On March 25th, the Supreme Court heard two cases brought by Hobby Lobby and Conestoga Wood Specialties, two privately held, for-profit corporations. The corporations and their owners claim that their religious rights are violated by the preventive services requirement in the Affordable Care Act (ACA)—namely that new plans must cover, without cost-sharing, FDA-approved contraceptive services and supplies as prescribed. HPV testing, HIV, and STD screening and counseling are also required preventive services under the ACA, although they are not the main focus of the corporate objections. (The American Association of University Women was one of many organizations gathered at the Supreme Court, photo courtesy of http://www.aauw.org/2014/04/04/hobby-lobby-supreme-court/.)
You may recall that the Obama Administration has already provided an exemption to non-profit “religious employers,” such as religious hospitals or universities, and for those organizations, payments for objectionable services and procedures (namely birth control, including emergency contraception), are issued through the insurance-issuer or the administrator. This accommodation means that covered employees (and their insured dependents) can still access contraceptive coverage at no cost, regardless of the religious belief of their employer. Because the insurer, not the employer, is providing contraceptive services, the employer does not have to pay for services that they deem objectionable or immoral along religious grounds.
Hobby Lobby and Conestoga Wood Specialties argue that corporations have religious rights (not unlike political speech rights protected under the First Amendment, as ruled by the Supreme Court in Citizens United v. Federal Election Commission) and that the individuals that own these closely-held corporations also have religious rights that are burdened by the contraceptive coverage requirement.
The controversy and media attention around this case undoubtedly, and understandably, focuses on contraception. However, there are several important implications for STD prevention as well.
First, because female condoms are an FDA approved barrier method, they can be covered by an insurance provider at no-cost to the patient if the patient has a prescription. If a woman decides that female condoms are her contraceptive method of choice—a wise one, since they also protect against HIV and STDs—she will have to pay about $4 per condom per sexual encounter, over the approximately 40 years of a woman’s reproductive life. If a woman is denied coverage, she may not be able to choose a contraceptive method that she can control that also protects her from STDs and HIV. Male condoms are also an approved FDA barrier method.
Second, allowing an employer to impose their religious beliefs on employees leaves the entire spectrum of sexual health care vulnerable. As Justice Sonia Sotomayor noted, what if an employer believes that vaccination is against their religion? Vaccines have long been a cornerstone of public health, and they are among the most cost-effective preventive services available. Because HPV can lead to cervical cancer, HPV vaccine has joined the long list of immunizations that can save lives—however, not enough children are being vaccinated. In 2012, only about a third of girls aged 13 – 15 and less than 7 percent of boys had received the shots. A recent piece in the New York Times highlighted the expansion of HPV vaccination in North and South America; more than 170 million doses of HPV vaccine have been given worldwide, and young women in Australia and Denmark, which introduced the vaccines early, have had sharp declines in precancerous lesions. HPV vaccination is critical to reducing the burden of HPV and the poor health outcomes associated with HPV, such as external genital warts, and it is critical that we protect vaccine coverage as part of preventive services.
The slippery slope concerns on this case go beyond vaccination. What if a business owner believes that HIV/AIDS is a punishment and refuses to cover HIV screening and treatment for employees and their insured dependents? And, one could reason that corporations could decline to provide spouse and partner benefits in states that recognize same-sex marriage, which would be discriminatory against LGBT individuals, a population already disproportionally affected by STDs and HIV.
This issue has ignited the reproductive and justice communities. Demonstrators rallied around the message “Not my Boss’s Business,” and while the crowd at the Supreme Court last month was decidedly pro-women and pro-choice, it is important to note that STD prevention is a critical piece of reproductive health and justice. When an individual makes a decision to be pro-active about their health care—by going on birth control, by using female condoms, by receiving the HPV vaccine—we should celebrate a victory for public health. The families that own Hobby Lobby and Conestoga Wood want to make sure that their religious beliefs come before the health of their employees.
As with many social issues, the Supreme Court is divided and Justice Anthony Kennedy will be the deciding vote in this case, which will be announced later this year. In the meantime, get tested, get vaccinated, and get to know your health benefits!
For more information on the case, I recommend the SCOTUS blog, “Sebelius v. Hobby Lobby Stores, Inc.” and also this Washington, D.C. briefing on the contraception coverage challenge sponsored by the Kaiser Family Foundation.
 Not publicly traded
 “Burdened” is used very intentionally here, as at the heart of this case is the Religious Freedom Restoration Act (RFRA), which prohibits the government from imposing a “substantial burden” on a person’s religious exercise. For more on RFRA and the HHS mandate see: http://www.virginialawreview.org/sites/virginialawreview.org/files/Rienzi.pdf.
 For more, see “What are my birth control benefits?” at HealthCare.gov here: https://www.healthcare.gov/what-are-my-birth-control-benefits/.
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