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Questions for Paul Ryan, Mitt Romney and Other Opponents of Health Care Reform: Where Are Your Facts?

12:09 pm in Uncategorized by RH Reality Check

Written by Amanda Marcotte for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Paul Ryan (United States Congress / Wikimedia Commons)

The Supreme Court ruling on the Affordable Care Act (ACA) on Thursday has caused a rush of panic from the opponents of universal health care. Lots and lots of claims about what the law does are being tossed around, and many of these claims are what you might call puzzling to those of us who actually know what’s in the ACA. Now, I don’t want to accuse anyone of intentionally lying without gathering more evidence, but without a deeper understanding of what various conservatives mean by their claims, it’s hard to suppress the sense that they may perhaps just be lying. So, I’ve made a list of questions I want opponents of health care reform to answer so I can better understand how their seemingly outrageous claims about the ACA make sense outside of the most obvious “lying” angle.

How does one “go on” Obamacare? Paul Ryan, denouncing the bill: “Millions of people who are otherwise going to go on Medicaid, are now going to go on Obamacare which costs a whole lot more money.” What is this “Obamacare” that people can go onto? I looked around to see if I could get an insurance plan through the “Obamacare” that Ryan and other conservatives are talking about Americans going on to and all I can find are the same old private insurance companies that existed before. The way Ryan & Co. talk about “Obamacare,” it sounds an awful lot like they think there’s a public option people can buy if they don’t want private insurance and aren’t eligible for Medicaid. But those of us who recall the big political fight over the ACA can tell you that there was originally a public option in the bill, but it was removed in order to get more votes from conservative Democrats. So what is this “Obamacare” conservatives keep insisting you can buy into and where do I find it?

How does the ACA remove your choice or get between you and your doctor? Various claims are being tossed around about health care reform “getting between you and your doctor” or taking away people’s choices in what medical treatments to pursue. In his remarks after the ACA ruling, Romney repeated this claim by saying the government is getting “more and more intrusive in your life” and “separating you and your doctor.”

So my question is: How? What medical decisions will the government now be making for you under the ACA? (Obviously, under conservative-supported legislation, the government has a lot of power to make decisions for women seeking abortion or contraception, but those laws aren’t part of ACA.) If you’re referring to the fact that insurance companies will retain the right to deny coverage for certain procedures they deem unnecessary, well, insurance companies already do that. If anything, the ACA has limited the ability of insurance companies to deny you the ability to pursue medical treatments you and your doctor choose, because the ACA has removed spending limits and banned insurance companies from denying you coverage based on pre-existing conditions.

Read the rest of this entry →

On Contraceptive Coverage, It’s Not Up to Obama to Decide What is More “Catholic”

11:51 am in Uncategorized by RH Reality Check

Benedict XVI (Photo: catholicism, flickr)

Benedict XVI (Photo: catholicism, flickr)

Written by Frances Kissling for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See all our coverage of the Birth Control Mandate 2011 here.

This article was amended at 2:22 pm Friday, November 25th to add a missing paragraph and missing words in three sentences.

When it comes to contraception Catholics have stopped listening to popes, bishops and other institutional leaders.  It seems the only person left listening is President Obama. Obama however lacks the theological training –and it would seem the scholarly advice –needed to figuring out if the bishops and various hospitals, universities and social service agencies clamoring for a “religious exemption” from new federal regulations really need them in order to be good Catholics. The regulations require insurance plans offered by employers to cover contraception without a co-pay, although they exempt churches and other specifically religious institutions from the requirement.

The President seems unaware of the fact that Catholic disagreement with the ban on birth control goes far beyond the average Catholic lay-person. Some bishops, many priests, religious orders, theologians and church-related groups have publicly and privately disagreed with blanket prohibition of contraception. All of them, individuals and institutions, are free to follow their conscience on contraception and there is ample evidence that many of the very groups asking for an exemption from the new federal regulations have not followed church regulations religiously. Some within the organizations may agree with the ban, but not all, and none are required to do so.

Of course, it would take courage for organizations such as the Catholic Health Association (which is now siding with the Bishops publicly in their fight to broaden exemptions) or Catholic Charities to publicly buck the U.S. bishops and just follow the law and give their employees health insurance that makes it possible to avoid pregnancies they cannot afford or do not want; but after all, being a Catholic is all about courage and helping the poor and marginalized. A fair number of employees of Catholic institutions are low-income workers, struggling to get by on a minimum wage. We Catholics are taught to follow our conscience rather than the positions of the Catholic church, even if it means getting kicked out of the church.  If Obama’s current religious advisors don’t know that, all he has to do is call one of the most trusted of Catholic theologians, Fr. Richard McBrien of  Notre Dame. McBrien will repeat what he has said in his widely used text Catholicism:

If, after appropriate study, reflection and prayer, a person is convinced that his or her conscience is correct, in spite of a conflict with the moral teachings of the church, they not only may but must follow the dictates of their conscience rather than the teachings of the church.”

Centuries earlier Thomas Aquinas said the same thing.  Yet, the Catholic-affiliated institutions asking for a religious exemption insist that corporations, like persons have a conscience. Read the rest of this entry →

Did God Tell Congress to Wage War on Women?

1:35 pm in Uncategorized by RH Reality Check

Written by Ellen Shafer for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See all our coverage of the Birth Control Mandate 2011 here

 

God has apparently signed off on the war on women.

Thanks to at least one member of Congress for setting us straight on that.

“It is not our job as Catholics to tell God what he should do. It is our job to learn and follow his teachings. Conscience is not convenience. We must enforce the laws of God.”

This was Rep. Tim Murphy (R-PA), who, having ascertained that the supreme deity is male, explained why Congress should deprive employees of Catholic schools, hospitals, and charities of the right to purchase affordable birth control, regardless of the employees’ own beliefs or practices. His statements were made at a hearing of the Health Subcommittee of the House Committee on Energy and Commerce on Wednesday, November 2, 2011.

Republicans in Congress are truly on the warpath against women’s rights, and in many cases against reason.

Just a few points here about women and contraception. For starters, while it usually takes two to conceive a child, only women get pregnant. The right and ability to make independent decisions about whether and when to become a parent are fundamental to every other aspect of a woman’s life: whether society recognizes women as autonomous, independent, responsible, and competent; and whether women themselves experience the same opportunities as men to acquire education and employment, and to construct a meaningful life based on loving relationships.

Cost is a barrier to purchasing birth control for lower-income women. More effective forms like new, safe intrauterine devices (IUDs) cost more than a year’s supply of birth control pills or devices like diaphragms which are cheaper overall but also are less reliable. The rate of unintended pregnancies is soaring among low-income women, and at 132 per thousand women ages 15 to 44 is five times higher than the rate for higher income women (those over 200 percent of poverty). Low income women are more likely to have unplanned births. The costs of contraception are minute compared to the costs of pregnancy and delivery, in dollars as well as in human health.

The new health reform law, the Affordable Care Act (ACA), calls for covering preventive health care services without requiring co-payments, effective in 2010. Co-payments are fees individuals must pay when they go for care, in addition to their premiums, and are intended to discourage health care visits. The problem is that they discourage people from getting care they need, particularly low-income people. Preventive health care services like flu shots can protect health by avoiding illnesses entirely or catching them early, and also save money. The ACA eliminated these co-payments for prevention.

Except in the case of contraception.

In 1968, despite the recommendation of the majority of Catholic bishops, the Pope adopted the minority recommendation to declare that using birth control was inconsistent with the Church’s beliefs. Nevertheless, U.S. Catholics continue to use birth control at the same rate as other Americans.  Virtually all heterosexually active couples of child-bearing age in the United States use birth control.  Still, the U.S. Conference of Catholic Bishops (USCCB) has grown increasingly insistent on enforcing the birth control ban.

As of August, 2011, after a year of studying whether or not contraception is a preventive health care service, and therefore should be covered without co-payments and deductibles, the federal Department of Health and Human Services (HHS) arrived at an answer: Yes on all counts.

In covering contraception as a preventive service without co-payments, HHS granted an exception for actual churches who provide health insurance to their employees, but required all other religiously-sponsored institutions such as hospitals that offer health benefits to follow the rule.

Catholic organizations have gone to court in the past to avoid state rules that require including coverage for birth control in the health care plans they provide for employees, and failed every time. The Church sponsors large organizations that include health care providers, universities and social service agencies, as well as churches. They employ millions of Americans, many of whom are not Catholic. Their work generates the funds their employers use to pay for health insurance. Most economists assert that the costs of employee health benefits are reflected in lower pay; that is, employers calculate benefits as a form of compensation, and many reduce wages accordingly. In effect, the money that pays for health insurance is really money that employees generate, and belongs to them.

This evidence is not good enough for the USCCB and the extremist Republicans running Congress. While dire economic threats face many Americans, Rep. Joe Pitts (R-PA), decided to change the subject. He called a hearing entitled “Do New Health Law Mandates Threaten Conscience Rights and Access to Care?”

Now let’s be very clear here. The Republicans and the Bishops are claiming that institutions have a conscience. Not a policy. A conscience.

Here is Joe Pitts’ description of his concern:

“Many entities feel that it [the proposed policy] is inadequate and violates their conscience rights by forcing them to provide coverage for services for which they have a moral or ethical objection. The religious employer exemption allowed under the preventive services rule — at the discretion of the HRSA [Health Resources Services Agency] — is very narrow.

“And the definition offers no conscience protection to individuals, schools, hospitals, or charities that hire or serve people of all faiths in their communities. It is ironic that the proponents of the health care law talked about the need to expand access to services but the administration issues rules that could force providers to stop seeing patients because to do so could violate the core tenants of their religion.”

In fact, there is no involvement of any individual employer in this matter, or any issue of an individual’s conscience except that of employees deciding to purchase and use contraceptives. The rule requires employers’ health plans to cover contraception without any additional co-payment. There are three parties involved here: employers, employees, and health plans. No provider or caregiver is involved, nor is any patient, student, or recipient of charity. At the most extreme, every Catholic institution could claim it will close their doors absent this exclusion. So far no such institution has done so where state requirements are in effect, and when Rep. Jan Schakowsky asked representatives of Catholic institutions at the hearing if they would close, they affirmed that they would not.

Rep. Gingrey (R-GA), opined: “Imposing the dictates of the state on the will of employers sounds un-American to me.”

And another gem: “Should we force religious employers to violate their consciences? To recognize same-sex marriage? Will we ethically neuter health care professionals?”

To a person, articulate Democrats on the committee–Henry Waxman (D-CA), Frank Pallone (R_NJ), John Dingell (D_MI), Lois Capps (D_CA), Tammy Baldwin (D_WI), Jan Schakowsky (D-IL), Edolphus Towns (D_NY), Eliot Engel (D-NY)–challenged this tripe.

Tammy Baldwin: “This is a war on women.”

Lois Capps: “An employer is not a person. Your boss’ conscience is not your own.”

Witnesses Jon O’Brien of Catholics for Choice and Dr. Steve Hathaway were articulate and brilliant in defending the truth.

But Rep. Tim Murphy, a psychologist in his fifth term in the House, was on fire:

“Conscience is at the core of Catholic teachings… and it is not left up to individuals to decide, thank goodness. Father Anthony Fisher tells us that …there is an objective standard of moral conduct. Vatican II teaches us that the moral character of actions is determined by objective criteria, not merely by the sincerity of intentions or the goodness of motives. It is not, I repeat, it is not our duty as Catholics to tell God what he should do or what image he should adhere to, or what he should think, but it’s up to us to shape our conscience to conform with the teachings he’s given us.

“Conscience, sir,” Murphy continued, “is not convenience.”

“Conscience is formed through prayer, attention to the sacred and adherence to the teachings of the church, and the authority of Christ’s teachings in the church. So asking a group in a survey whether or not they have ever acted or thought of acting in a certain way that runs counter to the Church’s teachings is no more a moral code than asking people if they ever drove over the speed limit as a foundation for eliminating all traffic laws.

 

“I end with a quote from John Adams, in 1776,” said Murphy, “when he was writing our Declaration of Independence of the United States: ‘It is the duty of all men in society, publicly and at stated seasons, to worship the creator and preserver of the universe, and no subject shall be hurt, molested or constrained from worshipping God in the manner most agreeable to the dictates of his own conscience, or for religious profession or sentiments, provided he does not disturb the public peace or obstruct others in their religious worship.’ The foundation of our nation is not to impose laws that restrict a person’s ability to practice their faith, sir.”

Well, actually, Tim: Exactly.

To do something about it click here: http://action.prochoiceamerica.org/site/Advocacy?pagename=homepage&id=5059&s_src=2011_adv_bc4me_whitehouse_web

and here: http://emilyslist.org/20111117_accesspoll/

 

The Other 99 Percent: Will Obama Betray Them?

12:56 pm in Uncategorized by RH Reality Check

the pill #1 (Photo: mr_b, flickr)

the pill #1 (Photo: mr_b, flickr)

Written by Carole Joffe for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See all our coverage of the Birth Control Mandate 2011 here.

There is another 99 percent group in our country, distinct from but inextricably entwined with the now more familiar #99Percent, those everyday Americans, who–in such a brilliant framing by the Occupy Wall Street movement–are to varying degrees affected by the vast economic inequality that characterizes American society. I refer to the 99 percent of American women who have ever had sexual intercourse and have used a birth control method at least some of the time.

Contraception obviously is a deeply held value by American women. But the fact that in the United States a startling half of all pregnancies are unintended makes clear that birth control is used only sporadically by some. There are a number of reasons why this is so, but a chief one is that so many women cannot afford contraception, especially the most expensive—and most effective–methods, such as birth control pills, and long lasting reversible contraception, for example, the newer (and far safer) models of IUDs (intrauterine devices).  In short, the same economic disparities that pervade every other area of American life manifest here as well: poor women depend on publicly-funded programs for their contraceptive services, but, according to the Guttmacher Institute, only a little more than half of the 17 million women who need these services currently receive them.

This situation of tremendous inadequacy was supposed to improve considerably. In one of the best pieces of news in the otherwise embattled reproductive health world since the battles over health care reform began, the Obama administration announced last August that it would accept the recommendations of a special panel of the Institute of Medicine and include contraception—including all FDA-approved birth control methods—as part of the basic package of preventative health services that health insurance plans must offer, without co-payments. Read the rest of this entry →

Do New Health Law Mandates Threaten Conscience Rights and Access to Care?

1:31 pm in Uncategorized by RH Reality Check

Written by Jon O’Brien for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

This testimony was submitted to the US House of Representatives Committee on Energy and Commerce’s Subcommittee on Health on November 2, 2011. It is written testimony for the hearing record on “Do New Health Law Mandates Threaten Conscience Rights and Access to Care?”

The article was amended at 12:38 p.m., Thursday, November 3rd to correct links in one paragraph.

Mr. Chairman, Ranking Member Pallone and Members of the Subcommittee, thank you for this opportunity to present testimony on behalf of Catholics for Choice on this important question of conscience rights and access to comprehensive healthcare.

For nearly 40 years, Catholics for Choice has served as a voice for Catholics who believe that the Catholic tradition supports a woman’s moral and legal right to follow her conscience on matters of sexuality and reproductive health. Throughout the world, we strive to be an expression of Catholicism as it is lived by ordinary people. We are part of the great majority of the faithful in the Catholic church who disagrees with the dictates of the Vatican on matters related to sex, marriage, family life and motherhood. We represent those who believe that Catholic teachings on conscience mean that every individual must follow his or her own conscience — and respect others’ right to do the same.

Certainly, at Catholics for Choice, we are no strangers to the intersection of religion, sex and politics. While religious voices and traditions are a vital part of public discourse, religious views should not be given disproportionate weight in public policy discussions. When this happens the lives of men and women can suffer greatly. We believe in a world where all voices, the voices of the religious and of the secular, of Catholics and non-Catholics alike, are heard in public policy discussions.

This hearing seeks to answer the question: Do new health law mandates threaten conscience rights and access to care? I firmly believe the requirements under the Affordable Care Act, and the slate of regulations being created to implement it, infringe on no one’s conscience, demand no one change her or his religious beliefs, discriminate against no man or woman, put no additional economic burden on the poor, interfere with no one’s medical decisions, compromise no one’s health — that is, if you consider the law without refusal clauses. When the question is asked in light of these unbalanced and ever-expanding clauses, the answer becomes yes, it would do all these things. When burdened by such refusal clauses, the new health law absolutely threatens the conscience rights of every patient seeking care for these restricted services and of every provider who wishes to provide comprehensive care to their patients. These restrictions go far beyond their intent of protecting conscience rights for all by eliminating access to essential healthcare for many, if not most patients, especially in the area of reproductive healthcare services. This will make it harder for many working Americans to get the healthcare they need at a cost they can afford.

The Affordable Care Act has many positive elements to it. Millions will now be able to access insurance coverage for their health needs and, with the basic level of coverage required under the new law, these newly insured and the millions of those better insured will now have greater access to a wider range of services than ever before. However, the law includes a refusal clause which has been expanded in the past decades to threaten the consciences of both those who seek to receive and those who want to provide services. Advocates of these expansive refusal clauses claim these are necessary to protect conscience rights. Others believe that refusal clauses such as these are simply part of attempts to derail the Affordable Care Act and to curb access to reproductive healthcare services entirely. Moreover, proposals to expand existing refusal clauses increase threats to the conscience rights of patients and providers by including not just abortion but also family planning services and, should some get their way, any other service deemed “unacceptable” by a tiny minority.

In recent years, under the guise of protecting religious freedom and “conscience rights” we have seen a dramatic upswing in attempts to expand the scope of refusal clauses, their application, and the entities able to utilize them. These new, ever-broader refusal clauses do far more than allow those healthcare professionals or social service providers with conscience objections to opt out. Instead, they are effectively being used as a means to refuse some treatments, medications, benefits and services to all comers.

These expansions have increased not only the services that may be refused—including reproductive health services as well as insurance coverage for those services and even training for medical professionals—but they have also the number of those who may claim these protections. Almost everyone, including most Catholics, agrees that it is reasonable to allow healthcare professionals, including doctors, nurses and pharmacists, to opt out of providing essential reproductive healthcare services and medications to which they conscientiously object. There is no doubt that there are times when the conscience of an individual doctor, nurse or pharmacist may conflict with the wishes orneeds of a patient. This often happens in cases related to abortion. Except in emergency situations, it is reasonable and indeed prudent to allow those who are opposed to abortion to opt out of providing the service. In these situations, women seeking these services should not have to worry about the religious and moral beliefs of their healthcare providers interfering with the provision of the best possible care. Therefore, it is in the best interests of all that only medical professionals committed to providing such services do so. Women need support and compassionate care when they access reproductive healthcare services, not judgment and disdain.

When this is not possible, a reasonable ethical fallback is for the institution to guarantee timely referrals to ensure that patients receive continuity of care without facing an undue burden, such as traveling long distances or encountering additional barriers to obtaining the desired services. Moreover, good practice should also compel a religious institution to make sure that the consciences of both the healthcare (or social services) provider and the patient (or client) are accommodated by having policies in place that enable individuals to receive whatever medications they are prescribed, procedures they require or services they seek.

Like many Catholics, I accept that conscience has a role to play in providing healthcare services, but recent moves to expand conscience protections beyond the simple right for individual healthcare providers to refuse to provide services to which they personally object go too far. Increasingly, demands and regulatory proposals attempt to grant that option to an institution or any individual along the spectrum of care, funding and coverage. It is incredible to suggest that a hospital or an insurance plan has a conscience. Granting institutions, or entities like these, legal protection for the rights of conscience that properly belongs to individuals is an affront to our ideals of conscience and religious freedom.

Allowing religious institutions to dictate the medical care available to their employees or religiouslyaffiliated organizations to dictate what services their beneficiaries are allowed to access would encroach on the individual consciences of those seeking care and assistance. Refusal clauses such as these fly in the face of true religious freedom by promoting the interests of certain elements of particular religions over the consciences and beliefs of individuals. They ignore the moral agency of the many who do not share the beliefs of a particular religious ideology. If allowed to stand, these refusal clauses do nothing but endanger many women’s access to the healthcare they need. When codified into law at the federal or state level, these “protections” actually constitute state-sponsored discrimination against women based on where they are employed, where and how they buy health insurance and where they seek to receive care.

Today, the 98 percent of sexually active Catholic women in the US who have used a form of contraception banned by the Vatican have exercised their religious freedom and followed their consciences in making the decision to use contraception. Thus, they are in line with the totality of Catholic teachings, if not with the views of the hierarchy. The problem is very clearly with the Catholic hierarchy and not the Catholic church, which includes the vast majority of the 68 million Catholics in the United States who use and support the availability of comprehensive reproductive healthcare services for all those who choose to utilize them.

Having failed to convince Catholics in the pews, the United States Conference of Catholic Bishops (USCCB) and other conservative Catholic organizations are now attempting to impose their personal beliefs on all people by seeking special protection for their “conscience rights.“ They claim to represent all Catholics when, in truth, theirs is the minority view. The bishops have identified several sympathetic high-profile allies in healthcare, education and social service provision to assist them in promoting their demands, but these allies are heavily reliant on the bishops for funding and prestige. Hospitals and colleges can lose their Catholic designation at the bishop’s whim, as happened recently in Phoenix, Arizona.

At a Catholic hospital in Phoenix, medical professionals acted to save the life of a pregnant woman by performing a life-saving abortion on a mother of four. The local bishop decided that his authority over the hospital allowed him to second-guess the medical decisions they made and he stripped the hospital of its Catholic designation. This is antithetical to the Catholic social justice tradition, which would not leave a woman’s life out of any healthcare equation.

What occurred in Phoenix helps to illustrate the problem with the bishops’ intrusion into medical decisions. The personal and professional freedom to make healthcare decisions is being threatened by expansive refusal clauses. The exemptions that the USCCB and other conservative Catholic organizations are demanding do not offer any more protection for religious freedom, but rather impede the religious freedom of millions of Americans, taking reproductive healthcare options away from everybody.

The USCCB and some Catholic organizations, many that receive taxpayer money, are asking to be allowed to:

  • deny condoms as part of HIV outreach;
  • ban employees and their dependents from getting the benefit of no-cost contraceptive coverage that other insured Americans enjoy;
  • opt out of providing emergency contraception to victims of sexual violence who come to Catholic hospitals for help; and
  • deny abortion care to everybody — even those women whose lives are threatened by their pregnancy.

They claim that they are representing all Catholics, but this is not true. The majority of Catholics support equal access to contraceptive services and oppose policies that impede upon that access. 

Two-thirds of Catholics (65 percent) believe that clinics and hospitals that take taxpayer money should not be allowed to refuse to provide procedures or medications based on religious beliefs. A similar number, 63 percent, also believes that health insurance, whether private or government-run, should cover contraception. A strong majority (78 percent) of Catholic women prefer that their hospital offer emergency contraception for rape victims, while more than half (55 percent) want their hospital to provide it in broader circumstances. This support for the full range of contraceptive services is unsurprising, as restrictions such as refusal clauses or prohibitive costs affect Catholics just as often as non-Catholics — 98 percent of sexually active Catholic women have used a modern method of birth control,mirroring the rate of the population at large (99 percent).

Advocating for expansive refusal clauses in healthcare delivery regulations would affect all patients — whether those patients are Catholic or not. Seeking exemptions for religious organizations to cover essential health benefits, such as full coverage of recommended preventive services including contraception, under the Affordable Care Act will only serve to endanger many women’s access to the healthcare they need — whether those employees share those religious beliefs or not. In reality, these exemptions would deny the right of everyone seeking comprehensive healthcare.

When religious voices are allowed to direct policymaking, the best interests of those seeking healthcare services can be ignored. This is clear in the case of the Catholic healthcare industry which, despite providing much valuable service, persists in refusing to provide a full range of reproductive healthcare services, even to those who are in desperate need of them.

Respect for individual conscience is at the core of Catholic teaching. Catholicism also requires deference to the conscience of others in making one’s own decisions. Our faith compels us to listen to our own consciences in matters of moral decision-making and to respect the rights of others to do the same. Our intellectual tradition emphasizes that conscience can be guided, but not forced, in any direction. This deference for the primacy of conscience extends to all men and women and to their personal decisions about moral issues.

Our faith also compels us to respect religious pluralism and religious freedom. Religious freedom is an expansive rather than restrictive idea. It has two sides: freedom of religion and freedom from religion. It is not about telling people what they can and cannot believe or practice, but rather about respecting an individual’s right to follow his or her own conscience in religious beliefs and practices, as well as in moral decision making. The protections we put in place to preserve religious freedom do not permit religious institutions or individuals to obstruct or coerce the exercise of another’s conscience.

Sweeping refusal clauses and exemptions allow a few to dictate what services many others may access. They disrespect the individual capacities of women to act upon their individual conscience-based decision. They impede the rights of women and men to make their own decisions about what is best for their own health, and that of their families, as well as restricting their right to act upon those decisions without undue and unjust burdens.

One woman who saw these burdens placed on her conscience rights is “Sandra,” a science teacher at a Catholic school in the Midwest. Her story is an example of the many Americans who fall under these types of expansive refusal clauses being pushed by the bishops and their allied organizations. What is a reality for Sandra today is what many women can look forward to in their future.

As with almost all Catholic schools, Sandra’s employers follow diocesan rules regarding employees’ insurance — meaning no contraceptive coverage, regardless of medical necessity. When she first learned of the refusal clause proposed in the recent regulation to implement the preventive health services under the Affordable Care Act, she was outraged. As she explained to us, they added “insult to injury” by ignoring the healthcare needs of women like her and allowing her employers to continue to deny her coverage.

“I just never assumed that in 2011 I would be denied birth control,” she said. “I’m in my mid-twenties. I have no intention of having kids at the moment. I like teaching kids, but it’s a whole other thing having them.”

Sandra lost coverage when she began working under the jurisdiction of her local diocese. “I went to fill my birth control prescription like I always do. I say ‘Here’s my new insurance card,’ and they say I’m not covered,” she related. “They thought that it was weird and asked where I worked. As soon as I said I worked in a Catholic school, they said, ‘Oh, 99 percent of Catholic schools will not cover it. We’ve never had it covered before.’ I had no clue.”

For Sandra, this posed a significant hardship. She had taken a salary reduction in order “to go to work every day saying that it’s what I love.” She and her husband had carefully considered their insurance plans and determined that it was more economical for them to remain on separate policies, but once she had to pay out of pocket for the birth control that was best for her, a non-generic prescription, their careful financial planning was all for naught.

“Birth control is a lot of extra money on top of the salary reduction, but the principle of it is really what gets me,” she told us. “I don’t like being told by some guy that I’ve never met that I can’t use it. The bishops are not even having sex in the first place. How are they supposed to know how to tell me what to do in that situation?”

Her story, as she recognized, is all too common and reflects the repeated marginalization of many women by the Catholic hierarchy—the same women whose voices have been deemed unimportant by those on both sides of the recent debates. Sandra is just one of the many individuals whose conscience is not being protected by refusal clauses exempting entire institutions from covering their employees for services guaranteed to everyone else by the new law.

Catholic teachings on conscience require due deference to the conscience of others in making decisions — that the employer should not be allowed to dismiss the conscience of the employee seeking coverage for the healthcare services guaranteed to any other. In light of this precept, the public policy efforts of the hierarchy should take into account the experiences of individual Catholics as well as the beliefs of patients and clients, workers in social services and healthcare providers of other faiths and no faith, so that patients will not be refused any legal and medically appropriate treatment or be denied services they seek.

You have heard from some conservative Catholics on this issue, but it would be a grave mistake to confuse the individual positions of a few powerful interest groups with the majority view of the more than 68 million Catholics in the United States. For Catholic employers to claim to be the arbiter of any person’s good conscience is clearly disingenuous. When medical professionals refuse to provide legal reproductive health services, or provide timely referrals to other providers, they violate the right to conscience of the person seeking those services. This does not fall under anybody’s definition of a good conscience. Catholics for Choice and the majority of Catholics respect everybody’s individual conscience and their ability to act in accordance with their personal beliefs. However, we expect the hierarchy and their allied organizations, in keeping with the teachings of our shared Catholic faith and our American tradition, to respect our consciences and the consciences of the patients and clients who seek the services they need. We hope that those who serve to represent all of us in public service and in government will respect our consciences, too.

Protecting the freedom of conscience for all Americans no matter what their beliefs may be — for the atheist, for the employee of a Catholic institution, for the sexual assault victim who seeks care at a Catholic hospital — is indeed the job of the government. Expanding individual refusal clauses to include institutions and exemptions for religious institutions to deny the rights of all would sacrifice these people’s rights. Public policy should be implemented to further the common good and to enable people to exercise their conscience-based healthcare decisions.

Lawmakers of all political hues can come together to support a balanced approach to individual conscience rights and access to comprehensive healthcare. It makes sense for all those who want to provide more options to women seeking to decide when and whether to have a child. It makes sense for those who want to keep the government’s involvement in healthcare to a minimum. And it makes sense for those who think that it is the government’s role to facilitate the healthcare decisions that people want to make. Above all, it makes sense for a society that believes in freedom of religion — a right one can’t claim for oneself without extending it to one’s neighbor. The bottom line is that protecting conscience rights and preserving access to care shouldn’t just be about protecting those who seek to dictate what care is and is not available to all. Nor should it be for those who would dismiss the conscience of others by imposing their view of which consciences are worth protecting.

Protecting individual conscience and ensuring access to affordable, quality care is not just an ideal, it is a basic tenet of our society and it is the right thing to do. I thank the Subcommittee for inviting me today and for your attention. I look forward to any questions Members may have.