POLITICS MARCH 12, 2012
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In January 1998, in the run-up to the twenty-fifth anniversary of Roe v. Wade, then-First Lady Hillary Clinton held a meeting in the Map Room of the White House with leaders of women’s groups ranging from Planned Parenthood to the National Women’s Law Center. The meeting took place in the aftermath of the painful and polarizing debate on late-term abortion—a debate in which conservatives capitalized on a seemingly extreme abortion position in order to bludgeon progressive leaders. In that meeting (I was there, as a staffer for the First Lady), Clinton pushed the groups to develop a proactive agenda around women’s health, one that would shift the debate away from a rarely used procedure and back toward the reproductive health needs of women. And if that debate took place in a way that demonstrated the extremes of the anti-choice position—so be it. Over the course of the discussion, Clinton and the leaders in the room hit on the issue of contraception: specifically, promoting contraceptive coverage in health care plans.
Fourteen years later, the strategy formed in the White House in 1998 is being tested on the national level, as we debate the Obama Administration’s contraceptive coverage proposal. But today’s debate differs from the one that took place in the ’90s—when many states passed laws mandating contraception coverage—in one troubling way: the vociferous opposition by religious groups. The past few months have seen the issue of contraception coverage turned into a question of religious liberty. And, initially at least, that rhetorical shift by conservatives made an enormous political difference.
Before it was made into a religious issue, contraception was a subject where the majority of Americans were firmly on the side of women’s rights: Most people viewed it as a basic health protection, not a controversial issue. And that’s why it was also successful as a political cudgel, helping isolate extreme anti-choice advocates from the mainstream. Indeed, it was a Republican Senator, Olympia Snowe, who introduced the Equity in Prescription Insurance and Contraceptive Coverage Act (which lacked any sort of “conscience exception”) in 1999, and plenty of Republicans co-sponsored it.
That extent of mainstream sympathy for contraception coverage was especially evident on the state level. At the time, state affiliates of women’s organizations started pushing contraceptive coverage in state legislatures—and in many places, they passed. One such organization was NARAL-NY, which advocated for the Women’s Health and Wellness Act in New York in 1999 and 2000. The legislation—like the original Obama policy—only allowed an exemption for houses of worship, not religiously affiliated hospitals or colleges, perhaps because its authors recognized that the vast majority of employees at these institutions are not Catholic. But the Catholic Church did not actively resist, or try to prevent the bill’s passing. At the time, the Church said that, in its affiliated hospitals, it would “continue for the immediate future providing the contraception coverage under formal protest.” This was far from the cries of “religious coercion” that we see today.
And, in some states, religious groups were silent altogether. In 1999, New Hampshire passed a law requiring contraceptive coverage in all prescription drug plans. (The law was passed by a Republican legislature and signed by a Democratic governor.) Both lawmakers and religious groups never raised the issue of religious liberty during the legislative debate; in fact, there was not a single discussion on that issue according to the legislative history.
How could it be that the Catholic Church did not object, and did not threaten to spend millions of dollars defeating political opponents? Simply put, contraception coverage was seen as part and parcel of health care access.
And, if Obama’s rising approval rating among women is any indication, it still is today. Moreover, after some initial uncertainty surrounding the politics of the contraception measure, it is now clear that a solid majority of Americans (63 percent) support it. Fourteen years ago, leaders of the women’s movement saw contraception as a unifying issue, one that the vast majority of Americans would support. They strategized that those who opposed contraception would be seen as extreme. In the past several weeks, they were proven right.
Neera Tanden is president of the Center for American Progress.
11 comments
Religious freedom does not involve Catholic bishops deciding health care insurance policy. It does involve Catholics being free to decide whether to use birth control, or not (a fact the Bishops probably don't like so much). It does involve people being free to follow the dictates of their conscience, not the dictates of Catholic bishops. Why has the press parroted the social conservatives spin on this? It's odd that Evangelical Christians support the bishops' position on this, more than Catholics who have had decades of deciding for themselves what their belief tells them is the moral route to follow.
- bsemple
March 12, 2012 at 12:46am
Sex drives people crazy. Making babies consoles us about our mortality. We breed too prolifically. Science fiction writer Issac Asimov once wrote that we should support and promote every possible sexual "perversion" especially if it satisfied our sexual drives without producing more unwanted babies. I guess using birth control ranks rather low on the twisted sex hierarchy, so get with it. Shut off your computer, put on a condom, or put in a diaphragm or XXX or XXX or XXX -- well, I leave the details to your dirty imagination. Just don't make a baby. Unless you really want one and can care for it properly. Good night. Have fun.
- skahn
March 12, 2012 at 1:26am
I won't continue my quixotic effort to avoid having the process of establishing "essential health benefits" (in the ten categories defined by ACA) from being highjacked for political purposes; it’s sad, but women’s health is inherently political, always has been, always will be. Today, only about half of large group plans cover birth control and only about a third cover oral contraceptives. By comparison, almost three quarters cover erectile dysfunction. Is this disparity attributable to science or politics? Consider that less than 25 years ago, most plans did not cover prenatal care because pregnancy was considered "voluntary" and not a medical condition; today, essentially the same argument is used to exclude birth control. I vividly recall the battle in my state over the state mandate for prenatal coverage; and, not surprisingly, many of the neanderthals who objected to prenatal coverage then are objecting to birth control coverage today. If, then, women’s health is inherently political, does that mean the political approach taken by the Obama administration with respect to birth control could not have been avoided? Under ACA, states have the flexibility to select a benchmark plan to define essential health benefits as long as it reflects the services offered by a "typical employer plan". I suspect many if not most states will choose this option for defining essential health benefits. Twenty five years ago, men comprised most of the workforce and, hence, the mandate for prenatal care was, for the most part, addressing dependent coverage. Today, women comprise over half the workforce, so the issue of coverage for birth control directly affects working insureds, not just dependents. One has to ask why working women would tolerate having their group plans discriminate against women (covering Viagra but not birth control)? If working women pressured their employers to add birth control, then such coverage would be part of the “typical employer plan” and, therefore, most likely included as part of “essential health benefits”. It’s an alternative path, one not taken by the Obama administration. But sometimes the indirect path is the best path, especially when it comes to highly charged political issues.
- rayward
March 12, 2012 at 8:57am
Perfectly stated bsemple. Your first sentence alone says it all.
- WandreyCer
March 12, 2012 at 9:36am
PPACA appears to give unprecedented authority to the Executive branch to define "preventive health care", which is troubling. I await the mandate that anyone who still smokes tobacco and/or drinks alcohol will be excluded from Medicare and Medicaid insurance coverage - maybe mandate mandatory drug testing for use of jalapeno peppers? :)
- K2K
March 12, 2012 at 12:21pm
K2K: Where do you get the idea that smokers and drinkers would ever be excluded by anyone from Medicare and Medicaid? That would eliminate health coverage for a huge percentage of the population, which is the opposite of Obama's intentions. It would also be political suicide for any politician who supported it. Obama has never called for mandatory drug testing. That is only advocated by anti-Obamacare Republicans as a way to sadistically punish the unemployed for seeing insurance benefits to which they are entitled. Your paranoia suggests that you're consuming way too much right-wing media, which has affected the functioning of your brain.
- heppner52
March 12, 2012 at 2:36pm
Heppner52, Excellent comment, but you left out one final point. Take K2K's point about tobacco and alcohol. If tobacco and alcohol affect the functioning of the brain (which they surely do), then consumption of right-wing media surely should surely exclude one from Medicare/Medicaid. I suppose "poetic justice" is nowhere listed in the approved formulary, alas.
- skahn
March 12, 2012 at 3:13pm
I'm wondering where this "freedom of conscience" arose. People of such delicate sensibilities that they have to be appeased, lest they can't sleep at night. Really? No tax money for anything you might strongly oppose? This is not how a secular democracy works. The Supreme Court has already ruled that the Native American religious practice of smoking peyote does not protect them from getting fired for doing so. Scaila himself wrote the opinion, saying that civil law trumps religious rights (at least for non-Catholics) The fact that the Church is seemly OK with Viagra for unmarried men negates their argument.
- dstatton
March 12, 2012 at 3:44pm
Oh this is all about power. No need to parse the details. Women are just the first victims because as rayward says, for some reason our health has always been political. This should not be the case but again, it's a power issue. That. Is. My. Broodmare. Look what they've come up with in Arizona: http://www.slate.com/blogs/xx_factor/2012/03/09/arizona_senate_approves_bill_allowing_anti_abortion_doctors_to_mislead_patients.html
- Sophia
March 13, 2012 at 1:46am
The article misleads by ignoring important facts and some of it is downright false. The state mandates did not provoke strong religious opposition simply because the state mandates could be avoided by self-insuring prescription drug coverage or by dropping that particular coverage altogether or by taking refuge in a federal law that generally pre-empts any state mandates (ERISA). Moreover the state mandates generally did not mandate abortifacient drugs.
- fsmiceli
March 13, 2012 at 3:59am
I repeat the key point: PPACA appears to give unprecedented authority to the Executive branch to define "preventive health care", which is troubling. Commenters like heppner52 fail to note that key point, which is a very slippery slope when the President gets to decide what is 'preventive health care'. One example: in 2010, when the Democrats controlled all of Congress and the Oval Office, Medicare decided that lipid panel blood tests that measure cholesterol, was NO LONGER deemed necessary more than once every five years. Hmmm, no cholesterol test for five years is a great way to increase heart disease among the elderly, so why is THAT not "preventive health care"???? heppner52 also is unaware that :) means 'joke'. Might want to invest in some literacy training...
- K2K
March 13, 2012 at 1:15pm