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What rides on the rider

In their statement on the revised version of the HHS regulations, the U.S. bishops write that under the new terms, the mandate "would allow non-profit, religious employers to declare that they do not offer such coverage [of sterilization and contraception]. But the employee and insurer may separately agree to add that coverage. The employee would not have to pay any additional amount to obtain this coverage, and the coverage would be provided as a part of the employer's policy, not as a separate rider."This redfaced point, which as far as I know has not been contested in any of the descriptions of the regulations that are out there, seems to me to matter quite a bit. For in order for there to be a meaningful sense in which the HHS mandate doesn't require employers to provide insurance coverage for sterilization and the purchase of contraceptives, there needs to be a meaningful sense in which the insurance policy provided by the employer is different from the one that covers these things. Otherwise, we end up with a situation where, while an employer-sponsored policy may not cover sterilization and contraception at the moment that it is issued by the employer, once the employee requests the insurer to add such coverage that same (employer-sponsored) policy now does cover these things, and such coverage is integrated seamlessly with the rest of what the policy covers. It may be true that the default employer-sponsored policy does not pay for anything that the employer finds morally objectionable, but if the modified policy is also an employer-sponsored one, and coverage for sterilization and contraception is a part of it, then the employer has sponsored a policy that covers sterilization and contraception. And surely it will not matter that the employer did not have to tell the employee that there was an employer-sponsored plan available that covered these things, or that the insurer happens to be making it available to the employer at a reduced rate.By contrast, if coverage for these things is on the books as an additional rider that the employee is offered the opportunity to add for free, then -- so long as it really is free for the employer -- the force of this worry diminishes significantly. For then it strikes me the most accurate way to describe the situation would be as one where it must be in the terms of the employer-sponsored policy that it includes an option to add some separate policy that would bring with it some additional coverage, albeit of a sort the employer would rather not provide. I do not expect that everyone who is worried about the mandate's effects on religious liberty would be persuaded by this, but I think I might (though I would still oppose the mandate on other grounds). In any case it would go some way to addressing the concern about the "seamlessness" of employer-sponsored coverage as described in the paragraph above.I will now be shouted at in the comboxes. Please be charitable, as I am not in anyone's pocket here, and I have been thinking a lot about these questions and working hard to set my thoughts straight.

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But Grant, it all hinges on the form that the contraceptive coverage takes. If it is simply folded into a single policy (i.e., the one sponsored by the employer), then it doesn't seem to me that it would be separate in any meaningful sense, and so it wouldn't assuage these concerns. But if its relation to the original policy is similar to that of a rider (and why not just call it a rider? Surely things that are usually paid for can sometimes be offered for free), then the claim that it is separate -- which, by the way, is nowhere in the lines you just quoted -- has some oomph. Was it really made clear to you by people in the Obama administration that the coverage for contraception will be separate from the rest of the plan in the (not merely notional) sense I am after here?Also, Jim Pauwels is exactly right.

If the bishops' description is correct, then this might be worth considering: employee group health policies aren't perpetual. There is typically an "open enrollment period" every year in which each employee re-ups (and learns how much more she'll have to pay than last year). Suppose, in Year 1, a new employee enrolls in his Catholic employer's health plan. Contraception is not included. During the same policy year, the insurer and the employee agree, per the proposed mandate, to 'add on' no-charge contraception (and the critical issue here is, what are the mechanics of adding on). Thus the employee now has the standard employer group plan, plus the no-charge contraception addition.Now, the end of Year 1 is approaching. It's open enrollment time. The employee wants to re-enroll for another year. Does the employer's group policy now include the contraception benefit, which is renewed when the employee renews the standard policy? Or does the employee and the insurance company have to separately re-enroll in the contraceptive policy? Is it the employer's job to track down the employee who forgets to re-enroll in the contraceptive policy? If the employer manages to forget to re-enroll in the contraceptive benefit during open enrollment, is he out of luck for the next year?

Grant, will the new policy be required to be offered to employees of exempt organizations as well or just non-exempt but objecting ones? Don't you think an expanded exemption coupled with this separate policy offered directly to employees would satisfy everyone better that the proposed revision? It will satisfy the pro-contraception parties that objected to the inclusion of any religious exemption, since the employees will still get access regardless of their employer. It will also satisfy those that don't like the limited exemption which treats relgiously affiliated schools and hospitals as "not really relgious." If the exemption includes Taco Bell's owned by those that object to contraception and actually provide health insurance to the limited number of employees they have, even Picarello should be satisfied. The only ones that wouldn't be satisfied are the insurance companies, which will have to offer a separate contraception coverage policy for free, but they should be fine since it is supposedly cost-neutral at worst. Why not try for a win-win solution like this? Any objection from commonweal?

"If the employer manages to forget to re-enroll in the contraceptive benefit during open enrollment, is he out of luck for the next year?"Sorry, should be, "if the *employee* managed to forget to re-enroll ..."

David N, EEOC has not stepped up enforcement of that policy. Belmont Abbey College lost an administrative case, but EEOC failed to file an enforcement action when Belmont hired Becket to defend them under RFRA. I have not heard of any other cases where EEOC has actually filed a action to enforce this decision, which was limited to prescription contraceptions and did not include sterilizations.

here is a link to the Becket Fund's description of the EEOC case: http://www.becketfund.org/belmont-abbey-college-north-carolina-2009/I have not found anything on the EEOC website.

John: You're free to call it whatever you want, but a rider is defined as an additional benefit to a policy that the beneficiary pays for.If the contraception coverage is folded into the policy paid for by the employee (with co-payments from employees, it should be noted), then you're right, we're back to square one. But that is precisely why I believe the senior administration officials who briefed reporters on the revised plan. I have reported what I could, according to the terms of the interview. Senior administration officials confirmed that the contraception coverage would be offered as a separate policy. Another questions: does it make sense to announce that insurers will contact employees to ask them whether they want contraception coverage (and let's not forget that it's optional) if the idea isn't to offer a separate policy? This too was a modification of Hawaii's arrangement. In Hawaii, employers that invoke the religious exemption must directly inform employees where they can obtain contraception coverage -- that is, as a separate policy from the insurer that handles employee health plan.

John Schwenkler, you're asking a question which assumes that there is a plan in which all the details have already been put into precise language.The document published in the Federal Register is only an outline of the major points of the plan. As the document says, the details will be worked out over the next year, before religious hospitals, universities, charities have to take any action. If you read the outline, there is nothing there to justify the bishop's claim that "the coverage would be provided as a part of the employers policy, not as a separate rider.The bishops may claim that that is the only possible way it could work, but that is not true at all. I don't personally like the term rider (used in Hawaii) because it suggests that it is an add-on to the employer's policy. I would prefer a separate policy. However, it's possible that it is not either and you just register online with the insurance company to join the "free contraception program" which is described on their website. I think the essential point is that the insurance contract the employer buys says that it excludes any coverage for contraception, just as it does now. I don't see any reason why that is not possible.

MikeD: I've written this up before. The revision only applies to religious employers that do not primarily employ and serve co-religionists and whose purpose is primarily to inculcate their religious values. That means that people who work in houses of worship, parish schools, chanceries will not be eligible to receive free contraception coverage as a separate plan. I don't see the administration allowing any employer who objects to contraception to opt out. It's nonprofit religious institutions at issue here.

John, I don't think you can have a policy that both covers and doesn't cover contraception. It either does or it doesn't. If insurance companies offer policies to Catholic organizations that do not cover contraception and then make some other arrangements with individuals, it would seem that the bishops are being accommodated. If you are imagining that the policy offered to the individual would somehow be the same policy the bishops paid for, I can't imagine how that would happen. A policy is a quite specific contract. The same policy could both cover and not cover contraception. By definition it would have to be different.

Matt, Arguing that the insurance policy belongs to the employee is a non-starter. The policy belongs to the employer and is purchased by the employer, the employees are the beneficiaries. ed gleason at 12:19 describes the situation perfectly and inadvertantly makes my case. He has no say over the changes in the policy and doesn't even have to agree with the changes, they just happen. Someone does though, and that is the owner of the policy which is the employer.

OOPS "The same policy could NOT both cover and not cover contraception. By definition it would have to be different.

Insurance without contraception coverage is one policy. The contraception coverage offered directly to employees is another policy. If contraception was just included in the policy if, in other words, it was all one policy why would the regulations phrase it this way? Separate coverage means separate policies.Again, as Harvard's Greg Mankiw has said without rebuttal, all that the administration has suggested it might do in the future is change from A to B below: A. An employer is required to provide its employees health insurance that covers birth control.B. An employer is required to provide its employees health insurance. The health insurance company is required to cover birth control.Whether you say the birth control offering is "separate" or is a "rider" or whatever is just semantics. In both cases, the employer is paying for something, and that something ultimately has to be accompanied by subsidized contraceptives. You can object to both, you can be happy with both, but it makes no sense to object to A but be satisfied with B.

Grant, I understand the proposal, but why not follow Hawaii more closly by expanding the exemption and offering the separate policy to all employees of exempt employers, even those that do primarily employ co-religionists and inculcate religious values. That would actually expand the amount of people who will be able to receive contraception. Based on the 98% figure that has been floating around the comments, I'm sure there are some parish secretaries or teachers that would like that coverage.

The facts are that many many many Catholic colleges and hospitals NOW have BC coverage. This ins. coverage is in their faculty/employee/union contracts. If they call one of the amateur canonist's posting here and asked 'do we have to terminate BC coverage right now or wait till the contracts expire'. What say you? Will the USCCB send them that Taco Bell attorney they have, to defend the inevitable law suits?

Grant, will the new policy be required to be offered to employees of exempt organizations as well or just non-exempt but objecting ones? Dont you think an expanded exemption coupled with this separate policy offered directly to employees would satisfy everyone better that the proposed revision?Do you think Archbishop Chaput wants his insurance company to offer free contraception to his chancery employees?My guess was that HHS kept the two groups separate to avoid disturbing the status quo for groups like churches, etc that satisfied the original definition.If the Church wanted to have the same plan with free contraception for both groups, my guess is that HHS would consider it. But I can imagine the uproar from the bishops if HHS did that on its own.

We seem to have a split on this now between conservative Catholics and progressive Catholics. Too bad.John Schwenkler 02/13/2012 - 11:54 am contributorYes, it is too bad. But that is why it is so important to clarify the underlying issues, which is what I am trying to do here. Whether or not I am a conservative (and I remain unsure what that even means), my worries are Catholic and philosophical, and certainly not partisan.

Yes, I agree that it's very important to clarify the issues. Terribly so. And I'm grateful to you for doing that well.Labels like "conservative", "liberal", and "progressive" have no clear boundaries and seem to be used mainly to do away with the bother of having to think things through, to spell them out. Also, of course, they're commonly used to segregate, to circle the wagons, and to vilify. I wish this were about something as simple as reproductive rights. Theoretically, at least, that could be discussed dispassionately, intelligently, with good will on all sides. Instead, this is about politics, and politics goes immediately into labeling people as friends and enemies.One fascinating thing about this so far is how Obama seems to have chosen the right approach to dividing the temporarily united "progressive" and "conservative" Catholics. In hindsight, it wasn't difficult, but it was certainly clever and insightful. There's a little article in The New Republic - an excerpt from a book written before all this - I don't remember any particulars - that remarks on Obama's ability to extricate himself from tight situations, but always at the last minute. Looks as though that's what happened here.

Bruce thinks I made his argument. Bruce thinks the bishops own the policies at Colleges and hospitals. Of course he is wrong. Maybe I own all the damn policies.. lookit up.

David G (12:53) quotes somebody:

Even assuming the Bishops are correct in their characterization, this objection seems excessively precious to me.

Well, yes, that's what the argument is all about, isn't it? You think it's trivial and they think it's not. Why not grant them that to them it's not, and it's their rights that they feel are being violated, not yours? Suppose it were the rights of a group that didn't involve Catholics at all? Would all Catholics be justified in writing it off as trivial?

MikeD 02/13/2012 - 1:56 pmIf the revised mandate were really like the approach in Hawaii, it would include a much broader exemption (for any organization that objects to including contraception/sterilization/abortifacient coverage on moral or religious grounds) and then have the separate rider for employees of exempt organizations be the means of achieving universal coverage for those that want it. I would be supportive of such an approach (despite my objections to mandates and contraception coverage in general). Whether the Bishops would support such an approach would be up to them, but I think it would be much closer to hat they want than the unwritten revision outlined in the federal register.

That all sounds good to me, Mike.If Obama had to stir up this hornet's nest at all, why didn't he at least choose that much more respectful approach? There was a comment out of the White House (as I recall) early on about government lawyers having reservations about the legality of their doing that. That sounds to me more like an excuse than an explanation. If they'd tried, they could have made it work. After all, they're the government - they have bottomless pockets and endless resources and patience. The extremely unfortunate fact is that they didn't try. And now we have this.

Nobody is going to pay any attention to the bishops at all if they continue with such made-up problems as this seems to be.

Ann, I think a lot of people are going to pay attention to them. This is just beginning.

GG: "a rider is defined as an additional benefit to a policy that the beneficiary pays for."Sed contra: Riders are usually paid for but can be given for free. For example, Those with older life insurance policies might have received an Accelerated Death Benefits Rider for free. Under this rider if you are faced with near certain death in the next few months you can withdraw some of the equity in your policy beforehand. New products commonly have such a provision but older ones did not. In order not to lose their long-time customers to the newer products the insurance company might offer the rider free, at least to selected clients. And not just in competition with other companies - - they may want to offer an updated rider so that their own new product does not cannibalize their own older productsThere is no necessary link between a rider and payment, not legally and not empirically. Some things in life are free, after all.But perhap the administration has plans to mandate payments for all riders that the rest of us don't know about.

Ed, let me ask you the following questions:1) Did you choose the Company?2) Did you negotiate what it covers?3) Did you negotiate its price?Those are the things the employer, as owner of the policy needs to do, even if you didnt see them. You and your fellow employees are the beneficiaries. We all realize the benefits are valuable and so accept reduced wages in exchange for them. But if you choose not to accept any benefits you dont receive increased compensation. The employers keeps any savings. All those things make the employer the owner. The employee has a right to the benefits under the policy, but that does not make them the owner.

Bruce, interesting. If you don't think of health insurance as a form of payment going from employer to employee--if you don't think a transfer of ownership is happening--it makes a lot more sense to me why someone would remain unsatisfied with the new arrangement. I don't think I buy that it's not a form of payment though. I think of health insurance as part of your compensation for work you've done. The employee has in effect paid for the insurance with his or her work.Your argument that the employer is the owner of the policy because he's the only one who can make changes to the policy doesn't hold up in this instance because the employee is in fact making changes to the policy once it's in her possession.

#1 Yes I had a choice of carriers i think about three at the start. . My employer was AT&T and they had more on their mind then about what ins. benefits were over 55 years,# 2. the HMO dictated what was covered. 3. No negotiations.. they raised the price every of the 55 years or so when the 'contract' expired.4. and the bishops still don't own the College and hospital polices.. 'Butt out... your excellency' ' would be a polite as I would get if I was Catholic hospital or college CFO.. . #5 AT&T transfered my health account to their pension plan and we both were happy.What's not to understand about 'Butt out ..your Excellency.. we don't see your name on the bill. the deed, the incorporation papers. 'Consult the USCCB Taco Bell attorney, he may help you out on who owns what.

I dont think I buy that its not a form of payment though. I think of health insurance as part of your compensation for work youve done. The employee has in effect paid for the insurance with his or her work.Matt Moses,In support of your position is the fact that the idea has occasionally come up to tax employer-provided health insurance as income.

Your argument that the employer is the owner of the policy because hes the only one who can make changes to the policy doesnt hold up in this instance because the employee is in fact making changes to the policy once its in her possession.

It seems to me that the employee is merely activating part of an existing policy. There's only one policy, no? As I understand it, if there were two policies, one of which could be entered into separately and voluntarily by the employee by choosing it, we'd have a very different situation and one that might come close to settling all differences.I wonder why the government is refusing to do it that way.I also wonder whey they opened this Pandora's Box in the first place, but that's become a separate issue, now. It seems unlikely that they'll confess error and close it, highly desirable as that would be (except, of course, to the people they were apparently trying to please in the beginning).Politics can be extremely unpleasant stuff.

Let me try this.Every state has a legitimate interest in the terms of the jobs that are offered to its citizens. Part of that interest is in seeing that employers do not exploit the economic power they have to hire and fire.Every state has a legitimate interest both in the way in which health care is provided to its citizens and in how that care is funded.Clearly, the Obama administration takes it that making contraception available is an important part of the preventive care that ought to be provided.Bishops disagree. They have every right to argue that the state ought to change its policies, even to argue that the administration policy is immoral. But they have to win that argument through the political process.So long as the no one is legally obliged to be an employer and no one is forced to use contraceptives, it is very hard to see that anyone's conscience is being violated.Now, there is a state interest in having Churches hire people to do all sorts of things that are in the public interest. That gives the bishops some clout in bargaining about the terms of employment. They are entitled to use that clout as they see fit. They might like to see their views prevail bot have no practical reason to think that they can get everything they think they have a moral right to argue for.So far as I can see, the bishops are using their clout poorly. They are also overreaching in their claims about conscience violations.

Matt,This link describes generally how health insurance works. And it leads me to change my description of the employer to sponsor as the plan rather than owner. http://www.kff.org/insurance/upload/How-Private-Insurance-Works-A-Primer... agree with your premise that health benefits have value and they are provided in return for work. I dont think that's enough to treat them exactly like wages however. For example, one could elect not to participate in the plan (common for a working couple) and there is not a commensurate increase in cash compensation. In effect, that non-participant is now working for less. That is different from other employee directed deductions out of wages.Davids comment about taxing employer provided health insurance is interesting in at least 2 respects. First the non-taxable nature of health benefits has created this problem by making health benefits more valuable to the employee than cash. That presumably makes employees will to take less value in health care benefits than they would demand in wages, which also benefits the employer. And second, because those health benefits are only non-taxable to the employee when paid directly by the employer (vs employee buying and deducting) they have created this conflict between the church and government (and numerous other problems as well).Nevertheless, I think the best way to think of employees in these plans is strictly as beneficiaries.

Ed,Your health benefits were paid directly by AT&T through a self-funded plan under ERISA. The 'health insurance companies' were merely administrators hired by AT&T to handle the day-to-day interactions between beneficiaries and providers. You merely had a claim as a beneficiary. The proposed solution clearly does not work in this case because the Catholic institutions will be paying directly for the problematic mandated services.As for your excellency comment, If I was the bishop I'd respond, "I'm the keeper of 'Catholic', if you choose not to follow my direction in this matter, then you can remove the 'Catholic' from your name. I believe that was the decision and solution in the case of adoption services in Illinois when faced dealing with adoptions by gays.

John Schwenkler, would you have any problem with this scenario?1. A Catholic hospital continues to buy from United Healthcare the same policy it has now - that policy excludes coverage for contraception.2. Without any involvement by the hospital, the government pays United Healthcare to provide free contraception to any employee of the hospital who wants itIf that does't pose any moral issue for the hospital, then determining how much the government should pay United Healthcare is an issue for the two of them to work out. It doesn't affect the morality of the scenario.The government says that United Healthcare is going to save so much money because of fewer pregnancies that it will either make more profit or, at least, break even. Therefore the amount of money it should pay United Healthcare is zero. Maybe they are right, maybe not, but that is a business deal for the government and United Healthcare (and the rest of the insurance industry) to work out. If United Healthcare and the other insurance companies won't agree to the zero payment, then there can be a discussion of whether the government or the employee should pay. In any case, the hospital won't have to pay. Any problem there?

Bernard,Your legal analysis is inverted for the following reasons. The highest law is the constitution which says that 'Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof'. So if Congress tries to make a law, even employment or healthcare law, which it believes is in the best interest of the community, it is precluded from doing so by the constitution if that law prevents the free exercise of religion. That is the Bishops fundamental position. And trying to mandate that any institution which has employees is not a religious institution runs afoul of the exact same problem. Even the original regulations conceded both these points, thats why they had the exclusion for tightly defined religious organizations.

John Hayes: I would oppose such a policy for other reasons (namely, that I don't think access to free contraception is a public good), but it might obviate the problem I am identifying with what I take to be the policy we're getting.

If the contraception coverage is folded into the policy paid for by the employee (with co-payments from employees, it should be noted), then youre right, were back to square one. But that is precisely why I believe the senior administration officials who briefed reporters on the revised plan. I have reported what I could, according to the terms of the interview. Senior administration officials confirmed that the contraception coverage would be offered as a separate policy.

Grant, if things are as you describe in your comment at 3:14, then basically the additional coverage is essentially a rider ("A supplementary clause or codicil added to a document after its first drafting", says the OED, and as Patrick Molloy explains it doesn't matter whether (or how) it's paid for), and so the policy would meet the objection I am raising here. So perhaps I was not right to say that there are no reports out there that conflict with what the bishops say in what I quoted, though I am not sure that the administration itself is clear enough on its policies to make these distinctions. If you want to trust that the officials you spoke to were able to make these distinctions effectively, that's your prerogative. Again, I am just trying to make it clear where the issues lie -- and I am glad that the distance between us seems to concern questions of fact rather than those of right.

John Hayes: I would oppose such a policy for other reasons (namely, that I dont think access to free contraception is a public good), but it might obviate the problem I am identifying with what I take to be the policy were getting.My sense is that what I described is what we will get if the insurance companies agree not to get paid extra. In that case, I think the regulations will not mention anything about getting paid - they will just require that any insurance company that sells a contract that excludes contraception must provide free contraception to any employees covered under that contract. The insurance company will do it because the regulations require them to do it - not because there is anything in the hospital's insurance contract that requires it.

Bruce. last week Catholic Health Care West changed it's name to Dignity Health Care. Biggest ..at least in the west. Now don't tell us that someone, a hierarch owns Dignity, even if it's the core of our respect life principles. If you take your arguments with their esoteric reasoning to the public square you will be ignored by the polite and mocked by the mean. ..

From the Catholic point of view, the issue lies in the degree of cooperation with the "evil" of contraception. If employers are not contracting and paying for contraception, then the cooperation is quite remote, and, given the great good of health coverage, licit.

If employers are not contracting and paying for contraception, then the cooperation is quite remote, and, given the great good of health coverage, licit.It may be that the level of cooperation would be remote enough to make it licit if there is no other way to provide health coverage. But that doesn't mean the state should force employers into that position, which is what is at issue here.

Last Sunday, on the front of the bulletin was an outraged letter from our archbishop on the HHS ruling. It was hard to sit in my pew. Politics had entered the Church. Sister Carol who actually works in health care had accepted the Presidents recent ruling on the birth control ruling. The bishops have decided that the Republican party is for them and is joining them to get rid of the President. It did not work the last time and this misuse of power continues to erode the love of the Church for many. Catholics are leaving the Church. They are making us choose. We want to stay but they are making it so hard.

John S. In the scenario I described I don't see any any cooperation in evil at all. The hospital excludes contraception from its insurance and it has no control over the insurance company distributing free contraception as required by the government. If the bishops' goal is to get to the point at which no one who works at a catholic hospital, university, etc can get contraception other than by paying for it with their own money or qualifying for a low-income program at Planned Parenthood, I think that is going to be a very hard sell.

No, Bruce. There is no infringement of free exercise clause by saying that , if in the course of doing so, you employ people that you don't have to employ. Any organization, religious or otherwise, can engage in whatever activity it wishes. But if they decide to employ citizens to do so, they are not free to do so on whatever terms they choose. There are legal consequences to the decision to hire people. The state has a legitimate interest to make sure that the employment of its citizens takes place under terms that protects the employees. Only the state has the legal authority to decide what these terms are. Of course, bishops, like the rest of us, can engage in the political debate to ask whether the state has picked out the right terms. But that debate is essentially a political debate. No one can elude the political nature of this debate by declaring, unilaterally, that its preferred position be legally controlling.

You can also look at it this way:The ins. co. decision to offer free contraceptives is just a cost of doing business for them. The Catholic employer asks the ins. co. for something simple: will you sell us a contract for an ins. policy that doesn't include contraceptives, etc. coverage? The ins. co. replies Yes, and they sign such a contract. End of employer=ins. co. relationship except for paying the premiums and giving it ins. co. the names of the employees of their institution. The ins. co. then asks the employees if they want riders. Some say Yes. So the company pays for them, and writes off the cost of said contraceptives, etc. End of ins. co.-employee relationship.Yes, the employer has to give the employee names, but they *have* to give the names so the ins. co. can pay for the other meds and services.

I thought what was at issue was the kind of cooperation we were talking about. After all, any time you pay an insurance premium you are subsidizing someone else's contraceptive services. There's a good chance that, according to the bishops' arguments, you're subsidizing abortions too.

No, the bishops' arguments do not have that consequence. For the subsidy is not deliberate in that case, whereas it clearly is when you are paying directly for someone's health coverage.

It has nothing to do with the deliberateness of the act, but rather the nature of health insurance. When you pay Aetna a premium for your coverage that does not include abortion, it's pooled with premiums from enrollees whose policies cover abortion.And now critics of the revised regulations (let us for the moment stipulate that the revision is real) are complaining that even if you split the policies, the employer will still be subsidizing the contraception coverage because they just know insurers will raise rates. Those sorts of objections misunderstand pooled risk.

Bernard,You said: "Any organization, religious or otherwise, can engage in whatever activity it wishes. But if they decide to employ citizens to do so, they are not free to do so on whatever terms they choose. There are legal consequences to the decision to hire people. The state has a legitimate interest to make sure that the employment of its citizens takes place under terms that protects the employees. Only the state has the legal authority to decide what these terms are."I believe the Supreme Court recently rejected that view 9-0.

And now critics of the revised regulations (let us for the moment stipulate that the revision is real) are complaining that even if you split the policies, the employer will still be subsidizing the contraception coverage because they just know insurers will raise rates. Those sorts of objections misunderstand pooled risk.Well that is not my complaint, though I do think it is important that premiums be shown not to go up as a result of the policy.But it is absolutely wrong to say that deliberateness is irrelevant. If I go to a restaurant and buy myself a meal, then I am not paying for your meal, even if in fact your meal was offered at a reduced price and the difference was made up by some of what I paid. Rather, I paid the restaurant for a service, which they provided, and then used what I paid to cover some other costs. In the very same way, when a company (or individual) buys into a health plan, they pay for a certain policy, and the insurer uses the money that was paid (which has now changed hands, as was noted above) in various further ways, including paying for things covered under the policies of other individuals. But the other policyholders (or their employers) are not paying for those services any more than I would be paying for your meal in the situation I described: rather, they pay only for the things they purchase from the insurance company, namely their own policies.

If a religious employer provides for employees a non-contraceptive (NC) plan and as a result the employees receive contraceptive (C) coverage both coverages begin not before the employer pays the initial NC premium and ceases when the employer stops paying premium (with a limited grace period) for any individual. In other words, if Jane Doe quits in the middle of the year both her NC and her C coverage will no longer be in effect. The C coverage lasts only as long as the NC coverage is being paid for. She cannot continue her "free" coverage if she is no longer part of the religious employer's plan. Whether we want to talk about one policy, two policies, or a base policy and a derivative policy (or rider) the two coverages could not be more closely united. I suppose it's possible that a benevolent insurer might continue the C coverage when Jane quits her job - there's no law against it - but I find that even harder to believe than the other dubious elements of the HHS grand bargain. After all, the insurer is supposed to profit from reduced pregnancy claims in the NC plan which becomes non-existent for Jane due to her separation from employment. It's impossible to deny that thetwo coverages are paid for with the same premium dollars whether the NC and C benefits are listed on the same page or disclosed in two separate mailings. BTW, if I were a big insurance company I would be wary of religious employers with a lot of transient workers. These workers would get the "free" C coverage but not stick around long enough for the insurer to reap the benefits from reduced pregnancies.

@Luke Hill on Lisa Fullam's example of the options available to Catholic couples"Its also because of these lived experiences that the overwhelming majority of Catholics just ignore ecclesiastic teaching on contraception."Exactly! While the technical intricacies of insurance policies and various theological hyper-distinctions are hashed out, real couples face options as best they can. Bishops have achieved their irrelevance the old fashioned it, by earning it. The amount of suffering they have facilitated is unfathomable.

I only meant that whether you intend it or not, when you pay premiums to an insurer, your money is being pooled with funds from people who are contacting for abortion coverage. Your premium is not segregated into a separate non-abortion-funding account.Of course, according to the Catholic moral calculus, whether you seek abortion coverage matters significantly. But that is something the revised mandate attempts to address. The USCCB said it was wrong for the government to require it to "pay for" (that's the language they kept using) contraception coverage. Obama said, all right. Even though we are already exempting houses of worship, parishes, and chanceries, we won't make you include contraception coverage in the health plans of your hospitals, schools, and charitable organizations. We will have insurers do that separately.

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