July 7th, 2014

granada holmes

health insurance, birth control, and my experience as a grad student at a Jesuit school

The recent Supreme Court case has me thinking a bit about birth control and my own experience working for an institution with an ideological problem with it. I've spent the last several years as a grad student at a Jesuit (Catholic) university, and as part of my stipend/work benefits/whatever, they provided my health insurance.

Catholics are opposed to birth control not only when it threatens to harm or kill an embryo (so abortifacients and drugs that prevent implantation), like Protestants, but they also think good, moral sex has to be open to procreation. "Natural" infertility like if you're post-menopausal or infertile due to a health problem or just not in the fertile part of your cycle is supposed to be okay, there's no problem having sex then, but trying to have sex in a way that wasn't open to procreation like anal/oral sex or with a condom or other kind of contraception is pretty strictly against the Catholic viewpoint. Fordham's a Catholic-affiliated school and so while it's separate to an extent and I never felt I had to be a Catholic to be welcome there, you're also going to have a certain amount of influence from RCC beliefs and policies on how things are done.

Which made the situation at Fordham... interesting, when it came to birth control. On the one hand, university policy clearly states that you can't distribute contraception of any kind on school property or at school-affiliated events, meaning there's no fish-bowl of condoms on the sign-in desk at the infirmary like there was at the two state-funded schools I've attended. (There's an exception made if the medication serves a legitimate health need, including --I asked because I was curious-- if there's a medical or psychological reason why getting pregnant would pose a danger to the would-be mother.) In those cases you have to go off-campus to get the prescription filled, but they will write the prescription for you.

What there was, in the pre-ACA days, were two pamphlets in the display that also housed information on anorexia, binge drinking, meningitis, flu vaccinations, and date rape. One pointed you to an OB-GYN that was maybe a dozen steps from the campus exit nearest to the infirmary that did provide prescriptions for contraception. The other one was an informational pamphlet put together by the infirmary on how to use condoms effectively, along with a map to public clinic just off campus that did have said fishbowl of condoms where you could just walk in and take them at no cost. On one occasion, I had a doctor at the clinic ask me specifically: you're thirty years old, your chart doesn't list birth control medication, would you like someone to talk to you about your options here and how your Fordham insurance covers them?

Because, yeah, the student insurance did cover birth control, you just couldn't get it through health services. I think there was a push after the ACA came through (I was at Fordham going back to Fall of 2008, so pre-Obamacare) to get the insurance to stop covering so-called abortifacients, specifically the IUD (I think some versions of that actually do raise the risk an embryo won't implant, though statistically there would also be much fewer embryos in question, so both fewer failed implantations and fewer unwanted pregnancies leading to chemical/surgical abortions) - we never had the nonsense about the morning-after pill come up. But the thing was, around the time Obamacare came on the scene, Fordham stopped just enrolling everyone in insurance, they gave you a credit to your student account which could be used toward your insurance or they could cut you a check and you could get your own. And just as I was leaving I noticed the infirmary making a real push to tell students (myself included) that this was what the student insurance did and didn't cover and if it wasn't sufficient for their reproductive health needs, there were other options like taking the money the school would contribute to your insurance and using it to buy insurance through the public exchange. And they did two things to make this more practical: they started cutting you a check for the full stipend even if you owed the school money for something else; and the infirmary pointed you to specific recommended plans that were similar to Fordham's but also covered pretty much every kind of contraception on the market.

(Worth noting: this is possible for Fordham where it wouldn't be for some place like Hobby Lobby, because grad students are legally students rather than employees, and they receive educational funding rather than wages. So Fordham doesn't have the same legal obligations to provide me insurance through the institution that it would for a non-student employee. I don't know what the coverage is like for employee health insurance.)

Because I wasn't sexually active during my time at Fordham, I don't know how well these attempts translated across the board. (I do know some Fordham students have been denied prescriptions or referrals, even for medical problems that had nothing to do with contraception. Obviously there are still problems - being told you have to go off-campus can be a bit overwhelming when you're eighteen and in the Bronx. But what I've seen at Fordham is an institution, or at least parts of it, that has tried to balance their beliefs about contraception against the needs of the people they're treating. Which left me feeling decidedly more tolerant toward those beliefs and the way it would impact me than I did toward Hobby Hobby, since the latter apparently didn't realize they were covering what they called abortifacients until it became a thing in the culture wars and then made no move to try to ease things for its female employees.

I guess my point is, there's ways to navigate this kind of a situation that doesn't compromise your values and beliefs but also tries to be an actual decent human being about it at the same time. I don't have a lot of positive things to say about my time at Fordham, but this is actually an area I found them operating above par.