Supreme Court: Companies can deny contraceptive coverage



WASHINGTON – For-profit companies cannot be compelled to provide insurance coverage for contraception if doing so violates the religious beliefs of the company’s owners, the Supreme Court ruled June 30.

Dissenting justices said that it had the potential to allow employers to use their religious beliefs as a way to object to providing coverage for vaccinations, blood transfusions, and other procedures, and that it could open the door to deny employment to certain individuals or groups.

The Court ruled 5-4 in the cases of Burwell v. Hobby Lobby Stores Inc. and Conestoga Wood Specialties Corp. v. Burwell.

Alicia Ault/Frontline Medical News

The Supreme Court decision in the Hobby Lobby/Conestoga Woodworking case could impact the physician/patient relationship, some critics contend.

Justice Samuel Alito, reading the opinion for the majority, said that the Religious Freedom Restoration Act (RFRA) of 1993 protected the rights of not just individuals, but also of individuals who run closely held for-profit corporations.

The terms of that law "make it perfectly clear that Congress did not discriminate in this way against men and women who wish to run their businesses as for-profit corporations in the manner required by their religious beliefs," according to the opinion signed by Justice Alito, Justice Anthony P. Kennedy, Justice Antonin Scalia, and Justice Clarence Thomas, and Chief Justice John P. Roberts.

The plaintiffs in the cases said that being required by the Affordable Care Act to provide insurance coverage for contraception violated their religious beliefs. In particular, Hobby Lobby and Conestoga Wood both objected to four specific types of contraception that they said interfere with conception and thus constitute abortion: the Ella morning-after pill, the Plan B morning-after pill, and hormonal and copper intrauterine devices (IUDs).

The majority opinion said that by requiring companies that did not comply to pay fines, the government was placing an undue burden on these employers. Justice Alito noted that Hobby Lobby would have to either give up its religious tenets or pay up to $1.3 million a day in fines*.

"If these consequences don’t amount to a heavy burden, I’m not sure what would," he said.

The majority also said that since the government already makes exceptions to the contraception requirement for religious organizations and nonprofit religiously affiliated groups, that it could have made the same allowances for for-profit companies. The government also could have offered to pay for the contraceptives that companies refuse to cover, they said.

Justice Ruth Bader Ginsburg, who read the dissenting opinion, called the majority’s opinion "a decision of startling breadth." If allowed to stand, it could raise what she called "a host of ‘me, too’ questions," such as whether an employer could opt out of coverage for antidepressants, vaccinations, or medications derived from pigs, "based on the employer’s sincerely held religious beliefs opposing those medical practices."

Joined by Justice Stephen G. Breyer, Justice Elena Kagan, and Justice Sonia Sotomayor, she also said that while the ruling might seem to be limited to access to the four contraceptives in the cases, it was likely that companies would seek to deny coverage for all available contraceptive technologies.

The dissenters also said that they doubted that Congress intended for the RFRA to be used to allow a company to stand in between a woman and her physician. Any decision to use a contraceptive "will be the woman’s autonomous choice, informed by the physician she consults," they wrote.

Many physicians’ and women’s health organizations called it a dangerous precedent.

The American College of Obstetricians and Gynecologists President John C. Jennings said in a statement that the group was “profoundly disappointed” in the decision, as it “inappropriately allows employers to interfere in women’s health care decisions.” Dr. Jennings also said that contraceptives should not be treated differently than other health care services for women. “The value of family planning – including contraception – has been clearly demonstrated,” he said. “The ability of a woman to time and space her children reduces infant, child, and maternal morbidity and mortality, and can lead to more optimal health outcomes for mother and for baby.”

Contraception also helps prevent unintended pregnancy, he said, adding, “This is absolutely essential in America, where nearly one half of all pregnancies are unintended.”

In a statement, Dr.Reid Blackwelder, president of the American Academy of Family Physicians, said, "With this decision, the court has moved health care decisions out of the exam room, where patients can consult with their physicians — and where such decisions should be made — and put them into the hands of business owners who base decisions on personal beliefs rather than [on] medical science." Dr. Blackwelder added, "Personal or institutional beliefs should not put Americans’ health and lives at risk, simply because employers control the insurance available to their workers. Unfortunately, the Supreme Court decision opens the gate for just such consequences."


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