Will the Hobby Lobby decision allow employers to ignore medical evidence?

July 1, 2014

As stakeholders across the country debate the religious, gender and political implications of the U.S. Supreme Court ruling in favor of Hobby Lobby, one physician advocacy group worries that the decision ignores the practice of evidence-based medicine.

As stakeholders across the country debate the religious, gender and political implications of the U.S. Supreme Court ruling in favor of Hobby Lobby, one physician advocacy group worries that the decision ignores the practice of evidence-based medicine.

The Supreme Court ruled on June 30 that "closely held" for-profit corporations can hold religious objections that allow them to opt out of the requirement to provide no-cost contraceptives for female employees under the Affordable Care Act (ACA). The justices' 5-4 decision is the first time the high court has ruled in favor of for-profit businesses holding religious views under federal law. 

The American College of Physicians (ACP) released a statement concerning the ruling, saying that it could undermine physicians’ authority to treat patients and have adverse affects on women’s health. The ACP states that the decision could lead to challenges of other government mandated, and evidence-based healthcare.

“We have no position or expertise on the legal arguments and precedents involved in the Hobby Lobby case; our expertise is based on the potential impact of the decision on public health, and specifically, the adverse health impacts on the patients seen by the 137,000 internal medicine specialists and medical students who are members of ACP,” David A. Fleming, MD, FACP, president of the ACP said in a written statement. “We are concerned that allowing employers to carve-out exemptions to the ACA’s requirements that health insurance plans cover evidence-based preventive services without cost-sharing, including but not necessarily limited to contraception, will create substantial barriers to patients receiving appropriate medical care as recommended by their physicians.”

Under the ACA, companies with 50 or more employees who offer health coverage that does not include all U.S. Food and Drug Administration (FDA)-approved contraception methods for women without cost-sharing would face fines of up to $100 a day per worker. Large employers not offering coverage would face a fine of $2,000 for most employees. For example, Hobby Lobby would have faced fines of $475 million per year for excluding some forms of birth control from its health coverage. 

As a result of the decision, the companies filing suit-Hobby Lobby Stores and Conestoga Wood Specialties, as well as Hobby Lobby subsidiary Mardel Christian book stores-will not have to offer women employees all FDA-approved contraceptives as part of a package of preventive services required to be offered without copays or deductibles. 

The Christian-based companies object mainly to the emergency contraceptives known as Plan B and Ella, and two types of intrauterine devices, on the grounds that the therapies are abortion equivalents that violate their religious convictions. Medical research from the National Institutes of Health, the Mayo Clinic and several other authorities has proven that emergency contraceptives do not cause abortions. Nearly 50 businesses have sued over being required to cover contraceptives.