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August 6 2012

What is the "HHS Mandate"?

National Review
Kathryn Lopez

The Independent Women’s Forum illustrates in a new infographic the high costs of the Department of Health and Human Services abortion-inducing drug, sterilization, contraception mandate. Making religious institutions choose between conscience and complying with the new regulation, threatens the future of some vital services like religious schools and charities. This is a needless, unconstitutional choice the Obama administration is forcing. And it’s one that you don’t need to be religious to be outraged by. Hadley Heath talked about the mandate and IWF’s illustration of its costs. You get the synopsis in my syndicated column and the longer version is below.

KATHRYN JEAN LOPEZ: Whatever does the HHS mandate — birth control — have to do with 5 million students?

HADLEY HEATH: More than 5 million students in the U.S. attend religious schools for K-12 education in the United States. Many of those schools are operated by the Catholic Church, meaning they will be faced with a decision: Do we violate the tenants of our faith and offer health insurance that covers sterilization and contraception, or do we pay a huge fine and shift resources away from our students, teachers, and educational programming? We shouldn’t be asking these schools to make this choice.

One example is Pius X Catholic High School in Lincoln, Nebraska, who sued the federal government over the rule, arguing that the school would be forced to choose between compliance or shutting its doors entirely. The Obama administration shouldn’t be in the business of reducing choices for the 5-plus million students who are currently attending religious K-12 schools.

LOPEZ: As far as my inbox from the likes of Planned Parenthood and NOW tells the story, August 1 was all about celebrating birth control. Why do you beg to differ? 

HEATH: This mandate is nothing to celebrate. We shouldn’t celebrate government running over the rights of a group of people. We shouldn’t celebrate that, to live in accordance with their faith, many schools, hospitals, and charities will have to reduce their services to the needy in our society in order to pay huge fines. This regulation, like all government action, will create some winners and many losers. At first it may seem like a benefit to get birth control at “no-cost,” but the cost is very great. Can you imagine being rushed to your local hospital — perhaps it is operated by Catholics — in the midst of an emergency, only to find out they can’t treat you because that wing of the hospital was shut down to finance the HHS mandate penalties?

LOPEZ: What about the women? Isn’t a protest against the HHS Mandate a protest against freedom? Against women? Against those who have ovarian cysts? 

HEATH: Actually, contrary to the false crisis depicted by Sandra Fluke and other Feminists, most women in the United States currently enjoy very easy access to the contraception they use. With a prescription from their doctors, American women have a spectrum of choices, ranging from very cheap generics ($9/month at Wal-Mart) to more expensive brand-name drugs like NuvaRing or Seasonique.

Less talked about are the economic arguments against the HHS mandate. Women of all religious and nonreligious stripes should oppose the mandate because the current system 1) encourages women to differentiate among drugs based on price, signaling market demand among drugs to producers and allowing for competition among drugs to keep prices low and 2) encourages innovation in contraceptive drugs, meaning even a birth control pill for men could be developed. But making birth control “no-cost” for the entire female population will distort important market incentives driving competition and innovation.

And currently, without a mandate, many employers who oppose birth control for religious reasons are happy to select an insurance plan that covers the drugs for women who require them for non-contraceptive use — for example for women with poly cystic ovary syndrome, endometriosis, or PMDD — so that isn’t really at issue.

LOPEZ: IWF seems to clearly communicate protesting the HHS mandate is not about religion or women? How can you say that?

HEATH: IWF is a secular organization, so we wouldn’t make arguments based on religion. And while we are women, we want what’s best for both women and men in public policy in the United States.

The HHS mandate is one particular egregious example, but we see many flaws in the Affordable Care Act that undermine personal responsibility. This may not sound like a good argument to everyone, but we recognize that taking responsibility for ourselves means more individual freedom, and that’s what we want for people in the United States, in health care and in every other policy issue. More freedom, more choices.

This mandate also clearly injects government into a debate about deeply personal moral convictions. We believe that debate is best had in civil society where good people with good intentions are free to come to different conclusions. In the private market, people of various religions and worldviews work together everyday to exchange goods and services and create wealth. We see this as a beautiful thing.

You don’t have to agree with owner of the store on everything in order to get your buy something; you just have to agree on the price. Government shouldn’t ask people to come to a common belief system in order to work together in the marketplace. Diversity of opinion has always been celebrated in the United States — until now it seems.

LOPEZ: But isn’t it really a “Catholic thing”?

HEATH: Absolutely not. I’m not Catholic, and I have no moral issue with birth control. But there are plenty of women, like me, who see this as government going too far here and injecting itself into a debate that’s better had among individuals and groups in society. Look at the division this has caused.

Non-Catholic people can appreciate the right to have one’s own opinions and be free from government persecution. If the government asks Catholics to violate their conscience today, who could it be tomorrow?

LOPEZ: How the heck does the HHS mandate come “with consequences for women who do choose to use birth control”?

HEATH: The HHS mandate forces employers and insurers to provide first-dollar coverage for birth control. In the short run, and considering only one side of the ledger, this seems like a gift for many women who use birth control.

But — and I’m sad to be the bearer of bad news — simply because birth control and other services will be provided at “no-cost” doesn’t mean they will be free. In fact we can expect to pay more for birth control in the future because drug companies will capture the biggest benefit from this regulation as the cost of contraception is simply passed to us all through higher insurance premiums. Again, the economic argument: It’s a bad idea to take price-based competition and incentives toward innovation out of the picture.

Women who use birth control drugs should also be concerned about control over their contraceptive choices. If employers and insurers are the ones paying for our contraception, they become the people in control of our contraception. It’s not far-fetched to think that insurers will limit which drugs are available at “no cost” in an effort to control their costs. I don’t want my employer or my insurer deciding for me which drug to use. I’d rather have some responsibility in paying for it and also have more choices.

Furthermore, consider the incentives in sexual health: If the government is skewing the market in favor of oral contraceptives, this in turn discourages condom use. Condoms are still the most effective means of preventing the spread of STDs, something public health officials should take into account before encouraging women to replace condoms with pills — especially considering that emergency contraception like the “morning-after” and “week-after” pills will also be covered, and shouldn’t be used beyond emergency occasions.

LOPEZ: What’s the most pernicious aspect of the HHS mandate?

HEATH: The most pernicious aspect, I believe, is that proponents of the HHS mandate make the argument that only two percent of the population has a moral conviction against using birth control, and somehow this justifies the mandate. Let’s ignore the debate over the exact statistic and take it for what it is: It’s true that a small minority of people actually refuse to use or cover birth control based on their morality or religion.

That shouldn’t matter. The whole reason we have a Constitution and a Bill of Rights is to protect the rights of people in the ideological minority. We are not a system of majority rule, or as Ben Franklin said, “two wolves and a lamb voting on what to have for dinner.” The “lamb” has rights, no matter how hungry the Obama administration is to score political points for the slaughter.

I think we can all — religious or nonreligious — understand what it’s like to hold an opinion that’s not popular. We should be able to hold those opinions and live in accordance with them, so long as we don’t infringe on the rights of anyone else. Otherwise we force people into conformity of thought; that’s certainly not in line with our American ideals.

LOPEZ: What about the other “Preventive Services” that went into effect yesterday? 

HEATH: Other “no-cost” preventative services that went into effect yesterday include well-woman visits, screenings for gestational diabetes, HPV, STIs, and HIV, and counseling for breast-feeding and domestic violence.

Again, we should not call these “no-cost” preventative services, but what they really are: “hidden-cost” preventative services. We should not be surprised when, even after the government makes these things “free,” the price of health care in our country continues to rise.

LOPEZ: What conversation do you wish you could have with every American voter? 

HEATH: I think the HHS mandate should spark a broader conversation about government involvement in our lives. Health care is extremely personal, and each individual should be able to make the choices that are right for her. It’s no surprise that we ran into trouble trying to decide what should be in every insurance policyin the United States. This isn’t a decision that should be made collectively, and there’s no such thing as one-size-fits-all health care. I should be able to choose my doctor, my insurance plan, my drugs, my treatment; you choose yours.

It’s understandable that many people are frustrated with the system as it is currently. The HHS mandate also highlights the silly over-involvement of employers in the health insurance market. This is due to government involvement as well: The tax treatment of health insurance strongly favors employer-sponsored insurance over individual-market insurance. But we should be able to choose our own insurance plans –and pay for them with pre-tax dollars — without going through our boss. We need to reform some health insurance and health care laws in the United States: It’s just that the Affordable Care Act took us in the wrong direction and wasn’t really reform.

LOPEZ: What do you make of this “War on Women” stuff?

HEATH: The “War on Women” is clearly a campaign tactic and nothing more. Women in the United States are better off than anywhere else in the world, and arguably better off than men in the U.S. No one, absolutely no one, is opposing women’s basic rights. In fact, as someone who has had the opportunity to travel the world, I find it disturbing that some Americans could assert that women are under attack in the U.S. Sadly, there’s a real war on women in many countries. But not here.

Independent Women’s Forum’s mission is to improve the lives of Americans by increasing the number of women who value free markets and personal liberty. Sister organization of Independent Women’s Voice.
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