The Obama administration will soon announce the final rule governing the reproductive health services insurers must offer women without additional cost sharing as a result of the Women’s Health Amendment in the Affordable Care Act. One question, however, remains: will President Obama cave to the pressure of religious groups and expand the interim rule’s existing conscience clause to allow all religiously affiliated organizations to deny comprehensive coverage to the millions of women who work for them? For the sake of anyone who has ever had to fear that a routine health care encounter could turn into a struggle between their medical needs and their provider’s private religious beliefs, including gay and transgender people, the answer should be no.
Broadening the conscience protections would not only undermine the potential of the Women’s Health Amendment (as well as of the Affordable Care Act) to improve the health and well-being of millions of women and their families. It would also perpetuate a dangerous precedent that already allows Bush-era religious refusal policies to continue to hinder the ability of public health efforts to reach populations in need of services.
For example, the PEPFAR program, which was established during the Bush Administration to bring health services to people around the world living with or at high risk for HIV/AIDS, contains a religious refusal clause that has had substantial negative impact on critical work internationally with populations most at risk for HIV. In places around the globe that have been hardest hit by AIDS, people in need of medical care may have only one health center accessible in their area. If that health center is run by a faith-based organization that refuses to provide proven preventive methods such as condoms or appropriate and comprehensive HIV prevention information, people must go without health care services that could save their lives.
And on World AIDS Day, we cannot forget that carving out ever-larger religious exemptions in insurance benefits and health care similarly has the potential to undermine efforts to halt the domestic AIDS epidemic, particularly among stigmatized populations such as men who have sex with men (MSM) and transgender people.
Right now the struggle is over contraceptives. But one day those same organizations who exploit religious refusal clauses to deny birth control to women or condoms to people trying to prevent the spread of HIV in their communities may take the opportunity to try to opt out of covering any HIV-related services, to refuse to administer exams or treatment for other sexually transmitted infections, to deny blood transfusions or end-of-life care, or to refuse to join the growing number of employees offering insurance benefits that are inclusive of transgender people or same-sex partners and their children.
One of the cornerstones of the Affordable Care Act is expanding access to insurance coverage and vital health services for everyone who needs them. An expanded religious exemption in the WHA rule would violate this fundamental principle by allowing private religious beliefs to trump evidence-based best practices in public health.