Religous Liberty, Politics and Women’s Health Care

MS. DIANE REHM

10:06:56
Thanks for joining us. I'm Diane Rehm. Some say it's an assault on religious liberty. Others call it a war on women. The issue of whether women should have easy access to affordable contraceptive services has become the latest sticking point. Religious liberty and women's health. Joining me to talk about the issue and its political implications, Barry Lynn of Americans United for Separation of Church and State, Anthony Picarello of the U.S. Conference of Catholic Bishops, Laura Meckler of The Wall Street Journal, and Sarah Brown of the National Campaign to Prevent Teen and Unwanted Pregnancy.

MS. DIANE REHM

10:07:46
I realize that this is a very controversial issue. I'll be interested to hear your comments and questions. Join us on 800-433-8850. Send us your email to drshow@wamu.org. Join us on Facebook or Twitter. And good morning to all of you.

MS. LAURA MECKLER

10:08:12
Good morning.

MR. ANTHONY PICARELLO

10:08:13
Good morning, Diane.

MR. BARRY LYNN

10:08:13
Good morning.

MS. SARAH BROWN

10:08:13
Good morning, Diane.

REHM

10:08:14
Laura Meckler, let me start with you. Tell us what the White House said yesterday -- or, as we know, David Axelrod is a spokesperson for President Obama on this. Tell us what that step was yesterday.

MECKLER

10:08:35
Well, yesterday, David Axelrod, who's a senior adviser, senior strategist for the Obama re-election campaign, said that the White House would be looking for a way to try to satisfy both sides of the issue, going forward on this controversial decision to require that almost all employers offer free contraception and that there was a narrow exception for churches, but not a broader exception for organizations that are affiliated with religious organizations, such as universities or hospitals that have religious ties.

MECKLER

10:09:03
Those people objected very strongly to many of them -- I should say objected very strongly to this, to this decision. And so what David Axelrod says, well, we're going to try to -- there's a year-long delay in implementing the rule for those groups, so they said, well, we're going to try to find a way to accommodate the concerns. But I think we should also note that the White House was very clear that they were not looking for a rollback. They said that all women who work for these employers would have access to free contraception.

MECKLER

10:09:34
So the question that was raised was, is there a way to try to, you know, split the baby somehow, find a -- so to speak, find a way to accommodate the concerns perhaps by selling that as a rider, as a separate policy that would cover contraception? So those are -- it's a little bit complicated, but they are looking for a way out.

REHM

10:09:56
Laura Meckler of The Wall Street Journal. Turning to you, Anthony Picarello, talk about, first, why so many Roman Catholic institutions objected to the president's ruling and then your reaction to David Axelrod's comments yesterday.

PICARELLO

10:10:17
Sure. Thanks, Diane. Basically, what's happened is the health care reform law provides for preventive services. That includes preventive services for women. The idea is to get out ahead of diseases with prevention, things like mammograms. That was actually what was discussed most prominently in the debate. That's the kind of thing that the Catholic bishops strongly support. The problem here, though, is that, within that mandate, there has been included now stuff that doesn't prevent disease but instead prevents pregnancy or people.

PICARELLO

10:10:47
And that's given rise to a lot of objection on the policy grounds. But really, the biggest uproar has been over the fact that there is now a legal compulsion for Catholic institutions, not just universities and hospitals, but also charities, those who serve others -- and precisely because they serve others, that's why they fall outside the exemption -- that they have to provide that kind of coverage to all their employees, even over their religious objection. And that government compulsion is what's giving rise to the religious liberty problem.

REHM

10:11:14
And your reaction to David Axelrod's comments?

PICARELLO

10:11:18
Well, my reaction is basically, you know, the way to fix the problem is to fix the policy. I mean, there's a lot of talk about trying to work this through and so forth over the one year. But if the one year is simply, as we've been told, just to provide more time for full compliance with the current policy, then that's not accommodation at all. What we need is a change in the policy. That's the only way we'll get an (word?) of the concerns.

REHM

10:11:43
Anthony Picarello. He's general counsel to the U.S. Conference of Catholic Bishops. Barry Lynn, what is the history of exempting religious institutions from state and federal laws?

LYNN

10:12:02
There are an enormous number of exceptions already built in, Diane, in the federal law. In just a review a few years ago by The New York Times, they found in the last 15 years prior to the study, there were over 200 exceptions and exemptions placed into federal law that only exempt religious institutions. But, unfortunately, 200 is not enough. Now, we find very powerful groups, including the Roman Catholic Church, interested in finding more and more excuses, more and more efforts to convince people that corporations have a conscience.

LYNN

10:12:38
To me, the real clash here is between the assertion that there is a corporate conscience on the part of the Roman Catholic Church or some evangelical churches that might run a hospital and the more important religious liberty interest of the individual conscience of women to make a choice, as they would always have under this plan, to either use insurance coverage for birth control or reject it. That's the conscience that really ought to matter here.

REHM

10:13:04
Barry Lynn. He's executive director of Americans United for Separation of Church and State. And to you, Sarah Brown, the question becomes, should we be surprised that this issue over birth control measures for young women, older women at religious institutions should become so controversial?

BROWN

10:13:38
You know, Diane, I've been working in this area since 1968. And I don't recall a time where it has been as contentious as it is now. And so, you know, as one of the older people in the room, I sort of see this over a long period of time, and I'm very puzzled by it. You know, this issue that we're talking about -- contraception, birth control -- is not a trivial matter. It's an enormously important preventive health service for women.

BROWN

10:14:07
Very recently, the CDC referred to it as one of the 10 greatest public health advances of the last century. On a par with immunizations, sanitation, clean air and water, this is major. And it has ramifications, and I think some of us almost forget because it's kind of been on the scene for so long.

REHM

10:14:27
Such as?

BROWN

10:14:28
Well, I mean, among other things, contraception helps to reduce maternal mortality. It improves the lives and health of children because of child spacing. It is a major way to approach endometriosis, uterine fibroids, anemia, bleeding. But, more importantly, really, it's allowed all of us women to participate fully in education and the U.S. workforce. So anything that threatens women's access to it is a very serious blow.

REHM

10:15:01
Sarah Brown, CEO of The National Campaign to Prevent Teen and Unwanted Pregnancy. The question, Laura Meckler, is, does this policy stop at birth control issues?

MECKLER

10:15:21
Well, this policy specifically only regards birth control. If -- I mean, if you're referring to the larger debate, obviously, there are very contentious debates over abortion.

REHM

10:15:31
Of course.

MECKLER

10:15:31
And where you -- whenever you're talking about birth control, you're kind of a hop, skip and a jump away from abortion. And that is extremely controversial of -- you know, we may get to it later -- another very controversial thing around Planned Parenthood, which kind of brings together birth control, abortion and -- other women's health, so...

REHM

10:15:48
But I want to understand where this ruling stops.

MECKLER

10:15:54
Well, this ruling does not require institutions to pay for abortion services, if that's what you're asking. I mean, there's no mandate for that, so -- and if there was, I think it would be a lot more controversial than even we see now with contraception.

REHM

10:16:10
Anthony Picarello.

PICARELLO

10:16:11
Yeah, well, there are a couple of things. There's a factual point here to begin with, which is that this mandate specifically includes sterilization, so it's not just limited to contraception. And on top of that, various -- of the FDA approved devices and drugs for contraception include things that have abortifacient qualities, such as the IUD, such as the newly-approved drug Ella.

PICARELLO

10:16:34
But the other thing is this -- and this is, I think, perhaps what's behind Diane's point -- the principle of religious liberty that's at stake is the same, regardless of whether the controversial issue happens to be abortion, contraception or whatever it might be. It's Catholic's beliefs today, someone else's beliefs tomorrow. And, in fact, abortion -- a mandate to cover abortion is on the docket right now before the Washington State Legislature. It came out basically right around the time this decision...

REHM

10:16:58
But it's not part of this particular ruling.

PICARELLO

10:17:04
That's correct. But if the principle is established and maintains, then that will be permitted. And, again, we already have abortifacient drugs.

REHM

10:17:09
OK. I want to go back to your reference to an IUD.

PICARELLO

10:17:14
Mm hmm.

REHM

10:17:14
How is that...

PICARELLO

10:17:17
My understanding -- and I'm not particularly expert in this area -- but my understanding is that an IUD -- part of the way it operates is that it tends to prevent implantation. It disrupts the implantation process. And if you understand abortion to occur by disruption of a pregnancy beginning at conception, then it has abortifacient qualities. But, again, the broader principle is, if it's morally objectionable and you're still forced to subsidize, to sponsor, then the door is open. The legal groundwork is laid for things that perhaps might be of more popular concern than contraception.

REHM

10:17:50
Laura Meckler.

MECKLER

10:17:51
And I think we're -- the interesting thing about this debate is that it takes place on two different levels. There's broad support for contraception in this country, even among Catholic women. You know, the vast majority of Catholic women say in services -- in surveys that they've used contraception. But there's also an underlying sort of philosophical point, which I think Anthony is getting to, which is sort of the principle. Do -- can government force a religious organization to pay for something that it finds morally objectionable?

REHM

10:18:18
Laura Meckler of The Wall Street Journal. We'll take a short break here. When we come back, we'll talk further, take your calls, your comments. Stay with us.

REHM

10:20:04
And welcome back. We are talking about the administration's decision on the distribution or access to birth control, birth control information to be provided not only by secular institutions, but religious ones as well, excluding churches but including Roman Catholic colleges, charitable foundations and so on. Here with me, Barry Lynn, executive director of the Americans United for Church and State. (sic) Barry Lynn, people who are opposed to this decision are calling it an attack on religious freedom. Help me to understand your view of that.

LYNN

10:21:05
Yeah, and I think this is an enormous stretch of the idea of religious freedom. Religious freedom is, can you wear a yarmulke when you're serving in the Air Force? I mean, we have been on the side of religious freedom and freedom of expression. The problem with the principle that Anthony just talked about, that kind of corporate conscience that allows an employer to make decisions for all the employees, including -- might be thousands of employees in a big hospital, most of whom have no connection to the Roman Catholic Church.

LYNN

10:21:35
I don't like to speculate about what people might do next. I like to tell people what they've already said they want to do next. David Stevens is the CEO of a group called the Christian Medical Association. He believes that one of the problems with this rule now is that it should be expanded not just to Catholic hospitals or other big institutions, but that individual employers should be allowed to say, no coverage of contraceptions for their individual employees.

LYNN

10:22:07
In other words, allowing the employer at the bookbinding store or the grocery store to say, we -- I do not believe in birth control, and I am going to refuse insurance coverage for any of my employees who might want it because I -- my rights, my claim of religious freedom trumps that of my employees. This is absolutely shocking. We're talking about trumping already, in Anthony's model, the rights of individual women who are parking attendants, cafeteria workers, nurses or physicians at what is nominally a Catholic hospital, but it serves the whole community.

LYNN

10:22:46
It gets federal funding, lots of it. It provides a public function. But in this case, Anthony says, but they don't have to abide by the law of confirmation, of coverage of contraception.

REHM

10:22:58
Anthony.

PICARELLO

10:23:00
Barry is describing a slippery slope at which we are already apparently at the dread bottom. In other words, all this alleged chaos that he's describing is a situation that currently obtains now, which is where employers are free to negotiate with their insurance companies and get the coverage that they want for their employees and not the coverage that they don't want. There are some state mandates, but those are much more easily avoidable than this kind of more nearly airtight HHS mandate.

PICARELLO

10:23:27
You know, freedom runs rampant, and that freedom has allowed not just employers to have freedom, but individual employees because the result has been that nine out 10 employer plans already provide for contraception. So it's widely available in society. It's widely available in health insurance. And what we are dealing with here is not birth control but control. It's about the government forcing institutions to go that extra mile, the last mile, as it were, between 90 percent and 100 percent.

REHM

10:23:54
Sarah Brown.

BROWN

10:23:55
Well, I mean, we've been talking here now about sort of the respective rights of a particular religion and how it should be managed. But I think it's absolutely critical to also talk about the rights of women as distinct from these institutional issues. Remember, it's women who get pregnant, bear children and often carry most of the responsibility for rearing them. So my view -- and I think a lot of other people feel this way -- is we need to give as much attention to meeting the needs of women as to meeting the needs of a particular religion.

BROWN

10:24:24
So what that translates into is something like protecting religious doctrine. And freedom should be matched by equal and intense attention to protecting the women who may be harmed by religious freedom. And that is a very, very important aspect of this. If these women are denied coverage, they are put out then into the community to find contraceptive services at the same time that the U.S. Congress is entertaining serious proposals to cut back public funding for contraceptive services in the community.

BROWN

10:24:56
These women are not eligible for Medicaid. Remember, they have jobs in these institutions. And so the question is, where are they going to get care? Health departments are already overwhelmed with patients. And we can't just say, well, you can't get it here, but just good luck out there. So whatever the resolution of this is, it has to be focused on individual women in the chaotic U.S. health care system.

REHM

10:25:19
Laura Meckler.

MECKLER

10:25:20
I just think one thing to keep mind, though, about what Sarah just said is that, under current law, there's no mandate that anybody provide contraceptive services, much less free contraceptive services, and people have found ways to get them. Now, that's not to say there isn't a case to be made for why we should make it easier for people to get them, but the people do find ways right now.

BROWN

10:25:41
And Laura's absolutely right about that. But if the new law of the land under the Affordable Care Act and with the advice of the Institute of Medicine is that contraception is defined as a preventive service and therefore free to women, we will create a new class of women who are being discriminated against if they are not able to access that new provision.

REHM

10:26:01
And that's the very effort I want to get at with you, Barry Lynn. How does this current effort compare to other efforts carving out civil liberties in the past?

LYNN

10:26:19
Well, I think this is an enormous new claim because this is a claim, as I said earlier, of a kind of corporate conscience that trumps all the time, would trump the rights of individual women who work at the hospital.

LYNN

10:26:32
By the way, if you're talking about a big hospital, there's nothing in the regulations that prohibits a Catholic hospital from putting up on the bulletin board, along with the employment discrimination law package from the Department of Labor, a statement that says, although we cover contraceptives in your health care plan, we, the leadership of this hospital -- you can say, we and God believe you shouldn't take advantage of them. There's nothing that stops an institution from trying to make that moral case, so-called moral case.

LYNN

10:27:03
But the way Anthony and some of the critics of this policy describe it, it's as if we are having dissolved birth control pills in the water cooler. That is not what this is about. This is about women making an individual choice about this kind of medical intervention in the same way they would choose anything else within the cafeteria of available services, medications and devices.

REHM

10:27:26
Anthony.

PICARELLO

10:27:27
What stops the situation that Barry described is right. It's not a law that prevents that. It's their institutional integrity that prevents that. Basically, if that were the rule, then institutions, religious institutions, would be forced to practice other than they preach. They would be forced to be hypocrites and fakers. They could teach one thing, but then they'd be sponsoring and paying exactly the opposite, which destroys their credibility on the question, and that's part of the First Amendment interest that's an issue here.

PICARELLO

10:27:55
The other thing that Barry mentioned several times -- I want to come back to it -- he's made reference derisively, I think, to what he refers to some sort of institutional conscience. But, of course, the Supreme Court has recently recognized, by a 9-0 vote, that religious organizations deserve "special solicitude" under the religions clauses of the First Amendment precisely because of these questions of institutional integrity.

PICARELLO

10:28:18
If religious institutions can control, how it is that they manage themselves, including things like employer policy such as this? Then basically -- and if, in turn, the government can control it, then whoever picks the messenger picks the message. And over time, that erodes the message and undermines the independence of those institutions from the state.

LYNN

10:28:36
Black case, really.

REHM

10:28:37
Laura Meckler, here's an email from Chris, who says, "I recall hearing on your program during the health care debate Julie Rovner saying insurance companies want to cover contraceptives and abortions because they are less expensive than pregnancy. Is there any lobbying going on about this? Secondly, do any of your guests know if religious organizations cover erectile dysfunction drugs? If they cover that, they really need to cover contraceptives." Anthony.

PICARELLO

10:29:21
I'm not aware about the precise policies. Those vary from place to place.

REHM

10:29:25
You don't know. Is that what you're saying?

PICARELLO

10:29:27
Yeah. I mean, they may or may not. You know, the question here, I think, is about, you know, of the freedom of those institutions to do things that are not inconsistent with their religious beliefs. There maybe some that object to providing that as a matter of their religious commitments, and they should be free to exclude those things just as well. And it's just -- again, it's the same principle applied in a different context.

REHM

10:29:47
Barry.

LYNN

10:29:48
See, that's exactly what I'm worried about, the same principle applied in a different context. If a Catholic hospital, for example -- let's stop at the beginning of life. Let's turn to the end of life. If a Catholic hospital, based on an interpretation of Catholic doctrine -- I realize there are different interpretations -- says, you know, we don't care if somebody signs a do not resuscitate order, we're not going to abide by the patient's wishes.

LYNN

10:30:10
We're going to do every single thing possible, after that heart attack, to bring that patient back. If any decisions made in a living will run counter, for example, to Catholic doctrine, under Anthony's theory, the hospital or the insurance company would be able to say, well, you know, we're not going to allow that decision to be made. And I think that puts patients last, corporate interest first, and that's the wrong balance of equities in a case like this.

REHM

10:30:38
Laura.

MECKLER

10:30:40
Well, there's a lot in what, I think, in what Barry just said there. I'm not sure if he was saying that...

REHM

10:30:47
Focus on the birth control issue.

MECKLER

10:30:50
Yeah. OK. Well, let's go back to what the questioner asked about insurance companies. And it is true that it's -- you can buy a lot of birth control pills for the cost of one childbirth. And insurance companies do have an interest in this. However, it should be noted that they could have been offering them for free all along, and they have been charging co-pays, you know, for many, many years.

MECKLER

10:31:11
So -- but, yes, I haven't heard of any specific lobbying around from insurance companies around this particular rule. But it is true that -- and in Hawaii, that's one of the ways they get around this particular dilemma, is that the insurance companies are essentially willing to offer this coverage for free so that the religious institutions are not really paying for anything.

REHM

10:31:31
I see. Go ahead, Sarah.

BROWN

10:31:34
Diane, earlier you raised the issue of sort of how does abortion play into all of this? And my own view is that this really all -- is all an argument about abortion. Anthony spoke earlier, for example, about some theories about how certain contraceptive methods work, which, incidentally, is not supported by developmental biologists or the Institute of Medicine or most medical experts. But I think the core concept is this: If we all are so upset about abortion, as I believe this conversation is all about, one of the few ways we know about how to reduce abortion is through the widespread use of contraception.

BROWN

10:32:09
And so I ask people always, you may be uncomfortable about contraception, but aren't you more uncomfortable about abortion in this country? This is the way forward. Prevention is through contraception, not through these endless arguments about control and religious doctrine and so forth. And there's international experience, as well as domestic experience, that backs that up.

REHM

10:32:32
How politically dangerous is this issue for President Obama, Laura Meckler?

MECKLER

10:32:40
You know, I think it's a little more dangerous than they expected it to be. They knew that this would be controversial, but this has really become, certainly, an uproar over the last several days. They -- and that's why we see comments like David Axelrod's trying to say that we're looking for a way to work this out, whether -- you know, whether what that results in or not, in the end, we'll see.

MECKLER

10:33:01
But, you know, Catholic voters marginally, by a small margin, supported President Obama in the last election. They tend to be a swing vote. But I think beyond the impact of any individual Catholic voters is sort of the fact that this is dominating the debate, and it's giving an opening for Republicans. Mitt Romney said that President Obama was conducting an assault on religious liberty. And, you know, it's just a distraction.

REHM

10:33:26
Laura Meckler. And you're listening to "The Diane Rehm Show." We have many callers. Let's open the phones now, 800-433-8850. First to St. Louis, Mo. Good morning, Amy. You're on the air.

AMY

10:33:47
Hi, Diane. Thanks for letting me call in. I have a question or a comment, rather, that there's many religious beliefs in the country that are going to limit the health care choices that individuals make. For example, Jehovah's Witnesses might refuse blood transfusion. And when it comes to end-of-life care, there's tremendous variation in individual consciences in terms of what decisions they're going to make.

AMY

10:34:22
And it's very interesting to me that in none of those other situations are we proposing that your employer has the right to micromanage your health care according to their religious beliefs. It's only when you're dealing with part of the body that belongs exclusively to women that there's even a controversy that your employer should be able to make those decisions for you.

REHM

10:34:55
What do you say to that, Anthony?

PICARELLO

10:34:57
Yeah. Well, that's actually not an accurate statement of what's in the health care reform law. That law includes accommodations for Christian Scientists, for people who have beliefs about spiritual healing. There's -- there are different sorts of accommodations, just not here and just not with respect to an area where freedom has resulted in the allocation that people want. Employers who want to provide this provide it.

PICARELLO

10:35:20
Employees who want to work for employers who provide it go and work for those employee -- employers. If they would rather work for the employer that doesn't want to do it and buy it on their own, they can do that, too. That's how freedom works, and everybody wins there. It maximizes freedom.

REHM

10:35:35
At the same time, I wonder how many people read the fine print when they take on a job that they may desperately need to have. For example, at a Catholic hospital, a janitor, someone who cleans the toilets, someone who works perhaps even in the operating room who may not be Roman Catholic...

PICARELLO

10:36:08
Yeah.

REHM

10:36:09
...but who desperately needs that job.

PICARELLO

10:36:13
Yeah. Well, Diane, generally the print is not that fine in the sense that there's a big crucifix hanging over the door, and it's a Catholic institution. And many people know what the Catholic Church stands for on these issues, and so it's what we lawyers might call coming to the nuisance. Or it's -- another example might be...

REHM

10:36:28
So you're saying they just shouldn't take the job...

PICARELLO

10:36:31
Well…

REHM

10:36:32
…because they should know.

PICARELLO

10:36:34
They have 90 percent of employers out there that are offering this in their coverage. They also have salaries that they can use to buy what is widely available and cheaply available contraception. And so that's one scenario, and compare that to the scenario where you have the federal government coming in and telling religious institutions that they must sponsor and subsidize something that violates their religious beliefs. And you compare those two scenarios.

REHM

10:36:54
Sarah Brown.

BROWN

10:36:57
Well, I think Anthony is focusing on the rights of the Catholic institution, its structure, its health insurance plans as it wishes. But what's left out of this is what do we do for the women who then are thrown out of the system when they seek contraception? It is not cheap. The average cost to women is about $600 a year. And for the better methods, it could be even more than that. The question is, are we going to give equal attention to making these women whole? And we can't do it in a way that's bureaucratic and separate pieces of paper and different requirements. It has to be seamless and smooth.

REHM

10:37:31
Sarah Brown. She's CEO of The National Campaign to Prevent Teen and Unwanted Pregnancy. Short break. We'll be right back.

REHM

10:40:04
And welcome back. Lest we forget, the Susan G. Komen Foundation seem to be part of this whole controversy when it announced, Laura Meckler, that it would no longer be providing grants to Planned Parenthood. What happened there? And now the reversal, the resignation of the vice president.

MECKLER

10:40:32
Right. This is sort of a parallel controversy that was happening at the same time. The Susan -- there's been, in recent years, a lot of controversy around Planned Parenthood because, in addition to the contraception they offer and the cancer screenings that they offer, they also offer abortion services. So they're -- in the anti-abortion movement, there is a big movement against Planned Parenthood, including an attempted congressional investigation.

MECKLER

10:40:56
The Susan G. Komen Foundation, which, of course, is a leading fighter against breast cancer was -- made a very controversial decision to cut off grants for breast cancer screenings to Planned Parenthood. They also, maybe perhaps like the White House, underestimated the response to that, which was tremendous. There was a huge backlash to that among many supporters of the Komen Foundation who had no idea that they would take a position like that and viewed it as highly political.

MECKLER

10:41:24
As you said, the Komen Foundation reversed course after a few days, and the vice president, who was the one who helped promote this decision in the first place and has been on record as against Planned Parenthood and anti-abortion movement, resigned yesterday.

REHM

10:41:42
Anthony, I'd be interested in your reaction to that whole squabble.

PICARELLO

10:41:48
Mm hmm. Sure. Well, it's a little bit outside our bailiwick. But one of the things that's interesting is how it contrasts with the other debate because what you're dealing with is, instead of a church-state conflict, you're dealing with a private-actor, private-actor conflict. And so that doesn't implicate religious liberty issues. One of the other things that it's made me think about is basically, you know, we were talking about some of the politics associated with the decision on the HHS mandate.

PICARELLO

10:42:11
And I can tell you that, for my part, I've been just sort of puzzled at what the political calculus was. And maybe the backlash associated with the Komen decision helps illustrate that in the sense that perhaps the White House was fearing that same kind of intimidation, where you have this massive, massive effort against Komen based on what -- with something in the high hundreds of thousands of its total grants to Planned Parenthood. There was just an extremely strong reaction against Komen. And perhaps the White House is fearing the same thing if it were done.

REHM

10:42:40
But isn't that interesting that Planned Parenthood, which provides abortions as a very small portion of its activity -- I gather it's no more than, what, 3, 4 percent, Laura?

MECKLER

10:42:58
Yes. That's what Planned Parenthood has -- says. Three percent of their services are abortion.

REHM

10:43:02
That that huge uproar over Komen no longer providing that money to Planned Parenthood would get such a huge backlash.

PICARELLO

10:43:17
Yeah. I'm not sure what the percentages are in relation to the overall Planned Parenthood budget, but they...

REHM

10:43:21
But that's what they say.

PICARELLO

10:43:22
Right. But the -- basically, they are the largest provider of abortions in the country, and you have a situation where Komen is doing breast cancer research, a non-controversial thing. And you have, on the other hand, Planned Parenthood, which is doing many controversial things. And I think it was the intersection of those things or the attempt by Komen to sort of sever that and keep themselves into purely non-controversial grounds that got them in trouble.

REHM

10:43:40
Barry.

LYNN

10:43:41
Yeah. No. I think what this Komen-Planned Parenthood issue demonstrates is that a lot of people, a lot of men and women said, wait a minute. If you set up a comprehensive health care system -- and in this case, we're talking in the HHS rule about a comprehensive health insurance system for women -- then it has to be comprehensive. You can't have people opting out of this procedure, that device, this prescription drug for, essentially, religious reasons.

REHM

10:44:07
All right. Here's a tweet. It says, "Here's the solution: Let the institutions do what they want, but eliminate their tax exempt status." How would you feel about that, Barry Lynn?

LYNN

10:44:25
Well, the problem is, in a lot of places, communities don't have public hospitals that meet all the needs of men or women in those communities. This has just happened in Louisville, Ky., for example. Then the tendency is to try to merge with a big Catholic hospital, again, something that was just stopped in Louisville, Ky., at least temporarily. But people don't have the choice to just work anywhere.

LYNN

10:44:47
If you look at the so-called fine print, as in classified ad fine print, in a lot of communities, these somewhat religious or religiously-affiliated employers are the biggest dogs in town. If you want a job, that's where you have to go, whether you're Catholic or Methodist or a non-believer.

REHM

10:45:07
All right. To Palm Beach, Fla., good morning, David. You're on the air.

DAVID

10:45:14
Good morning, Diane, and thank you for the opportunity. My concern is that -- I believe the pollings say that Catholic women, by and large, want contraception and want it to be available. I don't like the idea that the men of the Catholic Church, namely the bishops, are dictating to women how they should live their lives, particularly when the Catholic bishops' history over the last decade has been less than favorable.

DAVID

10:45:43
They're the ones that are, I think, pushing this harder than anyone else, yet they're the ones that turned their backs or closed their eyes to the pedophilia problems within the church. I think Catholic women have a right to -- of choice, and they should be allowed to have it so long as that is what they want. Men should not be dictating to women how to live their lives.

REHM

10:46:05
Anthony.

PICARELLO

10:46:07
Yeah. Basically, the only dictating that's going on here is by the government. No one is forcing anyone to work with a Catholic employer. No one is taking away the freedom that exists to go out and obtain contraception, which is widely available and, indeed, in many forms, cheaply available. And, you know, it just -- it -- every once in a while, it seems that when folks don't like the position the church takes, they just sort of raise the sex abuse scandal. And it's unfortunate when that happens.

PICARELLO

10:46:40
It has nothing to do with what's going on here. What we're dealing here with is a situation involving the government compelling religious institutions to do something over -- against their conscience. Like I said, those are the only people who are being forced.

REHM

10:46:53
Sarah Brown.

BROWN

10:46:54
Well, just back for a minute to the Susan Komen issue that we were discussing earlier. You know, this is partly about abortions -- we've been talking about -- but, please, remember that when the Affordable Care Act was being debated on the Hill, people were afraid to even put in the words contraception or family planning. We have gotten to a place in this country where this fundamental service that has changed the lives of women and men and children around the world has become controversial for reasons that really don't go to the core of the benefit.

BROWN

10:47:28
And with regard to the caller's point, I don't go through life thinking about sort of -- as sort of an angry feminist and they're men doing battle to women. But I have heard so much in the last several months about how many of the principle people taking positions against Planned Parenthood, against contraception, against mammogram, whatever, are men. How many leading women have been taking these positions against contraception?

REHM

10:47:56
And here's an email from Nicole, "What's next? Will Catholic hospitals limit health care to homosexual employees because they do not agree with homosexuality?"

PICARELLO

10:48:12
Oh, gosh. The answer is no. Basically, the church serves everyone based on need, not creed. They provide health insurance to their employees across the board in a manner that's consistent with their principles. The church is strongly opposed to unjust discrimination against people who have a same-sex inclination. And that's not a part of this debate. And it's not something that the church is inclined to do in the first place.

REHM

10:48:39
But hasn't the church called homosexuality sinful?

PICARELLO

10:48:46
It has called homosexual conduct sinful, but that doesn't mean that the church would not basically treat those folks equally in providing benefits that it generally provides to its employees and so forth. There are separate questions that arise when you're asking the church to affirm, either through its benefits or whatever, certain particular conduct. But if you're talking about persons and their own inclinations, everyone is treated equally.

REHM

10:49:10
Barry.

LYNN

10:49:10
Not quite, because I believe the bishops, along with a number of other Protestant, say, right-of-center religious groups, supported a bill passed by the House, probably, in my judgment, thankfully, not to be passed by the Senate, that says in an emergency care situation, if a woman comes into a hospital emergency room and the institution -- not the individual doctor -- but the institution says, you know, we're against abortion, and if we take certain steps, we will take this pregnant woman now in our emergency room and cause an abortion of this fetus, that that hospital -- if this bill were to be passed, that hospital would be able to say, I'm sorry, we simply won't help you.

LYNN

10:49:53
That's something John Boehner supported. The House passed it. And I believe the Catholic bishops have no problem with that all. Talk about treating everybody equally. We're talking about treating women in an emergency situation not equally. That's what troubles me.

REHM

10:50:06
All right. To...

PICARELLO

10:50:07
That's false.

REHM

10:50:09
...Metropolis, Ill. Good morning, Craig. You're on the air.

CRAIG

10:50:14
Yes. Thank you, Diane. The church is not treating men and women equally, and I'm an example of that. I received vasectomy at a Catholic hospital. Vasectomies are birth control. Why is it wrong to provide contraceptives services for men but not women?

REHM

10:50:30
Anthony.

PICARELLO

10:50:31
Yeah. The ethical religious directives that govern Catholic hospitals basically forbid the hospitals from providing sterilizations, and that includes vasectomies. And so if he received it at a Catholic hospital, he shouldn't have.

REHM

10:50:45
So vasectomies are also...

PICARELLO

10:50:47
Yeah. It's not -- again, it doesn't -- it's not relevant to gender. It's relevant to the question of whether the church is going to be made complicit in somebody doing permanent damage in their reproductive system, and the church won't.

REHM

10:50:56
Sarah.

BROWN

10:50:57
But, again, this falls most heavily on women because the vast majority of contraceptive methods are for women. I mean, maybe 20 years from now there'll be an equal number for men and women. And I suspect then this conversation would go differently given the prevalence of male leadership in the opposition.

REHM

10:51:14
All right. To Tallahassee, Fla. Good morning, Martha.

MARTHA

10:51:19
Hi. Good morning. I wanted to bring up a point that -- I agree wholeheartedly with the point made earlier that this is a debate really about abortion close in a debate about contraception. But it's important to view the medicine used in birth control pills, it's not only for birth control. In fact, in the developmentally disabled community -- I have a developmentally disabled daughter -- when our daughters start reaching puberty, we start having to make some very hard decisions about whether we're going to suppress, through, you know, contraceptives, their monthly cycle.

MARTHA

10:52:03
A great many parents opt to give these kids, you know, emerging teens, hysterectomies, which I think is inappropriate. And I've also been counseled by a doctor to undergo -- to have my daughter undergo sterilization treatment. He, incidentally, is a Catholic. I don't know if that makes any difference. But so, you know, I feel like this is a little bigger than just the right -- I mean, it's just a little bigger than women. It's a little bit bigger than abortion. It's all about access to quality medical care that's appropriate for the situation.

BROWN

10:52:40
And, you know, we've even heard case reports of employees in Catholic institutions -- in this case, I'm thinking in a hospital where they were put in the position of having to lie about their condition in order to obtain payment for needed services, to say it was a medical or, in the case of this wonderful caller, a developmental, disabled issue, in order to get the care needed because it was not affordable outside of the health insurance system.

REHM

10:53:07
And you're listening to "The Diane Rehm Show." To San Antonio, Texas. Good morning, Blair.

BLAIR

10:53:17
Good morning, Diane. Thanks for taking my call.

REHM

10:53:19
Surely.

BLAIR

10:53:21
I just wanted to bring up a comment especially relevant with your last caller. From what I understand -- and I'm not Catholic, so maybe this is incorrect. But from what I understand from my Catholic friends is that the problem of birth control is not that it's a form of abortion, that sex should be saved for procreation purposes, and that's where the issue arises, not from abortion. Secondly, though, I wanted to make the comment that I fully support birth control.

BLAIR

10:53:52
I think women should be more than welcome to take it. But I think it's kind of an infringement on freedom of religion to dictate what the Catholic Church can do, considering people have -- I mean, they can choose where they work. They don't have to work for Catholic institutions. And, I mean, if it's a big enough problem and nobody works for them, they would have to change their policies to say -- choose not to the change the policy. I think it's their religious right not to (unintelligible).

REHM

10:54:17
Barry Lynn.

LYNN

10:54:18
Yeah. I mean, I understand the claim, and it's the claim that Anthony is making about this and other matters. But I do think, frankly, that you have to look at the conscientious decisions, the religious liberty interests of the women who are working for these big institutions in particular. Remember, this is already -- Blair, this is already a compromise. This is a compromise that says churches, similarly situated religious institutions, do not have to cover these in their insurance plans.

LYNN

10:54:42
That was the compromise. But to say that this needs to go out to all these other institutions that serve the community and get your tax dollars and mine, as well as tax dollars from other Roman Catholics who may be opposed to contraception, I think, gives it much greater weight than is necessary under the Constitution or wise under any public policy to the institutional conscience over the woman's conscience.

REHM

10:55:05
We talked earlier about Susan G. Komen and the Planned Parenthood effort. Do you believe, Laura Meckler or Sarah Brown, that there is an effort underway to completely defund Planned Parenthood? Laura.

MECKLER

10:55:27
Yes. There's definitely an effort underway. I don't know about completely defund. I think everybody would support individuals making private contributions to Planned Parenthood, but there's certainly an effort to defund public support for Planned Parenthood and in, evidently, institutional, private institutional, like the Komen Foundation. So there has been -- I've definitely noticed, having, you know, paying attention to these issues for a while now, over the last few years, an increased attack on Planned Parenthood.

MECKLER

10:55:55
The reasoning being because of their -- there are other complaints that they have, but the upshot is because they don't like the fact that Planned Parenthood provide so many abortions.

REHM

10:56:03
Sarah.

BROWN

10:56:04
Well, I think Laura's absolutely right. But I also think there is increasing discomfort with public support of contraception in some instances, which is the point I've been making, really, this whole hour. This is a larger conversation about the presence of modern contraception in American life. And if we are going to work very hard to protect religious liberties and so forth, we have to work equally hard to the women who are harmed by those liberties.

REHM

10:56:28
Constitutional liberties versus religious liberties, Barry?

LYNN

10:56:33
Yeah. Well, it's interesting. There are two states, California and New York, that have provisions very similar to the HHS rule. They both have been upheld as constitutional against the very attacks that Anthony's made today.

REHM

10:56:44
Anthony, last word.

PICARELLO

10:56:46
Yeah, basically those exemptions can be gotten around much more easily. The mandates are much broader. The HHS mandate is watertight. This one isn't, so it's more vulnerable to constitutional challenge.

REHM

10:56:56
Anthony Picarello of the U.S. Conference of Catholic Bishops, Barry Lynn of Americans United for Separation of Church and State. He's also the author of "Piety & Politics." Laura Meckler of The Wall Street Journal, Sarah Brown of The National Campaign to Prevent Teen and Unwanted Pregnancy. Thank you all so much.

LYNN

10:57:25
Thank you.

MECKLER

10:57:26
Thank you, Diane.

BROWN

10:57:26
Thank you, Diane.

REHM

10:57:26
And thanks for listening, all. I'm Diane Rehm.
Transcripts of WAMU programs are available for personal use. Transcripts are provided "As Is" without warranties of any kind, either express or implied. WAMU does not warrant that the transcript is error-free. For all WAMU programs, the broadcast audio should be considered the authoritative version. Transcripts are owned by WAMU 88.5 FM American University Radio and are protected by laws in both the United States and international law. You may not sell or modify transcripts or reproduce, display, distribute, or otherwise use the transcript, in whole or in part, in any way for any public or commercial purpose without the express written permission of WAMU. All requests for uses beyond personal and noncommercial use should be referred to (202) 885-1200.

Our address has changed!

The Diane Rehm Show is produced by member-supported WAMU 88.5 in Washington DC.