I’m quite frustrated at the public discussion of the HHS mandate: that all employers, with a few narrow exceptions, if they offer health insurance to employees at all, provide coverage for abortifacients Plan B and Ella (and, yes, contraceptives and sterilization), with no deductible or copay.
I’m frustrated in part because of the avoidance not only of what I consider the “real issue,” but of anything close to the real issue. Today’s newspaper, for crying out loud, was full of reactions to Rush Limbaugh’s latest, and possible most-odious-ever, remarks. What does that have to do with anything? We’re distracting ourselves to death.
I’m frustrated, too, because the simple facts of the mandate are so little covered that I can only hope that my understanding, described above, is accurate. (Yes, you might want to put “contraception” first, but I acknowledge that it’s there.)
So I’m going to take a shot at discussing the real issues. I don’t claim this is comprehensive. An integrated law that revolutionizes one-sixth of the national economy is much bigger than this blogger.
First, the top issue, for me as an employer, is the coverage of abortifacients without deductible or copay. I’d never qualify for any likely religious exemption. So I’m going to find myself, soon, in a position where I must drop employee health insurance or prepay quite directly for something that I strongly object to – not as a violation of cultic spiritual taboos by employees who aren’t part of the cultus, but as public policy for the common good. (There’s a glimmer of hope, though, for me as an employer: “The requirements to cover recommended preventive services without any cost-sharing do not apply to grandfathered health plans.” I’m not sure if our plan qualifies as “grandfathered,” and what tweaks might end that qualification.)
Group insurance plans without that coverage will not be available (save possibly through some guerilla “insurers” running scams through church bulletins).
I don’t even think I’d balk so much if all FDA-approved prescriptions were covered subject to a deductible. We have provided a high-deductible plan to our employees, and they can fund Health Savings Accounts (HSAs) for a tax-deductible pot from which to pay routine medical expenses. I’m a couple of steps removed from approval of abortifacients under this plan. But that’s coming to an end.
This is a very big deal for me. In Catholic Social Thought (by which I am consciously informed although I’m not Roman Catholic), HHS seems to be requiring “material cooperation” from me in an intrinsic evil. I’m still working through the moral ramifications, with help from essays like this.
2. Restricting “Religion”
Second, I’m sympathetic to the argument that any law that requires a religious exemption for political viability is too intrusive almost by definition. Obviously, from what precedes, I’m feeling that intrusion.
But putting that aside, what reliable meaning does “religious freedom” have, for purposes of a religious exemption, if the government arbitrarily decides what qualifies as “religious”?
[F]or purposes of this policy, a religious employer is one that:
(1) Has the inculcation of religious values as its purpose;
(2) primarily employs persons who share its religious tenets;
(3) primarily serves persons who share its religious tenets; and
(4) is a non-profit organization under section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii) of the Code.
Section 6033(a)(3)(A)(i) and (iii) refer to churches, their integrated auxiliaries, and conventions or associations of churches, as well as to the exclusively religious activities of any religious order.
So much for Catholic Charities, which
(1) Has service to the poor as its purpose;
(2) employs people who share its purpose, regardless of their religious tenets;
(3) serves anyone who’s poor and probably serves anyone plausibly pretending to be poor.
The Catholic Church, though, is merely the most prominent. Many other Churches have a similar capacious view of their mission.
In a regime of strict separation of Church and state, or anything close to it, Church gets smaller as state gets bigger, all else being equal. HHS’s stingy definition of religion could serve as Exhibit A.
On the mandate’s application to Catholic Charities and similar entities, I think the Obama administration is going to get another 9-0 Supreme Court smackdown, just as it did in its statist position in the Hosanna Tabor case.
Even if they don’t get smacked down, it’s hard for me to avoid the feeling that the Administration consciously set out to bring religious individuals and institutions to heel, as part of an odious statist scheme. I think Obama may consciously be playing a “long game,” driving the result toward single payer/socialized medicine/national health insurance.
3. The Mandate Isn’t About Insurance
I alluded to the high-deductible plan my employees get. It took the extreme inflation in health insurance costs to wake us up that we had in effect been providing not insurance, but prepayment of routine expenses subject to a pretty nominal deductible – maybe $500 per year (a figure sensible people routinely exceed for preventive maintenance of the human body). We got out close to the cutting edge of health care reform by putting our employees back in touch with the costs of both their insurance and the routine care they get.
John H. Cochrane in The Real Problem With The Birth-Control Mandate spells out many of the levels on which the mandate is perverse as a supposed part of an Affordable Care Act, since it will fuel inflation in health costs.
I put “insurance” in quotes for a reason. Insurance is supposed to mean a contract, by which a company pays for large, unanticipated expenses in return for a premium: expenses like your house burning down, your car getting stolen or a big medical bill.
Insurance is a bad idea for small, regular and predictable expenses. There are good reasons that your car insurance company doesn’t add $100 per year to your premium and then cover oil changes, and that your health insurance doesn’t charge $50 more per year and cover toothpaste. You’d have to fill out mountains of paperwork, the oil-change and toothpaste markets would become much less competitive, and you’d end up spending more.
It’s well worth reading if you’d like to start thinking outside the box of employer-provided health insurance.
But we lost that battle politically. HHS didn’t invent no-deductible, no copay preventive care. That’s in the law.
Section 2713 of the PHS Act, as added by the Affordable Care Act and incorporated under section 715(a)(1) of ERISA and section 9815(a)(1) of the Code, specifies that a group health plan and a health insurance issuer offering group or individual health insurance coverage provide benefits for and prohibit the imposition of cost-sharing with respect to:
Evidence-based items or services that have in effect arating of A or B in the current recommendations of the United States Preventive Services Task Force (Task Force) with respect to the individual involved.
With respect to women, preventive care and screening provided for in comprehensive guidelines supported by HRSA (not otherwise addressed by the recommendations of the Task Force), which will be commonly known as HRSA’s Women’s Preventive Services: Required Health Plan Coverage Guidelines.
4. Gratuitous Coverage of Controversial Items
What Obama’s team seems to have added to the law, though, is a stacked-deck process to ensure inclusion of contraception, early chemical abortions and self-mutilating sterilization as “preventive health services.”
The law obviously left some details up to a “task force” and to “HRSA” (Health Resources and Services Administration). And those entities, presumably with the connivance of the Administration, were arguably quite biased.
So what? Elections have consequences, right? Councils and Task Forces and bureaucracies under Republicans aren’t straight up the middle either, right?
Yeah, but much of the controversy over the Affordable Care Act involved “life issues” (remember the “Death Panel” même?), and Obama essentially promised us that the ACA wasn’t going to push an abortion or euthanasia agenda.
HHS could have passed on inclusion of “contraceptives” whose operation prevents, or disrupts, implantation of a nascent human life.
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On Items 2 and 4 especially, I have to fault the Obama Administration, toward which I have been pretty restrained in my criticisms over the past 3 years. But as in the Hosanna Tabor case, Obama has shown himself to be a statist, glad to let the state try to usher in the eschaton and to shove the Church aside in the process. He may be a Christian of sorts – of that I have no real doubt – but he’s a Caesaropapist. That is an automatic disqualifier for me. It is hard to imagine a field of opponents to Obama whose shortcomings would be worse that that, and so, once again, I can’t imagine voting for re-election of our historic first “African-American” President.
On Item 3, I can only say it’s obvious that we’re not yet serious about actual reform that will contain costs, as we’re deeply unserious about almost every other aspect of our unnatural and doomed economy.
And on that happy note, I’m through.
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