Running The Omnibus Off The Cliff

Even by Congressional standards, the Omnibus legislation passed by Congress last week was massive.  The Consolidated Appropriations Act of 2021 is 5593 pages.  It includes the long-awaited COVID relief, the continued funding of the federal government, and the other spending priorities of both our Congress and our President.

Some of our friends on social media are learning about Omnibus legislation for the first time.  Their shocked ignorance is being fueled by people who know better but are enjoying the opportunity to take advantage of the newly “aware”.  For those who need a concise definition, this is from

Omnibus: [Latin, For all; containing two or more independent matters.] A term frequently used in reference to a legislative bill comprised of two or more general subjects that is designed to compel    the executive to approve provisions that he or she would otherwise reject but that he or she signs into law to prevent the defeat of the entire bill.

Major spending bills are passed on a bipartisan basis.  Spending priorities are not a Democrat vs. Republican issue.  There are regional concerns, geopolitical considerations, and a host of interests who have found a way to be heard.  Well-crafted legislation is remembered by each legislator for the victories scored.  Those same legislators ignore or forget where they have given ground.

I couldn’t wait to read the bill.  OK, not all of the bill.  I have a life.  My interests lie in Pages 4096 to 4463, “The No Surprises Act”.  I knew this was going to be good when a Senator, someone who had absolutely nothing to do with the drafting of this legislation, sent me an email.  His alert was filled with weasel words that made it look like he was responsible for the legislation.  He wrote that he was continuing “to work to ensure that health care opportunities are available to all Ohioans”.  Everyone was taking credit.

So how good is the legislation?  Pretty darn good.  The key element is that the patient is no longer a direct victim of Surprise Billing.  The insurance companies will deal with the non-network providers and hedge funds.  Protection for both Emergency and non-Emergency Care is included.  Even Air Ambulances are included in The No Surprises Act.  There is some haziness on the definition of Informed Consent, which must be addressed during the rulemaking.  All in all, this legislation could be an important benefit for the health care consumer.

It may also be irrelevant.

The Consolidated Appropriations Act of 2021 is in limbo.  Donald Trump has announced that he won’t sign it.  The stated reason is neither real nor relevant.   At this moment you may reduce his constant tweets and his bizarre video to “I didn’t really lose and I want more attention”.  As of right now, Sunday afternoon, he hasn’t signed the bill and he hasn’t vetoed it.  If he signs the bill, millions of Americans get COVID relief, our government is funded, and we’ve gone a long way towards ending Surprise Billing.  If he vetoes the bill, Congress has the opportunity to override his veto or face the voters if they fail.  But there is another option, a Pocket Veto.

From the US Senate website:

Pocket Veto – The Constitution grants the president 10 days to review a measure passed by the Congress. If the president has not signed the bill after 10 days, it becomes law without his signature. However, if Congress adjourns during the 10-day period, the bill does not become law

Congress cannot override a Pocket Veto.  If Trump continues this temper tantrum and neither signs nor vetoes the bill, it will be up to the next Congress to start all over.  The COVID relief needed by countless Americans will have to wait.  The funding of our military, our seniors on Social Security, and every other government function will be put on hold until Congress can pass new, emergency legislation.  And that legislation, thrown together by necessity, will have to be redrafted at that time.  The No Surprises Act may appear again someday as a separate piece of legislation or again a part of some larger bill.  It is unlikely that it will be included in the emergency continuing resolution Congress passes to keep the government open while we wait for the next administration.

We will revisit The No Surprises Act when/if it becomes law.  We have more important issues right now, like an Omnibus going over the cliff.


Picture – No Surprises Act – David L Cunix

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Who Is Selling Your Name?

I received a surprising call last week.  A Cleveland Clinic nurse called me to discuss Medicare options for her and her husband.  This was surprising because the Cleveland Clinic provides excellent coverage for its employees.  She told me that she had received a solicitation from an online health insurer that referenced her employer and MyChart.  She was directed to a website and Medicare Advantage products.  What really shocked her was that one of the featured products, one of the ones you see pushed on TV, didn’t include her Cleveland Clinic doctors!  This is what really confused her.  I would have been shocked had I not received the same solicitation, also from the same online seller, noting that they had received my name from University Hospital’s Follow My Health.  I assured her that her best possible action was to tear the solicitation into tiny pieces and throw it away.

We are used to the annual bombardment of advertisements during the Annual Open Enrollment period.  The phone calls.  The emails.  And the endless parade of washed-up athletes pushing high pressure call centers.  I am amazed by the money involved in one minute and even two minute television commercials.  The cost to send unsolicited packets to our homes every week is staggering.   And yes, we have even come to accept the violation of our privacy.  Yet this solicitation, one that appeared to come from our very health care providers, seems to cross every line.

It is not this particular online insurance sales organization.  They are no worse, nor no better, than any other boiler room operation.   They are all selling the same products.  Hell, any of us could sell the same stuff (many of us choose not to).  No, the issue is that our health care provider sold our names and allowed their name to be attached to the solicitation.  Does your doctor really want you to switch to the Medicare Advantage sold by Night Life of Nevada?  Does University Hospital really want you to change your coverage to a policy that sends you to a different hospital?

The nurse was sharp enough to realize that her doctors and her husband’s doctors might not be covered if she chose the wrong plan.  Any agent can tell you stories about clients who came to them after they had been talked into the wrong policy, one that had lots of FREE stuff, but not the access they needed.

It is time to ask “Who is selling my name and information?”  And it is time to stop them.


Picture – My Letter – David L Cunix



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What’s At Stake

Today, November 1, 2020, is the first day of Open Enrollment for individuals and families who are under age 65 and purchase their own health insurance.  Over the last two weeks I’ve sent emails or hand-written notes to my clients about their policy renewals.  I spent today in my office contacting the last several dozen of them.  One by one I review each of my client’s 2021 policy options.  Some have premiums increasing as much as 8%.  Some premiums are actually decreasing.  Most of my clients will see a small bump of 3% – 5%.  More interesting than the numbers are the stories, the people who own those policies and who depend on them to provide access and payment for health care.

I got a call in the last days of Open Enrollment last year from one of my regular readers.  She had a friend who needed me.  Her friend, Linda (name changed for obvious reasons), was in the middle of a health emergency.  She had been diagnosed with a potentially life-ending condition that required immediate attention.  Her medical care was guaranteed to cost at least $100,000, probably more, needed to begin as soon as possible, and she didn’t have any health insurance.  My reader wanted to know if I would help.

Why didn’t Linda have health insurance?  I asked her.  Her answer was that she had been healthy and had better ways to spend the money than on insurance.  Since she didn’t have to have insurance, she didn’t.  We all know lots of Linda’s.  But The Patient Protection and Affordable Care Act (Obamacare) has a true Open Enrollment.  We don’t ask any health questions.  You don’t have to have prior coverage.  Preexisting conditions are covered.  If given a choice, no insurer would take Linda.  They didn’t have a choice.  I got Linda health insurance.

I thought about this as I processed Linda’s renewal.  And that is what is at stake.  Linda got the same access to the world class health care that every other insured greater Clevelander enjoys.  The system would work better if everyone, healthy and unhealthy, participated.  It is difficult to create a health care payment system based on the sick and the responsible.

We need everyone.


Picture – Tools Of The Trade – David L Cunix

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Mitch Could Save Your Access To Health Care

Your Congressman, your insurance agent, and both of the major party candidates for president have something in common.  We all sound as if we are talking about your health.  The subject is a part of the non-stop political commercials flooding the airwaves and cluttering your mail box.  In truth, your health is not the focus.  This is really about money.  We are debating a payment system, how medical providers compensated.  Who pays and how much?  What was once about hospitals and doctors now encompasses hospitals, doctors, pharmaceutical companies, medical testing equipment, therapists, and countless others attached to the business of health.  Every one of them has an army of lobbyists in Washington and every state capitol.  And all of those lobbyists have checkbooks.  That’s not good.  That’s not bad.  It just is.

We’re going to talk about politics.

The Senate Judiciary Committee held hearings this past week on the Supreme Court nomination of Amy Coney Barrett.  It really didn’t really matter whether or not she answered any of the Senators’ questions.  The votes were counted prior to the nominee being named.  And her views are certainly no secret.  Judge Barret has been running for this gig since she worked on the Bush v. Gore lawsuit from the 2000 election.  She has been thoroughly vetted by the Federalist Society.  Her writings are public.  Will she vote to reverse decisions legalizing abortion and same-sex marriage?  Your Conservative friends sure hope so.  Since this is Health Insurance Issues With Dave, we’ll focus on the question so many of the Democratic Senators pressed her during the hearing.  Will Amy Coney Barrett vote that Obamacare, the Patient Protection and Affordable Care Act, is unconstitutional?

The Wall Street Journal, excited about the reshaping of the Supreme Court, has issued countless editorials downplaying the Texas/Trump Lawsuit and its chance for success.  But the case has made it to the Supreme Court.  We cannot afford to ignore the danger this case poses to our access to health care or to 20% of our economy.

The crux of the case is that after the Senate failed to repeal Obamacare in 2017, President Trump, the Republican controlled House, and the Republican controlled Senate passed a tax bill in December 2017.  Included in the bill was a provision to zero out the penalty for not having compliant health insurance (the Individual Mandate).  The Mandate wasn’t repealed.  The penalty was simply reduced to zero.

Once the case, pushed by the Attorney General of Texas and certain other states, started to gain traction, President Trump became a fan and instructed his Justice Department to get involved.  When asked about millions of Americans losing their health insurance and the elimination of protections for people with preexisting conditions, Senate Republicans disavowed any responsibility.   Senator Lamar Alexander (R-TN), was quoted in a Kaiser Health News article as saying, “I am not aware of a single senator who said they were voting to repeal Obamacare when they voted to eliminate the individual mandate penalty”.

Millions of dollars have now been wasted on this lawsuit.  Millions of Americans have suffered unnecessary stress over the thought of losing their health insurance, the way they access and pay for health care.  Mitch McConnell could end this controversy.  Senator McConnell could introduce and pass legislation reintroducing the personal responsibility penalty, the Individual Mandate, and assess the penalty at ONE DOLLAR.  The lawsuit claims that the lack of a penalty invalidates the entirety of Obamacare.  OK, insert a penalty, or as Chief Justice Roberts calls it, a tax.  One dollar makes the lawsuit moot.

Would a Justice Barrett rule the Patient Protection and Affordable Care Act unconstitutional?  Why in the world would you want to give her the chance?

Mitch could save your access to health care, but he’d have to actually care.


Picture – All You Need Is One – David L Cunix

Special Bonus for those capable of writing their own jokes.


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When Failure Is Not An Option

I completed both the Sudoku and the crossword puzzle from today’s newspaper.  I tackle these puzzles each day at breakfast and finish them, if I have a chance, later in the day.  The puzzles become more successfully challenging as the week progresses.  Solving Monday’s puzzles is really no big deal.  Friday and Saturday require more skill.  But be it Monday’s or Saturday’s, I hate to fail and give these games my best effort.

Insurance agents, especially those of us who have been practicing for decades, are used to a good challenge.  And, we hate to fail.  You might think that this is about selling.  It is not.  I am talking about the challenge of finding good, affordable health insurance for our clients.    This is not a game.  People’s lives depended on our success.  And that success was not guaranteed.

“Dave, you’ve got to find coverage for Jane or she’s gonna die.”

The name has been changed, but those words still ring in my ears nearly twenty years after a panicked husband called my office right after the association covering him, his wife, and hundreds of others lost their group insurance.  Her advanced cancer and other conditions made her virtually uninsurable.  Ohio and other states had a backstop at the time, a patchwork of HMO insurers that were forced to have periodic open enrollments.  The policies were limited, incredibly expensive, and difficult to access.  There were other failsafe options, like the association I had found for them two years earlier, but they were quickly disappearing in the early 2000’s as preexisting conditions overwhelmed our system.  And yes, I was able to find Jane and her husband coverage for her last couple of years of life.  It was one of my greatest professional successes.

There are those who would like to return to the way is used to be.  Let’s talk about what if was like to purchase a health insurance policy for you and your family in 2009.  You called my office and I asked you about your family’s health history.  I needed to know the entire health history of you, your spouse, and your children.  Sure you were prepared to answer questions about cancer and heart conditions, but I also needed to know about your kids’ ear infections and diagnoses of ADHD and asthma.  Our next questions dealt with accidents.  We then moved on to your driving records and whether or not you rode a motorcycle or traveled out of the country, and where.  You might be able to provide the answers we wanted to hear.  Lots of people couldn’t.

The insurance companies then had up to four options:

  1. Issue the policy at the standard rate
  2. Offer you a policy at a higher rate reflecting your higher risk
  3. Offer you a policy that excluded your preexisting conditions and/or hobbies (riders)
  4. Decline to issue a policy for one or more members of your family

Different companies accepted different risks.  Our job as independent agents was to find the company that would do the best job to insure each client (risk).

The Patient Protection and Affordable Care Act put an end to the underwriting of individual (non-employer sponsored) health policies.  This opened the door to millions of Americans with preexisting conditions.  There are now three questions:

  1. What is your date of birth?
  2. What is your home zip code?
  3. Do you smoke?

Here is my question – Do you really want to go back to 2009?

There are those in congress, in certain state capitals, and currently in the White House who would like to eliminate Obamacare.  And since there is no alternative, no other plan, no other fully-formed option waiting to immediately kick-in the minute the PPACA is repealed or declared unconstitutional by the Supreme Court, if you eliminate Obamacare you would return to 2009.

In 2016 the Kaiser Family Foundation found that 52 million Americans have preexisting conditions that would have precluded coverage under pre-Obamacare underwriting.  That is a little less than 20% of our under age 65 population.  One of them might be you or your family.

I love a good challenge, but I prefer my daily Sudoku and crossword puzzles, where there are no consequences to failure, to finding live-saving health insurance for less than perfectly healthy families.


Picture – Today’s Challenge – David L Cunix

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Assessing The Risk

The Merriam-Webster definition of insurance is:

…coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril

The steps are always the same whether we are talking about life or car insurance, health or fire insurance, or even if we are insuring whether a ship can load in Viet Nam and successfully deliver its cargo in San Diego.

  • Assess the risk
  • Pool it with like risks
  • Determine the cost to insure the risk based on the known factors plus the administrative costs and potential profit
  • Tender an offer to the potential client to insure the risk

Everything begins with Assessing the Risk.  And to assess a risk you must have good information.  The insurance industry can trace its success to its mastery of asking the right questions, from the right people, to fully understand the risks it has been asked to cover.  Anyone who has ever purchased a meaningful amount of life insurance remembers the health questions, the physical, and the insurer’s request for medical records.  The industry is constantly searching for better ways to develop a more complete picture of its clients.

Information is the key.

The health insurance industry, even in an era where we don’t do health screening questions of most of our clients due to the Patient Protection and Affordable Care Act (Obamacare), still depends on good, complete information to properly assess the risks we hope to insure.  And in the year 2020, information appears to be in short supply.

COVID 19 – How will the Coronavirus impact our health insurance premiums?  Honest answer – Who knows?  Really!  I’ve seen reports that we will eventually have Hell to pay for the outrageous cost of care, the sudden expansion of the ranks of the uninsureds, and the general upheaval in the hospital and business communities.  Others point note that COVID didn’t impact all parts of the country equally, that many non-emergency procedures such as hip and knee replacements were put on hold (which saves money), and the general resilience of the industry as reasons to shrug off the possible impact of the pandemic on our rates.  Both viewpoints are valid.  We don’t have nearly enough information to know how COVID 19 will impact rates for the years to come.  But we’ve never really had enough information on this disease.

President Trump is quoted in Bob Woodward’s new book, Rage, on February 7, 2020:

It goes through air, Bob. That’s always tougher than the touch. You know, the touch, you don’t have to touch things. Right? But the air, you just breathe the air and that’s how it’s passed.

And so, that’s a very tricky one. That’s a very delicate one. It’s also more deadly than your – you know, your, even your strenuous flus. You know, people don’t realize, we lose 25,000, 30,000 people a year here. Who would ever think that, right?

This is more deadly. This is five per- you know, this is five percent versus one percent and less than one percent. You know? So, this is deadly stuff.

This was/is important information.  Millions of Americans, not just insurance companies, could have done a better job assessing the risk COVID 19 posed to our families had we had good, complete information in January or February.  We as a country could have done a better job fighting this pandemic had there been one message, honestly delivered, from the White House on down.  To this day we have people mocked for wearing masks in public, often by people who really should know better.   The insurance industry, like the rest of the country, has been trying to sift through competing narratives in search of the truth, the hardest possible way to assess a risk.

The Texas Lawsuit – The Supreme Court will hear the Texas Lawsuit, the Trump / Republican request to declare Obamacare unconstitutional, on November 10, 2020.  Anyone following the current Senate knows that not only is there no Republican alternative should the case win, but it is unlikely Mitch McConnell could get his caucus to agree on much of anything.  The Texas Lawsuit is the equivalent of driving our entire health insurance system, the way most Americans access and pay for health care, over the cliff and Mr. McConnell has spent most of the last 3 years removing the guard rails.  How do we, as an industry, assess this risk?  What do we do if we are forced to start over?

We are about to enter the 4th quarter of 2020 with more questions than answers and more risk than we’ve known in quite some time.


Picture – Old School – David L Cunix

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Trump Draws A Lucky Ten

The Supreme Court gave the Trump administration a gift this week.  The Court ordered oral arguments for the Trump-backed Texas Lawsuit to begin on November 10, 2020, one week AFTER the election.  This allows Donald Trump to claim to be in favor of protecting Americans’ access to health insurance, even if they have preexisting conditions, while actively working to overturn the Patient Protection and Affordable Care Act, the law that currently makes this possible.  20 million Americans losing their health insurance during a pandemic would also appear to be of no concern to this administration.  That, too, may get missed by the lack of TV coverage prior to the Supreme Court hearing.

We would like to think that the Supreme Court will once again rule in favor of Obamacare.  Health care accounts for approximately 20% of our economy.  And health insurance is the way that most Americans access and pay for their health care.  But the Texas lawsuit could throw our entire system into disarray.  There are no guarantees that this Supreme Court will protect us this time.

So your assignment for today is to call, write, or email your Congressional representatives, House and Senate, and ask each of them what they are going to do if the Trump administration is successful and the Texas lawsuit wins.  Demand an answer.  Remember, your Republican representatives have voted dozens of times to repeal the law.  What would they do if the PPACA were to be declared unconstitutional?  It is what they allegedly wanted.  I’ve asked that question. I’ve never received an answer.  And for your Democratic representatives, ask them what they would do differently this time.

There will be no place to hide if millions of Americans suddenly lose their coverage.  Our country will need real leadership.  We will need the men and women of Congress to draft real legislation to solve this problem.  It can’t be done by edict.

The Supreme Court won’t hear this case until November 10th.  The court of public opinion may rule a week earlier.


Picture – The Ten Of Trumps – David L Cunix


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Special Delivery

A recent study led by Stacie Dusetzina, PhD, published in Health Affairs, found that Medicare Part D (Rx) plans encouraged the use of generic medications over the name brand drug.  The senior citizen pays significantly less for the generic equivalent.  And the best deals are available on the most commonly prescribed generics, often referred to as Tier 1 or Preferred Generics.  Medicare Part D policies incentivize, damn near beg, seniors to use the mail delivery option.  Many policies not only forego the deductible on Tier 1 medications, they will even send a 90 day supply directly to your home at no cost.  It is hard to turn down free.  A lot of my clients take advantage of this benefit.

The U.S. Department of Veterans Affairs is very proud of their ability to serve our veterans’ pharmaceutical needs.  The link to their site notes that in 2016 the V.A. processed 470,000 prescriptions daily.  It is impressive that 330,000 veterans received a package of prescriptions in the mail EVERY SINGLE WORK DAY.  That was four years ago.  Mailing medications saves the V.A. money, saves our veterans money, and it is convenient.

The elderly and disabled may not have easy access to a drugstore or V.A. facility.  The mailbox is only steps away.

We depend on our mail system for the delivery of medications, letters, packages, and yes, for ballots.  Anything or anyone who slows the delivery of the mail will negatively impact all of these needed services.


Picture – A Different Medical Device – David L Cunix

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Just Politics?

Otto von Bismarck is credited with “Politics is the art of the possible, the attainable — the art of the next best”.  The goal is not to posture and make noise.  The goal is to govern and get things done.  As in any art, there are greats, near greats, and others.  The US government is a huge stage.  The greats shine.  The near greats and others are exposed.

I spent a good part of today slogging through the 393 pages of H.R. 6800, the HEROES Act.  The US House of Representatives passed this bill on May 15, 2020.  There is a talent to drafting legislation, to knowing your goals and working through the various previously passed laws to get to your desired results.  The bill, like all Congressional bills, has any number of items which any of us could disagree.  Legislation produced by either the House or Senate are starting points.  The final legislation is produced in the conference committees that work out the final details.  The House got their work done on May 15th, over two and a half months ago.  The Senate couldn’t generate its bill by its own deadline of last Thursday.  There is way too much disagreement within the Republican ranks and President Trump and his team seem to have different goals.  A Republican compromise was released this week.  It was DOA.   Senator Lindsey Graham (R-S.C.) is prepared to immediately jettison one the White House’s priorities, a billion dollar plus new FBI building and has guessed that over 50% of the Republican Senators would vote against their own opening gambit.  There is no Senate bill.  The basis of all future negotiations will be the HEROES ACT.  So let’s take a look.

H.R. 6800 impacts almost all Americans.  Since this in Health Insurance Issues With Dave, we should take a look at a few of the provisions specifically relevant to health insurance.

  • Provide significant funds to the Center of Medicare and Medicaid Services for Program Management dealing with coronavirus on the state level
  • Create a Special Enrollment Period for individuals over and under age 65
  • Allow the government to pay for COBRA for those impacted by COVID 19
  • Modify and expand the Paycheck Protection Program
  • Increase the flexibility and carry-over provision of the Flexible Spending Accounts (FSA)
  • Relax the employer filing requirements of certain employer/insurance forms
  • Eliminate cost-sharing for COVID 19 treatment
  • Provide funding and establish requirements for COVID-19 testing and contact tracing
  • Require employers to develop and implement infectious disease exposure control plans

Details?  It is probably best to look at this as just part of a starting point.  Negotiations will begin in earnest in the next day or so.  Millions of Americans are dependent on state based unemployment insurance and the extra money provided by the federal government.  That is currently $600 and set to end this week.  The Heroes ACT extends the $600.  The current Senate offer is $200.  Again, this extra money ends in a few days.  That may be the main focus of this week’s talks.  The rest, such as FSA flexibility and COBRA funding, will fall into place.  This blog will report the results as available.

But if you are unemployed, if you are trying to determine how to pay for your COBRA health insurance, this isn’t politics and the art of the possible.  This is money and the key to survival.


Picture – Grand Masters – David L Cunix

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Picking Your Battles

Senator Claire McCaskill (D-MO) knew that she was going to have a tough reelection race.  It was 2012 and Missouri had taken a turn to the right.  Mitt Romney was going to beat President Obama.  The key would be to choose her opponent.  Knowing his weaknesses, Senator McCaskill chose Representative Todd Akin and helped his campaign.  It has been eight years and many of you still recognize his name and his statements about “legitimate rape”.   McCaskill picked her battles and won the war.

This blog has detailed the Obama administration’s decision to include birth control pills, IUD’s, and the Morning After Pill as part of the Preventive Care Benefit of the Patient Protection and Affordable Care Act (Obamacare).  The first of close to a dozen posts about this issue was More Free Stuff which was posted on July 24, 2011, almost nine years ago.  To be clear, I was not then nor am I now personally opposed to these forms of birth control.  This is not about my personally held beliefs.  Nor do the inclusion of or opposition to these birth control methods have much to do with medicine, insurance, or health care.   This is a battle over control and religion.  Kathleen Sebelius, then the Secretary of Health and Human Services (HHS), picked this battle.  And she won the war, until this week when the war was lost.

The Supreme Court decided in a 7 – 2 vote this week that businesses could limit or exclude coverage for birth control under religious or moral grounds.  The case, Little Sisters of the Poor Saints of Peter and Paul vs. Pennsylvania, was nine years in the making.  Chief Justice Roberts has expressed his frustration in having the birth control issue making its way to his court again.  He couldn’t understand why the two sides couldn’t find a way to accommodate each other’s beliefs and needs.  I am personally shocked that the Chief Justice would actually expect either side to want to accommodate the other, much less make an honest effort at accommodation.

The Obama administration proposed a compromise in February 2012.  The impacted employers wouldn’t have to pay for birth control.  The employers could opt out and the insurance companies would front the cost.  As noted in my post of February 13, 2012:

Senator Roy Blount (R-MO) quickly released a statement via email.  It stated, in part:

“It’s clear that President Obama does not understand that it isn’t about cost – it’s about who controls the religious views of faith-based institutions.  President Obama believes that he should have that control.  Our Constitution states otherwise.

Just because you can come up with an accounting gimmick and pretend like religious institutions do not have to pay for the mandate, does not mean that you’ve satisfied the fundamental constitutional freedoms all Americans are guaranteed.”

A year later in the post The Great Imposition, February 11, 2013, we learned that there were people who weren’t just offended that their businesses might be providing birth control to their employees.  We then discovered that the inclusion of birth control in individual policies meant that other people will be able to make their own decisions.  There appeared to be a large number of Americans who felt compelled to impose their religion/morality/choices on others.  You may not have realized that you were accepting someone’s definition of religion when you were accepting a job in their machine shop or dental office.  Now they were upset that they couldn’t extend their reach to complete strangers.

According to the Jesuit Review, in a survey of American Catholics including many who go to Church regularly, “just 8 percent said contraception is morally wrong, with 89 percent saying it was either morally acceptable or not a moral issue at all.”  This, again, is a reminder that this entire issue is about control and religion.

As we have previously discussed, our health insurance policies covered birth control pills even when they didn’t.  Under the old rules, teenage girls would complain about difficult menstrual issues and the family doctor would prescribe birth control pills to help regulate their cycles.  Two problems solved!  The pills weren’t free, but the parents who could afford the cost didn’t mind.  Those who could not afford the cost of the monthly prescription were sent to Planned Parenthood (yes, that Planned Parenthood) for a reduced cost or even free.  This was a workaround, neither efficient nor 100% honest.  The PPACA ended all of that.  Birth control was now available to everyone, not just to those who could afford it.  Universal access was not universally appreciated.

We learned in 2010 that corporations are people.  People may not be people.  Certainly people aren’t always treated as people.  But corporations are not only people, but it turns out, as I noted in a post from July 3, 2014, these entities can even have sincere convictions.  The Supreme Court (Burwell vs. Hobby Lobby), days earlier in a 5-4 decision, continued the trend of dehumanizing individuals while we anthropomorphize corporations.

This week’s Supreme Court decision was in response to a Trump administration action taken in October 2017.  At the time this action seemed as much about Trump scoring A Small Victory as it did about birth control.   The key was that it opened up the possibility of eliminating the benefit under either religious or moral grounds.  In my opinion the most important issue was that since the Obama administration had the power to define these forms of birth control as part of Preventive Care, the Trump administration could just as easily change the definition.  Two of the more liberal justices, Elena Kagan and Stephen Breyer, agreed that that each administration had the right to create exemptions.

So what does it mean? When it comes to the Supreme Court, I always turn to Amy Howe a reporter at ScotusBlog.  Here is her summation:

“As both Alito’s and Kagan’s opinions suggest, the battle over the exemptions from the birth-control mandate may not be over yet. Instead, the dispute will go back to the lower courts for them to weigh in on whether the expansion of the exemptions was the product of reasoned decision-making, virtually guaranteeing that the litigation surrounding the exemptions will continue until well after the 2020 election. And depending on the results of the election in November, a change in administration could lead to efforts to narrow or eliminate the exemptions. But at the very least, today’s decision cleared the way for employers to claim the exemptions going forward.”

We can’t always pick the battles we wish to fight, nor is there ever a guarantee of victory.  Former Senator McCaskill easily won in 2012, but she lost by 6% in 2018.  The battle over the access and payment of birth control will continue.  Each side will celebrate some victories and each side will suffer some defeats.  It is a battle both sides want.


Picture – Armed With A Pen, Hardly Dangerous – David L Cunix


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