This week marks the fourth Anniversary of the Affordable Care Act. Like much of the rest of the country, I have been enthralled, and often deeply worried, as I’ve watched it take form and gather speed. I’ve been more focused on it than most, perhaps, since I am a physician and serve an underserved, under-insured Hispanic community.
It is hard to understand why the administration would risk alienating so many people, just to provide something that was already cheap and plentiful like birth control.
For years I have found ways to help people get the care they need while uninsured. I have told people I care about, who are deeply worried about a loved one, that we can take care of this at home, I can visit them and bring the medicine they need, we can manage just fine without the hospital. Because a crushing hospital bill is something to be avoided at all costs.
The ACA was formulated expressly for the purpose of relieving people like that, a laudable goal. Four years later, though, we find out from the Congressional Budget Office that most of those people who were uninsured before the law was passed will remain without insurance. But the bad news does not stop there, and seemingly every day we learn of another damaging, unintended consequence of the law, like its perverse disincentives to work and advancement.
This week will also find one of the intended consequences of Obamacare before the Supreme Court: the contraceptive and abortifacient mandate. This mandate makes certain drugs that cause early, or chemical, abortion, like PlanB, “free” without a co-pay in every single plan. Employers must purchase these insurance plans for their employees, even though it will make them effectually complicit in an act some find morally repugnant. Like many of the law's requirements, this one has created virulent opposition and division. Unlike many of the mandates, it has not been eased, delayed or repealed by the administration.
From a physician’s perspective, this is pure madness. Never, not once, have I heard from my patients that they are having trouble finding or paying for birth control. My patients are not law school students looking forward to lucrative jobs like Sandra Fluke, or soccer moms who drive Range Rovers and find that two children is all they can juggle. They are people working hard at the lower rungs, many of them illegal and in constant risk of deportation. They know that birth control is cheap and even free, if you take the time to find one of the lavishly funded Planned Parenthood offices that mysteriously are always located in neighborhoods like theirs. Oh, and there’s always the calendar!
Yet, the administration has refused to budge on this mandate, no matter who they alienate and no matter how it tramples conscience rights. Catholic schools and charities, groups that wanted to support the ACA, have found themselves suing for the right to serve the public and still be faithful to the teachings of their religion. This week, the Supreme Court will decide whether for-profit companies like family owned Hobby Lobby can expect religious freedom protections. I would like to think that a just reading of our First Amendment rights will prevail.
At first glance, it is hard to understand why the administration would risk alienating so many people, just to provide something that was already cheap and plentiful like birth control. It can’t be women’s health, since any physician will tell you that women are dying of heart disease, diabetes complications, and undetected cancers, not unavoided children. I suppose it’s a cold political calculation, because it fans the flames on the “War on Women” meme. On one side, freedoms of conscience that are the envy of the millions of oppressed peoples of the world, and on the other, a hammer to pound your political opponents with. The administration will continue to cling to the hammer but I hope the highest court in the land will side with freedom. George Washington put it perfectly, when he wrote: “The conscientious scruples of all men should be treated with great delicacy and tenderness.”