Contraception: Integration of Church and State

On February 14, 2012 the Pew Research Center reported that the public is divided over the current birth control insurance mandate along religious, partisan, and gender lines.

Fifty-five percent of the religiously unaffiliated familiar with the issue say religious institutions that should be required to cover them like other institutions, while 39 percent favor giving them an exemption.

Among Catholics, 55 percent favor giving religious institutions an exemption from the federal rule, while 39 percent oppose exempting those institutions. White evangelical Protestants, by 68 percent to 22 percent, favor giving religious institutions an exemption.

Perhaps the most important among the respondent groupings are women, the direct beneficiaries of the insurance coverage in question. For those aged 18 to 49, 40 percent say that religious institutions should be given an exemption compared to 53 percent who say no to an exemption. Forty-two percent of women overall say an exemption should be granted.  This compares with 54 percent of men.  The bishops would apparently prevent non-Catholic women with a right to health care coverage from these same employers to be denied.

There are predicable divisions along partisan and ideological lines with 73 percent of Republicans and 29 percent of Democrats supporting an exemption.

Another poll conducted by the Public Religion Research Institute released on February 7 found different results, skewed even more in favor of full coverage.  That poll actually found that roughly 6-in-10 Catholics (58%) believe that employers should be required to provide plans that cover contraception.  Surprisingly, this is even higher than the number among all Americans, (55%) who agree that “employers should be required to provide their employees with health care plans that cover contraception and birth control at no cost.  Among Catholic voters, support for this requirement is slightly lower at 52 percent.

Now, here’s the part of this issue that forces an even closer scrutiny of the separation of church and state that derives from the First Amendment of the US Constitution.  While the bishops have claimed the legitimacy of an exemption based on freedom of religion as embodied in the First Amendment, the alternative argument is that the same amendment also provides for the separation of church and state.

As we all know by now, the US Conference of Bishops has adamantly opposed the mandate that applies the Affordable Care Act as it applies to women’s reproductive health.   On Friday, President Obama announced the expansion of that exemption to religiously affiliated employers such as large hospitals and universities.

Friday, President Obama announced that under the newer adjusted policy, religious employers would be exempt from paying for the portion of insurance that covers women’s birth control and related care. Instead, the insurance companies themselves would be responsible for picking up the tab. No mention of this accommodation was made in either poll.  I’m guessing that if it were, the results would fall even more in favor of coverage under the law.

In response, the bishops have dug in their heals, maintaining their objections, saying in a statement late Friday that the “…solution offered by the White House to quell a political furor was ‘unacceptable and must be corrected’ because it still infringed on the religious liberty and conscience of Catholics.”

As women, the prospective beneficiaries of the outcome of this policy, become the pawns in a debate on how health care coverage is applied on the ground, a very profound question arises about exactly how the separation of church and state plays out in relation to its First Amendment partner, freedom of religion.  I would also add that from the women’s standpoint, the Equal Protection Clause of the 14th Amendment is also very relevant here.

It also gets to the very heart of what constitutes the nature of health care and how that answer weighs in against the importance of the First Amendment issues.

First, I want to address the separation of church and state.  Immediately, the fact that the Catholic Church has participated in the provision of health care for so long in the United States renders the viability of unequivocal separation mythical at best.  Think about it.  We have government and religion both engaging in the provision of a public good, the public’s health.  This is obviously not a bad thing, given the long and extremely beneficial history of Catholic hospitals in America.

On the other side of this equation we have the government whose current mandate is to provide affordable health care.   That care includes women’s preventive care which in turn includes reproductive health.

In addition, we have the philosophical aspect of this as I wrote in an earlier piece. If, as Pope Benedict XVI and other Catholic church leaders have proclaimed, that it is the “moral responsibility of nations to guarantee access to health care for all of their citizens, regardless of social and economic status or their ability to pay, ” and that access to adequate medical care is one of the “inalienable rights” of man and as many others claim is the basis of the Affordable Care Act, the next question becomes, “What is the nature of health care – where are its boundaries?”

It has long been agreed that health care for women includes reproductive preventive services. It follows that it should be included within the service of health care. This, despite the bishops’ claim that pregnancy is not a disease.  True, but preventive related services for women now fall well within the generally accepted bounds of medicine as now practiced in the United States.

This brings me back to the polls.  At what point does a religious clergy continue to oppose the views (and practices) of a majority of its followers?  Yes, doctrine is doctrine.  But it’s also true that the whole purpose of that doctrine is the holistic wellbeing of its followers.  The position of the bishops is not doing much to mend the divisions that have already been rocking the Church for well over a decade.

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