Coverage improves for some women; others can only wait

Despite the hyperbolic predic- tions of the death of religious freedom in the United States, another provision of the Affordable Care Act kicked in Wednesday, and the sun came up Thursday.

As of Aug. 1, any woman covered by a health insurance plan that has changed since the ACA was enacted in March 2010, is eligible for a variety of preventive services, including birth control, without being charged a deductible.

If fully implemented, the provisions would cover about 97 million American women between the ages of 18 and 64. But as of today, it only covers only a fraction of those — women who are covered by private health plans, and even then only those that have been changed in the last 28 months. Women covered by Medicaid may or may not feel the effects, depending on the state they live in. And the Obama administration delayed for a year enforcement of the contraception requirement on employers that are ancillary arms of churches, such as nonprofit hospitals, social service agencies and universities. Those institutions still have to provide the less controversial services, a yearly well-woman doctor’s visit, HPV testing, gestational diabetes testing for pregnant women, counseling for sexually transmitted diseases, HIV screening and counseling, breast pumps and domestic violence counseling.

Between now and next August, any one of a number of things could happen that would break the stalemate between the administration and its opponents, the most vocal of whom were members of the U.S. Conference of Catholic Bishops.

Obviously, if President Barack Obama is defeated in November, the issue would become moot. If he wins re-election an agreed-upon compromise might be possible in an atmosphere that is less charged with a mixture of religion and partisan political fervor.

Competing freedoms

In a post-election United States, it might be possible to see this conflict as one of competing individual freedoms. It is not simply a matter of the government forcing its will on a religious institution in violation of the First Amendment. Churches always had an exemption based on the government’s recognition of religious freedom. But their affiliates, notably universities and hospitals, which function as big business even when they are nonprofit, were not exempt.

While the bishops and some faithful complained that the government was forcing the church to provide services to which it is morally opposed, there is an opposing argument. That would be that the church was attempting to enforce its religious beliefs on employees and students, many of whom are not Catholic, or at least not practicing Catholics by the bishops’ standards. Life in the United States is chock-full of such competing rights — the trite metaphor being one person’s right to swing his fist ends at the other person’s nose. In this case the question is whether the institution’s right to its religious beliefs supersedes the individual right of an employee to live by his or her beliefs or that of the employer.

The administration thought it had worked out a reasonable compromise — especially since some institutions had plans that provided contraception coverage. But these days, compromise is increasingly becoming a dirty word.