roughly 6-in-10 Catholics (58%) believe that employers should be required to provide their employees with health care plans that cover contraception,” according to a Public Religion Research Institute poll taken in January, meaning Catholics favor the provision by an even greater percentage than the solid majority of 55 percent of all Americans. When asked specifically about religiously affiliated hospitals and universities, a solid majority of Catholics agrees that the requirement should apply to these institutions.