It was one of the more remarkable moments in the saga of the “repeal/replace” of the Affordable Care Act. When Democratic Congressman Mike Doyle asked his Energy and Commerce Committee colleague, Republican Congressman John Shimkus, exactly what mandate in the ACA he objected to, Shimkus replied, “What about men having to purchase prenatal care? I’m just … is that not correct? And should they?”
Shimkus doubled down a few days later when he compared “forcing” men to buy policies that cover prenatal care and contraceptives to “buy[ing] a cabin in Montana that you’re never going to use.”
Now aside from the fact that “forcing” women to buy health insurance policies that cover prostate cancer is, in the bad vacation home analogy, like “buying a bungalow on the Jersey Shore that you are never going to use,” Shimkus is correct. Before the ACA, many individual insurance policies didn’t cover maternity care. Women who wanted that luxury needed to pay for a pregnancy rider that ran about $5,000—in other words, they needed to pay for their own pregnancy.
But where, pray tell, did people get the idea that they could pick and choose what kind of health care they would and wouldn’t pay for? And that certain kinds of health care, especially the kinds of health care that humans with ovaries and vaginas use, were some kind of special bonus health care coverage that wasn’t included in “regular” insurance?
The culprit might just be the Catholic Church. It was the Catholic Church after all that created the very first carve-out from health insurance when its own lobbyist crafted the Hyde Amendment that prevented Medicaid from paying for most abortions on the grounds that taxpayers shouldn’t have to pay for services they find immoral.
Then the church moved on to private insurance, arguing that employees in the federal employees health insurance plan should have the option of at least one plan in which their premiums wouldn’t go to services the Catholic Church banned, like abortion and contraception. But the essential argument here was that Catholics shouldn’t have to pay for services that they didn’t use or approve of others using.
When states began mandating the coverage of prescription contraceptives in the late 1990s, the U.S. Conference of Catholic Bishops argued that insurers should be free to opt out of such coverage based on “conscientious objection or long-standing religious beliefs against such coverage.” This laid the groundwork for the bishops’ objections to the contraceptive mandate in the Affordable Care Act, which they now argued would violate not just insurers’ rights, but the rights of the insured, who would be forced “to go out into the marketplace and buy a product that violates their conscience.”
Other social conservatives, like evangelicals, picked up on the Catholic Church’s idea that individuals had a right to reject certain forms of insurance coverage and joined the fray, objecting not just to the contraceptive mandate, but to maternity coverage as a reproductive health “extra” that they didn’t want to pay for (not on the basis of a moral objection, but a financial one). From there, it was just a short hop to where we are today, with Paul Ryan arguing that the problem with ObamaCare is “that the people who are healthy pay for the people who are sick.”
What we are now witnessing is a widespread degradation of the fundamental underpinning of the shared social sacrifice inherent in all insurance by reframing insurance itself as unfairly redistributive. As Bruce Bartlett, an economic historian who served in the Reagan and George H.W. Bush administrations, notes:
Republicans argue that redistribution is inherently immoral without acknowledging that the very nature of insurance is per se redistributive. You’re taking money from people whose houses don’t burn down to give it to the people whose houses do burn down.
There’s more than a little irony in this given how proud the Catholic Church is of its role advocating for universal health insurance coverage since the early twentieth century. The Catholic Church helped educate the country about the need for shared social benefit programs, then helped tear down the very foundations of those programs with its obsession with controlling access to abortion and contraception.