Little Sisters of the Poor and Free Birth Control

There was considerable outcry earlier this week when the Supreme Court upheld Trump administration regulations under Obamacare that provided the Little Sisters of the Poor, and other religious groups, did not have to provide free contraceptive services under their health plan.  Well, actually, it was more complicated than that.  The Obama administration had not required the Little Sisters to provide free contraceptive services; it required the Little Sisters’ health plan to provide free contraceptive services, without charging the Little Sisters for the services.¹  The problem for the Little Sisters was, as I understand it, that they did not feel comfortable with what they had to do in order to opt-out of providing free birth control.² 

Apparently, 70,000 or more women could be left without free birth control under the Trump administration regulation, which bothers (outrages) a lot of people.  But the point is, which a lot of people seem to miss, is there is a simple way to make sure free contraceptive services are provided to all women without forcing groups like the Little Sisters to violate their religious principles: Have the federal government pay for it.  If free birth control is that important, just pass a law and provide for it.  Nobody’s religious principles are violated,³ and women get free birth control. 

There are several ways to do this.  One, the government could provide birth control to people whose health plan doesn’t provide it.  (To stop companies from dropping coverage so the government has to pay for it, you could add a provision prohibiting companies that have coverage from dropping it.)  Two, the government could provide birth control to women who can’t afford pay for it (though Medicaid may provide it in some places).  

Three, just make it simple and have the federal government provide it.  Large parts of the Democratic Party support single-payer health care; i.e., “Medicare for All.”  Why not have birth control be the first step toward that goal.  Medicare already covers, in addition to healthcare for those over 65 and for certain disabled people, coverage for end state renal disease, i.e., kidney dialysis, for everybody.  Add birth control to that list.  Or pay for it separately.  Given all of the money we are spending on everything else these days, the cost of birth control for all should be nothing more than a drop in the bucket.

Those supporting the birth control mandate will complain this is unfair.  Why should the government have to pay for it instead of employers or whomever?  But if the goal is to make sure birth control is available, as opposed to the way it is done, having the federal government provide it gets it done.

The problem, of course, may be that those supporting the requirement in the Little Sisters case don’t think they can get free birth control for all passed by Congress.  Which raises an interesting question: If Congress won’t pass it, why should the bureaucracy be establishing a rule requiring it? 

A final point:  If Congress won’t pass it, the states can do it – and so many of the big states are controlled by Democrats, a large part of the country could get free birth control coverage.⁴
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¹ I never fully understood how this worked.  I mean, if the Little Sisters’ health plan is providing free birth control but not charging the Little Sisters’ for it, we may have found a great way to provide free health care, or free anything, to people: Make the insurance companies pay for “X” or “Y” and let their customers not pay for it. 
² As I said, the details are complicated, though the principle, perhaps, is simple.
³ If the federal government provides it, there is no problem because people can’t complain that their tax dollars are being used for something that conflicts with their religious beliefs.
⁴ For those who worry about states being able to afford it, they can always do what Illinois does: Require health care providers to provide the service and then don’t pay the bills when they are submitted.  Illinois has been doing that for years.