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Injunction highlights health coverage flaws

Judge Jon DeGuilio recently ruled in favor of the Fort Wayne-South Bend Diocese, barring enforcement of the Affordable Care Act’s contraceptive requirement. Arguments will tend toward one extreme or the other.

On one side, some will defend religious freedom and the diocese’s right to not provide contraception. On the other side, some will argue for adequate health insurance for all.

What got us here and what makes this problem so profoundly complex is that the insurance for these individuals is being provided by their employer.

It might be tempting to say that individuals who want insurance that covers contraception should simply purchase insurance on the open market.

But that fails to understand two important facts. First, insurance provided through an employer is provided with substantial tax incentives. Second, insurance available on the open market lacks these same incentives.

What this means: Insurance costing $6,000 that’s provided by an employer costs $6,000 and is tax free. However, insurance costing $6,000 on the open market effectively costs between $6,600 and $8,000 in income because it’s purchased with after-tax dollars.

Individuals who have different religious beliefs from their employers would have to pay more for their insurance. This limits the employee’s expression of his or her religious beliefs.

It might also be tempting to say the religious beliefs of business owners should have no role in the insurance provided for their employees. And this is a powerful argument. After all, it’s not the employer’s insurance, but the employee’s.

But at the same time, we think it would be dehumanizing to require an individual to give up their religious beliefs if they go into business. If I hold a particular religious view with great conviction, why should I be required to violate it the minute I begin to employ people in my business?

If I am a Christian Scientist and don’t believe in Western medicine at all, why should I be required to provide health insurance for my employees? If I am a Jehovah’s Witness and start a business, why should I be required to help pay for blood transfusions (which I believe violate God’s commands) for my employees?

For a long time, this potential conflict was avoided through the haphazard nature of our health care system. But the Affordable Care Act includes a requirement that insurance plans meet minimum standards. For example, there will no longer be any health insurance plans that cover only $2,000 of a hospital stay. Another mandatory minimum is that health insurance must provide preventive care and contraception.

But because the Affordable Care Act must work within the existing system, those mandatory minimums will apply to insurance plans provided by employers. And so now we have a problem. To produce more universal coverage for a broader section of the population, we have to require businesses (or at least incentivize them through tax rebates and penalties) to provide minimum coverage for their employees. These incentives, though, will apply to the Christian Scientist, the Jehovah’s Witness and the Catholic just the same.

Until we have a new system for providing health insurance to our citizens, we cannot protect the liberty of individuals to get contraception through their health insurance and also protect the liberty of business owners to dictate the features of the plans provided for their employees. This then leaves us with a question.

What is more important to us: Providing contraception as a feature of good health insurance or protecting the religious liberties of business owners as they determine the features of the insurance offered to their employees?

Abraham Schwab is a medical ethicist and associate professor of philosophy at IPFW. He wrote this for The Journal Gazette.

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