How to balance competing interests

Last week, conservatives made effective political use of the Health and Human Services rule requiring employers and insurers to provide reproductive-health benefits at no cost to energize socially conservative voters — so much so that the White House scrambled to find an “accommodation” that would satisfy birth-control advocates yet somehow not cede more ground to religious conservatives. Even after this effort, the Catholic bishops appear not fully satisfied. They and others, for political reasons and perhaps some from sincerely held beliefs, continue to argue “religious freedom” is under attack by the Obama administration. Notwithstanding the administration’s face-saving change to the rule, the issue is less about religion and more about the appropriate benefit package as we move toward universal healthcare.

By wrapping their objections under the cloak of “freedom of religion,” these politicians distracted voters and the public from important and critical policy questions regarding what services and products should be covered by health insurance. They argued that the “religious liberty” of certain employers is more important than the reproductive health of countless women, many of whom are Catholic. The “religious liberty” of these religious employers apparently is morally superior to the rights of employees who access healthcare through these employers. Employees apparently should not be free to make decisions about their healthcare and whether those decisions conflict or conform to their beliefs, religious or otherwise. If this is really about religious freedom, why is the “religious liberty” of a Catholic — or a non-Catholic who works for a Catholic-affiliated institution — who decides to use contraceptives less deserving of protection than the “religious liberty” of the institution that employs her? Who is interfering with whose “religious liberty?”

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In truth, the issue is not about religious freedom at all — rather, it is about whether this rule is fair in its application to a broad and heterogeneous range of employers (and employees) with a multitude of beliefs and value systems. Having worked in government at the highest levels, I know that governing is about finding a balance between competing interests. It is about finding a path to achieving goals that are widely shared though there is disagreement about the means to get there.

Providing greater access to healthcare and health insurance is a widely shared goal; how to get there is wildly disputed. In this case, we have employers who are affiliated with religious organizations — hospitals, schools, day care centers, universities, etc. — who are acting as employers, involved in lines of business not strictly within the religious realm. And in a world where so many Americans obtain health insurance through their employers, what is an appropriate or standard health benefit package is quite an important issue. 

Today we recognize that prescription insurance is a critical component of health insurance. Moreover, after some early struggles (relating to Viagra being covered under health insurance but not birth control), it is now common to have contraceptives be part of prescription coverage.

Understanding this context makes it obvious that the original HHS rule took common expectations of what should be covered, and balanced those against the concerns of employers affiliated with religious institutions. The revised rule — religiously affiliated employers will not be required to pay for contraceptive benefits — allows both sides to claim victory. But it is the rest of us who will pay the price. Yes, insurers will now pick up the bill for contraceptives, but do we really think that insurers will just eat those out-of-pocket costs out of the goodness of their hearts? No, they will pass those costs on to the rest of us through higher fees to other non-religious employers and individuals who purchase insurance.

Moreover, the delay in obtaining some uniformity regarding standard benefit packages across the country as we begin to implement healthcare reform means that institutions, not individuals, continue to determine the universe of choices. I thought individual freedom was a cornerstone of conservatism — apparently not, when it conflicts with a politically useful issue such as religious freedom. But if we are going to debate “religious liberty,” let’s first be clear about whose “religious liberty” we ought to be protecting. All things being equal, I would take individuals over institutions telling people what their choices are.

So as we save for another day the question of religiously affiliated institutions acting as employers in non-religious activities, is it fair and right for the government to require that they play by the same rules as other employers? Those who would respond by saying we should not require any employer or insurer to offer reproductive services would be ignoring both good health and good business practices. At least then, however, we would be arguing about the central points of healthcare policy, not the peripheral and distracting issue of religious freedom.

Echaveste served as White House deputy chief of staff during the Clinton administration.