Friday, February 8, 2013

The bishops, Hobby Lobby, and the contraceptive mandate

Yesterday, the U.S. Conference of Catholic Bishops released a statement about the latest HHS contraceptive mandate rules. While they are still opposed to what they see as a grave threat to religious liberty, the overall tone of the statement is measured, and they waited one week to officially respond while they considered the new rules.

In the post-2008 world of hyper-partisanship and hyperbole, I think we are entitled to label that a kind of progress.

The bishops still find inadequate the Obama Administration's attempts to create a wall between religiously-affiliated employers and the provision of free birth control to their employees. I think that the firewall is in fact adequate and consistent with norms in American political culture and the current and past relationship of the Catholic Church with the U.S. government and the flow of taxpayer money to the Church (see my prior posts on the subject).

For that reason, I don't think that the Church is going to win the battle of public opinion over the firewalls. They may continue to preach to the converted-- pro-life Catholics and evangelical Protestants who buy into the idea that there is a 'war on Christianity'-- but I don't think they are going to move the meter with mainstream American voters.

Regardless of whether the bishops have it right or not on the firewalls, because of their continuing dissatisfaction, the focus of their opposition is going to shift to the criteria for being exempt from the contraceptive mandate altogether, and/or qualifying for the 'accommodation' that the firewall provides.

The contraceptive mandate rules, as written, divide all employers into three camps:
  1. Religious employers, like churches. They are exempt from the mandate completely.
  2. Non-profit organizations that are affiliated with a particular church or religion, like Catholic hospitals and Catholic universities. If an organization is in this camp, they are entitled to the 'accommodation' of having a third party provide contraceptive services. 
  3. All other employers, including for-profit organizations and organizations that have a secular mission but are owned and/or operated by people of faith. A company like Hobby Lobby, which is challenging the contraceptive mandate in court, falls into this camp. These employers do not receive any sort of accommodation. 

The main question the Obama Administration will need to answer in the coming weeks is why Hobby Lobby and other secular businesses with religious owners are not entitled to firewall protection. Theirs is the only situation I can see causing mainstream Americans discomfort.


Article in Politico (February 7, 2013): Bishops reject contraception rule change

Statement from the United States Conference of Catholic Bishops (February 7, 2013): HHS Proposal Falls Short In Meeting Church Concerns; Bishops Look Forward To Addressing Issues With Administration

Web site for The Becket Fund for Religious Liberty, which is assisting Hobby Lobby with their lawsuit against the HHS

Tuesday, February 5, 2013

Why not impose the contraceptive mandate on everyone?

Given the revised contraceptive mandate rules, there are now clear firewalls between religious employers and the contraceptive services their employees shall receive (see previous post). As I put it earlier, it is not like religious organizations are even providing free birth control-- their health insurance company or the federal government is providing it. The fact that religious organizations provide health insurance for their employees is just the hook for third parties to provide their free birth control to their employees.

Here's a question: If any organization with religious conscience objections can be exempt from having to directly (or even indirectly) pay for birth control for their employees, why shouldn't all organizations that offer health insurance, religious organizations included-- like churches-- be covered under the mandate?

The system that is now being proposed essentially has secular health insurers or the government pay for birth control for employees of religious organizations that fall under the new rules. Most people who look at the proposed rules fairly will see that religious organizations are not being imposed upon by this system. Therefore, if the Obama Administration is arguing, I think correctly, that these new rules do no damage to an organization's religious practices, then why shouldn't the government and private health insurers offer free birth control to their employees?

The answer-- perhaps obvious-- is that while this makes sense on a logical level, it would be too much to sell on a rhetorical or symbolic level. Right now, the Obama Administration is very likely in a sweet spot, where a) many, many women are going to get free birth control coverage while b) the Administration looks-- to mainstream voters-- like it has done all it could to accommodate the concerns of religious organizations. If the Administration, on my logic, tried to move the bar further, it would look greedy and arrogant. It would also give religious organizations more fuel. If religious organizations continue to object to the propose regulations as they are now, they are going to lose credibility with the public.

Monday, February 4, 2013

The contraceptive mandate and indirect support of things we don't like

The latest proposals for the Affordable Care Act's contraceptive mandate were released a few days ago. From what I gather, there are two major adjustments:
  1. The types of groups that are exempt from having to provide free birth control in their health plans expanded slightly. 
  2. More importantly, of the groups that are still required to provide a health care plan with free contraceptive services, those with religious objections to contraception are further insulated from funding those services. Insurers, not the organizations who contract with them, pay for contraceptive services themselves (so that no employer money pays for birth control). For employers that self-insure, a separate government entity will provide the contraceptive services, again at no cost to the employer. 
At this point, for employers with religious objections to contraceptives, I think it is inaccurate to even say that they will be 'providing' contraceptive services to their employees. It is more accurate to say that a) insurance companies and b) the government are providing birth control coverage to employees of religiously-affiliated organizations. 

Pro-life activists and employers that still complain after these adjustments enter dangerous territory. 

If religious employers complain that indirect connections remain between their insurance premiums and contraceptive services, they are getting into the realm of something like the 'taxpayer' objection. The taxpayer objection goes something like this: I refuse to pay taxes because a) my money will go directly to something I don't like (unpopular war, dirty energy subsidy, etc.), or b) my money will pay for X (which I'm okay with), which in turn allows other government money to pay for Y (to which I object), thus indirectly subsidizing activity Y. 

The main problem with the taxpayer objection is that government would fail to work at all, because everyone's tax dollars directly or indirectly subsidize government decisions and actions that violate their moral and religious beliefs. Religious pacifists, for example, would pay no taxes whenever the American government was at war (so they would never pay taxes). Religious vegans would not pay taxes because of their resulting indirect subsidization of the meat and dairy industry. Non-Catholics would object to paying their taxes because of the millions of dollars governments provide to Catholic organizations each year in grants and subsidies. 

In my reading of American culture, Americans deal with the taxpayer objection in the following ways. First, we note that we have no idea whose tax dollars are paying for X, Y, or Z, because most tax money goes into one big pot and gets stirred up. So it is usually impossible to say that any one person's tax dollars directly pay for any particular government activity. 

Second, where the use of a given person's tax money can be directly linked to a particular government program, and that is the subject of conscience objections, we make it so that the government program is no longer  directly subsidizing that activity. And then we leave it at that. We generally reject the 'indirect' funding objection as asking too much and making the work of government impossible.

This is the Obama Administration position, and it is correct. 

Not only are pro-life activists and employers wrong to push their objection to indirect funding of birth control, they are also hypocritical, because, as noted, religious organizations in the United States are being 'indirectly' funded by millions of taxpayers who object to the tenets of their specific religion. 

For these reasons, I think the reaction to the new proposals, with their firewalls, has been relatively muted. What I am not seeing are precise objections-- in other words, I have not seen an explanation why the firewalls constructed by the new regulations are insufficient. Instead, the initial response seems to be to repeat platitudes about freedom of religious conscience.

A commentator for The New York Times, David Firestone, suggests that nothing the Obama Administration does will mollify those fighting the contraceptive mandate. Statements made by pro-life activists (see the pro-life media links, below) appear to confirm his suspicion. If pro-life and religious organizations don't move toward the Administration at least a little in the coming days, they will undermine their own credibility. Americans share their concerns about government regulations undermining freedom of religious conscience. Americans do not share their concerns about contraception itself. If it starts to look like their primary concern is to keep other Americans away from birth control, they have lost.


Fact sheet from the federal Center for Consumer Information & Insurance Oversight (CCIIO), describing proposed changes to the contraceptive mandate: Women's Preventive Services Coverage and Religious Organizations

PDF version of the Notice of Proposed Rulemaking (NPRM) covering the contraceptive mandate, from the Office of the Federal Register (January 30, 2013)

Fact sheet from web site, explaining in general the benefits of the ACA for women (updated February 1, 2013): Affordable Care Act Rules on Expanding Access to Preventive Services for Women

Post by David Firestone on the Taking Note blog at The New York Times (February 1, 2013): Contraception Compromise

Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief on the U.S. Department of Health and Human Services web site (February 2012): The Cost of Covering Contraceptives through Health Insurance 

Article in The New York Times (February 1, 2013): Birth Control Rule Altered to Allay Religious Objections

Editorial in The New York Times (February 2, 2013): A Good Compromise on Contraception

Article in (February 1, 2013): Pro-Life Groups Blast Revisions to Obama Abortion-HHs Mandate

Article in (February 1, 2013): Obama admin releases revised rules for HHS mandate: met with skepticism

Article in (February 1, 2013): Catholic and pro-life leaders slam White House 'compromise' on birth control mandate

Sunday, February 3, 2013

America's falling birth rate?

One wing of reproductive politics focuses on the world's human population and the population of specific countries. The things I read about population growth, decline, birth rates, etc., all seem to be weapons in a proxy war over gender roles, contraception, abortion, and family planning.

Many people who are pro-life simply care about the sacredness of life or the rights of the unborn or declining  family values. They do not necessarily want more babies, per se. Others, however, are pro-natalist-- they see an active good in more babies being born and increasing the size of the population. They also focus on evils done in the name of population control-- China's one-child policy, for example-- and the unintended consequences of the worldwide family planning movement, such as the use of sex-selective abortions in countries like India.

The wing of the pro-life movement that is pro-natalist tends to fight against the conventional wisdom that the size of the world's population is out of control and needs to be reduced. In fact, they argue, declining populations-- especially in Europe and Japan-- are going to create serious economic and social problems in the coming decades. They also deny that large populations in poor countries are the source of many economic and social problems.

If you want to get a taste of pro-natalist thinking, take a look at the web site of the Population Research Institute, which has a series of interesting videos about the "myth" of overpopulation.

The Wall Street Journal just published a long essay by writer Jonathan V. Last that is an excellent example of pro-natalist, overpopulation-is-a-myth thinking. Last asserts that "the only thing that will preserve America's place in the world is if all Americans. . . decide to have more babies."

Last makes three arguments against mainstream concerns about overpopulation:
  1. The United States currently has a fertility rate-- 1.93-- that is below replacement rate. So our population will be shrinking, with negative consequences to follow. "The root cause of most of our problems is our declining fertility rate."
  2. "[G]lobal population growth is slowing to a halt and will begin to shrink within 60 years." 
  3. "[G]rowing populations lead to increased innovation and conservation [of natural resources]. . . Human ingenuity, it turns out, is the most precious resource."
Obviously, you'll need to read the whole essay to assess his claims. Here are some things to think about while reading (some of which, to his credit, Last discusses): 
  1. It is my understanding that, as long as the replacement rate is 1.9 or above, a country is okay in terms of sustaining its population. 
  2. As a country, we should never be unattractive to skilled and hard-working immigrants. Unless we have some reason to be anti-immigrant-- and we shouldn't be, given our history and success with immigration-- we can always solve marginal population decline by letting more people into the country and/or continuing to be an attractive place in which to live. 
  3. There is a lot of evidence to show that the more a government does to enhance gender equality, the better a country's birth rate will be. There is a middle ground in population growth. Where one has extreme gender inequality, birth rates tend to be high. On the other hand, where one tends to have some approach toward gender equality-- women have some access to the career options and dreams of men, but are still subject to a lot of discrimination and gender stereotyping about family roles, etc.-- birth rates tend to be low. In this latter situation, where governments and societies move toward making the promise of gender equality a reality, birth rates tend to go back up to replacement rate. If pro-natalists want to ensure a stable replacement rate, they should actually advocate for government-sponsored gender equality, rather than a return to 'traditional family values.' 
  4. Historically, growing populations have created an impetus to develop innovations in agriculture and environmental conservation. (I note the irony that many conservatives who are pro-natalist and long for traditional family values also tend to object to increased environmental regulations and government-sponsored conservation.) The fact that societies have been forced to be creative in the face of growing populations does not mean that the growing population itself -- i.e., the increased number of brains at work on social problems-- is the key contributing variable. It could be that growing populations create tangible, undeniable problems that successfully spur political action. There is nothing to say that we can't have stable population numbers and continued innovation in conservation, food science, etc.
  5. Last argues against himself. If growing populations lead to more innovation, then why is he happy that the global population will stabilize within 60 years? 
  6. The global population is not stabilizing by itself. It is stabilizing because of a decades-long family planning movement that promotes gender equality, easy access to effective contraception, and sex education that works. The latter two have been strongly opposed by pro-natalists and pro-lifers. 
Let me know if you find Last's arguments persuasive. Enjoy!


Essay in The Wall Street Journal by Jonathan V. Last (February 1, 2013): America's Baby Bust

Mr. Last's essay is based on his recently released book, What to Expect When No One's Expecting: America's Coming Demographic Disaster. You can learn more about the book and purchase it from Mr. Last's web site. 

Home page of the Population Research Institute 

If you want to read an informative and sympathetic account of the worldwide family planning movement, I recommend Michelle Goldberg's book The Means of Reproduction

Saturday, February 2, 2013

TRAPs, Mississippi, and pink abortion clinics

Speaking of Mississippi (see my last post), the fight goes on over the state's only abortion clinic, in Jackson.

As you know, the Mississippi government is trying to implement regulations that would make it impossible for the Jackson Women's Health Organization to stay open. The status of the clinic is in limbo while the state and the clinic battle it out in court.

In the meantime, two developments:

First, the governor, Phil Bryant, committed a gaffe, which in American politics means he told the truth. At a pro-life event, he stated the obvious: He wants to shut down the Jackson clinic. To be fair, it is not clear that he meant that his support and defense of the current Mississippi regulations is driven primarily by a desire to shut down the clinic. Governor Bryant theoretically could have a parallel desire to make the abortion process safer for women.

It does seem a bit of a stretch. What marks the Mississippi regulations as "TRAPs"(Targeted Regulations of Abortion Providers) is that a) they impose requirements on abortion clinics that are not imposed on providers of medical procedures of a similar nature and risk; and b) they are medically unnecessary-- they do not make significantly safer a procedure that is already relatively safe under the status quo ante.

Because of these factors, the Governor is just saying out loud what the regulations by their nature suggest-- they are a cover for making abortion in Mississippi effectively illegal.

The second development is that the Jackson Women's Health Organization repainted its building Pepto-Bismol pink, as an act of positivity and defiance. A reporter from the Clarion Ledger described the color as a "vibrant, cheery hue." That's charitable.

I don't know. I guess if painting your building pink helps you whistle through the graveyard, then I can't object too much. When I saw the photo, however, two thoughts came immediately to mind. One is that I'm not sure that making your abortion clinic look like a piece of bubble gum or like a Lego set sends the right message. The question of what kind of 'tone' or atmosphere one should shoot for in a medical setting requires a longer discussion, but something about the color of the building seems unserious.

The other thought is that pro-lifers are going to look at the building and see the color of blood. Any enterprising pro-life photographer can take a picture of the building and darken the tone just enough to make the clinic look like a horror house. If you read accounts of pro-lifers who pray or stand vigil outside of abortion clinics, they often talk about the 'sense of evil' coming off of the building. Regardless of whether the feeling is genuinely sensed or self-generated, do you think that painting your clinic a color redolent of scary clowns is a PR winner?


Article in ThinkProgress (January 11, 2013): Mississippi Governor: 'My Goal Of Course Is To Shut Down' The State's Last Abortion Clinic

From the Center for Reproductive Rights, a short summary of Targeted Regulation of Abortion Providers (March 5, 2009)

Article in ThinkProgress (January 31, 2013): Mississippi's Last Abortion Clinic Sends a Message: 'We're Here And We're Not Going Anywhere

Article in the ClarionLedger (January 30, 2013): Abortion clinic makes a statement with a pink paint job

Friday, February 1, 2013

Turkey's proposed abortion law

The country of Turkey is dealing with its own kind of TRAP law, it seems. In reproductive politics, the term "TRAP" refers to Targeted Regulation of Abortion Providers-- regulations that ostensibly improve the safety of abortion as a medical procedure, but in reality serve to raise the expense and difficulty of providing abortions. By adding requirements, such as surgery-center quality facilities, which are nice but medically unnecessary, abortion clinics are driven out of business, limiting access to abortion.

One type of TRAP is to focus on the medical credentials of those providing abortions. In Mississippi, for example, the state is attempting to implement a requirement that all abortion doctors have admitting privileges to a local hospital. The problem is, all of the local hospitals around the sole abortion clinic, in Jackson, refuse to provide admitting privileges, either because they are pro-life or are intimidated by pro-life activists and government officials. As a result, the only abortion clinic in Mississippi may go under.

In Turkey, the proposed legislation focuses on medical credentials and the location of the abortion procedure. The Guardian reports:
Under the draft law, abortions will only be permitted if carried out by obstetricians in hospitals, according to reports in the Turkish media. Currently the procedure is also offered by certified practitioners and local health clinics. The new law also introduces the right for doctors to refuse performing an abortion on the grounds of their conscience, and a mandatory "consideration time" for women requesting a termination.
"This will dramatically limit availability, especially to women in rural areas and women with few economic resources," said Selin Dagistanli of the campaign group Abortion Is a Right.
"While there is no legal ban, these measures will make abortion de facto unavailable. In many towns there might only be one hospital, and maybe one obstetrician. What if this one doctor then refuses to perform a termination? Many women cannot afford to travel to another city or go to a private hospital," she said.
The proposal reflects an ignorance of the basics of abortion, especially early abortion, as a medical procedure, or a conscious attempt to limit abortion access in the guise of helping women. It sounds like the latter.


Article in The Guardian (February 1, 2013): Turkish law will make legal abortion impossible, say campaigners