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It may be months, even years before it’s clear whether access to and payment for contraception will be limited in the wake of the U.S. Supreme Court’s decision that for-profit companies can forego health insurance coverage of birth control methods that violate their religious belief.
At this point, only the two plaintiffs in the case – Hobby Lobby and Conestoga Wood Specialties – can change their health insurance coverage of contraception, based on the June 30 decision by the U.S. Supreme Court.
In the meantime, there is a lot of confusion among patients – and uncertainty among doctors -- about what the ruling means.
"We’re all scratching our heads and saying, ‘Now what?’ " said Dr. Anne Davis, medical director of Physicians for Reproductive Health. "All of us are very used to hurdles with coverage, but this is a new one."
Now, ob.gyns and other physicians may have to figure out if a patient works for an employer whose insurance will not cover certain types of contraception, or perhaps all birth control, said Dr. Davis of the department of clinical obstetrics and gynecology at Columbia University, New York.
The Supreme Court ruling is "a huge step backward," said Dr. Eve Espey, chair of obstetrics and gynecology at the University of New Mexico, Albuquerque. For physicians, a key concern is whether they will be paid for inserting an IUD or providing another service; for patients, it’s whether they can get the contraception and if they can afford it, she said.
When concerns mount, "those services tend to not happen," Dr. Espey said.
Ob.gyns. also expressed concern that the ruling had opened the door to interference in the physician-patient relationship.
Clinicians need the freedom to select the birth control method that makes the most sense for the patient, said Dr. Davis. "It’s going to be really unfortunate if you and the patient agree, and it’s the right thing and you find out that her employer has decided it’s not the right kind of birth control because of their beliefs," she said.
Dr. Jeanne Conry, immediate past president of the American Congress of Obstetricians and Gynecologists (ACOG), said that if she has decided that an IUD is best for a 34-year-old diabetic patient, but her employer says it won’t pay for that method, "that’s not in her best interest."
"They’ve just interfered with my best treatment for the patient," said Dr. Conry, an ob.gyn with Kaiser Permanente in Roseville, Calif.
Dr. Mitchell Creinin, chair of the obstetrics and gynecology department at University of California, Davis, said that the ruling could return contraception to a means-tested environment, in which only those who have the means will get the most effective methods, like the IUD. Instead, he said, it should be a benefit for all. Preventing pregnancy "is a public health issue and we’ve got to look at it that way," Dr. Creinin said.
Just after the ruling, ACOG President John Jennings agreed, expressing dismay that the Court was overlooking what had been firmly established. "The value of family planning – including contraception – has been clearly demonstrated," he said, in a statement.
But pro-life groups, including Americans United for Life and the Association of Pro-Life Obstetricians and Gynecologists, applauded the Hobby Lobby decision, saying that it helps preserve the right to practice according to conscience.
"Respect for the constitutionally guaranteed rights of conscience – whether held by business owners or medical professionals – must and should be protected," said Dr. Monique Chireau, AUL board member, with the department of ob.gyn at Duke University, Durham, N.C.
Dr. Gene Rudd, senior vice president for the Christian Medical and Dental Associations (CMDA), said that he did not think the decision would have any direct impact on ob.gyns.’ practices. However, he said, "Had the Justices allowed the government to force business owners to act against their conscience, that could establish a legal precedent by which the government might one day force physicians to act against their consciences."
The CMDA’s membership view the ACA’s mandate that women receive contraceptives free of charge as a potential infringement on their right to practice according to their beliefs, said Dr. Rudd, an ob.gyn.
In a CMDA survey, "95% of our members said they’d leave medicine before being required to violate their conscience," he said. They want "women free to pursue getting the contraceptive of their choice," but not to force either individual physicians or religiously affiliated organizations or small private employers to do things that are against their beliefs.
Who might be affected?
For now, there is no definitive answer on how many women could potentially lose coverage of contraception as a result of the Supreme Court decision. Hobby Lobby has 500 stores and 13,000 employees. Conestoga Wood Specialties has 950 employees. There are 90-100 cases challenging the contraception requirement, with about half them from nonprofit organizations and half from for-profit companies. And there’s motivation to sue: Companies that do not comply with the ACA requirement face fines of $100 per day per enrollee.
According to the Dept. of Health & Human Services, about 48 million women are eligible for preventive services because they are in "non-grandfathered" health plans.
Millions of women receive family planning services outside of employer-sponsored insurance, and thus may not be directly affected. A Guttmacher Institute report shows that 19 million women need publicly funded services and supplies because they are low income or are assumed to have a low income because they are under age 20 years. Family planning services provided through federal and state government funding helped women avoid 2.2 million unintended pregnancies in 2010, according to Guttmacher.
Reversing the decision
A handful of Democrats in the House and Senate introduced legislation July 9 to reverse the Supreme Court’s decision. The Protect Women's Health From Corporate Interference Act, introduced by Sen. Patty Murray (D-Wash.), would eliminate the loophole given by the court to companies that are not religiously affiliated.
ACOG praised the effort and applauded the legislators "for recognizing that contraceptives and other essential health care services should not be treated differently than other forms of health care.
"We look forward to working with them and other Congressional leaders to ensure that the ability of physicians to provide care for women is no longer subject to outside interference," Dr. Jennings said in a statement.
The White House said in an official Statement of Administration Policy that it strongly supported the legislation, saying that it "would prevent owners of for-profit companies from asserting their personal religious views to deny their employees federally-required health benefits."
Senate Democrats attempted to bring the bill to the floor on July 16, but failed to secure enough votes for debate. Republican Senators in the meantime introduced their own legislation to guarantee that employers could not bar "access" to contraceptives. The Preserving Religious Freedom and a Woman’s Access to Contraception Act (S. 2605) was introduced by Sen. Kelly Ayotte (R-N.H.).
Neither of the bills are expected to gain much traction in either the Senate or the House.
ACOG has asked its members to report coverage problems to their regional chapters, Dr. Conry said.
The federal government also could pursue several methods of reinstating the coverage. It could give for-profit employers the same accommodation that it has given nonprofit religiously affiliated employers like schools or charities. If these employers self-attest that paying for birth control violates their beliefs, then the employer’s insurer pays for the contraception. For self-insured employers, the exemption is not as easily navigated, because they would have to pay for the coverage.
That accommodation is being challenged by at least 45 legal cases that argue filling out the form violates plaintiffs’ religious beliefs because it means they are facilitating access to birth control.
The government could also pay directly for contraception for women whose employers receive an exemption. Supreme Court Justice Samuel Alito suggested such a possibility in his majority opinion in the Hobby Lobby case.
Dr. Davis said that, ideally, gynecologists would be able to give patients the contraception of choice on the same day of a visit and that the physician would be reimbursed for the cost of the device plus a fee for placing it. And, physicians should be able to counsel patients without thought of potential oversight from an employer or anyone else.
But, she said, "We are very far away from that right now."
On Twitter @aliciaault
It may be months, even years before it’s clear whether access to and payment for contraception will be limited in the wake of the U.S. Supreme Court’s decision that for-profit companies can forego health insurance coverage of birth control methods that violate their religious belief.
At this point, only the two plaintiffs in the case – Hobby Lobby and Conestoga Wood Specialties – can change their health insurance coverage of contraception, based on the June 30 decision by the U.S. Supreme Court.
In the meantime, there is a lot of confusion among patients – and uncertainty among doctors -- about what the ruling means.
"We’re all scratching our heads and saying, ‘Now what?’ " said Dr. Anne Davis, medical director of Physicians for Reproductive Health. "All of us are very used to hurdles with coverage, but this is a new one."
Now, ob.gyns and other physicians may have to figure out if a patient works for an employer whose insurance will not cover certain types of contraception, or perhaps all birth control, said Dr. Davis of the department of clinical obstetrics and gynecology at Columbia University, New York.
The Supreme Court ruling is "a huge step backward," said Dr. Eve Espey, chair of obstetrics and gynecology at the University of New Mexico, Albuquerque. For physicians, a key concern is whether they will be paid for inserting an IUD or providing another service; for patients, it’s whether they can get the contraception and if they can afford it, she said.
When concerns mount, "those services tend to not happen," Dr. Espey said.
Ob.gyns. also expressed concern that the ruling had opened the door to interference in the physician-patient relationship.
Clinicians need the freedom to select the birth control method that makes the most sense for the patient, said Dr. Davis. "It’s going to be really unfortunate if you and the patient agree, and it’s the right thing and you find out that her employer has decided it’s not the right kind of birth control because of their beliefs," she said.
Dr. Jeanne Conry, immediate past president of the American Congress of Obstetricians and Gynecologists (ACOG), said that if she has decided that an IUD is best for a 34-year-old diabetic patient, but her employer says it won’t pay for that method, "that’s not in her best interest."
"They’ve just interfered with my best treatment for the patient," said Dr. Conry, an ob.gyn with Kaiser Permanente in Roseville, Calif.
Dr. Mitchell Creinin, chair of the obstetrics and gynecology department at University of California, Davis, said that the ruling could return contraception to a means-tested environment, in which only those who have the means will get the most effective methods, like the IUD. Instead, he said, it should be a benefit for all. Preventing pregnancy "is a public health issue and we’ve got to look at it that way," Dr. Creinin said.
Just after the ruling, ACOG President John Jennings agreed, expressing dismay that the Court was overlooking what had been firmly established. "The value of family planning – including contraception – has been clearly demonstrated," he said, in a statement.
But pro-life groups, including Americans United for Life and the Association of Pro-Life Obstetricians and Gynecologists, applauded the Hobby Lobby decision, saying that it helps preserve the right to practice according to conscience.
"Respect for the constitutionally guaranteed rights of conscience – whether held by business owners or medical professionals – must and should be protected," said Dr. Monique Chireau, AUL board member, with the department of ob.gyn at Duke University, Durham, N.C.
Dr. Gene Rudd, senior vice president for the Christian Medical and Dental Associations (CMDA), said that he did not think the decision would have any direct impact on ob.gyns.’ practices. However, he said, "Had the Justices allowed the government to force business owners to act against their conscience, that could establish a legal precedent by which the government might one day force physicians to act against their consciences."
The CMDA’s membership view the ACA’s mandate that women receive contraceptives free of charge as a potential infringement on their right to practice according to their beliefs, said Dr. Rudd, an ob.gyn.
In a CMDA survey, "95% of our members said they’d leave medicine before being required to violate their conscience," he said. They want "women free to pursue getting the contraceptive of their choice," but not to force either individual physicians or religiously affiliated organizations or small private employers to do things that are against their beliefs.
Who might be affected?
For now, there is no definitive answer on how many women could potentially lose coverage of contraception as a result of the Supreme Court decision. Hobby Lobby has 500 stores and 13,000 employees. Conestoga Wood Specialties has 950 employees. There are 90-100 cases challenging the contraception requirement, with about half them from nonprofit organizations and half from for-profit companies. And there’s motivation to sue: Companies that do not comply with the ACA requirement face fines of $100 per day per enrollee.
According to the Dept. of Health & Human Services, about 48 million women are eligible for preventive services because they are in "non-grandfathered" health plans.
Millions of women receive family planning services outside of employer-sponsored insurance, and thus may not be directly affected. A Guttmacher Institute report shows that 19 million women need publicly funded services and supplies because they are low income or are assumed to have a low income because they are under age 20 years. Family planning services provided through federal and state government funding helped women avoid 2.2 million unintended pregnancies in 2010, according to Guttmacher.
Reversing the decision
A handful of Democrats in the House and Senate introduced legislation July 9 to reverse the Supreme Court’s decision. The Protect Women's Health From Corporate Interference Act, introduced by Sen. Patty Murray (D-Wash.), would eliminate the loophole given by the court to companies that are not religiously affiliated.
ACOG praised the effort and applauded the legislators "for recognizing that contraceptives and other essential health care services should not be treated differently than other forms of health care.
"We look forward to working with them and other Congressional leaders to ensure that the ability of physicians to provide care for women is no longer subject to outside interference," Dr. Jennings said in a statement.
The White House said in an official Statement of Administration Policy that it strongly supported the legislation, saying that it "would prevent owners of for-profit companies from asserting their personal religious views to deny their employees federally-required health benefits."
Senate Democrats attempted to bring the bill to the floor on July 16, but failed to secure enough votes for debate. Republican Senators in the meantime introduced their own legislation to guarantee that employers could not bar "access" to contraceptives. The Preserving Religious Freedom and a Woman’s Access to Contraception Act (S. 2605) was introduced by Sen. Kelly Ayotte (R-N.H.).
Neither of the bills are expected to gain much traction in either the Senate or the House.
ACOG has asked its members to report coverage problems to their regional chapters, Dr. Conry said.
The federal government also could pursue several methods of reinstating the coverage. It could give for-profit employers the same accommodation that it has given nonprofit religiously affiliated employers like schools or charities. If these employers self-attest that paying for birth control violates their beliefs, then the employer’s insurer pays for the contraception. For self-insured employers, the exemption is not as easily navigated, because they would have to pay for the coverage.
That accommodation is being challenged by at least 45 legal cases that argue filling out the form violates plaintiffs’ religious beliefs because it means they are facilitating access to birth control.
The government could also pay directly for contraception for women whose employers receive an exemption. Supreme Court Justice Samuel Alito suggested such a possibility in his majority opinion in the Hobby Lobby case.
Dr. Davis said that, ideally, gynecologists would be able to give patients the contraception of choice on the same day of a visit and that the physician would be reimbursed for the cost of the device plus a fee for placing it. And, physicians should be able to counsel patients without thought of potential oversight from an employer or anyone else.
But, she said, "We are very far away from that right now."
On Twitter @aliciaault
It may be months, even years before it’s clear whether access to and payment for contraception will be limited in the wake of the U.S. Supreme Court’s decision that for-profit companies can forego health insurance coverage of birth control methods that violate their religious belief.
At this point, only the two plaintiffs in the case – Hobby Lobby and Conestoga Wood Specialties – can change their health insurance coverage of contraception, based on the June 30 decision by the U.S. Supreme Court.
In the meantime, there is a lot of confusion among patients – and uncertainty among doctors -- about what the ruling means.
"We’re all scratching our heads and saying, ‘Now what?’ " said Dr. Anne Davis, medical director of Physicians for Reproductive Health. "All of us are very used to hurdles with coverage, but this is a new one."
Now, ob.gyns and other physicians may have to figure out if a patient works for an employer whose insurance will not cover certain types of contraception, or perhaps all birth control, said Dr. Davis of the department of clinical obstetrics and gynecology at Columbia University, New York.
The Supreme Court ruling is "a huge step backward," said Dr. Eve Espey, chair of obstetrics and gynecology at the University of New Mexico, Albuquerque. For physicians, a key concern is whether they will be paid for inserting an IUD or providing another service; for patients, it’s whether they can get the contraception and if they can afford it, she said.
When concerns mount, "those services tend to not happen," Dr. Espey said.
Ob.gyns. also expressed concern that the ruling had opened the door to interference in the physician-patient relationship.
Clinicians need the freedom to select the birth control method that makes the most sense for the patient, said Dr. Davis. "It’s going to be really unfortunate if you and the patient agree, and it’s the right thing and you find out that her employer has decided it’s not the right kind of birth control because of their beliefs," she said.
Dr. Jeanne Conry, immediate past president of the American Congress of Obstetricians and Gynecologists (ACOG), said that if she has decided that an IUD is best for a 34-year-old diabetic patient, but her employer says it won’t pay for that method, "that’s not in her best interest."
"They’ve just interfered with my best treatment for the patient," said Dr. Conry, an ob.gyn with Kaiser Permanente in Roseville, Calif.
Dr. Mitchell Creinin, chair of the obstetrics and gynecology department at University of California, Davis, said that the ruling could return contraception to a means-tested environment, in which only those who have the means will get the most effective methods, like the IUD. Instead, he said, it should be a benefit for all. Preventing pregnancy "is a public health issue and we’ve got to look at it that way," Dr. Creinin said.
Just after the ruling, ACOG President John Jennings agreed, expressing dismay that the Court was overlooking what had been firmly established. "The value of family planning – including contraception – has been clearly demonstrated," he said, in a statement.
But pro-life groups, including Americans United for Life and the Association of Pro-Life Obstetricians and Gynecologists, applauded the Hobby Lobby decision, saying that it helps preserve the right to practice according to conscience.
"Respect for the constitutionally guaranteed rights of conscience – whether held by business owners or medical professionals – must and should be protected," said Dr. Monique Chireau, AUL board member, with the department of ob.gyn at Duke University, Durham, N.C.
Dr. Gene Rudd, senior vice president for the Christian Medical and Dental Associations (CMDA), said that he did not think the decision would have any direct impact on ob.gyns.’ practices. However, he said, "Had the Justices allowed the government to force business owners to act against their conscience, that could establish a legal precedent by which the government might one day force physicians to act against their consciences."
The CMDA’s membership view the ACA’s mandate that women receive contraceptives free of charge as a potential infringement on their right to practice according to their beliefs, said Dr. Rudd, an ob.gyn.
In a CMDA survey, "95% of our members said they’d leave medicine before being required to violate their conscience," he said. They want "women free to pursue getting the contraceptive of their choice," but not to force either individual physicians or religiously affiliated organizations or small private employers to do things that are against their beliefs.
Who might be affected?
For now, there is no definitive answer on how many women could potentially lose coverage of contraception as a result of the Supreme Court decision. Hobby Lobby has 500 stores and 13,000 employees. Conestoga Wood Specialties has 950 employees. There are 90-100 cases challenging the contraception requirement, with about half them from nonprofit organizations and half from for-profit companies. And there’s motivation to sue: Companies that do not comply with the ACA requirement face fines of $100 per day per enrollee.
According to the Dept. of Health & Human Services, about 48 million women are eligible for preventive services because they are in "non-grandfathered" health plans.
Millions of women receive family planning services outside of employer-sponsored insurance, and thus may not be directly affected. A Guttmacher Institute report shows that 19 million women need publicly funded services and supplies because they are low income or are assumed to have a low income because they are under age 20 years. Family planning services provided through federal and state government funding helped women avoid 2.2 million unintended pregnancies in 2010, according to Guttmacher.
Reversing the decision
A handful of Democrats in the House and Senate introduced legislation July 9 to reverse the Supreme Court’s decision. The Protect Women's Health From Corporate Interference Act, introduced by Sen. Patty Murray (D-Wash.), would eliminate the loophole given by the court to companies that are not religiously affiliated.
ACOG praised the effort and applauded the legislators "for recognizing that contraceptives and other essential health care services should not be treated differently than other forms of health care.
"We look forward to working with them and other Congressional leaders to ensure that the ability of physicians to provide care for women is no longer subject to outside interference," Dr. Jennings said in a statement.
The White House said in an official Statement of Administration Policy that it strongly supported the legislation, saying that it "would prevent owners of for-profit companies from asserting their personal religious views to deny their employees federally-required health benefits."
Senate Democrats attempted to bring the bill to the floor on July 16, but failed to secure enough votes for debate. Republican Senators in the meantime introduced their own legislation to guarantee that employers could not bar "access" to contraceptives. The Preserving Religious Freedom and a Woman’s Access to Contraception Act (S. 2605) was introduced by Sen. Kelly Ayotte (R-N.H.).
Neither of the bills are expected to gain much traction in either the Senate or the House.
ACOG has asked its members to report coverage problems to their regional chapters, Dr. Conry said.
The federal government also could pursue several methods of reinstating the coverage. It could give for-profit employers the same accommodation that it has given nonprofit religiously affiliated employers like schools or charities. If these employers self-attest that paying for birth control violates their beliefs, then the employer’s insurer pays for the contraception. For self-insured employers, the exemption is not as easily navigated, because they would have to pay for the coverage.
That accommodation is being challenged by at least 45 legal cases that argue filling out the form violates plaintiffs’ religious beliefs because it means they are facilitating access to birth control.
The government could also pay directly for contraception for women whose employers receive an exemption. Supreme Court Justice Samuel Alito suggested such a possibility in his majority opinion in the Hobby Lobby case.
Dr. Davis said that, ideally, gynecologists would be able to give patients the contraception of choice on the same day of a visit and that the physician would be reimbursed for the cost of the device plus a fee for placing it. And, physicians should be able to counsel patients without thought of potential oversight from an employer or anyone else.
But, she said, "We are very far away from that right now."
On Twitter @aliciaault
