The Supremes Take On Religion and Health Care

The latest battle over contraceptives isn't just about women -- the high court could allow employers to deny coverage on a wide range of medical issues. Jim Young/Reuters

Update: The Supreme Court said on Tuesday that it would consolidate two of the cases challenging the contraception mandate, Hobby Lobby and Conestoga Wood Specialities, and hear both in court. Read the full order.

What if your boss treated gay employees differently because his church preaches that homosexuality is wrong? What if he could refuse to cover your kid's measles vaccination because he believes the shots cause autism, or AIDS treatments because he thinks the disease is God's revenge for sinful behavior?

The Supreme Court is poised to hear a case tomorrow that could give employers an unprecedented right to deny coverage of specific medical treatments to which their employees are legally entitled -- mental health services, blood transfusions, cancer treatments, and more -- based on their personal beliefs, no matter how dangerously misguided those beliefs are. Unsurprisingly, the issue boils down to controversy over a woman's right to choose.

The Supreme Court will likely agree Tuesday to hear Hobby Lobby v. Sebelius, a case brought by the arts and crafts chain that opposes the Affordable Care Act's birth control benefit because its founders think some common forms of birth control cause abortions, a misconception widely debunked by the medical community. The court's ruling will have critical implications, not only for women's access to contraception but for the rights of bosses to curtail the medical care of their employees.

"Preventive care, including birth control, is basic health care for women – and the decision to use birth control is a conversation between a woman and her doctor, not a woman and her boss," says Cecile Richards, president of Planned Parenthood Federation of America. "Today there are people trying to take this right away from women – by letting corporations and employers make medical decisions for their employees, based on their personal beliefs. A woman and her doctor, not her boss or Washington politicians, should decide what health care choices are right for her."

The ruling's repercussions will extend far beyond contraception. For the first time, the courts could decide that employers have the right to choose which medical procedures your insurance covers, based on their personal beliefs.

"Once you get to the question of can a for-profit company practice religion, you've really opened up a quagmire," says Judy Waxman, the Vice President of Health and Reproductive Rights at the National Women's Law Center. "This is an important decision for women, but it goes far beyond women."

Since August 1, 2012, insurance companies have been required to give all women free access to standard forms of birth control, along with other preventive care treatments deemed crucial by the independent Institute of Medicine, like wellness visits, cancer screenings and vaccinations. This contraception mandate was backed by the medical and science communities as well as popular opinion: 70% of Americans think insurance companies should cover the full cost of birth control, just as they do for other preventive services; meanwhile, 99% of sexually active American women ages 15-44 have used birth control, and 60% take it for medical reasons that have nothing to do with sex, including treatment for ovarian cysts, hormone replacement after chemotherapy and endometriosis.

The mandate includes a generous religious exemption, which allows around 350,000 churches, religious schools, and houses of worship to use their right to religious freedom under the First Amendment to withhold the benefit to their employees.

But 46 for-profit businesses and corporations -- ranging from Eden Foods, a health food company, to construction firms and a publishing house -- have challenged the contraceptive coverage benefit in federal court, claiming that their personal beliefs deserve more protection than the medical needs of individual employees. The circuit courts have been split -- some companies received preliminary injunctions allowing them to refuse coverage, others were dismissed outright -- so the Hobby Lobby decision will decide whether the "religious expression" of corporations should take precedence over federal law.

"The idea that an individual employer should decide what kind of health care his or her employees need is really offensive," says Susan Berke Fogel, Director of Reproductive Health for the National Health Law Program. "Everyone should be able to make their own health care decisions based on what works best for them. That's the larger implication here: what does it mean for each of us to live our lives in the most healthful, productive way that we choose?"