Supreme Court Ruling Raises Alarm for Residents

On June 30, the Supreme Court issued its long-awaited ruling in Burwell v. Hobby Lobby. Under the Affordable Care Act, insurance plans are required to provide all preventative care services at no cost to the patient, including contraception. Originally, houses of worship were exempt from this requirement if paying for their employees’ contraception contradicted their religion’s beliefs. The Obama Administration later added a workaround for hospitals, universities, and social service agencies run or affiliated by religious organizations by which the patient would still receive free contraception, but the cost would be paid for by the insurance company, not the employer.

In a 5-4 split, the conservative majority on the court ruled that “closely held” corporations owned by a small group of people who express religious objections to paying for contraception cannot be required to pay for it.

“So, what does this mean for us as providers?” posited Dr. Barbara Rubino, Los Angeles County+USC Medical Center, and CIR Regional Vice President for California. “And what does this mean for our patients? As doctors we provide oral contraceptive pills not only as a form of birth control for our patients, but to treat multiple medical conditions. We use these important medications to mitigate dysfunctional uterine/vaginal bleeding, address hormone imbalances in states such as PCOS or hypopituitarism, and treat common conditions such as acne. If we do not have these medications at our disposal or if their cost inhibits our ability to prescribe them, we are not only stunting reproductive rights, we are impeding standard medical care.”

CIR’s physicians across the country had strong reactions to the ruling and expressed concerns that it represents bad employment law, but even worse medicine.

“This is a medical decision that should be made by a woman and her doctor,” said Dr. Samuel Popinchalk at Jackson Memorial Hospital in Miami. “An employer with no medical training should not overrule it.”

Dr. Jennifer Batisti, a resident at St. Luke’s-Roosevelt Hospital in Manhattan, summed up the feelings of many: “I do not support the idea that non-medical personnel should be permitted to restrict a woman’s access to methods of contraception that are known to be safe, effective, and legal.”

U.S. Senators Patty Murray and Mark Udall moved quickly to undo some of the damage of the case by introducing a bill to explicitly clarify that employers who offer health insurance “shall not deny coverage of a specific health care item or service” required under the Affordable Care Act. Had it been passed, the bill would have prohibited for-profit employers from picking and choosing based on their own religious beliefs what preventative care they are required to provide to their employees free of charge.

On July 16th, CIR advocates quickly answered an action alert email and sent messages to their Senators urging them to support the bill. Unfortunately, the bill was shelved when conservatives in the Senate filibustered the procedural vote to open debate. Any adjustment to the law in the wake of the Supreme Court’s decision will have to wait for the results of the Congressional elections in November.

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