Blunt-Rubio “Contraception” Amendment: A Stealth Attack on Essential Health Services?

Press coverage this week on the Blunt-Rubio amendment to a Senate highway spending bill focused to a large extent on its sponsors’ stated goal of allowing employers to deny contraceptive coverage in health plans offered to their employees, based on religious or moral objections. Republicans sought to frame the issue as freedom of religion while for Democrats, it was primarily an attack on contraception and, more broadly, on women’s rights.

It is important to realize that impact of Blunt-Rubio, were it to be enacted into law, extends far beyond contraceptives, sex, and religion, taking aim squarely (if quietly) at the entire idea of requiring insurance plans to cover what are deemed “essential services.” It is no exaggeration to say that this proposal has the potential to thoroughly undermine the long-established process of requiring insurers to cover a defined set of health services.

This amendment, which only failed by a 51-48 vote, would allow all employers to determine whether or not to deny coverage for contraceptive services, regardless of whether the Institute of Medicine, Department of Health and Human Services, or state insurance regulators judged these to provide substantial health benefits. But more signifcantly, what it would also do is to allow any employer to eliminate coverage for any health care service, based on the religious or moral beliefs of the CEO or other decision makers.

How do we define moral beliefs? Our morals may be based on religious teachings (Catholic, Protestant, Jewish, Hindu, Buddhist, Muslim, Scientologist, Wiccan, etc.). Or, they may be based on anything else we choose to believe. Morals are quite personal and American society is exceptionally diverse in the range of moral beliefs professed by its citizens. Your moral beliefs may be based on deep philosophical inquiry and meditation, or they may be based on the last thing you heard on your favorite talk radio station.

If you are a CEO who strongly believes that vaccination is immoral because it violates the sanctity of the body as a temple, or any other reason), should you be able to eliminate that coverage from your employees’ list of covered services? How about a CEO who has joined the Church of Scientology and decides as a result to eliminate psychiatric benefits from his employees’ coverage? Should a corporate leader who considers sex outside of marriage to be immoral be permitted to eliminate not only coverage for abortion or contraception but also prenatal care for those who transgress his moral code?

Where does this stop? Blunt-Rubio is silent on that question, with its advocates preferring to limit the discussion to contraception. Did they not think it through? Or is this a stealth attack on government’s ability to define essential services and require insurance policies to cover them?

The implications are truly breathtaking in their comprehensiveness. Any employer can deny any health service for any reason, as long as he or she states that their objection is “moral.”  This is philosophically consistent with the conservative philosophy of governance that judges democratically elected officials to be the worst imaginable source to depend on for health care policy, choosing instead to vest that power in the hands of the private sector, specifically corporate CEOs or those to whom they delegate their power.

Is that the kind of health policy you favor?