KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Viewpoints: Expanding Hobby Lobby Decision; The Faux War On Women; Dispute Over Pelvic Exams

Los Angeles Times: Danger Sign: The Supreme Court Has Already Expanded Hobby Lobby Decision
The Supreme Court wasted no time in delivering a message to anyone who thought its Hobby Lobby ruling was limited to religious objections to coverage of purported abortion methods: You're wrong. The day after handing down the Hobby Lobby decision on Monday, the court issued orders pertaining to six pending cases in which employers claimed religious objections to all contraceptive services required under the Affordable Care Act. The court either ordered appeals courts to reconsider their rejection of the employers' claims in light of the Hobby Lobby decision, or let stand lower courts' endorsement of those claims (Michael Hiltzik, 7/2).

The New York Times: Hobby Lobby, Or When Corporations Get Things Both Ways
The notion that a corporation is a distinct entity with its own rights and obligations separate from those of its shareholders is the foundational principle of corporate law. It means that people can invest in a company without risking personal assets beyond their investment. If a corporation fails to observe proper safety precautions in manufacturing a product, for example, the victim can only sue the corporation — not the individual shareholders. ... Under the new decision, religious owners of closely-held, for-profit companies get to have it both ways. They get to assert their personal religious identity to exclude legally mandated birth-control benefits from their company’s health insurance plan. Yet they will still enjoy the insulation against economic liability that comes from doing business as a corporation (Dorothy J. Samuels, 7/2).

The Wall Street Journal: Hooray! The War On Women Is Back
Do Democrats seem livelier than usual this week—more spring in their step, maybe, their cheeks rosier, extra gleam in the eye? Verily, the Supreme Court has liberated them to unleash their gender and other identity-politics grievances in an election year. Democrats claim to be distraught over the Court's Hobby Lobby decision, but really they can barely suppress their glee. Allowing some religious objectors in business to opt out of the contraception mandate lends them a campaign theme that isn't the economy, the Middle East in flames or incompetent governance. No agenda, no problem. Patriarchs and Republicans—if that's not redundant—are coming for your womb, ladies (7/2).

The Washington Post: Supreme Court Reveals Its Class Bias
It’s not often that social and corporate conservatives come together, but the five right-of-center justices on the Supreme Court fashioned exactly this synthesis in their Hobby Lobby decision this week. In a religious freedom case related to birth control, the majority focused on the liberties of the company’s owners, not of those who work for them (E.J. Dionne Jr., 7/2).

The Washington Post: The High Court Highlights The Problem Of The Middleman
Conservatives are hailing the Supreme Court’s 5 to 4 rulings in Burwell v. Hobby Lobby and Harris v. Quinn as victories for liberty, religious in the former case and associational in the latter. Liberals say what the decisions have in common is the obliteration of worker rights. I agree that the cases teach a similar lesson but would summarize it differently: Oh, what a tangled web we weave when first we channel government-subsidized social benefits through corporations and unions (Charles Lane, 7/2).

New England Journal of Medicine: When Religious Freedom Clashes With Access To Care
At the tail end of this year's Supreme Court term, religious freedom came into sharp conflict with the government's interest in providing affordable access to health care. In a consolidated opinion in Burwell v. Hobby Lobby Stores and Conestoga Wood Specialties Corp. v. Burwell (collectively known as Hobby Lobby) delivered on June 30, the Court sided with religious freedom, highlighting the limitations of our employment-based health insurance system (I. Glenn Cohen, Holly Fernandez Lynch and Gregory D. Curfman, 7/2).

Bloomberg: Answers To All Your Hobby Lobby Questions
But Hobby Lobby invests in companies that make birth control! They don't have a problem with IUDs when they can turn a profit, apparently! I don't blame you for saying this, because everyone else who read that somewhat overwrought Mother Jones article seems to have gotten the same impression. However.What Hobby Lobby does is outsource its 401(k) to a company that provides mutual funds; those mutual funds invest in companies that make birth control. There are all manner of reasonable distinctions here (Megan McArdle, 7/2).

The Chicago Sun-Times: Illinois Can Fight Court's Bad Health Care Ruling
The Supreme Court majority got it wrong. No one — not a boss and not a stranger on the street — should prevent a woman from exercising her constitutional right to make a private medical decision. The decision to use birth control is an individual one. And a prescription for birth-control bills can be written for a host of health care reasons, from acne to pre-menstrual cramps or endometriosis migraines. These health care decisions should be based on the individual’s personal religious beliefs and what is best for her health and her family (Sheila Simon, 7/2).

And on other health issues -

The Wall Street Journal: How Automatic Renewal Could Cost Obamacare Enrollees
The administration no doubt views auto-enrollment as a way to minimize what even a supporter of the health-care law called the "massive technological challenge" associated with redetermining eligibility. But as The Wall Street Journal reported two weeks ago, the lowest-cost plans for 2014 have recorded some of the highest enrollments this year—and have proposed large increases for 2015. Unless millions of individuals switch plans, they could be in for some nasty spikes in their out-of-pocket premium costs come Jan. 1 (Chris Jacobs, 7/2). 

The New York Times: The Dispute Over Annual Pelvic Exams
Two major medical groups have taken opposing positions on whether healthy, low-risk women with no symptoms should have an annual pelvic exam. The American College of Physicians, the largest organization of physicians who practice internal medicine, strongly advised against the exams, which many women find distasteful or painful. The American College of Obstetricians and Gynecologists, the leading group of specialists providing health care for women, immediately reiterated its support for yearly pelvic exams for asymptomatic adult women. The exams at issue are not the Pap smears used to detect cervical cancers. ... Oddly enough, both professional groups agree there is no credible scientific evidence that the annual pelvic examinations save lives. They simply disagree over whether that lack of evidence matters much (7/2).

The New York Times: Jay Nixon Vetoes A Terrible Abortion Bill
Gov. Jay Nixon of Missouri vetoed an extreme measure on Wednesday that would have tripled his state’s existing mandatory waiting period for women seeking an abortion, to 72-hours. In so doing he provided an example of principled leadership in defense of women’s reproductive rights — currently under unprecedented assault — and bolstered supporters of those rights in his state and across the country (Dorothy J. Samuels, 7/2).

Los Angeles Times: Beware The Rush To Help People Die
The Medical Society of New Jersey, the state's largest physicians group, opposed a recently tabled bill for physician-assisted suicide. But it is pushing an alternative that may be just as bad: the Practitioner's Orders for Life-Sustaining Treatment, or POLST. POLST is a legally binding form with medical instructions that other healthcare providers, such as paramedics and nursing home staff, must follow if the patient is unable to speak because of illness. It gives more specific instructions than a living will or advance directive, and is said to be more effective because it comes from — and is signed by — a medical authority, such as the patient's doctor (Ben Mattlin, 7/2).

WBUR: Time To Lift The Black Box Warning On Antidepressants
In 2004, the Food and Drug Administration made the difficult decision to apply a “black box” warning to virtually all antidepressant medications. A few months earlier, British health officials had issued a similar warning for paroxetine, or Paxil, a frequently used antidepressant. Both the United States and the United Kingdom were worried about the possibility of antidepressant use in some people causing an increase in agitated, and even suicidal, behavior. The warnings, still in effect, apply particularly to adolescents. But recent research suggests that perhaps the black box warning should itself have a black box warning (Steve Schlozman and Gene Beresin, 7/2). 

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