Thanks, Jan! I have no idea if I’m right, and it seems like a really odd conclusion, but it’s also hard to arrive at anything else other than “Citizen’s United is having some really weird consequences…”

Hi Jesse, thanks for the response (and sorry for the delay – I was about half-way through typing a response to you when the power went out at work; exciting). You are actually right; about 90% of the companies in the United States actually are closely-held companies. The thing is, it’s not just about being closely held. The other criteria is the sincerely-held religious beliefs, and that’s not something the Court takes lightly. There are pages of case law, and it’s pretty specific. Some company isn’t going to be able to start saying things tomorrow and claim sincerely-held religious beliefs. (There have actually been cases where a law has changed and someone tries to claim being religious and has been denied based on the timing.)

But, even aside from that, it’s worth questioning how many of those 90% were even required to implement the Affordable Care Act; mostly closely-held companies (as opposed to privately-held companies) are family owned and operated businesses, and many of those are too small to trigger ACA requirements. (I’d actually really love to see an analysis of that, but I’m having a hard time finding data at the moment…can’t imagine what’s clogging up Google.)

As for comporting to reality, at least with the IUD, the reality is that it is used as an emergency contraceptive to prevent blastocysts to implant. I do agree that it would be nice if we could get science to matter a bit more to people (and noted that in footnotes). But, we also sort of have to ignore the science because we don’t want SCOTUS regulating science. Well, at least I don’t. Because I’m terrified what might happen with, say, climate change, should it reach them.

I don’t think it will allow people to file suits against contraceptive pills, in part because all a company has to do is prove they’re closely held and have sincerely held religious beliefs that say contraceptive pills are against said religious beliefs. If it passes the Sherbert Test, then they probably can have the government step in to cover that (assuming that HHS is allowed to cover for-profits, as Kennedy indicated).

SCOTUS already saw your example about gay people being an abomination, and noted that, as case law has already established, sincerely-held religious beliefs did not allow discrimination (especially of suspect and quasi-suspect classes). Beyond that, such a challenge would fail the Sherbert Test: there is currently no other way in which to offer the HIV medications someone needs.

Essentially, I think what won the Hobby Lobby case today was the non-profit bypass the Obama Administration created last year. By doing that, they created an inexpensive way to get certain forms of birth control to women whose religious employers objected in paying for some of them. By doing so, the ACA mandate is no longer the least burdensome, least restrictive manner of providing contraceptive coverage to women. Because the government has shown it can do it itself.

That situation, however, doesn’t exist for HIV drugs, or blood transfusions, or lots of other potential arguing points over sincerely-held religious beliefs. And that’s why I sort of wonder if what we’re seeing is the groundwork for a single-payer system. It’s not that I have faith or confidence, but that I can’t see where else the ruling can lead, because of what the case law they’re generating seems to say. That case law seems to say: if the government can provide health care services for equal or less cost than a business, then that is the manner least restrictive and least burdensome and has to be done. I’m not sure if SCOTUS realizes this, has to do it because of implications from Citizen’s United, or has to do it because of the Obama Administration’s non-profit ruling last year. (And if it’s the latter, I’m not sure if that was intentional brilliance from the Administration, or accidental.)

Also, when getting pregnant is life-threatening, it’s no longer preventive medicine but curative. So all of the contraceptive options are back on the table. (In fact, this is how Notre Dame and other religious organizations got around the “we won’t prescribe an IUD for birth control” objection for years; it was “medically necessary” rather than “for birth control. In fact, if I recall correctly, that’s how much Catholic universities got around the ban on having contraceptives on campus; the pill had to be available to regulate abnormal menstruation or PMS or whatever, and so on.) So yes, Hobby Lobby actually does have to cover an IUD…if it’s medically indicated (rather than chosen birth control method).

Then there’s the issue of how many of those suddenly discover their sincere religious beliefs tomorrow. I suspect many will.

A third issue is this: “Hobby Lobby and Conestoga Wood both objected to this, saying that covering some forms of birth control, like the IUD/IUS or Plan B, violated their religious beliefs by requiring them to fund abortive medications.”

The problem is that the very definition of abortive medications used was the one from Hobby Lobby, not the one that comports to, you know, reality.

This leaves the door open to people filing new suits that will cover birth control pills, for instance, which are “abortive’ in the same way as IUDs — by a completely whacked-out definition.

Then there’s the issue of other lawsuits that could be filed. And the court has left itself few choices now but to rule in their favor. What if a religious employer running a small company files a suit saying that they believe gay people are an abomination, so he doesn’t want to cover HIV meds? By the logic of the court today they would be able to do that, and don’t think for one second that suit isn’t coming.

What if getting pregnant is life-threatening? For some people it is. How do we square that one now?

The bigger one is whether or not the Department of Health and Human Services has the authority to extend the non-profit contraception exemption to closely-held corporations; I expect we’ll see the Obama Administration clarify this quickly (and most people seem to think that HHS has the authority to do this, including SCOTUS).

You have far more confidence in the court than I do.