I would love to see most private businesses get out of the health care coverage business, which is why I supported a bipartisan bill during the 2009 health care reform debate that would have decoupled health insurance from employment. That Senate bill went nowhere fast, primarily because it would have disrupted the entire system in a way the Affordable Care Act hasn’t come close to doing.
Decoupling the two would give businesses and individuals more freedom and flexibility, something I think we all want. That would allow those wanting more religious exemptions for businesses to have their way without infringing upon the rights of individual workers. But it would also mean even more government involvement in health care, which is something many balk at – except when it comes to the highly-popular Medicare program. Besides that, the merger of private business and health insurance was an accident of history, not something well planned.
Today’s Supreme Court ruling underscores the need for even more reform.
Here’s the take of one health care writer:
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Health care is full of decisions that raise complicated ethical questions on which, inevitably, religious beliefs can dictate certain views. It’s not just whether to use certain forms of contraception. It’s also whether to use stem cell therapy, how to treat the end of life, and whether to take blood transfusions. The question is not whether the owners of closely owned corporation have a right to their religious views. Of course they do. The question is whether those views should affect the provision of a public program, enacted in part to promote public health as defined by public health professionals. (Alito, in his opinion, said the ruling would not apply to those other services. Ian Millhiser makes a good case for why that's not true.)
It’s worth remembering that, strictly speaking, the Obamacare mandate doesn’t “force” employers to pay directly for coverage of contraception or any other medical service. The law simply requires that employers bear the burden of medical expenses, broadly defined. They can do so by paying a fee to the government or, if they choose, they can decide to provide insurance on their own. The only caveat is that, if they decide they want to provide insurance, the policies must conform to certain regulations—among them, coverage of so-called essential benefits. And the federal government, relying on the (very sound) judgment of public health professionals, has decided that contraception belongs on the list.