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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.

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(Deleted comment)
marta_bee
Jul. 8th, 2014 08:41 am (UTC)
We Americans have a ... well, I can't really described it as anything other than fucked up, because the euphemisms I was reaching for don't do it justice. A fucked-up approach to health insurance. We say that if you have a job it's your company's job to arrange health insurance for you, rather than this being the kind of thing each individual has to do. It's truly messed up because it puts the boss in a position to either pay for things he doesn't approve of or to try to keep the employee from accessing them, and it's messed up even more because the individual worker has to not just work with her doctor, she has to not only work with the insurance that has a financial motive to deny care, but she has to also work with her boss if he doesn't like the kind of procedure she's trying to access.

It's a messed-up system and I would much rather we had something like the UK where most things are tax-supported or (if I remember correctly) Germany where there's health insurance but it's each individual arranging it herself, perhaps with a government subsidy but with no getting sponsored by another individual. I dream about that possibility. There are times when I really don't like American society and hate American politics even more (because this is political, it's all about making sure the people who get health care actually "deserve" it, as if people got sick to mooch the system), and it makes me sick - but I'm stuck here.

So I'm working within that messed-up system and seeing that the way things are, the system does put employers and institutions like the RCC in the position that they have to be involved in providing health insurance for the people working with them. Most actual Catholics here use birth control as well, and most don't think it's immoral, but we're not talking about people who go to church, we're talking about the institution, and I respect the fact that there's a conflict there that needs resolving.

That's what I was trying to talk about here. That in my experience, this particular Catholic institution was trying to navigate that conflict in a way that avoided the problem and mitigated how hard it made life for the people that they dealt with, rather than just looking to their rights and saying "we're not going to do this and if it creates a problem for you, that's too bad."

Btw, to be clear: this wasn't really about whether the insurance covered contraception. At least as of 2012 (the last time I checked my insurance documentation), the insurance covered both the cost of going to a doctor and the medicine itself. And after that point, Fordham may have gone on covering that thing (I suspect I would have heard if they didn't; I just don't have the documentation on hand to check for sure) and if they didn't they made it pretty easy to take the money they'd be applying to your health insurance and use it for another plan not affiliated with the university if that's what you wanted. The question has always been whether doctors employed by the universities would do the prescribing or whether you needed to go to a doctor.
(Deleted comment)
marta_bee
Jul. 8th, 2014 10:12 am (UTC)
Right, I honestly don't know what's wrong with me here. With both of your comment here (and this really is coming from my side I think) I've felt thoroughly aggressive. Which is odd because I agree with you and you're being thoroughly reasonable. I just typed out another long reply and deleted it, because it's just not what's going on either in the court case or even in our exchange here. I don't think.

So, maybe it will help to lay out why I'm so very frustrated over all of this.

(1) I'm pissed off as hell because some rich white guys are using my religion to support their culture war ethos or their bottom line or whatever else is going into this, because it's not a concern about their principles - they apparently didn't even know they funded the drugs until some uber-right wing thinktank came to them to get them to go to court and give the president a black eye.

(2) I'm pissed off because I grew up with the Holocaust as kind of my family legacy (and I'm sure I'm not alone, you probably even have more direct connections than I do), so I'm very sensitive to actual violations of religious liberty, like people getting killed or sent to jail because they're a religious minority, and having people talk about not having to pay an insurance premium as a great victory for religious freedom just makes a mockery of all that.

(3) I'm upset because there are so many big issues worth talking about in American politics, as basic as what we mean by a right - is it just not having anyone stop you, or are you actually entitled to be able to access it? I mean, I know what I believe obviously, but there are huge parts of American society who say, hold up, no one's making it illegal to buy contraception and there's a difference between saying women can't buy it and saying someone else should have to pay for it - and this is a conversation worth having because it's a huge divide in our culture and we can't get anything done because of it, and because the American media and blogs and whatever people read about this stuff is so divorced from each other, you just have people talking past each other all the time so these important conversations simply don't happen.

(4) I'm stuck here. God, I so wish I wasn't, and I know I should at least be grateful to be stuck in New York rather than North Carolina, but I don't have the skillset to land the kind of job someone would sponsor you for immigration, or the contacts or the money that make it possible to actually leave, and I want to throw my laptop out the window at that thought but it's the inescapable reality. And so being told I should be complaining about a system I have no real chance of either escaping or changing is so fucking frustrating it quite literally had me crying five minutes ago.

Which is probably too much information particularly for a public post, but... yeah. That's a huge part of the problem.

(And of course LJ is saying this is too long. Second half of this comment coming up.)
marta_bee
Jul. 8th, 2014 10:12 am (UTC)
(5) Correlated to (3) and (4), it feels like I can't say anything about this because at least one group of acquaintances will think I'm not just wrong but betraying them, and I'm so worn out with everything being a fight. because there's no center where people can really come together. I'm coming out of the classroom where you'd actually have conversations with people who didn't believe the same thing but were working through the same questions or concepts in a pretty detailed way and also had a relationship where they were doing it as a group. And things are just different out of that context. But there's something I can't quite nail down or explain that is so far beyond frustrating that word just isn't adequate, to being used to having actual conversations with people and being forced out into a situation where it feels like people are talking but not really hearing.</blockquote>

Let me be clear, I'm not saying you're doing all, or even any, of this. What I am saying is being told this is the conversation I need to be having, that if I talk about American health care or the current case in any context and I'm not answering these questions (which is what I'm hearing from you; quite possibly not what you're saying) is bringing up all kinds of other issues. Most of which (quite possibly all of which!) are emphatically not your problem. But they're what I can't quite see my way past.

Because I think, quite on top of everything else going on, there are other things worth talking about than the political and legal ones. There's a move to focus so heavily on your own rights I see sometimes, that I definitely see in this court case (not even rights, but perceived rights!), and I wanted to talk about how it was possible to be sure that this law would force you to enable something you thought was immoral, deeply so as in murder-immoral, but still work with that belief in a way that was more constructive and loving and connected than what I see in this "this is what I'm owed" approach. I wanted to talk about why that mattered, and it seems it's impossible to do (or at least I'm not able to) without propping up a system I find deeply, deeply troubling.

So... yeah. Maybe file my reaction to this under the "baby, it's not you, it's me" category. Sorry I can't do better than that.
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