Not many issues in American politics unite nurses, primary-care physicians and specialists. The U.S. Supreme Court
found one this week.
Frontline healthcare practitioners condemned in strong terms the high court's ruling in Burwell v. Hobby Lobby
that said closely held private companies should not have to provide insurance coverage for four types of contraceptives to which company owners have religious objections.
The 5-4 decision was immediately criticized by the American Medical Association, the American Nurses Association (PDF)
, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists for allowing employers to meddle in the exam room.
The decision “intrudes on the patient-physician relationship and will make it more difficult for many women to make their own personal medical decisions,” said Dr. Robert Wah
, president of the AMA. “We encourage the administration to provide alternative pathways to secure coverage for patients unable to obtain these services as a result of the court's ruling.”
Each of the groups urged officials in Washington to work quickly to restore coverage options for all insured women, saying that limiting insurance coverage would force women to take additional steps or pay out of pocket for birth control—which affects low-income women in particular.
Limiting contraception options can have negative effects on the health of women and families by exposing them to the risks of unplanned pregnancies, including heightened risk for pre-eclampsia and psychological complications from births that are not optimally timed, said Catherine Ruhl, a director with the Association of Women's Health, Obstetric and Neonatal Nurses.
Although the decision was criticized for obstructing evidence-based practices in medicine, proponents held it up as a victory for religious freedom.
The family that owns and operates Oklahoma City-based arts-and-crafts retail chain Hobby Lobby
said that the Affordable Care Act could have forced them to violate their religious beliefs against abortion. That's because HHS required private employers to provide insurance coverage for all 20 forms of contraception approved by the Food and Drug Administration
, including intrauterine devices and emergency oral contraceptives like Plan B. Critics of the policy contend the methods interfere with pregnancy in ways that they consider abortion of a fertilized human egg.
Lawyers for Hobby Lobby said the company could have faced $26 million a year in federal penalties if it decided to drop all workers' insurance plans rather than provide objectionable contraception coverage. The penalty would have been $475 million per year for offering insurance without contraception coverage. The Supreme Court on Monday agreed that HHS could not subject closely held companies to such large fines for exercising their religious beliefs.
“At the heart of the Hobby Lobby and related cases is the right of Americans to live and work according to their beliefs without fear of government punishment,” the Catholic Medical Association said in a statement. “Americans should never be forced to surrender their religious beliefs when opening a business.”
Justice Samuel Alito's majority opinion indicated that it was a limited decision applicable only to the facts of the Hobby Lobby
case and another related case, Conestoga Wood Specialties v. Burwell
Not everyone was convinced. It wasn't clear that closely held companies whose owners object to the other 16 other types of contraception and surgical sterilization procedures approved by the FDA wouldn't eventually bring similar lawsuits that rely on the same legal theory. And explicit language from five justices notwithstanding, it wasn't clear how the legal interpretation laid out in the Hobby Lobby
case wouldn't apply to other healthcare services to which religious groups could conceivably pose objections, like blood transfusions, vaccinations and psychological services.
“I think it's a bigger deal than just Hobby Lobby and Conestoga, and I think this is going to follow a theme that will be carried through the next couple of years, or certainly the next two election cycles,” said Paul Keckley, managing director in the healthcare practice at Navigant.Follow Joe Carlson on Twitter: @MHJCarlson