One More Bitter Pill to Swallow—and to Pay For

This week, the Supreme Court ruled that employers with religious objections don’t have to cover birth control on their employee health plans. It’s disappointing, particularly for women who happen to work for the companies raising these objections. The ruling is not restricted to churches or overtly religious organizations; those exemptions already existed. Now any business is free to claim a moral objection. And while birth control was on the table today, you can bet companies will object to other treatments in the future. I predict vaccinations will be next.

This ruling adversely affects poor women and young women, people who often toil away at low-paying, low-reward jobs largely because the job offers health insurance. And it penalizes women who use birth control to manage painful, heavy periods, to treat debilitating PMS, or to prevent ovarian cysts, among other conditions. No one seems particularly concerned about this, though. Women’s suffering never presents much of a moral dilemma.

We could avoid all of this moral hand-wringing if America did one simple thing: get rid of employer-provided health insurance.

Tying health insurance to employment was never a great plan. It makes it hard for people to move freely from one job to another, because any gap in employment likely means a gap in health insurance. Freelancers, contractors, small business workers, seasonal workers, and more, are left out of the employer-based health insurance racket.

That’s not good for anyone. Health insurance is expensive. In many cases, it’s too expensive to use. Most self-employed people opt for catastrophic health coverage, which means high deductibles for sub-optimal coverage. I speak from experience. My husband and I pay thousands of dollars every year for our insurance plan. We’ve never actually met our deductible. If we did, it would indeed feel like a catastrophe. We’re counting down the years until we’re eligible for Medicare.

picture of birth control pills

And if the Trump administration succeeds in undoing the Affordable Care Act, many people won’t just be priced out of health insurance, they’ll be denied coverage at any price because of pre-existing conditions. Health insurers don’t exist to provide coverage, they exist to deny coverage. But all of this could be fixed if we turned our efforts toward providing health care rather than health insurance.

I know it makes people nervous to contemplate losing their employer-provided health insurance. I get it. It’s a nice perk. But it is a perk. Your health insurance is part of your compensation package. If your employer no longer provides it, they need to compensate you in some other way, like, you know, money. If every American spent one month trying to buy health insurance on the open market, universal health care would be the law of the land in no time.

Finally, of course, removing health insurance from the workplace would remove any sort of moral quandary employers might have about providing things like birth control. If there’s no employee health plan, your employer won’t need to sit around worrying about your reproductive choices. That, I hope we can all agree, would be a very good thing.

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