The first thing to note is that this is not a First Amendment case. The Supreme Court did not find the mandate unconstitutional. Instead the Court found that, as applied to closely held family owned companies, the mandate did not meet the requirements of the Religious Freedom Restoration Act of1993, which passed Congress with a nearly unanimous vote in both chambers. However, in 1997 the Court found that the Religious Freedom Restoration Act was unconstitutional in its application to state laws.

The law on which this decision is based requires that when a person's religious beliefs are substantially burdened by a law of general applicability, the government may impose that burden only when it can show a compelling interest and then only by using the least restrictive available means. However, this requirement can only be applied to federal laws and not to state laws by the 1997 decision.

That last wrinkle will turn out to be important in this case since twenty-eight states have a contraception coverage mandate in their state insurance laws or regulations. Ordinarily a Court decision of this type would automatically invalidate those laws, but not in this instance where the decision is based on a law that can only apply to federal statutes.

Will Hobby Lobby have to sue in twenty-eight states? It's not clear at all what the implication of this decision will be for state mandates.

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Yes, but - if there's going to be group insurance available to anyone arranged by the government, why have employers doing insurance separately? 

If everyone, not just people who can't otherwise get insurance, were in the group insurance arranged by the government, then the premiums could be lower for that government insurance.

The insurance companies have the USA by the short hairs

Absolutely.  This was borne in on me recently when I temporarily had the Obamacare health insurance (until I found out the govt. plans are low-quality plans and don't cover almost all my medical expenses). 

When I had the health insurance, I found out the insurance co. gets paid a small fraction of what I was being charged as a self-pay patient!

At least, that's how it's worked with the allergist I've been getting shots from.  

He charges self-pay patients about 2.5 times as much as the patients with group insurance!

Not all doctors do this.  I'll probably be getting my shots soon from another allergist who charges self-pay patients maybe 30% more than insured patients, but not a ton more.

I've heard that self-pay patients at hospitals often are charged about 2-3 times as much as the hospital gets from insurance.

This seems blatantly unethical.  The doctors and hospitals who do that are trying to recoup the loss from the low prices charged insured patients, from self-pay patients!

In effect, what happens is that the insurance co. charges people who DON'T buy insurance as well!  It's a way of trying to bully everyone into these insurance plans. 

All these years I've gotten occasional self-pay discounts, and I thought I was being done a favor in exchange for less paperwork & getting paid faster - but nooo, it's likely that even with the self-pay discount, I was paying more than they get from insurance co's. 

And insurance co's dictate a lot of how medical care is done, it seems.  I have a good allergist in NYC, who doesn't belong to any group insurance plans.  Part of what enables him to be a good allergist is that he can do medical care his own way, he's not following the dictates of insurance co's. 

It's a horrible situation for bureaucracies to be running people's medical care to a large extent, in a paint-by-numbers way.  Medical care belongs in the hands of doctors.

If they have legally mandated health insurance, it should NOT be health insurance that is allowed to dictate people's medical care!  The health insurance should pay for what the doctor thinks is appropriate.   

However, I don't know why a single-payer system would be any better.  If there's a single-payer system, then the government is effectively insuring everyone.  Then you don't have any competition between insurance co's.

The Obamacare insurance plans available here did not seem significantly different. 

But competition is important in general to ensure efficiency and good service.  I do hear horror stories about govt-run healthcare.

Although large companies are able to negotiate with insurance companies to provide health insurance, small companies are not. Many smaller organizations are essentially self-insured—that is, the premiums they collect must cover their annual expenses or else they have to come up with additional funding out of their own resources. One difficult case can upset the apple cart.

Large companies are able to negotiate group insurance premiums that are much lower than an individual would pay and people are insured without a medical exam in most cases. For an individual premiums are higher and often people are rejected because of pre-existing conditions. Group insurance meant a lot to me personally—for most of my working years I would have been uninsurable because of a heart arrhythmia. With a wife and three children, one with asthma, the situation would have been difficult.

Large companies are able to negotiate group insurance premiums that are much lower than an individual would pay

The problem is, that results in hospitals and some individual doctors, seriously ripping off self-pay patients. 

Presumably people who are working have the option to sign up for the insurance bought through the govt?  If they didn't like the terms of health insurance from their employer, e.g. no birth control, they would have an alternative?

Based on my experience, I think the govt health insurance is probably lower quality than many insurance plans available through employers. 

I'm 65. I have had health insurance of various kinds throughout my whole life. Never during reproductive years (until I had a vasectomy in the 90s) was birth control EVER covered on any of my plans. Birth control was a normal expense, not an insurance item. It's not like this is some crazy new concept.

What we really need is re-engineering of our legal structure to separate health insurance from employers. There is no real sense to that (I don't get my home or car insurance through my employer). If we separate healthcare from employer, we actually improve our freedom to choose jobs.

I think pushing this issue, right down to the 'no co-pay' clause was a tactical mistake.

Here's a rather level headed (secular) analysis from Wharton Business school

https://knowledge.wharton.upenn.edu/article/hobby-lobby-case/

What we really need is re-engineering of our legal structure to separate health insurance from employers.

I made the same point.

I suspect that Obamacare was pushed through by means of a lot of compromises, and retaining that rather strange idea of employers providing health insurance was one of the compromises.  Obama promised that "you can keep your current plan" (only usually, in reality).

He initially wanted single-payer but, the insurance lobby was too strong.

The insurance lobby is just as bad as , if not worse than, the NRA.

The insurance lobby agreed to the provision eliminating pre-existing conditions as a reason for denial because they were going to get so many new customers that it looked affordable to them. The plans that people can't keep are those that do not meet the standards of the affordable care act. Insurance companies have withdrawn those plans to a large extent voluntarily in advance of the ACA taking effect.

I was glad to read that the Freedom From Religion Foundation ran a full-page ad in today's New York Times excoriating the decision, and calling for the repeal of the Religious Freedom Restoration Act. (Lots about the RFRA's unconstitutionality in FFRF's brief.)

"DOGMA SHOULD NOT TRUMP OUR CIVIL LIBERTIES"

"All-male, all-Roman-Catholic majority on Supreme Court puts religious wrongs over women's rights"

(Image from the Friendly Atheist article; click to embiggen)

Inspired by the Hobby Lobby decision, a group of religious leaders is calling on President Obama to include a religious exemption in his forthcoming executive order banning anti-LGBT discrimination by federal contractors.

To these religious leaders, Hobby Lobby ought to prompt the White House to reexamine the way it weights religious rights against other priorities. Liberals opposed to the decision, on the other hand, argue it creates a slippery slope to more and more carve-outs from important legislation for claims based on faith. This executive order could be the next battleground for those competing points of view.

http://www.theatlantic.com/politics/archive/2014/07/hobby-lobby-is-...

http://www.scribd.com/doc/232327567/Religious-Exemption-Letter-to-P...

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