Hobby Lobby Carve Outs.

It's not in my nature to celebrate my victories loudly or prematurely. I come from a clan that waits until the baby is viable to announce a pregnancy... just in case. We don't take for granted that a healthy birth is imminent, until the baby is safely delivered. I don't start celebrating my home team's victory in the final minutes, when there's still game to be played. Realistic like that.

Contrary to what you perhaps might think reading me here, I'm not cocky about success and I really don't blow my own horn.

For that reason, I would caution those who are stamping the Affordable Care Act a resounding success: there are still too many unknowns unaddressed.

Particularly disappointing to me: the mandate to be covered with health insurance necessarily does not cover undocumented newcomers -- those who presumably would need the preventative services and basic health care needs for growing children and families the most.

I think we politically should have put our issues in proper order:
1) Legally, what is a family? We have a variety of definitions in the states now, but how can you implement an insurance program -- mandate participation -- if we haven't first defined "dependents" under the insurance policy, and worked to equalize family treatment for both same-sex and opposite-sex families?

I would have waited to introduce a nationwide healthcare program, mandating participation, until there was better equality in addressing who was paying in for whom. Point blank: people with uncovered family members are not likely to be supportive of paying "extras" for those families currently recognized under the law as more legitimate and more deserving of benefits.

2) Immigration reform and securing the border.
It's really a farce to pretend that the progressive elite liberals who are anti-vaccine are the ones spoiling the herd immunity defense, when we have so many potentially uncovered and thus unvaccinated newcomers living, working and studying alongside us.

No one should leave the border detention centers until they have the basic vaccine protections, some of which require multiple injections timed over months. Before you call me a racist, consider: do you think unvaccinated children coming from rural countrysides will be susceptible to unknown diseases introduced into their systems as they travel the hemispheres, likely settling in crowded urban environments?

I'd like to see every single person -- documented and undocumented -- eligible for the basic preventative services the ACA demands. If we truly are all in this together in terms of public health, it does no one any good to pretend that basic medical service are being provided, and encouraged, to all. Open your eyes and see the need.

3) Then healthcare reform.
Put the players -- all the players -- in the game before you go announcing the new rules and pricetags. Don't assume that having health insurance is the same as having good health. Many of the newcomers from rural areas in other countries ARE healthy and do not rely on modernized medical care to treat routine health needs. If the genetic stock is strong, and often in young rural families it is, there is often need only for catastrophic -- or maternity -- care in the first 30 or 40 years.

People can and have practiced caution with their health for centuries: preventative maintenance in terms of healthy and simple diet choices, as well as not having the temptations for harming their health that more affluent younger people might have (sedentary lives, fast cars, cigarette and beer money, multiple sexual contacts of short duration).

Finally, before we celebrate the success of the ACA in its present form, consider the carve outs that the Hobby Lobby decision promises. (I know, I know, I read the opinion: The justices in the majority say they limited the extent of potential religious exemptions and carve-outs: don't you believe them.)

Among the many questions raised by the Supreme Court’s ruling in Burwell v. Hobby Lobby is how sweeping its legacy will be. Supporters of the decision have insisted that the ruling is “narrow,” as it explicitly addresses “closely held” corporations objecting to four specific types of birth control—including IUDs and Plan B—because the business’ owners consider them (inaccurately) to cause abortion. Besides, the Court argued, the government can just fill any coverage gaps itself, and it’s only women whom corporations are now permitted to discriminate against. “Our decision in these cases is concerned solely with the contraceptive mandate,” claimed Justice Samuel Alito, writing for the majority. “Our decision should not be understood to hold that an insurance-coverage mandate must necessarily fall if it conflicts with an employers’ religious beliefs.”

Bullshit, is essentially what Justice Ruth Bader Ginsburg had to say about the majority’s claim to have issued a limited ruling. In her dissent, Ginsburg deemed it “a decision of startling breadth.” She noted that “‘closely held’ is not synonymous with ‘small’,” citing corporations like Cargill, which employs 140,000 workers. Even more alarming is the majority’s endorsement of the idea that corporations can hold religious beliefs that warrant protection under the Religious Freedom Restoration Act.

In fact, it only took a day for the Court’s “narrow” decision to start to crack open. On Tuesday, the Court indicated that its ruling applies to for-profit employers who object to all twenty forms of birth control included in the Affordable Care Act’s contraceptive mandate, not just the four methods at issue in the two cases decided on Monday.
...
In light of its ruling on Hobby Lobby and a related suit, the Supreme Court ordered three appeals courts to reconsider cases in which they had rejected challenges from corporations that object to providing insurance that covers any contraceptive services at all. The plaintiffs in all three cases are Catholics who own businesses in the Midwest, including Michigan-based organic food company Eden Foods. Meanwhile, the High Court declined to review petitions from the government seeking to overturn lower court rulings that upheld religiously based challenges to all preventative services under the mandate.
...
Business owners now have a new basis for trying to evade anti-discrimination laws and their responsibilities to their employees. Religious liberty is already the rallying cry for conservatives looking for a legal way to discriminate against LGBT Americans; other business owners have tried to use religion to justify opposition to minimum-wage laws and Social Security taxes. Faith groups are already trying to capitalize on the Hobby Lobby decision out of court; on Wednesday, a group of religious leaders asked the Obama administration for an exemption from a forthcoming federal order barring federal contractors from discrimination on the basis of sexual orientation or gender identity.

I don't think Justice Samuel Alito's words are of comfort to many whose very existence is in conflict with some extremists' religious beliefs. The Court will have to draw a line somewhere on this slippery downwards slope. These extreme religious views, I believe, are indeed sincerely held. (Science says a fertilized egg not yet implanted in the uterus is not yet a fetus, or a developing child, before implantation. Their religious beliefs tell them otherwise.) You can only appease others so much and give deference to their personal beliefs before you run afoul of the Constitutionally protected rights of other citizens, whose religions, scientific beliefs, and personal moral codes teach otherwise in terms of public policy.

Let's close, then, with a question posed last year to Dr. Ezekiel "Zeke" Emanual, a champion of the ACA and brother to Democratic politician Rahm:

Q. How big a problem will it be if Hobby Lobby wins its Supreme Court case, and employers are able to carve out exemptions from the health law based on religious views?

A. I think this opens a huge can of worms as to what anyone’s religion is or what the religious dictates are, and how those connect with health services. There are lots of religions that don’t believe in circumcision — we’re not paying for circumcision. Or, we don’t believe in premarital sex, so we’re not going to cover the cervical cancer treatment, because the only way you get it is through premarital sex. My religion doesn’t like smoking – all right, we’re not paying for emphysema care or lung cancer care. Where is the end of this?