Our guest blogger is Andrew Cray, an LGBT health research associate at the Center for American Progress.
Today, the battle over coverage for the full range of medically necessary health services reached another milestone. The Blunt Amendment, which the Senate narrowly voted to table earlier today, would have given unprecedented discretion to any employer or insurance plan, whether or not religious, to exclude coverage for critical health care services on the basis of undefined “moral convictions.” This far-reaching proposal was not limited to particular services, instead restricting access to care in a manner so extreme that HHS Secretary Kathleen Sebelius described the measure as “dangerous and wrong.” The Amendment was the latest in the GOP’s continuing effort to limit access and autonomy in health care, a firestorm that House Speaker John Boehner (R-OH) has vowed to reignite.
The Blunt Amendment undermined the Affordable Care Act’s guarantee of coverage for essential health benefits, and could have placed access to preventive care services at risk for over 20 million women. Perhaps its greatest threat, though, was its potential to gut the crucial equity framework established by the Affordable Care Act, placing entire populations at risk of losing coverage for necessary, sometimes life-saving, care.
Among those with the greatest to lose from proposals like the Blunt Amendment is the lesbian, gay, bisexual, and transgender (LGBT) community. Broad and unfettered language of the kind advanced by Sen. Roy Blunt (R-MO) would grant insurers and employers the right to deny coverage for nearly any service provided to LGBT patients. For example, under the Blunt Amendment:
— An insurer could refuse to cover any health care service to a gay couple because of a religious or moral objection to such relationships.
— An employer could refuse to cover life-saving care for HIV or AIDS, due to an unfounded “moral objection.”
— An insurance plan could ban coverage for nearly any care provided to a transgender person, on the basis of moral or religious objection to their gender identity.
Denying coverage for these basic essential services – a central requirement of the Affordable Care Act – rolls back progress in public health, and places the lives of LGBT people at risk.
If this type of discriminatory measure seems familiar, it is because courts have struck down similar policies before. In 2008, the California Supreme Court held that anti-discrimination protections similar to the kind contained in the ACA cannot be broken by providers because of religious objections to serving patients. President Obama in 2011 repealed provider conscience clauses for insurers, nearly identical to the type contained in the Blunt Amendment, because of the very real fact that these types of exemptions put the health and safety of patients at risk. As if that is not enough, courts have held that religious exceptions to insurance coverage must be tightly contained, and that even expressly religious organizations “must be prepared to accept neutral regulations imposed to protect [employees’] legitimate interests in doing what their own beliefs permit.”
Even some of the Amendment’s supporters previously objected to tampering with the relationship between patients and their providers. That commitment, however, wavered as Blunt and other Senate conservatives used today’s vote as a divisive election-year strategy to advance their broader political agenda.
The Affordable Care Act has moved America’s health care system toward equal access and accountability for the health of all. The Blunt Amendment, and measures like it, take away patients’ decision-making powers and place them in the hands of employers and insurance companies. Continued improvements in access to high quality care for all depends on this steadfast commitment to equality and the public good, and not partisan games.