The ruling by the U.S. Supreme Court Monday that privately owned business can opt out of offering contraception services on the basis of religious beliefs illustrates the difficulties of health care implementation, Linda Schwimmer, the vice president of the New Jersey Health Care Quality Institute, said.
For Schwimmer, the 5-4 decision in what likely will be known as the Hobby Lobby case, is more about the state of the system and the Affordable Care Act’s attempt to fix it rather than a question of religion.
"This case is emblematic of the on-going challenges of the patchwork health care system we have in the U.S.,” she said. “We are trying to make sure that everyone has access to health care and health insurance, but we, as a country, don’t provide that access directly. Instead, we rely on employers, along with others, to purchase it and tell them what it must include.”
Therein, Schwimmer said, lies the problem.
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“This mandate and the individual mandate inevitably lead to push back,” she said. “In this case, the push back was over what the federal government, and the vast majority of public health experts would agree is good public health, that is giving free access to contraception, and the religious views of the owners of non-public corporations.”
Schwimmer fears the ruling will have a broad-based impact.
“The court’s decision has significant implications for health care, and for the employees of non-public corporations,” she said. “From a public health perspective, access to adequate contraceptives is important, and this decision would seem to exempt a whole class of employers from having to abide by the contraceptive mandate in the ACA. To that extent, this decision is challenging.”
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It also figures to keep challenges to the ACA coming.
“It may give fodder for new challenges to other mandates — even though the court tried to rule as narrowly as possible,” she said.
Schwimmer feels the ruling should remain limited — and hopes that it will.
“While this decision does seem to limit federal power in terms of implementing the ACA, it should not be read as a sweeping exemption from all ACA mandates,” she said. “We encourage employers to choose what is best for the health of their employees when it comes to their health care — regardless of this decision.”
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