Printer-friendly versionPrinter-friendly version Share this


By Joel A. Harrison, PhD, MPH

October 7, 2017 (San Diego) - According to an article in the San Diego Union-Tribune, “The Trump administration on Friday moved to roll back the federal requirement for employers to include birth control coverage in their health insurance plans, vastly expanding exemptions for those that cite moral or religious objections (Robert Pear. “Birth Control Mandate Rolled Back”, October 7, 2017, page A1). People believe that health insurance is a bonus offered by employers. Not true! To understand this, one has to understand both the history of employer-based health insurance and what a pay/wage packet is.

History of Employer-Provided Health Insurance

“In 1943 the War Labor Board, which had one year earlier introduced wage and price controls, ruled that contributions to insurance and pension funds did not count as wages. In a war economy with labor shortages, employer contributions for employee health benefits became a means of maneuvering around wage controls (Field, 1993). Following the War “unions began a push for employer provision and funding of health and other benefits (ibid).” Non-unionized employers in order to compete for employees also began offering health insurance.

As has been reported many times over the past years as the costs of health insurance have gone up, salary increases have either decreased and/or plans have been purchased with higher copays and deductibles (Bosworth, 2014; Desilver (2014).. Health plans offered through employers do have advantages:

  1. The larger the number of employees, balancing younger/healthier and older, the less expensive and, often, more comprehensive the plans are.
  2. “A further important boost to these programs came in 1954 when the Internal Revenue Code made it clear that employers' contributions for health benefit plans were generally tax deductible as a business expense and were to be excluded from employees' taxable income” (Field, 1993).

Pay/Wage Packet

A Pay/Wage Packet is the total compensation that any employee receives (Cambridge English Dictionary. Pay Package; Webster). A simple idealized example should illustrate this.

Imagine an employer decides to hire one additional employee. The employer evaluates how much revenue this additional employee will bring in, how much of this they want as profit, with the remaining the amount to cover the new employee. Obviously, the employer will try to maximize their profit and offer the least to the employee given the current market availability of potential employees. So, let’s assume that the max amount, after subtracting the minimum profit acceptable, is $50,000 per year. From this, there are mandatory “taxes,” e.g. FICA (Social Security), Medicare, Worker’s Compensation Insurance, Unemployment Insurance, etc. Just to make things simple, let’s assume these amount to $10,000 per year. So, we have $40,000 left. The employer can simply pay the employee the total amount or offer health insurance, perhaps also, a retirement plan. To keep things simple, let’s assume they offer only health insurance. This costs $10,000 per year, so the actual money remaining for salary is $30,000 per year. Again, as has been reported many times over the past years as the costs of health insurance has gone up, salary increases have either decreased or plans have been purchased with higher copays and deductibles.

Keep in mind that the fact that employers pay part of FICA, part of Medicare, and often the lion’s share of health insurance, while the employee’s also pay a part, is just a mirage to give the impression that the employer is “contributing” above the employee’s earned wage/salary packet.. To repeat, all comes from the employee’s wage/salary packet. In fact, it would be much more honest if the entire amount of mandated “taxes” were just deducted from the employee’s salary with adjustments to ensure taxes don’t become higher. Self-employed people do pay the total FICA and Medicare taxes.

So, as I wrote in a previous OpEd for East County Magazine (Harrison, 2013), how is it different if the employer purchases a group health insurance policy vs the employee purchasing an individual policy? Both are paid from the employee’s pay/salary packet. In fact, if one were to use an absurd slippery slope argument, what would stop an employer from reducing an employee’s salary if they simply purchased birth control out of pocket? After all, wouldn’t this also pose problems for an employer if this went against their religious beliefs since the money ultimately comes from the employer.

And if we again use a slippery slope argument, what would stop an employer who is a Jehovah Witness from excluding blood transfusions from an employee’s health insurance policy? Or an employer who is antivaccination excluding vaccines? Or how about a Jewish employer forbidding employees from bringing ham sandwiches to work?

The bottom line is that unless employers have the right to treat employees differently based on their religious preference, since health insurance is paid through the employees wage/salary packet, regardless of the myth that it is a “bonus” provided by the employer, then for the government to allow employers to exclude birth control is to further the interests of the employers religion over employees moral and religious choices. If this isn’t a violation of the 1st Amendment, then I don’t know what would be.

Is the 1st Amendment Just a Beautiful Myth?

A while back, I wrote another OpEd published by East County Magazine about the Mount Soledad Cross Controversy (Harrison, 2014). Apparently, one can circumvent the 1st Amendment by simply selling a small parcel of government land to private parties. In this case, a military cemetery. So, what’s to stop selling a 20’ by 20’ parcel of land in Balboa Park to private parties so they can erect religious symbols? Or, how about the White House lawn?

During Colonial times, various colonies had established churches, among other things, collecting taxes on their behalf. Various forms of discrimination were practiced against those not adhering to the established churches (American Bar Association. Debating Church-State Relationships), thus, came about the 1st Amendment. Unfortunately, prior to the 14th Amendment, the Bill of Rights applied mainly to the Federal government so that the States could continue to support one church over others.

On October 7, 1801, the Danbury Baptist Association sent a letter to the newly elected President Thomas Jefferson:

Our sentiments are uniformly on the side of religious liberty: that Religion is at all times and places a matter between God and individuals, that no man ought to suffer in name, person, or effects on account of his religious opinions, [and] that the legitimate power of civil government extends no further than to punish the man who works ill to his neighbor. But sir, our constitution of government is not specific. Our ancient charter, together with the laws made coincident therewith, were adapted as the basis of our government at the time of our revolution. And such has been our laws and usages, and such still are, [so] that Religion is considered as the first object of Legislation, and therefore what religious privileges we enjoy (as a minor part of the State) we enjoy as favors granted, and not as inalienable rights. And these favors we receive at the expense of such degrading acknowledgments, as are inconsistent with the rights of freemen. (Wikipedia. Baptist in the history of separation of church and state.)

Jefferson replied in a letter dated January 1, 1802:

Believing with you that religion is a matter which lies solely between man and his God, that he owes account to none other for his faith or his worship, that the legislative powers of government reach actions only, and not opinions, I contemplate with sovereign reverence that act of the whole American people which declared that their legislature would "make no law respecting an establishment of religion, or prohibiting the free exercise thereof," thus building a wall of separation between Church and State. (ibid)

Unfortunately, some people throughout history who, as minorities, elegantly championed individual freedoms, once become a majority, become nothing more than hypocrites. For many Baptists today and other people of faith, the original sentiments of the Danbury Baptist Church remain; but for others, it does not.

Historically, thanks to the 1st Amendment and the lack of an established church, religion has thrived in America. Among modern technologically advanced democracies we have the greatest diversity of faiths and the highest percentage of active attendance and participation in them. Religion and freedom of conscious thrive best when individuals respect each other. They are welcome to discuss their beliefs in a respectful manner; but not to impose them on others. It is fascinating how some Americans express fears of Sharia law, an absurd fear; but what is their fear other than one religion imposing its beliefs on everyone.

Some would want this to be a Christian nation, claiming that we began as one. Of course, each according to their interpretation of Christianity and there are many. Many of our Founding Fathers were deists:

Deism is a philosophical position that posits that a god does not interfere directly with the world. It also rejects revelation as a source of religious knowledge and asserts that reason and observation of the natural world are sufficient to determine the existence of a single creator of the universe. (Wikipedia. Deism)

However, John Adams, one of the Founding Fathers and our Second President was religious, though open-minded (Wikipedia, John Adams).

Adams signed the Treaty of Tripoli (Treaty of Peace and Friendship between the United States of America and the Bey and Subjects of Tripoli of Barbary), signed in 1796, was the first treaty between the United States of America and Tripoli (now Libya) to secure commercial shipping rights and protect American ships in the Mediterranean Sea from pirates.

Art. 11. As the Government of the United States of America is not, in any sense, founded on the Christian religion; as it has in itself no character of enmity against the laws, religion, or tranquility, of Mussulmen (Muslims); and as the said States never entered into any war or act of hostility against any Mahometan (Mohammedan) nation, it is declared by the parties that no pretext arising from religious opinions shall ever produce an interruption of the harmony existing between the two countries.

John Adams and the Senate made clear that the pact was between two sovereign states, not between two religious powers. (Wikipedia. Treaty of Tripoli)


America was born in freedom. The 1st Amendment, protecting the individual freedom of religion and conscious, has resulted in the greatest diversity and participation in religion among the developed industrialized democracies. Unfortunately, many Americans have forgotten our history and the blessings it has conferred. Whether circumventing the 1st Amendment by selling small parcels of government land or by maintaining the myth that health insurance is some sort of bonus paid for by ones employer rather than part of one’s wage/salary package, we are gradually chipping away at the 1st Amendment, one of the core foundations of our freedoms and democracy.


American Bar Association (accessed 2017 Oct 7). Debating Church-State Relations and Related Free-Speech Issues: Established Churches in Colonial Times.

Bosworth BP (2014 Dec 22). Sources of Real Wage Stagnation. Brookings.

Cambridge English Dictionary (accessed 2017 Oct 7). Pay Package.

Desilver D (2014 Oct 9). For most workers, real wages have barely budged for decades.  Pew Research Center.

Field MJ, Shapiro HT, editors (1993). Chapter 2: Origins and Evolution of Employment-Based Health Benefits in Employment and Health Benefits: A Connection at Risk, Washington, DC: National Academy Press.

Harrison JA (2013 Dec 11). Readers Editorial: Should Employers Be Able to Exclude Birth Control from Health Insurance? East County Magazine.

Harrison JA (2014 Jan 8). Readers Editorial: Reflections on the Meaning of Christianity and Religious Symbols - A Reaction to the Mount Soledad Cross Controversy. East County Magazine.

Webster S (accessed 2017 Oct 7). The Difference Between Base Salary & Total Compensation.

Wikipedia (accessed 2017 Oct 7). Baptists in the history of church and state.

Wikipedia (accessed 2017 Oct 7). Deism

Wikipedia (accessed 2017 Oct 7). John Adams

Wikipedia (accessed 2017 Oct 7). Treaty of Tripoli

Joel A. Harrison, PhD, MPH, a native San Diegan, is a retired epidemiologist. Dr. Harrison has lived and studied in both Canada and Sweden. Dr. Harrison has been a long-time supporter of a non-profit single-payer health care system/Medicare for All (check out Physicians for a National Health Program’s website at and a strong supporter of vaccinations wherein, he has, as a volunteer, been writing articles for Every Child by Two, a nonprofit founded in 1991 to promote vaccinations, especially in children. You can find his articles at

The opinions voiced in this editorial are the views of the author and do not necessarily reflect the views of East County Magazine. To submit an editorial for consideration, contact

Error message

Support community news in the public interest! As nonprofit news, we rely on donations from the public to fund our reporting -- not special interests. Please donate to sustain East County Magazine's local reporting and/or wildfire alerts at to help us keep people safe and informed across our region.