Elizabeth Nolan Brown is a Washington, D.C.-based Staff Editor for the libertarian magazine Reason, where she covers politics, gender issues, reproductive rights, food and drug policy, Gen Y, and digital culture. She was previously a writer and editor for the women's health blog Blisstree.com, a blogger for feminist site Bustle, and a news editor and web producer for AARP.
Blogging for AARP, Ms. Brown's coverage of Alzheimer’s and dementia earned her a spot on ShareCare’s list of the “Top 10 Online Influencers” in Alzheimer’s issues. She has ghostwritten about disease and nutrition for the medical community and her writing has also appeared places such as The Huffington Post, Fox News, San Francisco Chronicle, and Well + Good. She has been a guest on radio programs including the BBC World Service's "Business Matters" and is hosting an upcoming web series for the Association of Libertarian Feminists. Ms. Brown has an M.A. in strategic communication from American University, a B.F.A. in theater from Ohio University, and a nutrition certificate from Cornell University.
A self-professed atheist and a former Catholic, Ms. Brown has opposed the Obamacare essential services mandate, arguing in articles that birth control pills should be available over-the-counter rather than as costly prescriptions that burden third parties and limit women’s reproductive freedom. On July 3, I spoke with Ms. Brown by telephone about the recent Hobby Lobby ruling and the Obamacare mandate. The following transcript of that interview has been edited for clarity and length.
As an atheist, how did you feel about the Supreme Court’s ruling in the Hobby Lobby case?
I was very supportive of that ruling. I think they did a really good job of balancing the interests there. As an atheist, obviously, I still support freedom of religion in this country. That’s why I think it was a good decision for religious freedom, and even if you are not a religious person, you can respect that.
Although the ruling exempted for-profit businesses and individual employers from paying for specific forms of contraception, it did not affect non-profits. Do you believe Catholic parishes, schools, and charities should have to pay for contraception under their employee health plans?
No, I don’t, and from a libertarian perspective I’m against the essential benefits mandate in general because it says a company that provides health insurance must provide a specified list of services. I don’t think it’s appropriate for the federal government to be telling private or non-profit corporations what services they must provide for their employees, whether it’s contraception or anything else.
What about the Obama Administration’s proposed accommodation that the church’s health insurers should pay for contraceptive services, rather than the non-profits paying for them directly. Should insurers have to pay for these services?
I don’t think they should. I think it’s a strange goal to say that everyone should have some sort of subsidized contraception. Under any sort of accommodation, it sounds like some third party is going to be paying extra to subsidize the coverage, whether it’s the government or the insurers. I guess I just don’t understand how it is a legitimate goal of government to make sure that employee health coverage for birth control is subsidized.
Many people do see the essential services mandate as an “either-or” obligation for some institution — either the government, or the church's non-profits, or the insurers — to subsidize contraception under employee health plans. Are there any reasonable alternatives we’re not hearing about?
Well, a lot of libertarians have been questioning why most forms of birth control are prescription-only to begin with. It’s not totally apt in this case, because the forms of birth control that Hobby Lobby resisted are Plan B emergency contraception — which is already available over-the-counter, without a prescription — and the IUD which you need to go to a doctor to have medically inserted. But that’s kind of beside the point because people are talking as if the Hobby Lobby case involves all forms of birth control.
The regular birth control pill is not available over-the-counter right now, and we wouldn’t need to have so many of these fights if women could just get what works for them at Walgreens or CVS or Target. One of the biggest reasons women stop taking their pills regularly is that they do have to go to a doctor for a prescription. If they run out, they have to go back every year. If they have a problem and need to switch brands, they have to go back again. And that’s time off work, and that’s an insurance co-payment. Or if you don’t have insurance, that’s paying a doctor’s bill every time. That certainly makes it a lot harder to actually stick to being on the regular pill and to taking it in a way that’s best designed to prevent pregnancy. On the other hand, if it was available over-the-counter, then people would have easier access and maybe less need to take emergency contraception. I think emergency contraception is great, but it can be more expensive, and it's more controversial to people such as the owners of Hobby Lobby because it could possibly prevent implantation of a fertilized egg.
In a recent article, you pointed out the irony that the only three national politicians you could find in public support of over-the-counter birth control pills were male Republicans: Rep. Cory Gardner of Colorado, Gov. Bobby Jindal of Louisiana — who is Catholic — and Gabriel Gomez, the 2013 GOP nominee for U.S. Senate in Massachusetts. How would selling birth control pills over-the-counter benefit both sides of the HHS mandate debate?
All three of those men are totally anti-abortion, but I think what they’re saying is a very sensible approach, which is that in order to cut down on the number of abortions it helps that people have better access to preventing pregnancy in the first place. So that’s one reason why I think these pro-life Republicans are supporting it. Also, if you have birth control available where anyone can buy it without a prescription, then you don’t see religious employers and other entities being so much on the hook for covering it — because coverage isn’t as important when people don’t need that coverage in order to access it.
But I think it’s really interesting that you see this ideological breakdown, because I really looked and I couldn’t find any Democrats or women politicians at the national level pushing over-the-counter birth control. And I think that’s because it’s become such a politicized topic that Democratic politicians are much more likely to want to use the Hobby Lobby case to promote Obamacare and the idea that there’s a war on women. Talking about why birth control isn’t available over-the-counter doesn’t exactly help that narrative, and maybe that’s why you don’t see much of that.
So you’re saying over-the-counter birth control would satisfy both religious and non-religious concerns?
Right, because religious people wouldn’t feel like they had to be a part of it at all. What’s very strange, though, is that you do see a lot of people who should support over-the-counter birth control arguing against it because they worry about costs being entirely out of pocket rather than through insurance co-payments. That’s kind of an insane way to look at it, like you’re pretending insurance isn’t something you’re paying for anyway. Birth control pills would actually be pretty cheap in a variety of over-the-counter brands rather than as something you can only buy with a doctor’s prescription.
Who benefits financially from making birth control pills a prescription service that burdens health care providers?
Both doctors and the pharmaceutical companies do. When I’ve written about this and interviewed a lot of people, this is the answer I get from almost everybody. Obviously, pharmaceutical companies can charge more if third parties are paying for it than if they have to compete in the marketplace with their particular brands of pills. Also, doctors can use prescriptions to basically extort visits out of women, telling them they have to come every year to get their pack of birth control pills. A lot of gynecologists have even said “women won’t come in to see us every year if we don’t do that,” but that’s no justification to trick women into going to the doctor by manufacturing a need.
A lot of people have reduced the HHS mandate to a religious issue, seeing it as a question of whether Christian employers should have to pay for contraceptives and abortifacients. Do you see it that way?
I think contraception is only one part of a larger slate of things that all insurers are being forced to cover under the provisions of ACA, and that’s not a religious issue. There are many things they are being forced to cover which have no religious connotations at all. I think the real issue is that we’re seeing the government stepping in to tell private companies what they must do for their employees, what they must pay for, how they must run their business, and what benefits they must provide. That issue is leaning towards the religious aspect of the equation right now, but I still think the real problem with this essential services mandate is broader than the issue of contraception.
So what’s the deeper principle at stake here?
The deeper principle at stake is the questions you see in our country about Obamacare as a whole. Does the federal government have the authority to do any of these things, to tell private businesses that they have to provide certain services, to tell private people that they have to buy insurance? That’s the larger issue we should be talking about. How much can the government require people to do in the service of public health?
Any other thoughts?
When we determine that certain people or groups can be exempted from generally-applicable laws on grounds of freedom of religion or conscience, it questions the need for those laws in the first place. If we’re allowing people to be exempted because of religion, maybe those laws weren’t such a good or necessary thing. So there is a whole broader conversation about religious freedom and what that says about certain laws in our society, but that conversation isn’t happening right now because people are so hung up on paying for contraception versus not paying for it — which is only a small part of this issue.
So it’s possible to have objections to the essential services mandate that are not based on religion or on the particular issue of paying for contraception?
Right. Actually, a health food company called Eden Organic is part of one of the lawsuits against the contraception mandate, and its owner said he doesn’t have an issue with contraception but just doesn’t want the government telling him what to provide his employees in general. A lot of people don’t care about birth control, but they’re opposed to the government telling them what to include in their insurance policies. When more of these insurance mandate cases start getting attention, I think you’ll see more of a broader perspective than just religious opposition.
Sean Salai, S.J., is a summer editorial intern at America.