MONEY, SEX, AND RELIGION:
THE SUPREME COURT’S ACA SEQUEL
The Supreme Court decision in the Hobby Lobby case is in many ways a sequel to the Court’s 2012 decision on the constitutionality of the Affordable Care Act (ACA). Like the 2012 case, the decision was decided by a 5-to-4 vote, but in the initial ACA decision, Chief Justice John Roberts acted to “save” the ACA. The choice facing the Court in the Hobby Lobby case was whether to favor the exercise of religion by for-profit corporations over the federal government’s attempt to create a uniform set of health care insurance benefits. The majority decision, written by Justice Samuel Alito, granting for-profit companies an unprecedented right to impose their religious views on employees, is a setback for both the ACA’s foundational goal of access to universal health care and for women’s health care specifically the Court’s ruling can also be viewed as a direct consequence of our fragmented health care system, in which fundamental duties are incrementally delegated and imposed on a range of public and private actors.
Our systemic reliance on health insurance that is based on private employment provokes just this sort of clash between public and private values. Our incremental, fragmented, and incomplete health insurance system means that different Americans have different access to health care on the basis of their income, employment status, age, and sex. The decision of Hobby Lobby unravels only one more thread, perhaps, but it tugs on a quilt that is already inequitable and uneven. A central goal of the ACA was to repair some of this incremental fragmentation by universalizing certain basic health care entitlements. In ruling in favor of idiosyncratic religious claims over such universality, the Court has once again expressed its disagreement with this foundational health-policy goal.