TIME Innovation

Five Best Ideas of the Day: August 27

1. A reimagined NATO – with rapid response capability – could balance the Putin doctrine.

By David Francis in Foreign Policy

2. Hold the bucket: Focusing on a single disease isn’t a good use of philanthropy dollars.

By Felix Salmon in Slate

3. The Navy’s audacious plan for a new warfighting vessel was too good to be true. The result is a ship that meets none of our needs well. Cancel the Littoral Combat Ship.

By William D. Hartung and Jacob Marx at the Center for International Policy

4. The conventional wisdom is that social media stimulates debate, but self-censorship online actually leads to a ‘spiral of silence.’

By Keith Hampton, Lee Rainie, Weixu Lu, Maria Dwyer, Inyoung Shin and Kristen Purcell at the Pew Research Internet Project

5. Better living through design: Injectable, long-acting birth control will revolutionize family planning in the developing world.

By Heather Hansman in Pacific Standard

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

MONEY Health Care

How Some Insurers Still Avoid Covering Contraception

Locked up birth control pills
Nicholas Eveleigh—Getty Images

Under health reform, your birth control should be fully paid for by insurance. But even before the Supreme Court gave more employers an out, some insurers have been pushing back.

How much leeway do employers and insurers have in deciding whether they’ll cover contraceptives without charge and in determining which methods make the cut?

Not much, as it turns out, but that hasn’t stopped some from trying.

Kaiser Health News readers still write in regularly describing battles they’re waging to get the birth control coverage they’re entitled to.

In one of those messages recently, a woman said her insurer denied free coverage for the NuvaRing. This small plastic device, which is inserted into the vagina, works for three weeks at a time by releasing hormones similar to those used by birth control pills. She said her insurer told her she would be responsible for her contraceptive expenses unless she chooses an oral generic birth control pill. The NuvaRing costs between $15 and $80 a month, according to Planned Parenthood.

Under the health law, health plans have to cover the full range of FDA-approved birth control methods without any cost sharing by women, unless the plan falls into a limited number of categories that are excluded, either because it’s grandfathered under the law or it’s for is a religious employer or house of worship. Following the recent Supreme Court decision in the Hobby Lobby case, some private employers that have religious objections to providing birth control coverage as a free preventive benefit will also be excused from the requirement.

In addition, the federal government has given plans some flexibility by allowing them to use “reasonable medical management techniques” to keep their costs under control. So if there is both a generic and a brand-name version of a birth-control pill available, for example, a plan could decide to cover only the generic version without cost to the patient.

As for the NuvaRing, even though they may use the same hormones, the pill and the ring are different methods of birth control. As an official from the federal Department of Health and Human Services said in an email, “The pill, the ring and the patch are different types of hormonal methods … It is not permissible to cover only the pill, but not the ring or the patch.”

Guidance from the federal government clearly states that the full range of FDA-approved methods of birth control must be covered as a preventive benefit without cost sharing. That includes birth control pills, the ring or patch, intrauterine devices and sterilization, among others.

But despite federal guidance, “we’ve seen this happen, plenty,” says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive health research and education organization. “Clearly insurance companies think things are ambiguous enough that they can get away with it.”

If you are denied coverage, your defense is to appeal the decision, and get your state insurance department involved.

“The state has the right and responsibility to enforce this law,” says Sonfield.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

More on the Affordable Care Act and contraception coverage:

 

 

 

 

 

TIME Cancer

Recent Birth-Control-Pill Use Linked With Breast-Cancer Risk

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Birth control pills Raymond Forbes—Getty Images/age fotostock RM

But only pills containing high-dose estrogen

Oral contraceptives and an increased risk for breast cancer have been linked in the past, but now researchers have made the link again, showing women who recently used birth control pills with high-dose estrogen have an increased risk for breast cancer compared to women using other versions.

The researchers looked at pharmaceutical oral contraceptive records and prescriptions of 1,102 women diagnosed with breast cancer and and 21,952 controls. Compared to women who formerly used birth control pills or never used them, the risk for breast cancer was increased by about 50% for women who did. The researchers note that the highest risk was for high estrogen—and there was no risk found for low-dose pills. The study is published in the journal Cancer Research, under the American Association for Cancer Research.

The researchers stress that caution is needed when interpreting their findings. “Given that these results have not yet been confirmed, and the importance of assessing the many established benefits of oral contraceptives as well as the risks, we are not able to give any clinical recommendations based on this study,” says study author Elisabeth F. Beaber, a staff scientist in the Public Health Services Division of Fred Hutchinson Cancer Research Center. “It’s an intriguing finding, but there really do need be larger studies with larger sample sizes in different populations to really confirm if these results hold up.”

The formulations of oral contraceptives have changed over the years, and in fact, Beaber says that in general that there are few high dose estrogens formulations on the market. In their study, among the controls, less than 1% filled a prescription for a high-estrogen pills.

For now, the study is a call for further research. With prior evidence, the National Cancer Institute says that evidence shows their might be an increased risk for breast cancer, especially younger women, but that their risk returns to normal after 10 years of discontinued use. Women using oral contraceptives are shown to have a lower risk of ovarian and endometrial cancer. You can learn more about the link between oral contraceptives and cancer.

TIME Religion

Pro-Life Nurse Sues Family Planning Clinic for Hiring Discrimination

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Birth control pills Raymond Forbes—age fotostock RM/Getty Images

She said she would not prescribe birth control

PatheosLogo_Blue

This article originally appeared on Patheos.

We have a new frontrunner in the race for dumbest Christian Right lawsuit.

Sara Hellwege, a pro-life nurse, applied for a job at Tampa Family Health Centers (in Florida) this past April. TFHC is a Title X clinic, meaning they’re all about things like family planning, contraception, and birth control.

So when Hellwege mentioned her affiliation with the “American Association of Pro-Life Obstetricians and Gynecologists” in her resume, the interviewer (Chad Lindsey) asked her if that would be a problem since, you know, conservative Christians + birth control = crazytown.

Hellwege said she couldn’t prescribe birth control since, in her unscientific mind, it caused abortions. Lindsey, knowing that all of the job openings involved prescribing birth control, told her there were no other positions available and that there was no reason to proceed with the interview process.

So she’s suing him.

I repeat: She’s suing him because he’s not hiring her for a job she refuses to do.

It makes as much sense as a vegetarian suing Taco Bell for not hiring him even though he told the manager he couldn’t be near meat.

The misnamed Alliance Defending Freedom reiterated the whole misunderstanding about how birth control works while completely ignoring the job description:

Willingness to commit an abortion cannot be a litmus test for employment,” added ADF Senior Counsel Steven H. Aden. “All we are asking is for the health center to obey the law and not make a nurse’s employment contingent upon giving up her respect for life.”

I know we’re talking about birth control, and most forms of birth control are not abortifacients, but let’s roll with it for a second. If the job involves helping women obtain abortions, and you don’t want to help women obtain abortions for whatever reason, go find another job. Hellwege can’t do the very thing they need her to do.

No one owes her a job when she refuses to do it.

Maybe I should apply for an attorney position at ADF. My own sincere beliefs prevent me from defending Christians who have martyr complexes, but screw it. ADF owes me a paycheck.

Gregory M. Lipper of Americans United for Separation of Church and State put it simply: “Even after Hobby Lobby, this lawsuit retires the trophy for chutzpah.”

Hemant Mehta is the chair of Foundation Beyond Belief and a high school math teacher in the suburbs of Chicago. His latest book is called The Young Atheist’s Survival Guide.

Read more from Patheos:

TIME Birth Control

The Future of Birth Control: Remote Control Fertility

Birth Control Choices
Birth Control Choices Jenny Swanson—Getty Images

This startup hopes to give women ultimate control over their contraceptive device

We may be just years away from the longest-lasting and most hassle-free contraceptive ever invented.

The Bill and Melinda Gates Foundation has announced that it is backing a Massachusetts biotech company that is developing an implantable contraceptive that can be activated and deactivated by the user, the MIT Technology Review reports.

Current contraceptive implants—inserted into a woman’s upper arm where they release the hormone progestin—last about three years and are the size of a matchstick. MicroCHIPS Inc. is building a wireless device that is only 20 millimeters long and that would last 16 years. The chip, which would lie under the skin in the buttocks, upper arm or abdomen, slowly releases levonorgestrel, a hormone used in some types of the Pill, in some types of hormonal IUDs and in Plan B.

If the chip works as intended, women could “deactivate” their birth control without a trip to the doctor, which can be a major barrier for women who don’t have easy access to health care, such as in the developing world. The chip’s long lifespan would also minimize doctor’s visits: Currently no type of hormonal birth control lasts longer than five years. The non-hormonal copper IUD lasts 12. (Read more about IUDs here.)

The device is currently being tested for safety, efficacy and security. MicroCHIPS hopes to introduce the product, which would need FDA approval to be used in the United States, in 2018.

[MIT Technology Review]

TIME politics

The Only Controversy About Birth Control Is That We’re Still Fighting for It

Supreme Court Issues Rulings, Including Hobby Lobby ACA Contraception Mandate Case
Supportes of employer-paid birth control rally in front of the Supreme Court before the decision in Burwell v. Hobby Lobby Stores was announced June 30, 2014 in Washington, DC. Chip Somodevilla—Getty Images

Decisions about women’s health are being made, yet again, by judges and politicians who will never need to use birth control.

On Monday, the Supreme Court ruled that it’s better to be a corporation than a woman in America. In a devastating ruling, the Court gave CEOs of some closely held profit-making corporations the right to deny their employees coverage for birth control because of the CEO’s personal objections – even if those objections are not supported by science or medicine.

The Court’s ruling has unleashed an outcry from people across the country who are incredulous that decisions about women’s health are being made – yet again – by judges and politicians who will never need to use birth control. This decision — by five male Justices — opens the door for corporations to interfere in the private health decisions of their employees, who happen to be women. Both the Hobby Lobby ruling and the recent decision striking down protections for women entering healthcare centers that provide abortion reflect a staggering lack of awareness of what women have to go through to get health care. It’s no coincidence that all three women on the Court signed the dissent, which spoke to the realities of women’s lives and sounded an alarm. As Ruth Bader Ginsburg wrote, the Court “has entered a minefield.”

The decision in favor of Hobby Lobby and Conestoga Wood Specialties sets a dangerous new legal precedent treating some, perhaps all, for-profit corporations as if they were people, fully capable of expressing deeply held religious beliefs. The result? Some corporate owners have been given a free pass from following the law if they claim that doing so violates their religious beliefs – allowing them to enjoy both the legal protections of being a corporation and the privileges of being a person.

It’s unbelievable that in 2014, we’re still fighting for access to birth control – but we are. Ninety-nine percent of women in this country have used birth control at some point in their lives, including 98% of Catholic women. For millions of women in this country, the only thing controversial about birth control is the fact that we’re still fighting to have this basic health care covered by insurance – especially given the overwhelming evidence that birth control, when used correctly, has a host of health and medical benefits. It can help relieve painful menstrual cramps, avert infertility by addressing the symptoms of endometriosis, and – shockingly – prevent unintended pregnancy.

Birth control is only a social issue if you’ve never had to pay for it. Many women pay an average of $600 a year — and sometimes much more — for contraceptives. A 2010 survey found that more than one-third of women voters have struggled to afford prescription birth control at some point in their lives – but when they have access to it, they can support themselves financially, complete their education, and plan their families and have children when they are ready. It’s good for women, it’s good for families, and it’s good for this country.

Here’s the good news: Despite the Supreme Court, the birth control benefit of the Affordable Care Act remains in place. More than 30 million women already have access to this benefit, and in its first full year, women saved an incredible $483 million more on birth control prescriptions than they did the year before. This is the biggest step forward for women in a generation.

The real consequence of this ruling is that it invites “closely held corporations” to pick and choose what methods of birth control are covered by insurance. Far from a narrow ruling, the Court’s decision affects enormous for-profit companies employing thousands of women and more than half of the workforce in this country. This is unacceptable, and we have heard from members of Congress, the White House, and numerous medical groups including the American College of Obstetricians and Gynecologists, the American Medical Association, the American College of Physicians, the American Academy of Pediatrics, and the American Nurses Association—all of whom are fighting alongside Planned Parenthood to make sure that women have access to affordable birth control. We’re working with women’s health champions in Congress to ensure they protect and expand women’s access to no-copay birth control, and we encourage companies to do the right thing and provide women full birth control coverage. And we’ll take this fight to the ballot box in November, showing women across the country where candidates in their state stand on their access to birth control.

Meanwhile, our #JointheDissent campaign lit up the social media landscape, with nearly 6 million people seeing and sharing our campaign information with their friends on Facebook in the first day alone. Even if the Supreme Court doesn’t understand what’s at stake for women, Americans around the country do.

The bottom line: Our health care decisions are not our bosses’ business – and neither is our use of birth control, for any reason. That we even need to argue this point is incredible – but politicians, corporations and the Court need to hear from women.

Cecile Richards is the president of Planned Parenthood Action Fund.

TIME politics

5 Things Women Need to Know About the Hobby Lobby Ruling

Obamacare Contraceptive Rule To Be Decided On By Supreme Court
Activists who support the Affordable Care Act's employer contraceptive mandate demonstrate outside of the U.S. Supreme Court in Washington, D.C., U.S., on Monday, June 30, 2014. Bloomberg—Bloomberg via Getty Images

What the Supreme Court's ruling on contraception means for women

On Monday, the Supreme Court ruled in a 5-4 decision that the government cannot require certain employers to provide insurance coverage for birth control if they conflict with the employer’s religious beliefs. The ruling on Burwell v. Hobby Lobby Stores, Inc. is not only a blow to the Affordable Care Act but also, critics argue, to women’s rights.

Here’s what women need to know:

1. If you work at certain types of for-profit companies, they no longer have to cover the cost of any contraception that they say violates their religious beliefs

The Affordable Care Act (a.k.a. Obamacare) requires most health insurance plans to cover birth control without cost-sharing. Without healthcare coverage, the pill can cost about $25 a month and an IUD (intrauterine device) can cost up to $900 (though it’s inserted once and lasts up to 12 years).

Before the ruling, houses of worship were already exempt from the birth control insurance mandate. Non-profit organizations with religious affiliations, like Catholic colleges and hospitals, have to inform the insurer if they object to contraceptives, and the insurer is then responsible for figuring out a way to guarantee contraceptive coverage for the workers without the company using its premiums to pay for it.

The privately-owned corporation Hobby Lobby, an Oklahoma-based craft store with self-described Christian values, argued that they too should not have to cover certain emergency contraception because of their religious beliefs. The company objected to paying for emergency contraception including Plan B, Ella—both commonly known as the morning after pill—plus two types of IUDs. Hobby Lobby said they believe these types of birth control amount to abortion. The company did not object to covering other types of contraception, including birth control pills.

The Supreme Court ruled in favor of Hobby Lobby, but the ruling applies only to companies considered “closely held.” According to the IRS, a company is “closely held” if five or fewer people own more than half the corporation. Closely held firms make up over 90% of all American businesses, and about 52% of the American workforce works for a closely held corporation, according to studies from Columbia University and New York University. The Affordable Care Act, however, only requires employers with 50 or more employees to provide health insurance to workers, so many “closely held” firms are already exempt.

Justice Samuel Alito suggested in his ruling that the Health and Human Services (HHS) department could extend the accommodations that they have in place for religious non-profits to these for-profit companies so the insurer would provide birth control without charging the company. However, both religious groups and women’s rights groups think this would be insufficient. Some religious non-profits have alleged that these accommodations still infringe on their religious beliefs and are suing the federal government. And advocates at the Women’s National Law Center have said companies should be required to provide contraception as a basic healthcare need. The Obama administration may need to come up with a an alternative way to provide coverage, but it’s unclear what those options would be or how difficult they would be for consumers to access.

2. All three female Justices dissented, arguing that this ruling limits women’s rights

Justice Ruth Bader Ginsburg wrote the dissenting opinion and was joined by Justice Sonia Sotomayor, Justice Elena Kagan and Justice Stephen Breyer (the only male justice who dissented). “The exemption sought by Hobby Lobby and Conestoga would…deny legions of women who do not hold their employers’ beliefs access to contraceptive coverage,” Ginsburg wrote. “Religious organizations exist to foster the interests of persons subscribing to the same religious faith. Not so of for-profit corporations. Workers who sustain the operations of those corporations commonly are not drawn from one religious community,” she continued.

Ginsburg notes that an IUD without coverage costs a month’s pay for minimum-wage workers. And critics of the ruling say that because a federal work around hasn’t been developed yet, many of the women who currently work for places like Hobby Lobby have lost easy access to key family planning options and the most most effective type of birth control. Even after the gap is filled, it still may be cumbersome to acquire birth control. While some women are able to choose their place of employment taking health care into consideration, because of geography and economic restrictions, that’s not possible for all women.

(Read the entire opinion and dissent here.)

3. The ruling may depress use of IUDs at some privately held corporations that deem it a form of emergency contraception

Health groups have begun to lobby for an increased use of IUDs. The IUD has a failure rate of less than one pregnancy per 100 women in a year, better than both the pill (9 pregnancies per 100 women per year) and condoms (18 pregnancies per 100 women per year), according to the CDC. Despite all these benefits, just 9% of women in America use it—the lowest of any developed country. (By comparison, 23% of women in France and 41% of women in China use IUDs.) It’s just starting to gain traction in America: Planned Parenthood reports a 75% increase in use since 2008.

Today’s decision, which gives certain companies the option of not covering the IUD among other types of contraception, arguably undermines gains made in IUD usage. The IUD can also be used as emergency contraception if it is inserted five days after intercourse, hence the Hobby Lobby’s objection to it and not birth control pills.

This isn’t the way most women use the IUD: many gynecologists will only schedule an appointment for IUD insertion until after a woman gets her period that month so as to ensure she’s not pregnant. Some will even perform an ultrasound. There are no statistics on how many women use the IUD as an emergency contraceptive method instead of alternate methods like the “morning after” pills, but James Trussell—a Princeton Professor who has done extensive research on the topic—told TIME’s Sarah Begley, “I would say that the number [of women] who get IUDs as emergency contraception is miniscule.”

The fallout from today’s ruling could be that some women who work companies that refuse to cover the IUD may be discouraged from using this effective birth control method by additional costs they may incur or the complications of finding supplemental insurance.

4. Women’s rights groups are angry because they see the ruling as a loss of autonomy for women

Some women’s rights advocates have taken the argument even further than Ginsburg did. Up until this point the Religious Freedom Restoration Act (RFRA) has been interpreted as a protection for individuals’ religious practices—not those of corporations. The Supreme Court just said that these protections also extend to for-profit companies, but didn’t protect a woman’s right to choose her method of birth control. Thus, many critics argue, the Supreme Court decided that corporations are people, but women are not. Women’s rights groups say restricting insurance coverage for some types of contraception, or making coverage more difficult to obtain, undermines access to birth control in general and point to studies that have shown that offering greater access to contraception—rather than restricting it—leads to fewer unintended pregnancies and thus reduces the number of abortions by 75 percent annually.

5. Under the ruling, some corporations could attempt to refuse coverage for other, non-contraceptive medications and procedures citing their religious beliefs

As Ginsburg writes in her dissent, “Would the exemption…extend to employers with religiously grounded objections to blood transfusions (Jehovah’s Witnesses); antidepressants (Scientologists); medications derived from pigs, including anesthesia, intravenous fluids, and pills coated with gelatin (certain Muslims, Jews, and Hindus); and vaccinations?”

In the majority opinion written by Justice Alito, he specifies that the ruling applies only to the contraceptive mandate, and states that it should not be understood to include to other insurance mandates, like those for blood transfusions or vaccinations. But Ginsburg notes that even if the Alito exclusion holds, there are other issues: “Approving some religious claims while deeming others unworthy of accommodation could be ‘perceived as favoring one religion over another,’ the very risk the [Constitution's] Establishment Clause was designed to preclude,” said Ginsburg.

 

TIME politics

Hobby Lobby Ruling Is a Win for Separation of Church and State

Supreme Court Rules In Favor Of Hobby Lobby In ACA Contraception Case
Sister Caroline attends a rally with other supporters of religious freedom to praise the Supreme Court's decision in the Hobby Lobby, contraception coverage requirement case on June 30, 2014 in Chicago, Illinois. Scott Olson—Getty Images

The Supreme Court decision will be good for all Americans, including those who disagree strongly with it now.

The Hobby Lobby victory in the United States Supreme Court Monday has broad implications for religious liberty, many of them I’ve discussed elsewhere. But one aspect some might miss is that in this case the Court upheld the principle of separation of church and state.

In his majority opinion, Justice Samuel Alito addressed the question of whether the Green family (owners of Hobby Lobby) and the Hahn family (owners of Conestoga Wood Specialties) have a reasonable case to believe that paying for the drugs and devices at issue would be immoral. He noted that the families believe that paying for these things would mean potentially empowering the destruction of a fertilized embryo and would thus be immoral. He then noted that the question here is one the courts, in his words, “have no business addressing.

“This belief implicates a difficult and important question of religion and moral philosophy, namely, the circumstances under which it is wrong for a person to perform an act that is innocent in itself but that has the effect of enabling or facilitating the commission of an immoral act by another,” he writes. “Arrogating the authority to a binding national answer to this religious and philosophical question, HHS and the principal dissent in effect tell the plaintiffs that their beliefs are flawed. For good reason, we have repeatedly refused to take such a step.”

In the case syllabus, the majority points to the moral and theological questions involved and writes: “It is not for the Court to say that the religious beliefs of the plaintiffs are mistaken or unreasonable.”

I say “Amen” to that. There are many reasons why this decision will be good for all Americans, including those who disagree strongly with it now, but one reason is found in the court’s refusal to play theological referee.

“Separation of church and state” is a fairly partisan phrase these days, since it has come to be equated with the “naked public square” of secularization. Many, quite wrongly, use the phrase to suggest that believers ought to place their religious convictions in a blind trust when they leave their churches or synagogues or mosques to go out into the marketplace or the voting booth.

But the phrase didn’t start with the secularizers. It’s a principle held by very orthodox believers, especially in the Baptist tradition, who wanted the government out of dictating doctrine. The early Baptists and their allies understood that a government in the business of running the church, or claiming the church as a mascot of the state, invariably persecutes and drives out genuine religion.

The American Civil Liberties Union didn’t invent the separation of church and state. Jesus did, when he said that we should render unto Caesar that which is Caesar’s and render unto God that which is God’s (Matt. 22:21). And many who use the phrase “church/state separation” actually believe in just the opposite—a church dominated by the state and a state empowered to tell believers what they ought to believe and why.

The Left often demonizes those with strongly held religious convictions as, by definition, theocrats who want to take over the government. This is hardly the case. Hobby Lobby didn’t start this skirmish with the government. The families involved have no interest in what sorts of contraceptive plans are in other companies’ benefits packages.

They want simply the freedom not to be compelled to submit to the government’s morality lesson. Moreover, they want the freedom for the government not to tell them, theologically, what they ought to care about when they stand before the judgment seat of Christ.

As they did earlier in the Greece v. Galloway prayer case, the Court has declared its competence to decide constitutional law but its incompetence to try to, as we Christians would put it, rightly divide the Word of Truth. That’s good news, and good news for everybody.

In the meantime, it ought to prompt those of us on the more conservative and religious side of the spectrum to reclaim the name for what we’ve always believed: the separation of church and state. It’s a good old phrase that’s been highjacked by the Left for long enough.

Dr. Russell Moore is president of the Ethics & Religious Liberty Commission of the Southern Baptist Convention.

TIME politics

The Supreme Court Ruled in Favor of Patriarchy, Not Democracy

Supreme Court Issues Rulings, Including Hobby Lobby ACA Contraception Mandate Case
Supporters of employer-paid birth control rally in front of the Supreme Court before the decision in Burwell v. Hobby Lobby Stores was announced June 30, 2014 in Washington, DC. Chip Somodevilla—Getty Images

The Hobby Lobby decision displays the profound depth of religious and male norms that deny women autonomy and the right to control our own reproduction.

On Monday morning, the Supreme Court delivered a severe blow to women in the United States when it ruled that “closely-held” corporations, such as Hobby Lobby, can refuse to provide insurance coverage for birth control based on owners’ religious beliefs. Liberal Justices Stephen Breyer, Elena Kagan and Sonia Sotomayor partially joined Justice Ruth Bader Ginsberg in a 35-page dissent against the majority decision of the five conservative, male justices.

That the Court ruled this way should surprise no one. What should surprise, however, is the continued expectation that we overlook patriarchal religious fundamentalism, its collusion with constitutional “originalism” and its discriminatory expression in our political system.

Most analyses of this case will parse the law and, in doing so, make no challenges to two fundamental assumptions: 1) that the law and the Court are both “neutral” to begin with and 2) that we should not question the closely held religious beliefs of judges and politicians, even when those beliefs discriminate openly against women. This is a judgment. And judgments come from norms. And norms are based on people’s preferences. The Court is made up of people who have beliefs, implicitly or explicitly expressed.

In the practice of many religions, girls’ and women’s relationship to the divine are mediated, in strictly binary terms, by men: their speech, their ways of being and their judgments. Women’s behavior, especially sexual, is policed in ways that consolidate male power. It is impossible to be, in this particular case, a conservative Christian, without accepting and perpetuating the subordination of women to male rule. It is also blatant in “official” Catholicism, Mormonism, Evangelical Protestantism, Orthodox Judaism and Islam.

The fundamental psychology of these ideas, of religious male governance, does not exist in a silo, isolated from family structures, public life or political organization. It certainly does not exist separately from our Supreme Court. Antonin Scalia, for example, makes no bones about his conscientious commitment to conservative Catholic ideals in his personal life and the seriousness of their impact on his work as a judge. There are many Catholics who reject these views, but he is not among them. These beliefs include those having to do with non-procreational sex, women’s roles, reproduction, sexuality, birth control and abortion. The fact that Scalia may be brilliant, and may have convinced himself that his opinions are a matter of reason and not faith, is irrelevant.

What is not irrelevant is that we are supposed to hold in abeyance any substantive concerns about the role that these beliefs, and their expression in our law, play in the distribution of justice and rights. They are centrally and critically important to women’s freedom, and we ignore this fact at our continued peril.

Ninety-nine percent of sexually active women will use birth control at some point in their lives. The Court’s decision displays the profound depth of patriarchal norms that deny women autonomy and the right to control our own reproduction—norms that privilege people’s “religious consciences” over women’s choices about our own bodies, the welfare of our families, our financial security and our equal right to freedom from the imposition of our employers’ religious beliefs. What this court just did was, once again, make women’s bodies, needs and experiences “exceptions” to normatively male ones. This religious qualifier was narrowly construed to address just this belief and not others, such as prohibitions on vaccines or transfusions. It is not a coincidence that all three female members of the Court and only one man of six dissented from this opinion.

While there are hundreds of bills and laws regulating women’s rights to control their own reproduction, I’m not aware, after much looking, of any that similarly constrain men or tax them unduly for their decisions. As a matter of fact, we live in a country where more than half of our states give rapists the right to sue for custody of children born of their raping and forcible insemination of women. Insurance coverage continues to include medical services and products that help men control their reproduction and enhance their sexual lives.

As Ginsburg outlined in her dissent, the costs that this decision will accrue to women are substantive. The argument that employers shouldn’t pay for things they don’t believe in is vacuous. Insurance benefits are part of compensation. Even if you reject that notion, it is clear that we all pay for things we don’t like or believe in through our taxes and, for employers, through insurance. That’s how insurance and taxes work—except when it comes to women and their bodies. That’s sexism.

That we live with patriarchy is evident. That this dominance is and always has been the opposite of democracy is not to most people. SCOTUS’ decision is shameful for its segregation of women’s health issues and its denial that what should be valued as “closely held” in our society is a woman’s right to make her own reproductive decisions. American women’s equality continues to be undermined by the privileging of religion in public discourse.

Soraya Chemaly is a media critic and feminist writer whose work focuses on the role of gender and sexualized violence in culture, politics, religion and free speech. You can find her at @schemaly.

TIME health

#ReligiousFreedom v. #NotMyBossBusiness: SCOTUS Contraception Ruling Ignites Hashtag War

The ruling set off a "hashtag battle" between #religiousfreedom and #notmybossbusiness

The Supreme Court Monday decided in favor of the arts-and-crafts chain Hobby Lobby, ruling that “closely held corporations” could refuse to cover employee contraception methods on religious grounds. And the Twitterverse had some thoughts on that. (For a fuller explanation on the ruling and its implications, see my colleague Kate Pickert’s piece.)

In true Twitter showdown fashion, the decision set off a “hashtag battle” between #religiousfreedom and #notmybossbusiness. Conservative politicians and court observers alike used the former to applaud the five justices who made the majority decision labeling it a victory for religious freedom. They also preemptively called out any attempts from the left, specifically Obama, to interfere with the Court’s ruling. Meanwhile, more liberal members of Congress as well as abortion rights groups used the hashtag #notmybossbusiness to flood the social network with responses of disappointment or shock and demand legislative action to cover all forms of contraception.

A selection of both sides—from Paul Ryan to Planned Parenthood—is below:

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