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Sometimes women accidentally get pregnant and don’t want abortions. Can we all figure out how to deal with that?

I don’t disagree with the rest of the paragraph, but honestly [emphasis added]:

The elitism is a big part of this, but so is the sex part. As Franke-Ruta notes, the only other coverage point that has created as much conservative ire is the contraception benefit. What do contraception and maternity coverage have in common? Both imply that the woman who is using the benefit willingly chose to have sex. It really isn’t much more complicated than that. Which is why Mankiw insists that having children is a “choice”, even though it’s not that simple. Half of pregnancies in this country are unintended. Of those, not an insignificant number result in childbirth because the woman felt that abortion was not really a choice, either because she’s been guilt-tripped by anti-choice propaganda, bullied by family members, or simply couldn’t afford to jump through the rapidly expanding number of hoops that Republicans are putting in place to keep women from abortion. When conservatives say it’s a “choice”, they are pretending that abstaining from sex is a realistic expectation to place on the majority of American women who are not members of the economic elite, full stop. That’s what this is about.

Shorter Amanda Marcotte: no woman acting according to her own free will and moral compass would ever feel that abortion was an unacceptable choice for her in the event of unintended pregnancy.

Mankiw, in the blog post Marcotte quoted, was pretty repulsive himself:

But having children is more a choice than a random act of nature. People who drive a new Porsche pay more for car insurance than those who drive an old Chevy. We consider that fair because which car you drive is a choice.  Why isn’t having children viewed in the same way?

Because a child isn’t a consumer good, he or she is a human being who both needs and deserves care. Because none of that is any less true if that child’s mother could have had an abortion and didn’t. And because parenthood shouldn’t be a luxury reserved for the well-off.

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Highlights of health insurance reform for pro-lifers

Starting today, people in the U.S. who need health insurance can go to to enroll in a plan through their states’ new exchanges.

There’s a lot for pro-lifers to love about health insurance reform. All plans offered on the exchanges must cover prenatal care, delivery, and care for mother and baby after birth. Prior to the Affordable Care Act, most individual insurance plans didn’t cover maternity care, and women who were already pregnant often couldn’t get insurance at all.

In addition to the reform of maternity care coverage, the ACA requires insurance plans to cover a number of preventive services with no cost-sharing. These include, but are definitely not limited to:

Having these vital preventive services available without a co-payment will help more women and children live healthy lives as well as making it easier for women to avoid unintended pregnancy and abortion.

* These are currently required to be covered for women but should be available without cost-sharing to everyone, in my opinion.

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I’ll have my OB-GYN start a tab. Er, wait.

Imagine that you worked for somebody whose religion forbids drinking alcohol. Now, that doesn’t mean you couldn’t get a beer. The way it would work is that your boss would tell the bank where your checks are deposited that she’s anti-beer. You’d get your salary minus the amount you spend on beer, and then when you buy beer, you’d have to tell the store or bar to bill your bank. Then the bank would keep track of how much they’d spent on paying for your beer, and submit that information to the government to be reimbursed.

Imagine that around half the country supported this system — or thought even this Rube Goldberg arrangement wasn’t good enough, and still amounted to your employer being forced to buy you beer — and said if you didn’t want your boss deciding how you could spend your pay, you should just find a different job. You know, in an economy where unemployment has been above 7.5% for almost five years.

Sound reasonable? No? Well, that’s basically the situation that now exists with another form of employee compensation: the employee’s health insurance policy.

If it would be ridiculous for beer, why is it OK for family planning?

[I’d bookmarked the HHS announcement but hadn’t started drafting this post yet when two stories came out about workers who are forced to get their pay in the form of prepaid debit cards and get screwed by the cards’ high fees. A friend of mine pointed out that soon, it could become technologically feasible for companies to pay their employees with debit cards that can’t be used to buy certain things. And won’t that be a paradise of religious freedom?]

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In the news: family planning

Yesterday, the New Evangelical Partnership held an event at the National Press Club to unveil a statement called “A Call to Christian Common Ground on Family Planning, and Maternal, and Children’s Health.

The statement makes three main points:

  1. Family planning strengthens families and creates more stable and healthy communities worldwide.
  2. Family planning protects the health of women and children.
  3. Family planning reduces abortion.

We agree wholeheartedly, of course, and are pleased to have the New Evangelical Partnership as part of the movement for family planning freedom.

You can watch the whole event on YouTube. I recommend at least watching Rev. Jennifer Crumpton’s presentation of the NEP statement, starting at about 8:15 in, Dr. Mark Hathaway’s talk at 19:00 about the medical benefits of family planning for women and children, and Katherine Marshall’s talk at 28:10 about the international context of family planning.

Speakers at the NEP event referred more than once to a study recently conducted by Washington University in St. Louis. The project provided women and teens at high risk of unintended pregnancy with the contraceptive method of their own choice at no cost. The results were dramatic. The abortion rate fell to 6 per 1,000 women, compared with a national average of 20 per 1,000 women. The teen birth rate from to 6.3 per 1,000, compared with 34.1 per 1,000 nationwide.

Imagine the impact of cutting the abortion rate in the U.S. by almost two thirds.

As the Agence France write-up of the study noted: “If the same results were replicated across the United States, free birth control could prevent 1,060,370 unplanned pregnancies and 873,250 abortions a year.”

Yes, that’s a big “if.” [Edited to add: as the researchers pointed out, the sample of women who participated in this study is not generalizable to the total population of women of reproductive age in the United States. That said, they likely bear a great deal of similarity to the population of women at the highest risk for unintended pregnancy and abortion.] And of course, there are important caveats. Women’s consent must be free and fully informed. Women must never be coerced into using long-acting contraception because other people think it would be better for them not to reproduce. It must always, always be the woman’s choice to use contraception. In addition, protection against HIV or other STDs is vital, and the forms of contraception chosen by most women in the study did not provide that protection.

But imagine it. Imagine 873,250 fewer unborn human beings destroyed every year. Imagine 873,250 fewer women going through abortions. Imagine 1,060,370 fewer women having to experience unplanned pregnancy, and instead being able to bear children at a time when their age, health, and life situation are better suited for motherhood — or being free to choose a different life path than motherhood.

Earlier this month, a Republican-appointed federal judge in the United States District Court for the Eastern District of Missouri rejected a lawsuit brought against the U.S. Department of Health and Human Services by an employer in a secular industry (mining, metals, & ceramics) who, due to his own religious beliefs, doesn’t want to provide his employees with insurance that covers contraception.

Judge Carol Jackson noted that employers already pay their employees a form of compensation that could be used to purchase contraception: their salaries. This is an argument I’ve made in the past. The full ruling is online here.

The burden of which plaintiffs complain is that funds, which plaintiffs will contribute to a group health plan, might, after a series of independent decisions by health care providers and patients covered by OIH’s plan, subsidize someone else’s participation in an activity that is condemned by plaintiffs’ religion. This Court rejects the proposition that requiring indirect financial support of a practice, from which plaintiff himself abstains according to his religious principles, constitutes a substantial burden on plaintiff’s religious exercise.

RFRA is a shield, not a sword. It protects individuals from substantial burdens on religious exercise that occur when the government coerces action one’s religion forbids, or forbids action one’s religion requires; it is not a means to force one’s religious practices upon others. RFRA does not protect against the slight burden on religious exercise that arises when one’s money circuitously flows to support the conduct of other free-exercise-wielding individuals who hold religious beliefs that differ from one’s own…

Just as in Mead, plaintiffs must contribute to a health care plan which does not align with their religious beliefs. In this case, however, the burden on plaintiffs is even more remote; the health care plan will offend plaintiffs’ religious beliefs only if an OIH employee (or covered family member) makes an independent decision to use the plan to cover counseling related to or the purchase of contraceptives. Already, OIH and Frank O’Brien pay salaries to their employees—money the employees may use to purchase contraceptives or to contribute to a religious organization. [emphasis added] By comparison,the contribution to a health care plan has no more than a de minimus impact on the plaintiff’s religious beliefs than paying salaries and other benefits to employees.

And once again, despite the claims in this and similar lawsuits that the HHS mandate forces them to cover abortifacients, the belief that emergency contraception is abortifacient has not been borne out by the evidence. I’m going to keep repeating that until new evidence comes to light or people stop making this claim, so get used to it.

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Notes on the Notre Dame lawsuit

The University of Notre Dame has filed a lawsuit against the Departments of Health and Human Serivces, Labor, and the Treasury. They object to HHS’ inclusion of contraception as one of the core preventive services that must be provided in health insurance plans without cost sharing, on the grounds that covering contraception (and, they claim, abortifacients, but we’ll get to that later) is against their religious beliefs and the exemption for religious employers isn’t broad enough. I’m not a lawyer, so I’m not going to claim that Notre Dame has zero points in its favor in this lawsuit, but its arguments have some problems.

80. “Other commenters noted that ‘preventive care’ could not reasonably be interpreted to include such practices. These groups explained that pregnancy was not a disease that needed to be ‘prevented,’ and that a contrary view would intrude on the sincerely held beliefs of many religiously affiliated organizations by requiring them to pay for services that violate their religious beliefs.”

Whether or not evidence shows a practice to be ‘preventive care’ has nothing to do with anyone’s sincerely held religious beliefs about that practice’s morality. Pregnancy is not a disease, but it is a tremendous exertion, and the ability to plan it for those times when a woman is best prepared is beneficial to both the mother’s and the child’s health.

OK, you might say, we’ll grant for the sake of argument that contraception can be considered preventive care, but making Notre Dame include it in their employee health plans still violates their right to practice their religion. Just how far does Notre Dame want to extend this ability for employers to simply not offer coverage for medical treatments they disapprove of? They’re hoary old examples, but they keep getting trotted out because they are still relevant: Should employers who are Christian Scientists be able to refuse to provide any health insurance? Should employers who are Scientologists be able to refuse to provide insurance that covers mental health care? What about employers with a sincerely held belief that vaccines are dangerous and shouldn’t be considered “preventive care”? Do all of these employers get to offer nonstandard health benefits that conform to their religious beliefs, or just the more numerous and more politically powerful anti-contraception employers? And do the conscience rights of employees with regard to how they use their own health insurance have any weight at all?

I would also argue that in most cases, employers are not paying for contraception, or for any other particular procedure or service. They are taking part of their employees’ compensation and using it to pay premiums so that the employee will have affordable access to health care. Then the employee and her doctor decide on what health care the employee needs, and then the insurance company takes money from the pool of all of its clients’ premiums and pays the claim. The employer is no more directly involved in the supposed evil of contraception than if the employee went out and bought condoms with her paycheck — and no employer gets to stipulate that wages can’t be used to buy contraception. I’ll grant that Notre Dame’s situation is a little different, because it’s self-insured for its employees’ health plans. I think that if the Administration was going to have this compromise saying that religious employees could punt responsibility for contraception coverage to the health insurance companies, it probably should have thought a little harder about what self-employed companies would do. Of course, Notre Dame also wants to make sure that its students, who are insured through Aetna, can’t access contraception with that insurance either (despite Aetna having all the responsibility of informing students of the benefit and paying for it), so the suit doesn’t exactly hinge on that distinction.

87. FDA-approved contraceptives that qualify under these guidelines include drugs that induce abortions. For example, the FDA has approved “emergency contraceptives” such as the morning-after pill (otherwise known as Plan B), which operates by preventing a fertilized embryo from implanting in the womb, and Ulipristal (otherwise known as HRP 2000 or Ella [sic]), which likewise can induce abortions of living embryos.”

As we have pointed out many times, Plan B has been shown to have no mechanism of action besides the prevention of implantation [edit: I can’t believe this was up so long before I noticed this mistake — of course it should read “no mechanism of action besides the prevention of fertilization.”]. The mechanism of action of ella has not been fully explicated, and a contragestive effect can’t be ruled out at this time, especially since large or repeated doses of ulipristal acetate can be abortifacient. However, I have been able to find no studies in which a single dose of 30mg, as used in ella, has been shown to prevent implantation or to harm embryos after implantation. This paragraph is factually incorrect with regard to Plan B and presents speculation as fact with regard to ella. Arguments relying on the information in this paragraph should be discounted accordingly.

157. Furthermore, the U.S. Government Mandate is not narrowly tailored to promoting a compelling governmental interest. Even assuming the interest was compelling, the Government has numerous alternatives to furthering that interest other than forcing Notre Dame to violate its religious beliefs.

158. For example, the Government could provide or pay for the objectionable services through expansion of its existing network of family planning clinics funded by HHS under Title X or through other programs established by a duly enacted law. Or, at a minimum, it could create a broader exemption for religious employers, such as those found in numerous state laws throughout the country and in other federal laws.

Except that creating broad exemptions undermines the government’s interest in setting a minimum standard that all insurance policies must meet. This isn’t a new concept; the government sets minimum standards for many products, to protect consumers. And not including family planning as preventive care when evidence points to its usefulness in improving women’s and children’s health undermines the government’s interest in being able to shape its health care policy according to what actually works.

184. The religious employer exemption is based on an improper Government determination that “inculcation” is the only legitimate religious purpose.

Actually, the regulation does not say that organizations with a “legitimate religious purpose” will receive an exemption and then set out to define legitimate religious purpose. The regulation, quite properly, does not have anything to say about legitimacy. The limitations on the exemption appear designed to grant exemptions in those cases where employees can reasonably be expected to share the religious views of their employers, and therefore are less likely to be deprived by the exemption of a benefit that they might otherwise take advantage of.

Notre Dame then attemps to show that the mandate is not a neutral law of general applicability:

198. The Government has also crafted a religious exemption to the U.S. Government Mandate that favors certain religions over others. As noted, it applies only to plans sponsored by religious organizations that have, as their “purpose,” the “inculcation of religious values”; that “primarily” serve individuals that share those religious tenets; and that “primarily” employ such individuals. 45 C.F.R. § 147.130(a)(iv)(B)(1).

That does not favor particular religions over others. Notre Dame and other religiously-affiliated organizations are not, themselves, religions. Frankly, if anything the exemption favors religion over non-religion, but it does not favor any one religion over another. It distinguishes between organizations in which there is likely to be a difference of belief between the employer and the employees, and organizations in which there is less likelihood.

199. The U.S. Government Mandate, moreover, was promulgated by Government officials, and supported by non-governmental organizations, who strongly oppose Catholic teachings and beliefs regarding marriage and family. For example, on October 5, 2011, after Defendants announced the interim final rule but before they announced the final rule, Defendant Sebelius spoke at a fundraiser for NARAL Pro-Choice America. Defendant Sebelius has long been a staunch supporter of abortion rights and a vocal critic of Catholic teachings and beliefs regarding abortifacients and contraception. NARAL Pro-Choice America is a pro-abortion organization that likewise opposes many Catholic teachings. At that fundraiser, Defendant Sebelius criticized individuals and entities whose beliefs differed from those held by her and the other attendees of the NARAL Pro-Choice America fundraiser, stating: “Wouldn’t you think that people who want to reduce the number of abortions would champion the cause of widely available, widely affordable contraceptive services? Not so much.”

We live in a country in which government officials have the right to criticize the policy positions of religious organizations, especially when those policy positions have negative implications for people who do not share the beliefs of said organizations. This is not evidence of discrimination.

200. Consequently, on information and belief, Notre Dame alleges that the purpose of the U.S. Government Mandate, including the narrow exemption, is to discriminate against religious institutions and organizations that oppose contraception and abortifacients.

Notre Dame can only make this allegation because it refuses to acknowledge the validity of the evidence in favor of the health benefits of family planning, or to consider those health benefits a sufficiently compelling reason for the government to include family planning as part of its standards for health insurance plans. Notre Dame can only make this all about them by denying that their employees have any valid interest in being able to use the health insurance they earn to access health care services according to their own beliefs.

Notre Dame, not everything is about you.

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On the contraception mandate

I should point out before I begin that in this post, I am speaking for myself only. The All Our Lives board is not unanimous in the details of our opinions on requiring religious employers to provide insurance that covers contraception, though we are united in our belief that widespread access to contraception is vital.

I have a problem with the whole way this whole issue has been framed as “making churches pay for something they find morally objectionable.” Health insurance that someone earns as part of their employment compensation package is theirs, not the employer’s. If an institution’s religious freedom does not extend to allowing them to tell the employee that she can’t use her salary to pay for contraception, why should it extend to telling the employee that she can’t use her insurance benefit to pay for contraception? Yes, the money to pay the premium is coming from the employer, but so is the money to pay her salary. As far as I can tell, the difference is that religious institutions have been able to restrict the way that employees use their insurance benefits in a way that they have not been able to restrict the way that employees use their salaries, but the ability to do something does not make it a right. If there were some kind of special money that could be used to buy anything except contraception, would it be a violation of religious institutions’ First Amendment rights to require all employers to pay in standard money?

I’m an atheist. I rely on the separation of church and state to protect my freedom. Because of that, I’m leery of anything that even remotely smacks of government interference in religion or religious interference in government. That’s why I can appreciate the impulse behind the Adminstration’s accomodation allowing religious institutions to offer restricted insurance to their employees while still requiring the insurers to provide contraception coverage to those employees. I won’t claim to respect the belief that contraception is intrinsically evil. I think it causes great harm and is based on a number of false premises. But I do respect people’s right, as much as is possible in a pluralistic society, not to cooperate with something they think is evil. What happens, though, if Jehovah’s Witness employers decide that their employee’s insurance plans shouldn’t cover blood transfusions? What if Scientologist employers decide that their employees shouldn’t be covered for psychiatric treatment? At what point do we decide that a person’s right to practice their religion is interfering with another person’s right to live their life without having to submit to the rules of that religion? The degree of the employers’ “cooperation with evil” in these cases is remote — paying a benefit which the employee decides to use for a purpose condemned by the employer’s religion — while the impact on the employee who is restricted in their use of their own benefit is direct. The same is true of insurance coverage of contraception.

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Three quick news links

Busy day today, but I wanted to draw people's attentions to a few items:

Groundbreaking Bill Integrates Pregnancy and Violence Prevention Strategies for Young People of Color

The “Communities of Color Teenage Pregnancy Prevention Act,” HR 2678, recognizes that a broader approach is needed to address teen pregnancy in communities of color, including the role coercion and violence plays in unintended pregnancy, and invests in getting young people of color the information and skills they need to build healthy relationships.  It further addresses the need among racial or ethnic minority and immigrant communities for culturally appropriate information and education on issues of reproductive and sexual health.

Know Your Rights: A Conference Call for Pregnant and Parenting Students!

Wednesday, August 10, 3pm Eastern

Pregnant and parenting students have a right to equal educational opportunities! Interested? Get more information about protections for students against discrimination.

Court: No tax-funded abortion in healthcare law

"Whether it is possible, under contingent circumstances, that at some point in the future, upon the execution of x, y, and z, that the [Patient Protection and Affordable Care Act] would not prevent taxpayer funded abortion is entirely different from providing for 'tax-payer funded abortion,'" the opinion states. "The express language of the PPACA does not provide for tax-payer funded abortion. That is a fact, and it is clear on its face."

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Vital services for women to be available without co-pay under Affordable Care Act

The U.S. Department of Health and Human Services has accepted the Institute of Medicine’s recommendations about women’s health care services that should be provided by all insurers without co-payment under the Affordable Care Act. Among these services are HIV screening and counseling, domestic violence screening and counseling, support for breastfeeding, and contraception. These recommendations will be in effect for insurance policies with plan years beginning on or after August 1, 2012. Religious organizations which are opposed to contraception may opt out of having that coverage provided by their insurance.

All Our Lives applauds HHS’s acceptance of the recommendations. Having these vital services available without a co-payment will help more women and children live healthy lives as well as making it easier for women to avoid unintended pregnancy and abortion.