In the US, there are two ways most of us get health insurance: through Medicaid (53 million enrollees) or Medicare (nearly 45 million), or through an employer (148 million).

That’s 44% of us relying on health insurance through our jobs, and the federal government has regulated this area for a long time, including mandating the inclusion of certain types of care. Nixon signed the Health Maintenance Organization Law of 1973, designed to encourage the formation of HMOs to provide medical care and contain costs. HMOs were required to deliver “basic health services” including mental health (maximum of 20 visits), medical treatment and referral for alcohol and drug abuse or addiction, home health services, and preventive services (vision care and preventive dental care for children, and family planning services). Other providers of health care for employees

Another 16% of the population receives health care through Medicaid, which is paid for jointly by the federal government and each state. States design their plans but must obey federal rules, which since 1972 have required that states include “family planning and supplies furnished (directly or under arrangements with others) to individuals of child-bearing age (including minors who can be considered to be sexually active)” to Medicaid eligible individuals. Though Medicaid coverage of prescription drugs is generally an option for states, contraceptives are specifically included under the mandate and therefore are required for all state programs. [This information is from a joint report by the Kaiser Foundation and the Guttmacher Institute; at the end of the post there appears an excerpt which summarizes why family planning was mandated.]

So, there is nothing new about the federal government requiring health care organizations such as HMOs to offer contraception, and every person or business paying state or federal taxes is supporting contraception dispensed by Medicaid.

What’s new is the government requiring that employers offer health care, and that the health care include contraception. Previously, we must suppose, religious organizations opposed to contraception have chosen health care plans that don’t cover it. Now, for good public health reasons (see the report excerpt at the end), that loophole is being closed.

Obama’s response to criticism of this requirement—criticism marked by hyperbole, e.g. calling it a “war on religion”, and a violation of freedom of religion—has been to say that the services must be offered, but no religious organization has to pay for contraceptive services: the insurance company must absorb the cost itself. Catholic bishops still object, and say they will take the issue to court, partly because some religious organizations are self-insured; no insurance company is involved. But as we have seen, if the churches are paying any taxes (sales tax, property tax on buildings they own and rent out, etc.) they’re already paying for Medicaid’s family planning, from counselling to IUDs and pills. If their court case succeeds, will they then file to be exempted from taxes that support Medicaid?

If Obama’s accommodation is the right solution, then surely we should exempt the Christian Science church from paying for health care insurance at all! And following this precedent, the rest of us should demand the same sort of line item veto for our income tax so we can opt out of paying for this or that war, for the agencies enforcing laws about civil rights and equal employment, for the next bank bailout, for federal aid to schools that teach sex education or evolution, for whatever we don’t personally like or need. The Tea Partyers will love this!

Below is the excerpt from the Kaiser Foundation/Guttmacher Institute report, Medicaid’s Role in Family Planning (2007).