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July 2, 2014: News, Research and Events from Rice University's Baker Institute
Baker Institute Update: Burwell v. Hobby Lobby and the Affordable Care Act; young professionals Q&A
In this edition
Five Questions: Burwell v. Hobby Lobby and Obamacare

The Supreme Court handed down a 5-4 ruling on the Burwell v. Hobby Lobby case Monday, allowing some for-profit companies to opt out of paying for certain contraceptives for their employees. Elena Marks, president and CEO of the Episcopal Health Foundation and Baker Institute Scholar in Health Policy, offered her insights on the ruling and how it will impact implementation of the Affordable Care Act, women’s access to reproductive care and future court cases.
What do you make of the reasoning of the majority opinion in Burwell v. Hobby Lobby?
The court’s opinion is based on its conclusion that the Religious Freedom Restoration Act of 1993 gives multi-million dollar, national, for-profit corporations the same constitutional right of religious freedom that historically has applied to human beings. This is similar to the court’s reasoning in the Citizens United case that concluded that corporations could spend unlimited amounts of money in political races without public accountability.
How will the Supreme Court’s ruling affect the implementation of the Affordable Care Act? Does the ruling alter the effectiveness of the ACA in any way?
The court suggested that the ACA’s accommodation for religious nonprofits should be made available to Hobby Lobby and its fellow plaintiffs. This allows a religious nonprofit that has objections to birth control to refuse to cover it, while ensuring that the nonprofit’s employees receive the coverage without cost-sharing directly from the insurance company. The way the accommodation works is that the insurance company retained by the business to provide or administer the health plan would include coverage for contraceptives without charging the cost of that benefit to the business. As a practical matter, including contraceptive coverage lowers the cost of health plans because of the comparative costs of paying for contraception versus prenatal care and delivery. If the accommodation is made available to religious for-profits, then the employees of these corporations will still have access to contraceptives through their insurance plans. This is likely a more complicated mechanism for achieving the result, but it may enable women employees to obtain the benefits the ACA intended for them.
What are the implications of the ruling in Texas, where many women’s clinics that offer subsidized birth control are closing due to legislation passed by Texas lawmakers in 2013?
There is no direct relationship; however, both are evidence of a backward trend toward the rights of women to access affordable reproductive care. From a public health perspective, this is a huge step backward that stands in stark contrast to the rest of the developed and developing world. The increasing difficulty faced by women, especially younger and poorer women, will translate into increased unintended pregnancies, with negative health and economic consequences that can last for generations.
How do you expect Congress or the Obama administration to respond to the Supreme Court’s ruling?
Congress is so deadlocked that it has been unwilling or unable to make any changes to the ACA, even when they agree on a needed change. I would expect the Obama administration to seek a reconsideration of the ruling, and if the ruling stands, I would expect they might offer the same accommodation offered to religious nonprofits.
In Justice Ruth Bader Ginsburg’s dissent, she mentioned Jehovah's Witnesses’ objection to blood transfusions and Scientologists’ objection to antidepressants, among other examples of health care and religion being at odds. What effect will this ruling have on future court cases that concern both health policy and religious beliefs?
Despite the majority’s statement that this case is solely about contraceptives and not about other health services, there is nothing in their reasoning that distinguishes contraceptives services from immunizations, blood transfusions or antidepressants. One of the ironies of the majority opinion is that it actually argues in favor of a government-sponsored, single-payer plan, like Medicare, as a way around the mandate challenged by Hobby Lobby.

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Q&A: Roundtable Emerging Leaders

As part of an ongoing series of Q&As with Roundtable Emerging Leaders, Mike Freedman — a 2014 graduate of Rice University’s Jones Graduate School of Business who formerly served in the U.S. Army Special Forces — talks about why he joined a young professionals group at the Baker Institute.

1. What drew you to the Baker Institute and the Emerging Leaders?
I love Rice, and I think the Baker Institute is one of the coolest things Rice has going for it. Obviously, with my history, policy has been — and still is — a big part of my life. Ambassador Djerejian and Secretary Baker have brought so much to the table, and I’m excited to see a whole new generation exposed to public policy at the institute.

2. How does your Emerging Leaders membership benefit your job or career?
The Emerging Leaders is great for meeting other like-minded individuals, and it’s important to me to have a greater awareness about what’s going on in the world from firsthand sources.

3. What has been your favorite program or event at the Baker Institute?
I really enjoyed the Texas Monthly event on the shale boom. I typically am drawn to the more unconventional events the institute has to offer. 

4. What do you feel is the number one policy issue of our time in the U.S.?
The war on terror — its management and mismanagement.

5. What makes Houston such a great place for young professionals?
Coming back to Houston after nearly a decade away, I appreciate the amenable cost of living, the friendly people, the great art community and the wildcatter spirit of Houstonians.

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Rice University's Baker Institute for Public Policy is a nonpartisan public policy think tank located in Houston, Texas. The institute's distinguished fellows and scholars conduct research and collaborate with experts from academia, government, the media, business and private organizations on domestic and foreign policy issues with the goal of bridging the gap between the theory and practice of public policy.
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