Health Insurance Coverage: Imposition of Religious Beliefs is Not Religious Freedom

Republicans are attacking the Obama administration, in often vicious words, with the charge that Obama is leading an “assault on religion” (Romney), that he “has declared war on religious freedom in America” (Gingrich), and that “the president has reached a new low in this country’s history of oppressing religious freedom that we have never seen before” (Santorum).  And yesterday, in the nationally televised Sunday morning talk show “This Week” on ABC, Santorum extended his attack to the late President John F. Kennedy, saying that the well known speech during the 1960 campaign to the Greater Houston Ministerial Association, in which Kennedy stated his belief in separation of Church and State, made him almost “throw up”.

These attacks are appalling.  They originated in a dispute on what should be included in health insurance plans for those plans to be considered as minimally adequate in terms of what they cover, and not a sham.  Understanding why this is important is central to understanding the health insurance reforms identified with Obama.  This will be reviewed here.  And once this is understood, it will be clear that to permit religious institutions, or indeed anyone else, to impose their particular religious beliefs on their employees or on others over whom they have authority or leverage, is not religious freedom but rather its antithesis.

The aim of the Obama health insurance reforms is to allow access by all Americans to health care services.  This could have been achieved in a variety of ways (as we see from what other countries have been able to do at far lower cost than the system in the US), but the realities of the politics in Congress dictated that this had to be done through employer based health care plans and private health insurers, which already cover most but not all Americans.  But for such universal coverage to have any meaning, one has to define what a minimally adequate health insurance plan would cover for the employees.

The dispute arose over whether minimally adequate health insurance plans would cover the costs of contraceptive services and certain other health services for women.  No employee would be forced to use such services:  that would be up to them.  The question is whether religious and other institutions should be allowed to prohibit their employees from having access to such services through their health care plan, based on a religious belief that such services should not be used.  The Catholic Church was the most prominent opponent to allowing such access, which it wanted to extend not only to priests and nuns, but also to all other employees (such as nurses or janitors) of institutions such as universities or hospitals they operate or even direct business operations (such as in publishing).

It is worth noting at this point that this would not have been an issue if the health insurance reform had allowed for a “public option” health insurer, which would compete with private health insurers and would be available to all.  This was killed by Joe Lieberman, Senator for Connecticut, a state where several prominent private health insurers are headquartered.  With a public option insurer available, one could ensure a minimally adequate set of services was available to all without the need for doing this through private insurance plans.  But private insurers did not want to face such competition.

But without such a public option to serve as an alternative, the private health insurance plans need to meet some minimum standard for them to be meaningful.  The question is whether the Catholic Church or any other employer should be allowed to prohibit access through the employee health insurance plans to certain health care services that they believe run counter to the religious beliefs of the employer.  They argue that “religious freedom” means they have the right to impose particular religious beliefs on their employees.

But this is not religious freedom, but the opposite.  Religious freedom is the right to hold the religious beliefs that you do, not the right to impose certain religious beliefs on others.  If certain religious views can be imposed, by organized religions directly, or by the state at the behest of organized religions, one does not have religious freedom, but rather Iran.

And if the heads of religious organizations can block access by their employees to certain health care services based on religious views, where would this stop?  The current debate is over whether women would have access to contraceptives.  Santorum has argued women should also be denied access to pre-natal testing.  In the past, there have been religious leaders who have wanted to limit access to patients needing treatment for syphilis and gonorrhea, or for HIV/AIDs, saying these diseases reflected God’s just punishment for those who have sinned.  Would religious organizations similarly be allowed to limit access to treatments resulting from smoking tobacco, or from too much alcohol, or from obesity?

There is also the apparent confusion by the Republican candidates and others that for some reason the health insurance plans provided to the employees are not part of the wage compensation package provided to the employees for the work that they do.  Rather, they see them as a “gift” or something similar from the employers.  But they are not “gifts”.  They are part of the compensation package the employee earns in return for the work that he or she does, just like wages paid directly.

And if religious institutions would now be allowed to restrict access through one part of the employee compensation package (the health insurance plans) to certain expenditures based on religious beliefs, would there be any limits?  Suppose employee wages started to be paid through Debit cards or some similar technology to track what the wages were used for.  Would the religious institutions then be permitted to prohibit their employees from using their wages to purchase birth control pills or condoms on their own?  And one can then quickly go to even more absurd examples, such as Catholic institutions prohibiting their employees from purchasing meats in restaurants on Fridays during Lent, or Jewish or Muslim institutions not allowing their employees to buy pork, or Mormon or other religious groups not allowing their employees to buy caffeinated beverages such as coffee or Coca-Cola, and no one being allowed to buy a subscription to Playboy?

On Sunday, Santorum extended this to an even more worrying belief.  On “This Week” on ABC (for a transcript, see here), Santorum said that on reading a transcript of President Kennedy’s famous speech to the Greater Houston Ministerial Association during the 1960 campaign (for a transcript and video, see here), he “almost threw up”.  When asked to clarify, Santorum made clear that he is opposed to what most of us thought was the now well accepted Constitutional principle of separation of church and state, as stated in Amendment 1 to the Constitution.  The interviewer (George Stephanopoulos) asked “Why did it [the Kennedy speech] make you throw up?”  Santorum responded “Because the first line, the first substantive line in the speech says, ‘I believe in an America where the separation of church and state is absolute.’  I don’t believe in an America where the separation of church and state is absolute.”  Santorum argues that those with particular religious beliefs should be allowed, through their representatives in the government, to impose their particular religious views on all Americans.  A minority would no longer have Constitutional protections from being forced to adhere to such religious beliefs.  His argument is a confused one, as he argues that with separation of church and state, those with religious beliefs are somehow excluded from public debate and that non-believers then impose their views on all.  He therefore wants the opposite, ignoring the fundamental point that no one should be allowed to impose particular religious (or non-religious) views on anyone.

This would then not be religious freedom, but rather religious tyranny.