Last week, women celebrated the 60th anniversary of the birth control pill—just as the Supreme Court heard two consolidated cases challenging an employer’s ability to deny workers contraceptive coverage. (Yes, during a global pandemic.)
In many ways, 2020 and the COVID-19 crisis feel like Groundhog Day, especially when it comes to a woman’s right to choose. (Meanwhile, groups of Americans are protesting the stay-at-home bans because it’s “their body, their choice” to endanger the lives of other living, breathing humans.)
Didn’t the Supreme Court already hear a case about birth control? Yes, yes it did. In fact, this is the third time in recent years that the Court has heard complaints against the Affordable Care Act’s contraceptive mandate—the provision that requires employers to provide health insurance that covers a full range of birth control options without cost sharing.
The “birth control mandate” has been in conservative crosshairs since the moment it was added to the health law. If the last decade has told us anything, it’s that nothing gets conservatives’ hackles up quite like the possibility that women might be able to control their reproductive lives.
The attacks on reproductive health access—birth control, abortion and comprehensive health care more broadly—have been relentless. And in recent years, the Court and the Trump administration have given employers more and more latitude to deny their workers access to family planning.
One of last week’s cases, Trump v. Pennsylvania, again centers on the question of whether employers who claim religious and moral objections to contraception should be able to deny contraceptive health insurance coverage to their employees.
As the Court prepared to hear the arguments in the most recent case, Mark Rienzi, president of the Becket Fund for Religious Liberty—the organization serving as one of the counsels on the case—told NPR, “There are many other ways to provide contraceptive coverage to people if they happen to work for religious objectors.”
As examples, Rienzi said people could get coverage from a spouse’s plan or through a state exchange. He also said that Title X provides money to state and local governments to pay for women’s healthcare, including birth control.
Rienzi’s arguments are dishonest, damaging and delusional, and should be discounted in the public debate. They ignore the fact that family planning is a fundamental component of women’s health care and disregard the administration’s attacks on both the Affordable Care Act (which established the state exchanges) and on Title X, the federal family planning program.
Let’s unpack each of these lies.
Lie #1: Employees who work for birth-control objectors can get coverage from their spouse’s insurance plan.
Let’s first tackle why this is factually incorrect.
First, lots of people don’t have a spouse whose plan they can be covered under. Millennials are marrying later than previous generations and many are forgoing marriage altogether. Research shows that a quarter of millennials report they are unlikely ever to marry.
Second, some women are actually covered under their spouse’s health insurance, and those spouses work for employers who are now threatening to exclude birth control coverage from their plans. When an employer changes their health insurance coverage, it doesn’t only impact the women who work for them; it impacts every family member covered by their workers’ plans.
In other words, if a man worked for an employer who claimed a religious exemption to birth control, every member of his family—think: wife and children—would no longer be able to access contraception under their family plan.
This is all to say nothing of the fact that we are living in the midst of a global pandemic and once-in-a-century economic crisis that has left roughly 27 million people without their employer-based health insurance.
Now let’s address why this is morally suspect. The cavalier comment about women getting on their spouse’s insurance encapsulates everything we really need to know about the Right’s opposition to birth control. It says that if women aren’t married, they should be. It says that women shouldn’t need and definitely don’t have a right to control their own bodies.
It’s a reminder of the historical point of reference for conservative politicians and thoughtleaders: the utopian “good old days” when good women got married, lost their virginity to their husbands and likely had boring pleasure-less sex as a way to procreate so they could stay home in a cute dress and heels and happily raise children while keeping a tidy house. This reverence of the past illustrates a longing for a time when women “knew their place”—a time when women couldn’t have an abortion or get birth control, couldn’t refuse to have sex with her husband; couldn’t report sexual harassment or apply for a credit card.
The majority of women in this country are swimming hard and fast to move away from that past, while conservatives are increasingly working to change the tide and deliver us to a dystopian reality.
Lie #2: Employees can get coverage by switching to a different insurance plan on an Obamacare exchange.
First and foremost, there are no circumstances in which anyone should ever have to leave one health insurance plan to access basic health care. Family planning is just that: basic health care, not a fringe benefit. It has long been established that access to birth control is essential to women’s health and economic security. Employer’s should not have a say in whether their employees—and their employee’s families—can access it through their health plans.
Rienzi ignores the fact that conservative opposition to universal health care has left us all in a health coverage hellscape and switching from one plan to another is often literally impossible. Rienzi tells us we should simply switch to a plan on the ACA exchange if we don’t like what our employer-sponsored plan has to offer us.
The irony, of course, is that the Republicans are—even in the middle of a global pandemic—relentlessly working to block access to the exchanges and to overturn the ACA and all of the benefits it has delivered to women.
When it’s not impossible, it’s almost always cumbersome, confusing and outrageously time-consuming.
I’ve dealt with a lot of health insurance problems and also have had three kids. On more than one occasion, I’ve made mental lists of all the things I’d rather do than navigate the mind-numbing bureaucracy of the health insurance system. More than once I’ve thought I’d rather go through childbirth again—which may be just what they’re hoping we do.
Lie #3: Birth control is also available under a program known as Title X.
If you can’t switch to your (potentially non-existent) husband’s plan or enroll in an ACA exchange plan the government is actively trying to eliminate, Rienzi is here to let you know you can simply find a Title X provider near you.
He’s hoping you forget that the Trump administration recently made such dramatic changes to Title X—the national family planning program—that capacity of the providers in that network was cut in half and has jeopardized care for 1.6 million women across the country.
And he’s hoping you don’t know that on a number of occasions over the last decade, Republicans have tried to eliminate and undermine the program—despite the fact it was started by President Nixon and championed by then-Congressman George H.W. Bush.
Telling women they can rely on Title X while the administration is actively trying to dismantle it is gaslighting of the highest order.
Title X has been a critical backbone of the federal reproductive health infrastructure, providing high quality and affordable care to millions of individuals. Though it has been chronically underfunded, it has consistently delivered outstanding results. The work of the Title X network of providers has never been more important than it is today as millions of people lose their jobs and their employer-based health coverage.
Further, many more want to plan the timing and size of their families, as the nation faces an economic crisis that may be the longest and worst the nation has ever seen.
It remains to be seen how the Court will rule on these cases.
Justice Ginsburg called into the hearing from her hospital bed and had no time for nonsense:
“You have just tossed entirely to the winds what Congress thought was essential—that is, that women be provided these services with no hassle, no cost to them. Instead you are shifting the employer’s religious belief—the cost of them—onto the employees.”
She added, “The women end up getting nothing… They are required to do just what Congress didn’t want”—search for coverage from government programs, jump through hoops to get alternative coverage or pay for it out of our own pockets.
Everyone should have access to no-cost contraception of their choosing. Reproductive healthcare is a public good and should be treated as such.
In an ideal world, people wouldn’t have to depend on their employers to stay healthy, and we would have universal health coverage that would decouple health insurance and work. There’s no moment like the COVID present to remind us why our current employer-based model is broken.
But while we work to reform the health system, we must ensure that all individuals, regardless of their employment status, have full contraceptive coverage.
And we should not be gaslighted by folks trying to convince us we will be just fine without it. We know better.
