Forward motion.
Yesterday, the Obama administration signaled that it’s willing to try to address the concerns of religious institutions that object to the HHS ruling requiring them to cover contraception in their employee health plans. When Press Secretary Jay Carney first began fielding questions about the mandate, he repeated the mantra that the administration had found “an appropriate balance” between the health-care needs of women and the First Amendment rights of religious groups. Then, after polling data showed that the mandate wasn’t exactly a hit with Catholic voters — especially white Catholics — Carney’s tune changed. Now he identifies a “need to find an appropriate balance” in a way that ensures “that the policy is implemented and that all women have access to these services that also deals with the concerns that have been expressed.”
As Melissa Rogers first suggested back in October, Hawaii state law may provide a model for striking such a balance. Hawaii mandates that all employers include contraception in their employee insurance plans. A religious employer can invoke a refusal clause that allows it to exclude such services from employee health plans. Once a religious group invokes that clause, it must provide written notice informing employees that contraception is not included in their health plans; they must also tell employees where such services can be obtained. Employees can then purchase contraception coverage from their insurer at a cost no higher than the enrollee’s pro-rata share of the price the employer would have paid had it not exercised the religious exemption. In other words, religious employers don’t have to subsidize plans that cover contraception, and employees can, for a nominal fee, purchase a contraception rider with their own money.
Given that the main objection of the U.S. Catholic bishops has been that the HHS ruling forces them to “pay for” contraception coverage, an arrangement like Hawaii’s ought to satisfy them. So why is the associate director of the USCCB Secretariat of Pro-Life Activities throwing a wet blanket on the idea?
“I’ve reviewed the Hawaii law, and it’s not much of a compromise,” Richard Doerflinger told the National Catholic Register. “The Hawaii contraceptive mandate has many of the same features as the new federal mandate.”
Like the federal rule, he said, the Hawaii bill “covers all FDA-approved ‘contraceptives’ (including drugs that can cause an abortion); and the religious exemption is very narrow (though it does not include the requirement that the religious organization serve only people of its own faith to be eligible).
“It adds an extra feature — the requirement that any religious organization that is exempt must still tell all enrollees how they may directly access contraceptive services and supplies in an expeditious manner.”
Referring for services the church deems immoral is not something the bishops will accept.
Doerflinger says that discussing the Hawaii law is “irrelevant” because “the administration says it is making no more changes to its mandate. The laws of Hawaii and every other state, and their exemptions, will be overridden by the sweeping national mandate.” Not if both the Obama administration and representatives of objecting religious institutions can reach an agreement.
Doerflinger seems to believe that people like Rogers are suggesting that the only way forward is to take every piece of the Hawaii statute and apply it federally. But, as Rogers notes, laws like Hawaii’s are “far from perfect.” What if we used such laws as a starting point for negotiations? What might such an arrangement look like?
There are two points of disagreement: Catholic employers want a broader religious exemption so that they don’t have to pay for health coverage that includes contraception, and the Obama administration wants to make sure women have easy access to contraception services through an insurer.
The first thing HHS would have to agree to would be widening the religious exemption to include institutions like Catholic colleges and hospitals. Exempted religious institutions would not be required to provide employees with health plans that cover contraception. Employees of those organizations could, with their own money, purchase such coverage on favorable terms. That would allay the bishops’ concerns about financially sponsoring contraception.
What about Doerflinger’s objection to the provision of the Hawaii law (like the HHS ruling) that requires exempt employers not only to inform employees that they don’t offer contraception coverage, but also to tell them where they can obtain such services? Even if one finds that objection (or the requirement itself) questionable in the age of Google, there are easy ways around it. The insurer could, as a matter of course, send such a letter to employees after they’ve enrolled. Or, as a couple of Mirror of Justice bloggers have suggested, employers could issue a letter that doesn’t directly refer employees to contraception-service providers, something like: “Because we are a(n) [Name of Ecclesial Affiliation] institution, there are some devices and procedures offered by some medical providers for which we are not able, in clear conscience, to subsidize insurance coverage. For further information please consult your insurance provider.” Or the federal government could do it. Point is, this is eminently negotiable.
During the health-care debate, Doerflinger often emphasized that when it came to abortion funding the U.S. Catholic bishops simply wanted to preserve the status quo — that is, the Hyde Amendment, which bars federal funding of elective abortions. Hyde does not conform to Catholic teaching (which objects to direct abortions, even in cases of rape or incest), yet the bishops were comfortable with keeping it in place. Hyde prevents the mingling of federal and state monies in states whose Medicaid enrollees are entitled to elective abortions. So if the bishops could accept a funding segregation scheme along those lines, then they why shouldn’t they accept a Hawaii-like arrangement? After all, if Catholic institutions are not made to subsidize health plans that cover contraception, then they don’t have to cooperate with what they consider evil.
If recent news reports are right, and the Obama administration is seeking an arrangement along those lines, then the USCCB should welcome such a “compromise” as one that compromises no important principle at stake.
Tags: contraception, HHS, USCCB
” — if Catholic institutions are not made to subsidize health plans that cover contraception, then they don’t have to cooperate with what they consider evil. ”
Then why did Bishop Robert Morlino of Madison, WI do exactly that? Could it be that to cooperate was the cheaper of the options available to him? So much for principles and “religious convictions.”
http://www.datalounge.com/cgi-bin/iowa/ajax.html?t=9513046
Here is a suggestion: when people sign up for insurance, they have the option of checking a box marked “Catholic”, and in that case, their insurance only provides them with a subset of services, namely, those that the Catholic bishop of their diocese approves of.
This guarantees that Catholics are only provided with coverage for the type of health care that is purely according to Catholic tradition.
Would that satisfy our bishops?
Doerflinger would not be a good person for the USCCB to have in the negotiations. The church needs actual hospital and social agency folks involved – they understand and grasp the issues. Doerflinger has a tendency to react and violate the “overreaction syndrome” that the Commonweal editorial warns against.
Most bishops just mimic whatever the USCCB says. Let Sr. Carol weigh in.
Claire – nice suggestion but would increase the cost of a self-insured plan for a hospital. Plans keep costs lower by spreading the expenses across the largest number of signed up members. The smaller the member number is – the more expensive the plan becomes.
Compromise should be relatively easy for people of goodwill, what with so many states’ experience to go by. First, as the bishops demand, the religious exemption should be extended to all religiously-affiliated organizations, then exceptions to the exemption can be made to protect the rights of individual employees, which HHS says is its concern. What is so difficult here?
Claire’s suggestion is what the hierarchs dream about: I’m sure they would love the government imposing, policing, and enforcing the kind of bands on contraception that they in the 21st century can’t. And while we Catholics just smile at them and think, “Aren’t those guys just a hoot.” [I hope, and assuming, that Claire was just being cynical?!?]
The reason that “the associate director of the USCCB Secretariat of Pro-Life Activities [is] throwing a wet blanket on the idea” is because the hierarchs were never really seriously concerned about providing women needed access to health care. Their political gambit is to sabotage the reelection of the president.
The hierarchs are such totally political animals: They want to score some cheap, easy points with their patroni in the Vatican, at the expense of basically young women who are employed at Catholic hospitals or attend Catholic universities.
And, if they could rub a moderately liberal president’s nose in it at the same time, it was all political gravy for the hierarchs who would have no political clout in the first place if it wasn’t for the fact that they have unlimited, unaccountable access to billions of dollars to play with in their political games.
It is this kind of political and pastoral leadership that renders the hierarchs irrelevant and alienated from the lives of most Catholics. I think most thinking people could see that since accommodations on providing women necessary health care access have been made for years in over 28 states, including ones with large Catholic populations with nary peep from the hierarchs, there was really no basis for the hierarchs to be so unnerved by the requirements of the ACA.
It’s more a case of “The lady doth protest too much, methinks.” (Hamlet, III, 2)
I wouldn’t be so surprised that President Obama is sending signals that he would like a compromise so that his constituents don’t get in a twist over this bogus issue during his march to reelection. Barack Obama is, after all, a politician just like the hierarchs – albeit one that knows that he’d better respect the democratic prerogatives of voters or he will be sent into early retirement.
Now, that would be truly sweet if we could only rid ourselves as easily of these hopelessly feudal oligarchs.
Forgive me if this issue has been covered on the many other threads about this issue, not all of which I have followed, but what happens when a doctor prescribes a hormone therapy (i.e., “birth control” pills) for pre-menopausal symptoms or to alleviate symptoms of endometriosis?
Would the insurance policy be set up so that the meds could be covered if the doctor codes in a certain diagnosis?
If there is a complete ban on any medication that renders a woman sterile for a time, I’m wondering whether some common medications that reduce sperm count and fertility, such as erythromycin, tetracycline, dilantin, colchicine, etc. would be handled.
Not saying the Church shouldn’t stick to its own teaching here, but I think it’s an interesting question.
” Would that satisfy our bishops? ”
Of course it would! The would keep Catholics acting as the sheeple that the bishops want them to be!
Catholics, if they want to be treated as adults, must accept the adult responsibility of making their own decisions based on how they have informed their consciences.
” Compromise should be relatively easy for people of goodwill, — ”
Now, apply that theory to the provision of abortion services and —- oh, forget about it.
Bill, Jim, Jimmy: I am joking, of course, but only half-joking. You’re assuming that Catholics would check the box “Catholic health insurance”, but some of us – those of us who want contraception covered, for example – wouldn’t. It would be a form of voting, a vote of confidence, and one would then see how many Catholics the bishop really represents when he talks about health care.
Your editorial never says that objectors should accept the “Hawaii rule”, but take out all the compromises so it isn’t a compromise anymore, it is a universal exemption. Change your editorial if that is your view. Until you change it, it is sufficient to say that the Hawaii rule you insist people accept is not acceptable for reasons that the USCCB has complained about all along, but which you apparently missed. They have objected to forcing entities to promote contraception by the mandated “education and counseling” that the Obamacare mandate includes. Did you know it includes those things, and that the USCCB’s memos all oppose it? For the same reasons the Hawaii compromise violates the freedom of a religious entity not to promote by active facilitation a practice that it morally opposes. Actively facilitating referrals to abortifacient, contraceptive and sterilization coverage is arguably even more direct cooperation than funding it, at least according to your own standard that “direct” is central to cooperation being really objectionable. But whatever your own conscience has concluded on the theological questions of what “principles” are “important” and what ones are not, why should religious organizations who reach a different conscientious conclusion than you be told by you or by the government that they should compromise and violate their consciences? Why should they have to accept your conscience at the penalty of the federal government? How can you defend such compulsion, as Catholics, as liberals, as Americans? Why should only Catholic schools and hospitals be exempt–why not evangelicals, orthodox Jews, Muslims? Why not social service agencies? For that matter why not businesses run by religious believers? This publication complains about the ethical failings of the capitalist system and its corporations all the time, so how can you insist on ethics in wall street if you unless you also afford businesses religious rights to operate without the federal government forcing them to violate their religious beliefs? You cannot relegate religion out of business, to serve a contraception agenda, and still insist on ethics in business. And finally, why do you continually ignore the fact that the Obama Mandate is illegal under the Religious Freedom Restoration Act, that prohibits the federal government from violating religious beliefs when it could, if the political will existed, provide free contraception etc. itself without coercing any objecting employers? Don’t you realize that under RFRA no “compromise” is possible–not forcing referrals, not ignoring evangelicals or social agencies or businesses, not ignoring individuals forced by Obamacare to buy this coverage–because federal law mandates that every kind of entity or person be protected from any mandate violating his or its religious beliefs in this situation? The mandate violates federal law–how can you defend it? And in any event, how can you impose your own conscience about what cooperation is OK or not, what principles are important or not, on other people who have reached a different conscientious conclusion? Is that liberal? Is that Catholic? Is that even humane? It is certainly a rejection of Dignitatis Humanae that Commonweal is now telling other religious entities, including Catholic ones, that they must compromise their consciences because yours reaches a different conclusion. That’s a breathtaking position your editorial and so many of your bloggers propose. How can you take this view? Michael Sean Winters now calls your view “shameful,” because it is.
I laugh at the thought of the armchair ideologues ruing their frenzy when they find themselves obliged to pay the full cost of contraceptives for themselves and their families.
It’s a start. This is politics. Obama said he wouldn’t budge. He budged. The bishops say they won’t budge. They will.
It’s a quarrel between politicos, and the people who will suffer are not being consulted.
David Smith–
I’m not so sure. Obama recognizes that he is a politician and make take political losses. The bishops are being prophets, in their own minds at least. Prophets don’t tend to compromise.
This NCR piece shines a little more light on the Hawaii plan.
http://ncronline.org/news/politics/hawaiis-contraception-model-has-downsides-some-say
Here’s my thought for the day: the Hawaii plan is presented as having three main elements:
1. A ‘refusal clause’ for those employers who have religious objections to providing contraceptive coverage
2. For employees whose employers have invoked the refusal clause, a provision whereby the employee can pay for contraception herself, but at the discounted group rate rather that the retail list price.
3. A requirement that these employers provide employees with a list of places where contraception can be procured. (As an aside: whether this amounts to a “referral” is something worth considering. In my business life, I think of a referral as having an element of personal testimony and recommendation that arguably is not present in merely giving the employee a list of nearby retailers. Essentially, all the requirement does is save the employee the time and effort of having to grab the Yellow Pages and look up “Pharmacies”. I’d argue that, morally, providing a list of retailers falls short of making a referral for contraception).
Doerflinger has put his finger on #3 as being objectionable. For the sake of conversation, let’s stipulate he’s correct about that (and I’m certainly not saying he’s wrong). Fine. Then let HHS cross of no. 3 from its compromise proposal. There is no reason I know of that an HHS compromise offer has to mimic the Hawaii plan in every respect. Clearly, nos. 1 and 2 are the key provisions that would satisfy Catholic moral objections to the current plan. Neither of those depends on no. 3. A compromise plan that provides nos. 1 and 2 by themselves should satisfy all parties.
Three things:
1. The referral issue is, as I wrote in the post, easily fixed by having someone other than the employer initiate communication with the employee.
2. Why doesn’t the diocese in question contract with insurers that offer a policy without contraception? Lots of employers offer only one health-coverage plan.
3. Isn’t it a bit rich for Bishop Lori to complain about the referral rule as a bridge too far when he approved the decision to allow Catholic hospitals in his diocese to provide emergency contraception services?
Mr. Gallico–I think it’s important to be clear on this. If you are proposing a “Hawaii Compromise Amended,” and the terms are
(1) objectors do not have to cover the objectionable items
(2) objectors do not have to DELIVER INFORMATION about the objectionable items or cover the same
(3) any entity, any business, any individual, and any insurance company can be an objector
Then that sounds fine, but it’s not a compromise anymore. It is a universal exemption. So are you and the Editors advocating a Hawaii Compromise in favor of a universal exemption or not? If so, just say it. We are in agreement. And the USCCB, by the way, is taking a position that requires nothing more. But if not, which of these points do you not accept as too extreme, and to that extent, how can you justify imposing your conscience on those entities/persons, or to require them to contribute to coverage, or to require them to communicate referrals?
“1. The referral issue is, as I wrote in the post, easily fixed by having someone other than the employer initiate communication with the employee.”
My group insurance plan (which, I should keep reminding myself, I am blessed to participate in) already gives us a list of pharmacies who are in its network – not just for contraception but for any prescription. If a putative compromise requires a list of pharmacies be given to employees, I’d consider it already delivered.