Sex, Coverage and Gender Bias: Being “Hobby-Lobbied”!

Posted on | July 16, 2014 | 2 Comments

David and Barbara Green/Hobby Lobby

Mike Magee

In its 5-4 decision in favor of Evangelical Christian purveyor of all things crafty, Hobby Lobby, the conservative male contingency of the Supreme Court managed to both engage and enrage all sides in the culture wars of a half century past.

With the decision, “closely held” (whatever that means) corporate entities “gained a conscience”, just like individuals, and the right to pick and choose from the menu of 20 forms of contraception required under the Affordable Care Act. Hobby Lobby chose to delete 2 morning after pills and 2 intra-uterine devices (IUD’d) they considered to be abortion inducers.

The Democratic leadership rapidly responded with a proposed Senate Bill (Protect Women’s Health From Corporate Interference Act) that would negate the effect of the Supreme Court decision and immediately drew the support of the 55,000 gynecologists strong American Congress of Obstetricians and Gynecologists which, in a clear slam down stated, “a woman’s boss has no role to play in her personal health care decisions…The value of family planning, including contraception, is clear. It allows women to time and space their pregnancies, leading to more optimal health outcomes for mother and for baby. And it helps to prevent unintended pregnancy; in America, nearly one half of all pregnancies are unintended…It is also essential that when an ob-gyn prescribes the appropriate contraceptive for each individual patient, he or she can trust that the patient will have access to that treatment option. Restrictions to this access are an unnecessary, inappropriate impediment in the patient/physician relationship.”

The last time ACOG came out this strongly on birth control was a half century ago when ACOG’s then director of women’s health issues, Luella Klein, MD, labelled the growing reimbursement for the newly released Viagra in the face of widespread non-coverage of birth control pills a “form of bias against women”. “People say pregnancy is natural, but what woman wants 21 or 25 pregnancies… This insurance exclusion makes no sense. Contraception provides great savings to the health care system, yet it is the individual woman who is shouldering the burden of this cost savings to insurers.”

While the pill had been legal and widely available since 1965 when the ruling in Griswold v. Connecticut struck down state laws banning the sale of birth control, the pill remained largely uncovered as the new millennium approached by insurance companies who said it was not a “medical necessity”. This claim had been under attack for decades, but legislation over the years had been successfully defeated by a coalition of businesses and the United States Conference of Catholic Bishops. This is the same group that pharmaceutical giant Pfizer approached in 1997 to get a Vatican read on whether they would actively oppose Viagra.

As a Catholic commentator explained the nuanced tortured rationale leading to the green light years later, “The Church has not condemned the use of Viagra. Artificial contraception, as you must know, is the intentional prevention of conception or impregnation through the use of various devices, agents, drugs, sexual practices, or surgical procedures before, during, or after a voluntary act of intercourse. Viagra, on the other hand, is a drug that helps males to overcome a pathological condition preventing them from engaging in the conjugal act with their spouses. Destroying or denying a good (conception) is quite different from enhancing or strengthening a good (as by use of Viagra).”

In the first six weeks after Viagra’s approval, the Church stood by it’s word – no opposition expressed to the drug, and tacit affirmation that this was “real medicine for a real disease” that made possible the normal resumption of natural marital relations. The tightrope for Pfizer was attempting to maintain the support of physicians who were becoming increasingly vocal about what they considered to be gender specific reimbursement bias, without triggering a negative reaction to Viagra reimbursement by the formidable Catholic lobby.

The fact that Gloria Feldt, then president of Planned Parenthood had made a very publicized comment about the disparity was of some concern. But when the 39,000 strong American College of Obstetrics and Gynecology issued a statement condemning the lack of coverage in the face of reimbursement of Viagra as a “form of bias against women”, pressure was building. Forced to take a stand, Pfizer quietly voiced support for reimbursement of both Viagra and contraceptives as necessary and medically sound therapies, and added coverage of birth control pills for its own employees for the first time.

With the Hobby Lobby ruling, instigated in part by the prior compromise with the US Conference of Catholic Bishops over coverage of contraception in Catholic organizations including hospitals and universities, the old lines have been reformed. And once again, American women and their doctors are caught in the cross-fire.

For Health Commentary, I’m Mike Magee

Comments

2 Responses to “Sex, Coverage and Gender Bias: Being “Hobby-Lobbied”!”

  1. Marj
    July 17th, 2014 @ 10:12 am

    I find it confusing that people think employers have to provide for everything they want.

    When did this happen? If you don’t like the coverage (medical) that your employer provides, you can always supplement it or choose to purchase your own, and keep the monies that would have gone to payroll deduction, just like you can for Life insurance, IRAs, long term disability.

    If forced, the employer could just close their business and put a lot of people out of work, isn’t it better for people to pay out of pocket for things they want that the employer doesn’t provide? Or chose to work for a different employer?

    Just because your an employer doesn’t mean you should have to leave your beliefs at the door.

  2. Mike Magee
    July 17th, 2014 @ 3:37 pm

    Thanks, Marj. The linkage of health insurance and employment’s problematic, for the reasons you lay out, and many more. There is a fundamental conflict of interest when employees and employers get tangled up in such a sensitive and privacy laden group of services. I expect we are already witnessing a de-linkage and will soon join all highly developed nations and let go of employer based health insurance. Mike

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