The debate over birth-control insurance coverage has traveled from the presidential campaign trail to the church pews. And now it's heading to the courts.
The Obama administration mandate that employers provide workers with contraception coverage is not a United Methodist issue per se. But church members often speak up when issues of religious liberty enter the national conversation.
For many, the debate boils down to this: Does the mandate violate religious freedom, or is it expanding access to an important aspect of women's health care?
Not surprisingly, individual United Methodists answer that question in varied ways.
The U.S. Constitution "guarantees religious expression in all aspects of life, so it's broad enough to encompass religious institutions and religious-sponsored institutions in the exercise of their religious beliefs," said the Rev. Keith Boyette, founding pastor of Wilderness Community Church in Spotsylvania County, Va. He is an attorney and the chairperson of the board of Good News, an unofficial evangelical caucus in the denomination. Boyette is also a former member of the United Methodist Judicial Council, the denomination's equivalent of the Supreme Court.
Boyette and some other United Methodists said they think the plaintiffs - including 43 Catholic groups in the U.S. - have a good case that the federal government is infringing on their First Amendment rights.
Still, others in the denomination disagree.
"I don't think that this is a religious liberty issue at all," said the Rev. Cheryl B. Anderson, a former practicing attorney, a United Methodist elder and an Old Testament professor at United Methodist-related Garrett-Evangelical Theological Seminary in Evanston, Ill. Her research has focused on women and biblical laws.
"The government is not requiring that all women use contraception," she said. "The provision simply means that, under the circumstances specified, if a woman does use contraception, the expense will be covered by an insurance company.... It seems to me that, by filing lawsuits, these conservative denominations are attempting to impose restrictions on the use of contraception by any and all women."
How the dispute reached this point
The Obama administration announced in January 2012 that most health insurance plans must cover contraceptives for women free as part of preventive care. The mandate, part of the Patient Protection and Affordable Care Act, covers birth-control drugs and procedures approved by the Food and Drug Administration including emergency contraception, which some Americans view as inducing abortions.
The rule, from the beginning, has exempted religious employers such as houses of worship but not religiously affiliated employers that do not primarily employ or serve people who share their religious tenets, which includes educational institutions and hospitals.
After a public outcry, President Obama announced in February what he termed an "accommodation" for religiously affiliated employers with moral objections to artificial contraception. For such employers, he said, the insurers would cover the costs rather than the employers themselves.
Within hours, the U.S. Conference of Catholic Bishops rejected the revised rule. Weeks later, Sandra Fluke - a United Methodist and third-year law student at Georgetown University, a Jesuit institution - caused a stir when she testified in support of the compromise, focusing on the medical uses of contraception beyond pregnancy prevention.
At least 55 individual plaintiffs have filed 23 suits in U.S. federal court to block the Obama administration action. Roman Catholic and evangelical Protestant organizations are among the litigants. Those suing on religious-liberty grounds include seven states, religiously affiliated hospitals, universities, schools, businesses and 13 of the 195 Catholic dioceses in the United States.
The suits could prove moot if the U.S. Supreme overturns in entirety the Patient Protection and Affordable Care Act. The high court's ruling in that case is expected this month.
For now, the new federal regulation is scheduled to take effect in August 2013 for most religiously affiliated employers.
Birth control and theology
The Roman Catholic Church and The United Methodist Church have different views of where birth control fits in God's plan.
Catholic teaching, reaffirmed by Pope Paul VI's 1968 encyclical Humanae Vitae, rejects artificial contraception as an obstruction to the divinely willed life-giving power of marital relations. In short, the church teaches that a couple's intimacy should always carry the potential for procreation unless God's design prevents that possibility, such as a wife no longer being of childbearing years.
Because of this emphasis on natural law, the Catholic Church has moral objections not just to the use of birth-control pills and sterilization procedures but also to in vitro fertilization.
The Social Principles of the United Methodist Book of Discipline, the denomination's law book, discuss family planning in the context of "The Right to Health Care." It affirms "the right of men and women to have access to comprehensive reproductive health/family planning information and services that will serve as a means to prevent unplanned pregnancies, reduce abortions, and prevent the spread of HIV/AIDS." The passage cites John 10:10b, which quotes Jesus: "I came that they may have life, and have it abundantly."
The United Methodist Church diverges from Roman Catholic thinking in "the importance it gives to individual conscience as well as its recognition of the complexities involved," said the Rev. Gary B. MacDonald, the director of Advanced Ministerial Studies at Southern Methodist University's Perkins School of Theology in Dallas. He leads workshops on the Social Principles. He also is completing a doctoral dissertation on the church's social function.
"The Principles' view of sexuality as a gift is also at work here," he said. "It seems to leave open an understanding of the sexual act as related to human fulfillment and dignity, putting such values on par with procreation."
Another Social Principle specifically prohibits using abortion as a means of contraception or gender selection.
As a practical matter, this means United Methodist-affiliated clinics and hospitals around the globe offer contraception to patients and most United Methodist institutions provide insurance for artificial birth control. Linda Bales Todd, director for the Louise and Hugh Moore Population Project for the United Methodist Board of Church and Society, said the denomination's stance also affects advocacy work by her agency and annual (regional) conferences.
"Because we have a position that advocates strongly and, historically, family planning, we are able to take grant money to advocate on Capitol Hill (on this issue)," she said.
Birth control and ethics
Even if they personally support the use of contraception, some United Methodists still view the adjusted mandate as too intrusive on faith. Boyette, the Virginia pastor, said the regulation would set a troubling precedent that might one day lead to government interference in United Methodist teaching.
He said he sees Obama's proposed compromise "as a shell game." Insurance companies, he said, likely will raise their premiums for the institutions to cover employees' birth-control costs.
"It's not materially different from saying this religious institution itself should provide the benefit directly," he said.
Boyette pointed out that the new rule also does not address the many religiously affiliated institutions that self-insure - that is, provide health insurance directly to employees and pay the health care claims of their workers.
What The United Methodist Church teaches:
- The Social Principle on health care and family planning
- The Social Principle on church and state relations
- A resolution "Maternal Health: The Church's Response" approved at the 2012 General Conference for the United Methodist Book of Resolutions
Administration officials told the New York Times in March that final rules for "self-insured employers" would be issued after the November elections.
Jim Winkler, the top executive of the United Methodist Board of Church and Society, and others contend the health benefits of birth control should outweigh consideration of objections of religious leaders.
The nonpartisan U.S. Institute of Medicine recommended the new federal mandate in July 2011 after multiple studies showing that unplanned pregnancies are more likely to lead to low-birth-weight babies, higher mortality rates for children under 5 and more maternal death.
Winkler also pointed to studies, such as a 2009 report by the nonprofit Guttmacher Institute and the United Nations Population Fund, which found contraception use reduces abortions.
When religious groups reject contraception in their related institutions, they "in essence, neglect the protection of women and children's health," Winkler said, "and this results in unnecessary death and illness.
"Every 90 seconds, a woman dies of birth-related complications," he added,citing the United Nations Foundation.
The legal arguments
Michael J. Perry, Robert W. Woodruff professor of law at United Methodist-affiliated Emory University in Atlanta, said he thinks the plaintiffs will face a tough legal battle. Perry specializes in U.S. constitutional law and the role of religiously based morality in the law.
Oral contraception should not be confused with abortion, says a United Methodist physician.
Much will depend on how courts interpret the 1993 federal Religious Freedom Restoration Act, Perry said. The act says religious institutions can challenge federal laws that would put a "substantial burden" on their ability to exercise a religious belief. He said he thinks the Obama administration's accommodation for religiously affiliated employers would make it hard for institutions to argue that their religious beliefs are being impeded since they will not be paying for it directly.
Courts also would face the question of whether providing more access to birth-control coverage is a compelling government interest, and, if it is, whether it can be accomplished in a way less intrusive on faith.
However, the Becket Fund for Religious Liberty, a nonprofit firm representing at least four of the plaintiffs in the lawsuits, argues that its case is persuasive.
"The question is: Who is being coerced in this situation?" said Emily Hardman, an attorney and communications director with the Becket Fund. "And, the only entity being coerced to violate its conscience is the religious entity. A woman working at those institutions is free to get birth control. No one is blocking anyone's access to birth control. All we're saying is we're not going to pay for it."
*Hahn is a multimedia news reporter for United Methodist News Service.
News media contact: Heather Hahn, Nashville, Tenn., (615) 742-5470 and [email protected].