By Garrett FitzGerald
Columnist E.J. Dionne Jr., a stalwart of the Religious Left, caused quite a furor in progressive circles this past week when he took to the opinion page of the Washington Post to lament President Obama's "breach of faith" over new administration guidelines mandating "that required contraceptive services to be covered by the insurance policies that will be supported under the Affordable Care Act." The rub, for Dionne, is the lack of an exemption in the new policy guidelines for certain religious institutions, particularly Catholic universities and social service providers, for whom the financial support of contraceptive services might constitute a breach of the Church's official stance on their use.
Dionne attempts to strike a balance in his article between his progressive understanding of the "perfect sense" it makes for these Catholic institutions to cover contraception costs and the pang of betrayal he feels as "an American liberal who believes that religious pluralism imposes certain obligations on government." Despite the many excellent reasons Dionne lists for supporting contraceptive coverage for women employed or enrolled at such institutions, Dionne ultimately considers the Obama Administration to have "[thrown] his progressive Catholic allies under the bus" while reinforcing the position of conservative, reactionary elements within the national Catholic hierarchy.
As challenging as I am sure it must be for Dionne to be caught in a tug-of-war between his political and his religious sensibilities, it is a true shame to see such a typically reliable advocate of progressive causes lash out at this administration over a decision that has been hailed as a policy win for advocates of women's health and reproductive rights, including religious leaders from some fairly diverse traditions. As Dionne suggests in his article, many advocates for reproductive rights have been less than impressed with the Obama Administration's track record on related policy decisions to date. Our own Caryn Riswold did a terrific job debunking the Administration's rationale for denying over-the-counter access of Plan B contraception to women under the age of 18. And although he does not offer his own two cents on the subject, Dionne makes reference to the fact that "Obama was also willing to annoy some in his liberal base during the battle for the health-care bill by making sure that Catholic institutions do not have to perform or pay for abortions."
In light of these earlier policy failures on the part of the Obama Administration, many progressives were encouraged by the January 20th announcement of increased contraceptive coverage from the Department of Health and Human Services. But despite this apparent win for supporters of women's health and reproductive rights, Dionne has lamentably determined that the Obama Administration "utterly botched" the decision. While Dionne's article is admittedly softer in tone than some similar criticisms emerging from the Right, it nevertheless perpetuates a number of dangerous misconceptions about women's healthcare and its relationship to religious expression.
I take umbrage with Dionne's position on two points: his refusal to acknowledge the very serious danger to the health and well-being of the women who would be denied access to affordable contraceptive coverage if Dionne had his way, and his insistence that the respect for religious beliefs and practices that actively endanger the health and well-being of these women is in any way essential for or constitutive of a healthy culture of pluralism.
Let's start with the former question by examining what, exactly, the mandate contains and what it does not. As Dione admits, institutions "who primarily serve and employ members of their own faith traditions" are exempted under the new policy. But according to Talking Points Memo's Sahil Kapur, even those religious institutions not covered by the mandate's exemptions will not have to directly provide contraceptive services, but rather must only guarantee insurance plans that coverage such services to the people they employ and serve, should these individuals desire such coverage. As Kapur explains:
The regulation is only for insurance carriers, not health providers. For instance, Catholic hospitals with religious objections to birth control do not have to provide it to their patients. They simply cannot deny their employees the same access, should they want it, as other employers are required to provide. Most insurance plans already cover birth control but many include copays that can be a deterrent.
Secretary of Health and Human Services Kathleen Sebelius confirms Kapur's analysis in a recent USA Today article, which details the Administration's decision-making process behind the formulation of the religious exemption. As Secretary Sebelius explains in the article, the exemption guidelines set forward by the new administration policy are actually substantially more robust than in some of the 28 states with pre-existing mandates for contraception coverage, including eight states that currently have such mandates but which offer no religious exemptions at all. And, per Kapur's article, Sebelius also confirms that the new guidelines do not force individuals or institutions to administer contraceptive services directly:
It's important to note that our rule has no effect on the longstanding conscience clause protections for providers, which allow a Catholic doctor, for example, to refuse to write a prescription for contraception. Nor does it affect an individual woman's freedom to decide not to use birth control.
Even in light of these attempts to accommodate dissenting groups and individuals, Dionne presses the administration for not seeking alternative exemptions, citing Hawaii's exemption model as one possibility. But the alternatives Dionne mentions, and for which he takes the president to task for not pursuing, are in fact not viable alternatives at all.
In particular, I am not convinced of Dionne's assurances that the employees of a Catholic institution which has opted out of contraceptive coverage would be able to subsequently access such essential medical coverage at what Dionne calls "their own at modest cost." The increased economic burden of assuming full responsibility for the cost of contraception would be off-set, in Dionne's mind, by the added convenience achieved by requiring institutions who opt out of contraception coverage to "[describe] alternate ways for enrollees to access coverage for contraceptive services," effectively replacing any actual benefits for women's physical and economic well-being with information that could be turned up with a quick Google search.
As a recent, in-depth New York Times article on the fallout from the contraception guidelines explains, denial of coverage for contraceptives can result in out-of-pocket expenses of over $100 a month for renewable prescriptions, or similarly prohibitive prices (such as a $400 initial procedure plus the cost of follow-up appointments) for IUDs and other longer-term contraceptive plans.
To put faces to these numbers, consider Dionne's claim of the "modest" out-of-pocket expense that obtaining such vital coverage would represent for graduate students or low-paid employees at Catholic universities whose healthcare plans do not cover contraception. The question is slightly different for undergraduate students at the same institutions, as many of them likely still share their parents' insurance, but for staff living on lower-income salaries or for graduate students living on stipends of less than $20,000 a year, the prospect of paying over $100 a month for contraception is hardly 'modest,' but absolutely prohibitive. In offering a similar critique, Sen. Barbara Boxer (D-CA) highlights the shameful statistic that "34 percent of women voters report having struggled with the cost of prescription birth control." As Sen. Boxer points out in her defense of the new policy,
After all, virtually all women, including 98 percent of Catholic women, have used birth control at some point in their lives and 71 percent of American voters, including 77 percent of Catholic women voters, support this policy.
Despite these facts, and despite the Obama Administration's attempts to safeguard the consciences of religious groups formally opposed to the use of contraceptives, Dionne's bottom line finds the imposition of a contraception coverage mandate, even with the inclusion of the thorough exemptions currently offered, to be a threat to the health of our nation's religious pluralism.
Yet unfortunately for Dionne, or at least for his argument, his article grossly mischaracterizes the factors necessary for pluralism to flourish. To the extent that their implementation as matters of public policy limits women's access to vital contraceptive care - access to which the Institute of Medicine recently declared to be medically necessary “to ensure women’s health and well-being” - the Catholic Church's anachronistic teachings on contraception represent a serious health risk for women. In calling on the Obama administration to allow the Catholic Church and its attendant institutions to deny contraceptive coverage to any woman, and especially to non-Catholic women employed or enrolled at Catholic institutions, Dionne has overstepped the bounds of responsible pluralism and crossed the line into the dangerous territory of relativistic rationalization. As I've discussed many times before on this blog, religious progressives have a very real problem with their fetishization of relativism, the privileging of which must surely seem all the more attractive as a possible defense when the beliefs and practices of one's own religious community come under scrutiny. But just as progressives should not accede to the justification of harm in the name of the moral or theological relativism, we must be doubly vigilant in not allowing harmful beliefs and practices to receive a pass by masquerading as facets of a healthy culture of pluralism.
It is not imperative that the religious communities voicing strong opposition to contraception change their views on women's access to reproductive rights. At least, not yet. As long as access to women's reproductive care can be achieved without relying on these dissenting groups for resources, their disapproval can remain an unfortunate footnote in the on-going struggle for women's reproductive and economic rights. But I am deeply disappointed that E.J. Dionne has chosen to take such an unfortunate stand on the issue, and that he has done so in a way which, to my mind, cheapens the vital culture of pluralism for which religious progressives in this country labor.