It may be months, even years before it’s clear whether access to and payment for contraception will be limited in the wake of the U.S. Supreme Court’s decision that for-profit companies can forego health insurance coverage of birth control methods that violate their religious belief.
At this point, only the two plaintiffs in the case – Hobby Lobby and Conestoga Wood Specialties – can change their health insurance coverage of contraception, based on the June 30 decision by the U.S. Supreme Court.
Courtesy Physicians for Reproductive Health
Dr. Anne Davis
In the meantime, there is a lot of confusion among patients – and uncertainty among doctors -- about what the ruling means.
"We’re all scratching our heads and saying, ‘Now what?’ " said Dr. Anne Davis, medical director of Physicians for Reproductive Health. "All of us are very used to hurdles with coverage, but this is a new one."
Now, ob.gyns and other physicians may have to figure out if a patient works for an employer whose insurance will not cover certain types of contraception, or perhaps all birth control, said Dr. Davis of the department of clinical obstetrics and gynecology at Columbia University, New York.
The Supreme Court ruling is "a huge step backward," said Dr. Eve Espey, chair of obstetrics and gynecology at the University of New Mexico, Albuquerque. For physicians, a key concern is whether they will be paid for inserting an IUD or providing another service; for patients, it’s whether they can get the contraception and if they can afford it, she said.
When concerns mount, "those services tend to not happen," Dr. Espey said.
Ob.gyns. also expressed concern that the ruling had opened the door to interference in the physician-patient relationship.
Clinicians need the freedom to select the birth control method that makes the most sense for the patient, said Dr. Davis. "It’s going to be really unfortunate if you and the patient agree, and it’s the right thing and you find out that her employer has decided it’s not the right kind of birth control because of their beliefs," she said.
Dr. Jeanne Conry, immediate past president of the American Congress of Obstetricians and Gynecologists (ACOG), said that if she has decided that an IUD is best for a 34-year-old diabetic patient, but her employer says it won’t pay for that method, "that’s not in her best interest."
"They’ve just interfered with my best treatment for the patient," said Dr. Conry, an ob.gyn with Kaiser Permanente in Roseville, Calif.
Courtesy ACOG
Dr. Jeanne Conry
Dr. Mitchell Creinin, chair of the obstetrics and gynecology department at University of California, Davis, said that the ruling could return contraception to a means-tested environment, in which only those who have the means will get the most effective methods, like the IUD. Instead, he said, it should be a benefit for all. Preventing pregnancy "is a public health issue and we’ve got to look at it that way," Dr. Creinin said.
Just after the ruling, ACOG President John Jennings agreed, expressing dismay that the Court was overlooking what had been firmly established. "The value of family planning – including contraception – has been clearly demonstrated," he said, in a statement.
But pro-life groups, including Americans United for Life and the Association of Pro-Life Obstetricians and Gynecologists, applauded the Hobby Lobby decision, saying that it helps preserve the right to practice according to conscience.
"Respect for the constitutionally guaranteed rights of conscience – whether held by business owners or medical professionals – must and should be protected," said Dr. Monique Chireau, AUL board member, with the department of ob.gyn at Duke University, Durham, N.C.
Dr. Gene Rudd, senior vice president for the Christian Medical and Dental Associations (CMDA), said that he did not think the decision would have any direct impact on ob.gyns.’ practices. However, he said, "Had the Justices allowed the government to force business owners to act against their conscience, that could establish a legal precedent by which the government might one day force physicians to act against their consciences."
The CMDA’s membership view the ACA’s mandate that women receive contraceptives free of charge as a potential infringement on their right to practice according to their beliefs, said Dr. Rudd, an ob.gyn.
In a CMDA survey, "95% of our members said they’d leave medicine before being required to violate their conscience," he said. They want "women free to pursue getting the contraceptive of their choice," but not to force either individual physicians or religiously affiliated organizations or small private employers to do things that are against their beliefs.