DAVID GREENE, BYLINE: Here in Washington, the U.S. Supreme Court wraps up its term today. And once again, we are waiting for a major decision on the Affordable Care Act. The High Court is set to rule on whether the health insurance that for-profit employers offer to their workers has to include birth control even if the employer has a religious objection. Our colleague Steve Inskeep spoke to NPR White House correspondent Scott Horsley about the case.
STEVE INSKEEP, HOST:
The Affordable Care Act has already been before the U.S. Supreme Court and the majority of it - the essence of it - was upheld. We're talking about a narrower case here.
SCOTT HORSLEY, BYLINE: That's right. So the stakes are not quite as high in this case as they were two years ago when the law as a whole was sort of on trial. But this is an important provision of the law. It says health insurance plans must include birth control along with other preventive services at no additional out-of-pocket cost to the patients. And while that requirement has been controversial, especially with Catholic bishops and other religious institutions, the administration has pretty much stuck to its guns here.
This requirement grew out of a recommendation from the Institute of Medicine which said that there would be real benefits to making birth control more widely available in a country where nearly half of all pregnancies are unintended. And so if that requirement is struck down by the Supreme Court, it would be a real blow for the White House.
INSKEEP: So how are Hobby Lobby and these other employers building their case against having to do this?
HORSLEY: Well, they say they have a religious objection to offering some of the forms of birth control that are covered under the law. And they say that forcing them to include that in their insurance plans violates the Religious Freedom Restoration Act. Now, there's a question - because these are for-profit companies - whether they're entitled under that act to exercise religious freedom. So that's sort of the first question that Supreme Court has to answer is, are for-profit employers even covered under that law? And if the answer to that is yes, then the court has to perform a sort of balancing test to say, is the government's interest in making birth control more widely available - does that justify putting this kind of burden on for-profit companies?
Now, there are other legal challenges that are coming down the pike that have not yet made it to the Supreme Court which come from more overtly religious organizations - for example, nursing homes that are run by an order of Catholic nuns. So even if the High Court upholds the birth control requirement in the case of for-profit companies like Hobby Lobby, that won't be the end of the story. On the other hand, if the High Court says even Hobby Lobby doesn't have to provide this kind of coverage, then I think the contraceptive requirement is pretty much done for.
INSKEEP: Are there other provisions of this law that are proving as controversial as contraception?
HORSLEY: Not really. You know, things like stepped-up diabetes screening just haven't really proven to be the same sort of third-rail for politicians that the birth control requirement has. There was a story in USA Today that put it rather well saying, this is a case about God, money, power, sex and Obamacare.
INSKEEP: You've got everything in their.
HORSLEY: That's a pretty volatile mix. And as I said, the initial outcry came mostly from Catholic bishops and overtly religious groups. And the administration did try to make some accommodation for them. Churches, of course, were exempt from the get-go. They're not required to offer this kind of coverage to their employees. And for church-affiliated organizations, like those nursing homes and their employees that I talked about, the administration tried to put some distance between the employer and the birth control that they find objectionable. In some cases, for example, they said the insurance companies themselves would have to provide the coverage.
HORSLEY: But those accommodations have not been satisfactory to everyone. Now, in this case, a couple of court justices suggested if the government thinks birth control is so important, why doesn't it just make the birth control available itself? And that's kind of an example of how, in its effort to steer clear of a big government single-payer system, Obamacare has left us with a more complicated and some cases more conflicted system.
INSKEEP: Scott, thanks.
HORSLEY: My pleasure, Steve.
GREENE: That's NPR White House correspondent Scott Horsley, speaking to our colleague Steve Inskeep about a major decision on the Affordable Care Act expected from the Supreme Court today. And you're listening to MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.