Hobbled by Hobby Lobby

An interview with Planned Parenthood’s Cecile Richards

Wednesday, August 13, 2014

For a brief moment, the reproductive rights of women had finally arrived.

At the beginning of the year, an estimated 47 million women across the country had access to the birth control of their choice, along with other preventative health services, without being charged an additional co-pay. That isn’t a benefit that’s likely to go unused. Nearly 100 percent of U.S. women have relied on contraception at some point in their lives.

“One of the most contentious issues under the Affordable Care Act, surprisingly to me given the numbers of people affected, was getting birth control coverage for all women under insurance at no cost,” said Cecile Richards, president of the Planned Parenthood Federation of America and the Planned Parenthood Action Fund. The CEO of the nation’s largest provider of reproductive health service was in Bellingham last week discussing the new law and its challenges with staff, volunteers and supporters of Mt. Baker Planned Parenthood. “Women can finally get the birth control that they need and want. Not just what is cheapest.

“That is revolutionary,” Richards said of the new law. “Too many women in this country still either can’t get the kind of birth control that is best for them because of the cost, or they go without birth control altogether because they are trading off other vital necessities in their lives.

“We know what happens when women are forced to choose between their own needs and the needs of their family. Women go without.”

Yet women in the United States were able to save an estimated $483 million on their out-of-pocket costs for the birth control pill in 2013, according to data from the IMS Institute on Healthcare Informatics. The health care data company found that the Affordable Care Act has “dramatically reduced” women’s out-of-pocket costs now that insurers are required to cover preventative care without charging an additional co-pay.

Compared to data from 2012, about 24 million more birth control pill prescriptions were filled without a co-pay in 2013. That means each of the women filling those prescriptions ended up saving an average of $269. Those savings can make all the difference for women who are struggling to afford the reproductive care they need.

A common misperception about Obamacare’s contraceptive provision is that women are now getting birth control “for free.” In reality, women are accessing birth control through their private, employer-sponsored health insurance plans. Women do pay for the benefits included in those plans, both by working at their job and by paying a monthly premium. Under Obamacare, the difference is that women don’t have to pay an additional out-of-pocket cost for the preventative health benefits specific to their gender.

Earlier this summer, in a closely watched case, the U.S. Supreme Court ruled private companies can refuse to provide birth control in their employee health plans as required by the Affordable Care Act if they register a religious objection. In a 5-to-4 ruling opposed by all three women on the court, the justices ruled that requiring “closely held corporations” to pay for contraception violates federal law protecting religious freedom. About 90 percent of U.S. businesses are considered “closely held corporations.”

One company, Hobby Lobby, objected to certain methods of birth control on religious grounds, claiming they are akin to abortion, despite scientific consensus to the contrary. Critics say the ruling allows discrimination against women, 99 percent of whom will use birth control at some point in their lives. The decision allows corporations to claw back a benefit employees have already earned through their labor.

In a blistering dissent, Justice Ruth Bader Ginsberg argued that a woman’s decision to claim birth control benefits is not equivalent to a moral action on the part of her employer. She noted even if Hobby Lobby was burdened by the contraception mandate, providing no-cost birth control to women is “a compelling interest in public health and women’s well being.” She added, “Those interests are concrete, specific, and demonstrated by a wealth of empirical evidence.”

“I have no doubt that if the court had been composed of nine women the result would have been different in Hobby Lobby,” Ginsburg said.

Richards agrees.

“When the decision came down, obviously, we were very disappointed in the court and in, frankly, the lack of appreciation or understanding of basic women’s health care,” Richards said. “Certainly Justice Ginsberg is so forthright on that topic. There are too many justices on the court who just don’t get that.

“For women, this is not a controversial issue. It is a basic healthcare issue. It is an economic issue.”

While CEO of one of the largest health care providers in the country, Richards is not your typical administrator. She is an activist to her core. Daughter of firebrand Texas Governor Ann Richards, Cecile Richards served as a labor organizer and deputy chief of staff to then–House Majority Leader Nancy Pelosi. In 2004 she led the Democratic electoral coalition America Votes. Since taking the helm of Planned Parenthood in 2006, Richards has steered the organization through some treacherous currents as hardened, anti-choice efforts have doubled down again and again against reproductive freedom and, indeed, medical science itself. She hung tough through the decision of the Susan G. Komen Foundation, the largest breast cancer fundraiser in America, when Komen decided to stop providing grants to Planned Parenthood over abortion; a few days later, when Komen reversed course, Richards worked to heal wounds between the women’s care advocates.

“We provide health care to more than 3 million people every year,” Richards noted of her organization. “But one of the most important things we’ve done as an organization was advocate for women under the Affordable Care Act, to ensure that women—whether they came to Planned Parenthood or not—could get health care coverage.”

The fight has always been hard, she argues.

“Margaret Sanger, when she started nearly 100 years ago, was thrown in jail for providing birth control information,” Richards said of the founder of organizations that evolved over a century into Planned Parenthood. “So, I would say we were born out of a sense of understanding we had to move the country forward in terms of women’s health and access. I certainly wish we could take these issues out of the political realm—the partisan divide that’s been created over the past few years—because women need access to health care, regardless of what party they belong to, or whether they belong to any party.”

Cascadia Weekly: You understood the Hobby Lobby decision was coming and that, due to the make-up of the court, it might not be favorable. How did you prepare?

Cecile Richards: Six months ago, around January, we knew something like the Hobby Lobby case was going to heard because there have been so many lawsuits filed by for-profit employers who, for one reason or another, did not want to provide birth control. We knew from the make-up of the court that it could go either way.

One thing that was really important to us collectively was that the American people understood that this case was going to be argued and that there were going to be important ramifications for women in America.

You know, there are a lot of Supreme Court decisions that have huge impacts on our lives, but it is difficult to get people to focus on them. We spent a good six months, along with a lot of allies around the country, highlighting what the Hobby Lobby case was all about. The important thing for us was—win, lose or draw—people need to understand what happened there. The result is Hobby Lobby has become a household word.

We’re working very closely with the Administration and Congress to address the issues of women who are going to lose access to birth control as a result. But I also hope it is a learning opportunity to help women understand that, one, this is a benefit they need to ask about and that we’re here to help them find out if they have coverage and, two, to remind women again how important it is that we vote.

Sometimes the Supreme Court seems like such a far-away body, but when you have a decision like this that impacts women’s day-to-day access to health care, women are very, very conscious of this.

CW: Hobby Lobby argued that several of the contraceptives offered through their insurance were abortifacients. Medical consensus disagreed, but the court majority did not seem inclined to consider that or to distinguish between them in any way. Was the distinction important?

CR: Hobby Lobby objected to two forms of birth control that they consider to be abortifacients, even though no major medical organization in the country would agree with their “science.” Subsequent to the decision, the court delivered further instruction to employers that, in fact, it didn’t matter. If you had any objection to any form of birth control, you could deny it to employees as a religious right.

There were only three justices in the courtroom that day who asked, “What are the impacts on women? What are the impacts on employees?” The rest of it all revolved around the rights of corporations and CEOs, all in a very abstract fashion when the impacts on women and the employed were very evident and concrete. The fixation of this court on corporations and their rights, versus the rights of actual people, is really remarkable.

What was being cast as a very narrow decision is, instead, an enormously broad decision. And again, not only about women’s access to birth control, but the right of an employer to discriminate against their workers based on religious points of view. That is a very slippery slope.

CW: Women use contraceptives for a variety of health care reasons apart from birth control, so this decision impacts much more than women’s reproductive rights.

CR: That’s correct. This is a point we were trying to make, which is, “Are women now going to have to start bringing a doctor’s note to their employer, explaining why they need birth control?”

Because you’re right: I believe up to 50 percent of women use birth control for at least an additional reason altogether. It runs the whole gamut between women who want to regulate their menstrual cycle, young women who want to deal with acne, women who are dealing with endometriosis or hormonal imbalance.

That, to me, is one of the more significant ironies in this case, in that women who were literally trying to protect their own fertility and make wise decisions in family planning could be prevented from getting access to this care.

CW: Earlier this year, the Supreme Court also struck down a law that prevented protesters from coming within 35 feet of abortion clinics in Massachusetts. That decision was unanimous, ruling it a violation of the First Amendment.

CR: Women who want access to basic care come to us for a huge variety of reasons. Protestors don’t distinguish, they yell at everybody. It can be very challenging for women to cross through that hostility.

The Supreme Court was not sympathetic to this idea of a buffer zone. My own opinion is they don’t understand particularly well what it is like for women, just being able to access care.

We’ll continue to work with local law enforcement and state legislatures to ensure that we can protect women and doctors and clinicians. Planned Parenthood is building beautiful new centers, with more capacity for women to come in without having to pass through angry protestors.

CW: It strikes me there has been a change in conservative talk over the past several years that tries to blur any distinction between contraceptives and abortion, an effort to confuse one with the other, to argue that one is the other in order to eliminate all. Has that been your observation, and what purpose does it serve?

CR: Five or six years ago, when we would tell people that there were people in office who wanted to eliminate all forms of contraceptives, these people would think that was just crazy. How could any claim be so far-fetched?

Yet we see in the Affordable Care Act, in the congressional hearings where they actually refused to allow women to testify about why they might actually need birth control coverage—and, again, all these employers and their insurers already covered most birth control methods—the Right has ginned up as many lawsuits as they can. I think it is fundamentally that we are dealing with people who believe women should not have access to controlling their reproductive gear, period—whether it is access to birth control or through safe and legal abortion.

I’m glad you raised the point of Hobby Lobby using their own medical “facts” or beliefs to characterize IUDs or emergency contraception as abortifacients. We’re seeing more of this now, and we’re going to see more of this in the states, trying to prevent insurance coverage for abortifacients, again blurring this line.

There’s no scientific basis for any of this. I think it stems from a belief that, somehow, women got too big for their britches.

Now that women are able to control their fertility, finish school, compete in the workforce—there’s clearly a bunch of folks, some in Congress, who think these advances need to end.

CW: That seems a tremendous irony of our times. Teenage pregnancy rates have plummeted, the abortion rate is as low as it’s been since 1973, children are born where they are wanted, birth defects are down. These are all outcomes our society has dreamed about, and they’re all related to access to safe, effective contraceptives.

CR: I agree. We sometimes wonder at Planned Parenthood why it is so difficult at times to receive good news. And there is tremendously good news out there.

One thing we know is that when women have the birth control that works for them and that is affordable to them, they stay on it. That prevents unintended pregnancies, a very important goal for our society.

CW: And similarly, most media coverage of Planned Parenthood focuses on abortion, but the organization is involved in much more than that. Can you comment?

CR: If you interview the average American, they actually know what Planned Parenthood does. Because they went there for birth control or advice, everyone’s got a story. We provide an enormous amount of family planning, we were foremost in the testing for sexually transmitted infections last year; we are easily the largest sex educator in America and advocate for responsible family planning.

One of the most exciting things is we not only operate more than 700 health centers, but we have about 5 million visitors online every month who are able to access information they were formerly unable to access anywhere.

Again, we know as a health care provider, if you’re able to get access to family planning, if you’re able to get tested and treated for disease, when you do want to have a family you are better prepared. That’s good for everybody.

CW: What do you anticipate will be the response from your organization, and organizations like yours, in response to these court decisions?

CR: The November elections are going to be fascinating.  It’s very clear from our polling this is [laughs] fertile territory for women, because it was already clear to them before that there were people in Congress “out to get them,” and these decisions only add to that.

In an election year where turnout is everything and women are a key voting demographic, it will be interesting to see how much this is a motivating issue. And I think it will be, a referendum on who’s on your side and who is not.

Look, we need to make sure that the next Congress, the next President, the next appointees to the Supreme Court respect women and women’s rights.

An inspirational speaker, CEO Cecile Richards helped raise more than $32,000 in donations and contributions to Mt. Baker Planned Parenthood during her visit last week.

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