Today, after a week of tiresome hemming and hawing, the Obama administration announced an utterly common-sense compromise on religious employers and birth-control coverage. Beginning Aug. 1, every American woman with an employer-provided health-insurance plan will be entitled to co-pay-free birth control. Religious employers who object to contraception will be given a one-year grace period, after which they, too, will be required to offer workers insurance plans that include birth-control coverage. The new compromise is that religious employers themselves will have no responsibility to either pay for this coverage or to communicate with employees about it; instead, those burdens will shift to insurance companies, at no additional cost to consumers.
Because pregnancy and childbirth are so much more expensive than contraception, this policy is expected to provide cost-savings for insurers. According to a 2006 report (PDF) from the National Business Group on Health, providing birth-control coverage can save an employer tens of thousands of dollars over a five-year period; under the Obama compromise, these cost-savings will simply shift from religious employers to insurance companies.
Women who use birth control and work for religious-affiliated employers, such as Catholic hospitals, can expect coverage to be "seamless," says Adam Sonfield, senior public policy associate at the Guttmacher Institute, which researches reproductive health. "If a religiously affiliated employer objects, they won't have to deal with it administratively, talk to their enrollees about it, or communicate that they are covering contraception. Instead, the insurance company will be communicating with the enrollee."
The Catholic Health Association has endorsed the compromise, though conservative Republicans like Orrin Hatch are already saying employers should retain the right to deny women birth-control coverage, even if the employer will not be paying for it. The ball is now in Mitt Romney's court: will the GOP frontrunner acknowledge this compromise protects religious conscience, or will he embrace the harder-right position motivated more by antipathy toward women's sexual freedom?
Indeed, what's really at stake in this debate is the age-old culture war over women's bodies. Way back in 1993, when then-first lady Hillary Rodham Clinton headed to the Hill to advocate for her husband's health-reform proposal, angry Republicans on the Senate Finance Committee challenged the Clinton plan's inclusion of coverage for both abortion and contraception. (A defiant Hillary told the senators that the plan would absolutely "include pregnancy-related services, and that will include abortion, as insurance policies currently do.") As soon as the Obama health-care plan passed by a hair (with major limitations on abortion coverage), conservative activists shifted their sights to the looming battle over birth control. In July 2010, as the Department of Health and Human Services tentatively began to research the cost and health benefits of contraception coverage, the U.S. Conference of Catholic Bishops, the National Abstinence Education Association, and the Heritage Foundation all told The Daily Beast they were girding for a fight on birth control.
"We consider it an elective drug," the bishops' spokeswoman, Deirdre McQuade, said. "Married women can practice periodic abstinence. Other women can abstain altogether. Not having sex doesn't make you sick."
Needless to say, this attitude toward sex and pregnancy is far outside the mainstream, even among Catholics themselves. More than 90 percent of Americans say they have pre-marital sex; by the age of 24, even 89 percent (PDF) of unmarried Catholic women are sexually active. Only 2 percent of sexually active Catholic women say they rely on the bishop-endorsed "periodic abstinence," also known as the rhythm method or fertility awareness. Indeed, 68 percent (PDF) of Catholic women use a birth-control method their church opposes, such as the pill, sterilization, or an IUD.
So despite the hand-wringing of ill-informed pundits who claim the president's decision will harm his reelection odds, it's clear that when it comes to contraception, the bishops do not speak on behalf of Catholic voters. Indeed, according to a poll released this week by the Public Religion Research Institute, 58 percent of all Catholics and 62 percent of Catholic women said they believe employers should be required to offer birth-control coverage. A Public Policy Polling survey found that 55 percent of independent voters agree.
There's nothing more predictable in American politics than hard-core religious conservative opposition to common-sense policies on women's sexual health. In the past, the Obama administration buckled on insurance coverage of abortion in order to save the overall goals of health-care reform; it's a relief to see that on the far-less controversial issue of birth control, they won't be doing the same.
It's worth remembering, however, that today's compromise is necessitated by the unfortunate fact that in the United States, employers are the intermediaries between citizens and their medical care. In a rational world, a woman's boss would have no influence whatsoever over how she conducts her sex life. But since single-payer health care is nowhere on the horizon, we aren't likely to get relief from the reproductive health care culture wars any time soon.