Last week the U.S. Supreme Court agreed to review two lower court decisions involving for-profit businesses seeking religious exemptions from the Affordable Care Act’s so-called “contraception mandate.” The mandate requires that employer healthcare plans cover all FDA-approved contraception without “cost-sharing”—that is, without a copayment or other out-of-pocket patient expense beyond the monthly plan premium. Churches and other “houses of worship” are fully exempt from the mandate, and there is a regulatory accommodation for religious nonprofits like religiously affiliated colleges and hospitals, which excuses them from complying with the mandate so long as they certify that compliance violates the tenets of their affiliated religion.
For-profit employers whose religious beliefs condemn the use of some or all of the mandated contraceptives have challenged the mandate under the Religious Freedom Restoration Act (RFRA), which prohibits the federal government from imposing a “substantial burden” on a person’s religious practices unless it is pursuing an exceptionally important goal that it cannot accomplish in another way. These employers are claiming that RFRA grants them the same kind of exemption as has been granted to churches, synagogues, and other religious congregations, even though they are unambiguously secular enterprises like craft stores, auto parts manufacturers, construction companies, and medical supply businesses. (I examined the weaknesses in these cases in an ACS Issue Brief last fall).
One of the mandate decisions the Court will review, Hobby Lobby Stores, Inc. v. Sebelius(10th Cir. June 27, 2013), decided that a for-profit corporation that operates a nation-wide chain of craft stores is a “person” who “exercises religion” under RFRA and thus is entitled to its protections. The other decision, Conestoga Wood Specialties Corporation v. Sebelius(3rd Cir. July 26, 2013) went the other way, finding that a for-profit corporation that operates a cabinet-making business is not protected by RFRA, and additionally holding that the mandate does not violate free exercise rights protected by the First Amendment.
A panel of the Second Circuit Court of Appeals in New York has just taken under consideration the Food and Drug Administration’s motion for a stay of a district court order directing the agency to make levonorgestrel-based emergency contraceptives available to women and girls of any age without a prescription and without other point-of-sale restrictions. In deliberating on this motion, the panel of judges should not, I am sorry to say, take anything the FDA has said in its briefs at face value. The government’s opening and reply briefs on the motion to stay are so full of misstatements and omissions that the court could badly err if it did not take everything the government says with a shaker full of salt.
One of the factors in deciding whether to grant a stay pending appeal is the likelihood that the moving party will succeed on the merits. The government devotes most of its briefs to this factor. It makes two arguments as to why the court of appeals should find that the government is likely to win on appeal and should thus stay the district court’s order on emergency contraception. Both arguments depend crucially on incomplete and inaccurate renderings of the law and facts of the case.
Before turning to these arguments, a bit of context is necessary. The levonorgestrel-based emergency contraception at the center of this legal dispute takes two forms. One, Plan B and its generic versions, requires two pills. The other, Plan B One-Step and its generic versions, requires one pill. Both involve the same total dose of levonorgestrel. Despite these obvious similarities, the FDA has worked very hard to treat these drugs very differently; it has made Plan B One-Step available without a prescription to all women and girls over the age of 15, it has apparently blocked nonprescription market access to generic versions of Plan B One-Step for girls under 17, and it has resisted requests to make Plan B and its generic versions available without a prescription to girls under age 17. The district court’s order would make all of these drugs (except Plan B, which is no longer marketed) available without a prescription; the FDA would like to keep treating them differently.
On April 5, U.S. federal judge in Tummino et al. v. Hamburg ordered that the Morning-After Pill be made available "without a prescription and without point-of-sale or age restrictions within thirty days."
Until the court’s ruling, emergency contraception was only available without a prescription for women 17 and up, forcing all women to be “carded” to buy it. Now, the Morning-After Pill or “Plan B” can be stocked on any shelf in any store, next to condoms, aspirin, or shampoo. No prescription or identification will be needed to buy it.
The Morning-After Pill prevents pregnancy up to 5 days after sex; but is most effective within the first 24 hours. It is not RU-486, which induces an abortion. If you are pregnant, it will not work. But, having this form of birth control at our fingertips will give women enormous freedom--if we don’t want to have a child, we won’t have to.
When women can’t control how many children we have, it impacts us as a group, not just individually. Not being able to control the course of our lives has deep implications for women. It means we have less leverage, whether in the workplace, with partners, in our families, or in our public lives. No birth control method is foolproof. Sometimes our partners resist using condoms, condoms break, and sometimes we forget to take the pill. Less frequently we are "swept away" by the moment, but should that mean that we have to bear a child? The Morning-After Pill is one more way for us to prevent unwanted pregnancies.
For over a decade, grassroots feminists with National Women’s Liberation (NWL) -- including lead plaintiff Annie Tummino -- have been waging the most important fight in decades to expand access to birth control in the United States: making the Morning-After Pill available over-the-counter without any restrictions.
It’s been 40 years since the Supreme Court protected a woman’s right to make a decision about whether to have an abortion, and some are still trying to take that right away. In the world of abortion politics that’s dismaying -- but certainly not shocking news.
It’s been longer still since the Court first protected the right to contraception in Griswold v. Connecticut in 1965. And while many of us in the reproductive rights movement have long known that our opposition is keen to limit access to birth control as well, that largely came as news to the public. Watching in disbelief, many turned to activism as the availability of affordable contraception was attacked time and again this last year. Indeed, recently national attention has been laser-focused on birth control -- whether women should have insurance coverage for it, and what to do about the objections of employers who want nothing to do with it.
The federal contraceptive coverage rule -- one of the greatest advances in women’s health policy in decades -- guarantees insurance coverage of birth control, with an exception for houses of worship. Right off the bat a small but vocal opposition came out swinging, arguing that the rule is an unparalleled violation of religious liberty. These groups did not only want a sweeping set of loopholes, they pushed -- and are still pushing -- for the rule to be dismantled altogether, so that no woman would have its benefits, no matter where she works.
University of Notre Dame’s religious leader the Rev. John Jenkins claims the string of federal lawsuits challenging the Obama administration’s health care policy on birth control is all about protecting religious freedom. But in reality the lawsuits are on wobbly legal ground, and Jenkins’ assertion about protecting a cherished First Amendment freedom is tired.
Like a federal lawsuit lodged earlier this year on behalf of Ave Maria University, a Catholic institution in Florida, the new lawsuits argue that a portion of the health care reform law requiring insurance companies to provide birth control to employees, including ones at religious institutions, is a serious affront to the religious institutions’ free exercise of religion rights.
The Affordable Care Act, however, does not single out religious entities for unheard of treatment. Instead it is a law of general applicability, meaning it covers secular and religious institutions. There are all kinds of laws of general applicability, which may offend religious beliefs, but do not amount to a violation of the free exercise of religion.
Nonetheless, the religious groups are apparently counting on judicial activism from some of 12 federal courts where their lawsuits have been lodged. In a press release about his school’s lawsuit, Jenkins stuck to the religious liberty canard, saying it “is about the freedom of religious organizations to live its mission ….”