On a cold rainy day, during what felt like one of winter's last tantrums, the Supreme Court heard from Hobby Lobby's owners, Steve Green and his family, whose Southern Baptist beliefs apparently conflict with the Affordable Care Act's requirement that contraception be offered in every health insurance plan's list of women's preventive health services. Among the questions before the court is whether this requirement puts an undue burden on the conscience and religious freedoms of Hobby Lobby (which may or may not be a person, despite its absence in medical school curricula). In addition to remembering the critical role contraception plays in women's health, I ask my fellow Americans to search their consciences about a REAL moral burden: millions of working poor families are being denied health insurance because of where they live.
Now, I hate to be yet another male commenting on birth control and women's health, but as a physician and a member of the public health community, there are basic facts about contraceptives that are worth remembering. As physicians, we prescribe these medications for a variety of conditions that have nothing to do with family planning: ovarian cysts, painful periods, and endometriosis are just a few examples. This is basic health care, backed by evidence-based research, that has proven effective for millions of women. When combined with the women who are using contraceptives for family planning, it is understandable how 99 percent of teenagers and women aged 15 to 44 have used contraception.
Besides being quite effective, birth control is also quite expensive, especially for low-income women. In addition to having to pay for clinic office visit co-pays, a woman can face $60 per month for generic contraception. More than half of women ages 18 to 34 reported the cost of birth control as a challenge to using it consistently. In order to promote basic health care for women and eliminate financial barriers to that care, the Affordable Care Act requires all new health insurance plans to cover all FDA-approved methods of birth control without cost-sharing. Nationwide, 27 million women are covered by this benefit.
This particular benefit has the added potential for uplifting women's lives and giving Americans opportunities for personal growth and development. By empowering women to safely control their reproductive destiny, birth control has allowed mothers, daughters, sisters, and friends to attain education and career goals. This value of birth control in modern society does not conflict with our morals or spiritual values. After all, in 1966 the leaders of Planned Parenthood bestowed its first Margaret Sanger Award on a Reverend who understood the relationship between family planning, poverty, and enlightening the soul of a nation that had been indifferent towards its inequalities. In his acceptance speech, Reverend Martin Luther King, Jr. offered wisdom that our Supreme Court Justices could learn from:
"There are mountainous obstacles still separating Negroes from a normal existence. Yet one element in stabilizing his life would be an understanding of and easy access to the means to develop a family related in size to his community environment and to the income potential he can command."
For a 2014 reader, there are some serious questions posed by this speech from 1966: How are we still arguing about the importance of birth control in modern society? How can one of the most important spiritual leaders of American history value contraception's impact on the nation's poorest communities, but today's business leaders are opposed to it for "religious" reasons? Is birth control really the American conscience's top priority in health care?
The Supreme Court's 2012 ruling on the Affordable Care Act made the expansion of Medicaid for any state optional. Because half the country's governors have opted for ill-advised political stands against expansion, there are now almost 5 million Americans who are stuck in the "coverage gap." Basically, these are families whose incomes are too low to buy health insurance through the Affordable Care Act's marketplace exchanges, but they earn too much to be eligible for their state's Medicaid program. For example, in Oklahoma, where the Medicaid program is not being expanded, and where the owners of Hobby Lobby happen to live, there are 144,480 Americans in the coverage gap. Ninety percent of these uninsured Oklahomans earn $11,490 per year or less as individuals, or $23,550 per year for a family of four (that's 100 percent of the federal poverty level). If they lived in neighboring states like New Mexico or Colorado, they would have access to Medicaid because these states are expanding the program. Where is the moral outrage of the owners of Hobby Lobby for the millions of Americans without health insurance for no other reason than they are poor in the "wrong" state? Does this not wound their consciences?
A few months prior to receiving Planned Parenthood's Margaret Sanger Award, Reverend Martin Luther King, Jr spoke at the Second National Convention of the Medical Committee for Human Rights in March 1966. There he called upon the American soul to recognize that, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." As an American-born Hindu, and as a pediatrician, I believe we are all children of God, with the same divine spark within each of us, regardless of where we live. If we are to have any moral or spiritual objection to the Affordable Care Act, it should be directed towards the political obstruction of the law leaving millions of our brothers and sisters without the dignity of basic health care.
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