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The narrow 5-4 Supreme Court decision of Burwell v. Hobby Lobby is a significant event. Five Supreme Court justices (in an opinion written by Justice Samuel Alito) sided with closely held corporations (a corporation where five or fewer shareholders own at least 50 percent of the company). The ruling gave them the legal right to opt out of the Patient Protection and Affordable Care Act's mandate to provide coverage for birth control assistance to employees on the basis of religious objection.
This is a significant decision as it is the first time that the high court has provided this right to nonreligious for profit entities. Up until this point, religious affiliated organizations or churches were exempt from providing care that violated religious values and beliefs; small employers with less than 50 employees were exempt from providing healthcare insurance at all.
Why is this decision so important? As emphasized by the minority opinion written by Justice Ruth Bader Ginsburg, there are thousands of closely held corporations in the United States: In-N-Out Burger and Forever 21 that could opt out of many laws for religious objections and the Supreme Court offers no guidance as to the limits covered.
In addition, there is an access issue for millions of women who rely on healthcare coverage to pay the average cost of $45 for emergency contraception (which 20 percent of pharmacies do not offer according to the New York Times) or of $1,000 for an IUD. This is contrary to the Institute of Medicine report last year that supported the Affordable Care Act's mandate for preventative healthcare services including "a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes."
Interestingly, the Supreme Court decision is contrary to a majority opinion, according to a Kaiser Foundation. Many felt that "employers should be required to cover birth control regardless of whether it violates the owners' religious beliefs."
Obviously, advocates for religious freedom laud the decision while members of the Obama administration vow to pass legislation to work around the exemption so that employees may receive healthcare coverage for comprehensive preventive health services.
What fundamental healthcare issues does this important case bring out?
Burwell v. Hobby Lobby pits employers with sincere religious beliefs against employees who require preventive birth control healthcare services, and this is both unnecessary and inappropriate as an individual's religious values should be both personal and private. This case highlights the necessity to provide fundamental preventive and palliative services to all citizens so that neither employers nor employees are placed in a position to place personal values over the healthcare needs and personal beliefs of others.
Jonathan H. Burroughs, M.D., is a certified physician executive and a fellow of the American College of Physician Executives and the American College of Healthcare Executives. He also is president and CEO of The Burroughs Healthcare Consulting Network.
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