The Supreme Court on Tuesday confirmed that its decision a day earlier extending religious rights to closely held corporations applies broadly to the contraceptive coverage requirement in the new health care law, not just the handful of methods the justices considered in their ruling.

The justices did not comment in leaving in place lower court rulings in favor of businesses that object to covering all 20 methods of government-approved contraception.

If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider.

“Our decision in these cases is concerned solely with the contraceptive mandate,” claimed Justice Samuel Alito, writing for the majority. “Our decision should not be understood to hold that an insurance-coverage mandate must necessarily fall if it conflicts with an employers’ religious beliefs.” (snip) In her dissent, Ginsburg deemed it “a decision of startling breadth.”

In fact, it only took a day for the Court’s “narrow” decision to start to crack open. On Tuesday, the Court indicated that its ruling applies to for-profit employers who object to all twenty forms of birth control included in the Affordable Care Act’s contraceptive mandate, not just the four methods at issue in the two cases decided on Monday.

In light of its ruling on Hobby Lobby and a related suit, the Supreme Court ordered three appeals courts to reconsider cases in which they had rejected challenges from corporations that object to providing insurance that covers any contraceptive services at all. The plaintiffs in all three cases are Catholics who own businesses in the Midwest, including Michigan-based organic food company Eden Foods. Meanwhile, the High Court declined to review petitions from the government seeking to overturn lower court rulings that upheld religiously based challenges to all preventative services under the mandate. (snip)

According to Alito, courts have no authority to “tell the plaintiffs that their beliefs are flawed.” Where, then, are the boundaries? How will courts decide which beliefs are “sincerely held?” Alito asserts that the majority opinion provides “no such shield” for other forms of discrimination, but we have to take his word on it. The language of the ruling may be limited to contraception, but there are no explicit constraints on its underlying logic.

This week, in the Hobby Lobby case, the Supreme Court ruled that a religious employer could not be required to provide employees with certain types of contraception. That decision is beginning to reverberate: A group of faith leaders is urging the Obama administration to include a religious exemption in a forthcoming LGBT anti-discrimination action.

Their call, in a letter sent to the White House Tuesday, attempts to capitalize on the Supreme Court case by arguing that it shows the administration must show more deference to the prerogatives of religion.

"We are asking that an extension of protection for one group not come at the expense of faith communities whose religious identity and beliefs motivate them to serve those in need," the letter states.

Last week, Justice Samuel Alito Jr. speciously defended the Supreme Court’s disastrous ruling in the 2010 Citizens United case by arguing that the ruling, which allowed unlimited independent campaign spending by corporations and unions, was not really groundbreaking at all. In fact, he said, all it did was reaffirm that corporations have free speech rights and that, without such rights, newspapers would have lost the major press freedom rulings that allowed the publication of the Pentagon Papers and made it easier for newspapers to defend themselves against libel suits in New York Times v. Sullivan.

Yesterday, I widely posted and referenced the American College of Obstetricians and Gynecologists statement on the HL decision. In it, they warned that the decision would allow employers to interfere in the doctor-patient relationship, by limiting what discussions and options patients would be presented with. I met some resistance from people who insisted that this was a narrow ruling that would "only" prevent payment for services, and not prevent women from accessing said services. Therefore, I was very happy to see your diary where you dove into the nitty-gritty of the court documents to show that, yes indeed, HL sought to prevent payment for "counseling and education" too.

Unfortunately, that sent many chasing the rabbit down the hole of ICD-9 codes. The theory being that since there is no specific code for "contraception counseling" then insurance companies, and by extension, the employers who contract with them, wouldn't know whether a woman discussed contraception with her physician. This is so not true. Physicians are required to document in patient charts what they and the patient discussed, what treatment recommend actions were made, and the medical reasoning behind those recommend actions. This information is available to the insurance companies under the terms of service the patient agrees to when they enroll in coverage. Furthermore, for most procedures and many prescriptions, the physician must send in documentation to the insurance company about the recommended treatment plan, and the discussions that led to the agreed upon course of action. If an insurance company wanted to, they could easily do an audit of claims and find out that illicit counseling occurred. The wide implementation of electronic medical records would make this an easy task!