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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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For any given day or week or year there will be all sorts of cross-subsidies in insurance payouts. On Monday NARAL may subidize the Little Sisters of the Poor Nursing Home and on Tuesday the resuls may be reversed. But over longer periods (which is the proper insurance perspective), if the pricing actuaries are doing their job the magnitude of cross-subsidies will be minimized. The plan sponsors will tailor their plans for a given set of benefits and the premium will closely correspond to that set and not the benefits chosen by others. Over time they will get roughly what they paid for and not a random lottery-like result characteristic of daily payouts. If NARAL ends up susidizing the Little Sisters Nursing Home for more than a year they should get a different consultant to help them find more appropriate coverage and vice-versa. Religious employers should not throw up their hands in the belief that since we can't monitor the movements of every dollar on a daily basis it's useless to distinguish between degrees of cooperation over longer periods. They should maintain their rights to choose a set of benefits fitting their mission.

When you pay Aetna a premium for your coverage that does not include abortion, its pooled with premiums from enrollees whose policies cover abortion.And the relevance of this is what? You're still not paying to get abortion coverage for anyone -- they're having to pay extra for that themselves, if they want it.

Even though we are already exempting houses of worship, parishes, and chanceries, we wont make you include contraception coverage in the health plans of your hospitals, schools, and charitable organizations. We will have insurers do that separately.This is a distinction with any moral difference. Mere semantics.

Sandra, no one on this thread is going to pay any attention to you, so I, also a woman, will step up. If you notice here and if you check back on similar threads over the past few days, you will see that the posters are overwhelming male. They just seem to love those angels dancing on the head of a pin arguments. The more abstract the better. It is more than offensive. And you are correct. People are fed up, especially women and those men who love and respect women. And yes, it is a misuse of power by the bishops, those crazy old uncles up in the attic. We can't get rid of them because they're part of the family. We just have to take them out of the attic occasionally for ceremonial occasions and hope they don't embarrass the rest of the family.

Grant said: If employers are not contracting and paying for contraception, then the cooperation is quite remote, and, given the great good of health coverage, licit. And John responded: 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 doesnt mean the state should force employers into that position, which is what is at issue here.John is exactly right, and it's a point Grant refuses to address. Even if Grant's view of cooperation is one legitimate view among Catholics (something John's questions are poking holes in), the point is that there are organizations out there, Catholic and otherwise, who don't agree with grant and who object to levels and balances of material cooperation that Grant does not object to. Why should everyone have to agree with Grant or be fined by the government? Even if Grant's view is one legitimate one, that does not even begin to get Grant to the conclusion that his view justifies mandating every other Catholic, Christian, Jew and Muslim (especially ones running businesses) that their consciences can be violated because they don't adopt Grant's moral calculus. That is insane from a Catholic perspective, from a liberal perspective, and also from the perspective of the federal Religious Freedom Restoration Act which prohibits any such burden (which Obama's rule simply says he is in compliance with, without offering any explanation of why, because no explanation is possible for the simple fact that the government could give away contraception free ITSELF instead of forcing others to do so). And this gets us back to John's question: the fact that the government could provide contraception coverage itself, to any comer, shows why the Mandate is NOT independent of the employer's plan. Not any woman can walk into the Insurance Office and say give me my free coverage. It can only be a woman whose employer already pays that company. There's nothing separate about it, when you consider the alternative of the government offering it regardless of where the heck you work. The contingency of the employer's plan being paid for for that employee is a necessary and direct condition of the woman getting her extra coverage under the President's proposal even according to Grant's interpretation of it. But the point isn't whether there is or is not a way to make Grant correct that the cooperation can be mollified even in those circumstances. The point is that Grant has offered absolutely no excuse why every religious person affected by this mandate must agree with Grant on this question--why dissent from Grant's moral view can legitimately be squashed by the federal government.

Politics had entered the Church.

Yes, Sandra, but it came from outside, not inside. Before August of last year (as I recall) this issue did not exist. Then the White House created it. Would you have had the Church simply accept the change without protest, and start paying for insurance policies that covered contraception and sterilization? Or did you object to the original dictum but feel that the second version solved the problems presented by the first?

I do think it is important that premiums be shown not to go up as a result of the policy.

John, that's impossible, no? How could such a thing ever be proved? There must hundreds of thousands of interrelating factors figured into rate increases. It would simply be buried in the noise.

Bernard,I agree with you that the state has a legitimate interest to make sure that the employment of its citizens takes place under terms that protects the employees'. Unfortunately, its subordinate to the constitution. The administration's carve out for religious institutions demonstrates that they agree and the recent Supreme Court decision in Hosanna-Tabor Evangelical Lutheran Church and School v. EEOC decided on Jan 11, 2012 by a unanimous vote demonstrates that the court agrees as well. You can read the entire decision here. http://www.supremecourt.gov/opinions/11pdf/10-553.pdf One pertinent part on pg 21 says The interest of society in the enforcement of employ- ment discrimination statutes is undoubtedly important. But so too is the interest of religious groups in choosing who will preach their beliefs, teach their faith, and carry out their mission.Your position while well argued just doesnt hold water.

Ed, I think your example about Dignity just demonstrates the validity of my argument, no matter how esoteric you consider it. And if that means being ignored and mocked, so be it. I'll happily change my mind given a well-reasoned and Truthful argument, but mocking and ignoring are neither.

The USCCB said it was wrong for the government to require it to pay for (thats the language they kept using) contraception coverage. Obama said, all right. Even though we are already exempting houses of worship, parishes, and chanceries, we wont make you include contraception coverage in the health plans of your hospitals, schools, and charitable organizations. We will have insurers do that separately.

Grant, don't you have even a tiny nagging doubt about the ethics or possibly the legality of the President's simply ordering insurance companies to suck up the cost of contraception and sterilization coverage (yes, of course there's a cost) just to give him political cover with enough Catholics?

David Nickol, thanks for the link.Bruce,I don't think the fact that an employee could elect not to participate in health insurance offered by their employer makes it any less of a form of compensation. Money left on the table is still money. The idea of employees being merely "beneficiareis," gives me a connotation of employees benefiting from their employer's generosity, rather than the employees being independent actors in a business relationship who are receiving payment for services rendered. I love capitalism.John Schwenkler,You bring up intentionality. This is how I understand your refutation of Grant's arguments about pooled insurance money: the Church isn't funding BC when it pays into a health insurance plan because even if that money goes into the pot that funds BC for people on other plans, the Church isn't intending to pay for BC and so its conscience remains clear. If this is true, then couldn't the same argument be made in support of the revised rules? If you still feel Church money is being used to fund BC, then isn't the Church's conscience in the clear because it isn't intending its money to be used this way?

Ann, You posited the following: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 doesnt include contraceptives, etc. coverage?Since the insurance will know that it must provide 'free contraceptives' as part of a policy with a religious employer, even if that policy on its face does not include contraceptives, wont it just figure those into the cost of the policy? There is no way to force a demarkation. Everybody knows the policy must include 'free contraceptives' and thats the fundamental problem. I believe its a Hobson's choice: a free choice but with only one choice. In my book, thats not a free choice.

Matt,I love capitalism too. And I agree money left on the table is still money. By beneficiaries, I dont mean to imply that its not fair deal mutually negotiated between the employer and the employee. I only mean that the only way the employees can access the compensation is by accessing medical benefits. Those benefits are funded, in part, by the employers cash. And if they include contraception et al, then the employers cash is purchasing those benefits on behalf of the employee and voila, we have the bishops problem. They are different from wages because the employee cant do whatever they want with them.

Matthew Yglesias, a leftist commentator, after making the obligatory sneer at Catholic "obscurantism," points out how how the HHS mandate actually operates (he might also say that there's quite a bit of progressive obscurantism involved in the HHS scheme):"Another point worth making is that this is one of these issues where the actual incidence of the costs of a policy and the legislative incidence are going to be quite different. Liberals often like making "employers" pay for things as an alternative to taxing people. But in practice, employers are making a tradeoff between health care spending and wages. If your employer shifts from not subsidizing contraceptives to subsidizing them, what happens is that the workers who don't use contraceptives are providing cross-subsidy to those who do."http://www.slate.com/blogs/moneybox/2012/02/10/the_economics_of_birth_co... some good comments on the post - about the less than impressive record of preventive measures.

Bruce, I think that's a better argument: they're different from wages because the employee can't do whatever they want with them. They can only buy health care with this particular form of compensation. But even if it's a payment that can only be spent on health care, shouldn't the employee be allowed to spend it on health care as they decide? Must my employer add additional limitations on what this particular form of compensation is allowed to be spent on?

John S: "I do think it is important that premiums be shown not to go up as a result of the policy."If only. My premium went up significantly a year after AFC passed Congress. I'd think the only way to stop insurance companies from raising premiums for whatever purpose they like would be federal regulation. But how far can that go? If premiums don't go up one year, they'll go up the next. I think it's a given insurance companies will raise premiums whether they need to or not, and when they do, those opposed to the HHS mandate are going to claim that just proves -- again -- that the President's "so-called" accomodation was a scam.It seems to me the USCCB distrusts everything that comes out of this White House. They seem perfectly willing to put the worst possible spin on virtually anything Obama does. Now, some have gone as far as to accuse him of intentionally attacking religious liberty. Who else speaks of the President this way? Three guesses. It's hard not to think somebody's throwing partisan wrenches into the works, if not the bishops themselves, those advising them.

Having read this exhausting discussion I am starting to wonder why the government needs to spell out in detail what must be covered by health insurance. I think one could easily devise some more flexible system of incentives to motivate employers to buy decent coverage for their employees, without all this micro-managing.

I'm not endorsing Fox News here. This interview with Cardinal Wuerl is posted on the Archdiocese of Washington's website: http://www.foxnews.com/on-air/americas-newsroom/index.html#/v/1450080861...

Cardinal Wuerl raises one good point: the administration has to work with institutions that self-fund their employee health plans to figure out how to keep them from funding contraception coverage. The notion that the proposed revision violates Catholic institutions' religious freedom is a canard.

Grant,I'm not sure how your first and second sentences work together.

Bishop Lynch, in the Diocese of St Petersburg, says his diocese is self-insured, so the fix actually leaves him in a worse position. Bishop Lynch seemed pretty reasonable on health care reform generally, so I would give his concerns some weight. http://dosp.co/2012/02/little-more-than-a-nod/

Matt,You asked: Must my employer add additional limitations on what this particular form of compensation is allowed to be spent on?Almost all of our entire health care system is based on the employer deciding what will be covered and to what extent, except when the government steps in with its mandates. I'm guessing employers try to balance cost against employee happiness (or maximize utility in economic speak) but as the sponsor its the employer's decision. And I dont think its an easy fix because as soon as you move to individual policies, and away from groups, you get the problem of adverse selection where only sick people enroll or the individual mandate. But because the employers sponsor health care coverage for their employees, and the church is an employer, you get the current issue.

Grant,I think you are way to quick to dismiss Cardinal Wuerl's religious freedom issue. The administrations recent revision is a formulaic response but as this long thread demonstrates there is substantial disagreement about whether it has any substance. In our world of employer sponsored health care its virtually impossible to separate the employer from the health care provided. Its impossible for any self-insured entity, and the notion that the triangle of Employer-Insurer-Employee that the administration envisions somehow gives independence to the employer when all three know the endgame is at best a fig leaf and at worst laughable.

Re Bruec and Josh:Both of you cite the Supreme Court ruling to refute what I said. Note that the Supreme Court is a branch of the government. Nothing in the decision you cite suggests that the Supreme Court takes it that the bishops are entitled to determine the meaning of the Constitution. The bishops are entitled to raise a LEGAL challenge to any law that they see fit. They are not legally entitled to determine the validity of that challenge. That is a governmental function, sometimes to be performed by the Supreme court and sometimes to be determined by either the executive or the legislative branches.None of this means that the legal trumps the moral in every respect. Sometimes the moral issue is so important that the legal norm must be violated whatever the legal cost. Sometimes the moral issue is not so important. In either case, it makes no sense to suggest that the bishops can or ought to be the ultimate determiners of the legal. That they are not so does not mean that their moral claim to freedom of conscience has been infringed upon. Rather it means that exercising it may have a legal price to pay.

"Since the insurance will know that it must provide free contraceptives as part of a policy with a religious employer, even if that policy on its face does not include contraceptives, wont it just figure those into the cost of the policy? There is no way to force a demarkation."We expect that, if the insurance company is rational, it will try to make up the loss on the 'free contraceptives' somehow. It is not a given that it will do so by raising the premium to the Catholic employer. For one thing, the market may not permit it; if United Healthcare tries to jack up the rate, the Catholic employer may be able to switch its business to Aetna or Blue Cross/Blue Shield and get the same or a lower price.Perhaps the insurance company will make up the loss by charging its non-Catholic-institution clientele a higher rate for their 'free contraceptives'. Or perhaps it will do so by imposing higher co-pays on actual healthcare meds across the board on the employees of all its clients. Or, for all we know, there could be a tax write-off benefit to just sucking up the loss on the 'free contraceptives'.

Grant, I agree with Bruce: you are dismissing these concerns way too quickly, especially given the lack of any written document or other official statement from the administration that confirms your interpretation of the law.

John and Bruce: Only if you believe Obama was lying or crazy would you think that he had no intention of codifying the proposal he made on Friday in a nationally televised press conference. The regulations themselves promise to work out something along those lines. If the ultimate final regulations actually require Catholic employers to contract and pay for contraception services, I will criticize the Obama administration again -- as I did many, many times before the revision was announced last Friday.

Grant: Nothing Obama said in his televised press conference is sufficient to clarify the issue I am raising here. Nor is it clarified in the document released by the WH press office, which looked like it had been written up in about five minutes. Nor is it clarified in the version of the regulations posted to the Federal Register, which as I understand it do not include the accommodating language at all. So no, I don't have to think anyone is lying or crazy to want something more than the word of an unnamed administration official who said some things in a conference call about a policy that he or she may not wholly have understood, and indeed that may not really have been worked out in detail at the time, especially given that those descriptions of the policy are contradicted by ones that other parties seem to have come away with.

John Schwenkler, I don't understand your comment "Nor is it clarified in the version of the regulations posted to the Federal Register, which as I understand it do not include the accommodating language at all."The Federal Register includes the "deal points." As in any business negotiation, these have to be developed in a second step to describe he exact methods by which the points will be accomplished. As explained in the document, that development will go though the normal federal rulemaking process, which provides for input and comment on drafts by stakeholders. That rulemaking process will happen during the coming year and final rules will be published before the hospital, universities, etc. have to comply.Here are the "deal points" (my emphasis)

With respect to certain non-exempted, non-profit organizations with religious objections to covering contraceptive services whose group health plans are not grandfathered health plans, guidance is being issued contemporaneous with these final regulations that provides a one-year safe harbor from enforcement by the Departments.Before the end of the temporary enforcement safe harbor, the Departments will work with stakeholders to develop alternative ways of providing contraceptive coverage without cost sharing with respect to non-exempted, non-profit religious organizations with religious objections to such coverage. Specifically, the Departments plan to initiate a rulemaking to require issuers to offer insurance without contraception coverage to such an employer (or plan sponsor) and simultaneously to offer contraceptive coverage directly to the employers plan participants (and their beneficiaries) who desire it, with no cost-sharing. Under this approach, the Departments will also require that, in this circumstance, there be no charge for the contraceptive coverage. Actuaries and experts have found that coverage of contraceptives is at least cost neutral when taking into account all costs and benefits in the health Plan. The Departments intend to develop policies to achieve the same goals for self-insured group health plans sponsored by non-exempted, non-profit religious organizations with religious objections to contraceptive coverage.A future rulemaking would be informed by the existing practices of some issuers and religious organizations in the 28 States where contraception coverage requirements already exist, including Hawaii. There, State health insurance law requires issuers to offer plan participants in group health plans sponsored by religious employers that are exempt from the State contraception coverage requirement the option to purchase this coverage in a way that religious employers are not obligated to fund it. It is our understanding that, in practice, rather than charging employees a separate fee, some issuers in Hawaii offer this coverage to plan participants at no charge. The Departments will work with stakeholders to propose and finalize this policy before the end of the temporary enforcement safe harbor.Nothing in these final regulations precludes employers or others from expressing their opposition, if any, to the use of contraceptives, requires anyone to use contraceptives, or requires health care providers to prescribe contraceptives if doing so is against their religious beliefs. These final regulations do not undermine the important protections that exist under conscience clauses and other religious exemptions in other areas of Federal law. Conscience protections will continue to be respected and strongly enforced.

John Hayes: I don't think the second boldfaced sentence (which is the crucial one) settles anything. For my worry hinges on the relation that the contraceptive coverage offered by the issuer, if accepted by a plan participant, will bear to the employer-sponsored policy. If it's not a separate policy from it (which language is not included in the regulation), then the policy doesn't meet my standard.

A lot of discussion has assumed that today's health insurance companies are like Ben Frankln's fire insurance company where a group of homeowners pooled the risk that some of their homes would burn down and agreeed that those people would be reimbursed out of a pool of money that they had all subscribed. That arrangement is what is called a mutual insurance company and the policyholders are the owners of the company.if the company makes a profit, some of the profit goes to a reserve against future losses and the policyholders get the rest either as a dividend or as a reduction in future premiums. But companies like Aetna and United Healthcare are not mutual companies. They are businesses with investor shareholders. They make a contract with you that you give them a certain amount of money and they will take the risk of paying all the claims that fall within the terms of the policy. You are not involved in any pool. If claims are high, they bear the loss; if claims are low, they make a profit. You do not share in their profits or losses unless the contract has some special provision for that. I think this has a bearing on some of the moral issues that have been discussed.

Officials. As in senior administration officials who were involved in crafting the policy. The revision of which was reported by every major media outlet in the country. I certainly won't try to force you to take the word of people who can't meet your standards of press-release composition, but I would ask that you consider how politically daft it would be for Obama to do what what those advancing the other "interpretation" claim he will. Namely, nothing. If Obama was planning all along to force Catholic hospitals, universities, and charities to pay for contraception coverage for their employees, then last week's press conference and press briefings were an elaborate ruse. Why would he do that unless he wanted to offer his political opponents another cudgel with which to beat him?Also, it's not quite accurate to say that the regulations codified Friday do not include the accommodating language "at all":

Specifically, the Departments plan to initiate a rulemaking to require issuers to offer insurance without contraception coverage to such an employer (or plan sponsor) and simultaneously to offer contraceptive coverage directly to the employers plan participants (and their beneficiaries) who desire it, with no cost-sharing. Under this approach, the Departments will also require that, in this circumstance, there be no charge for the contraceptive coverage.

There would be no point in describing two offers of insurance, one without contraception coverage, and one offering just contraception coverage, if the original "final" ruling was going to stand, forcing religious employers to purchase contraception coverage for employees.

John Hayes-- this language which you bolded is of no legal significance whatsoever:

Specifically, the Departments plan to initiate a rulemaking to require issuers to offer insurance without contraception coverage to such an employer (or plan sponsor) and simultaneously to offer contraceptive coverage directly to the employers plan participants (and their beneficiaries) who desire it, with no cost-sharing.

Grant is wrong to say that "the regulations promise" anything. What's written above isn't a regulation at all. The regulation is what comes at the end. What's written above is just fluff, as far as the law is concerned. It doesn't bind anyone, and if the Department doesn't initiate such a rulemaking, or if this (currently hypothetical) rulemaking doesn't turn out as promised, no one will have any recourse.

John Schwenkler, I guess you'll have to wait to see how it develops in detail during the next year. However, note that the FR language " Specifically, the Departments plan to initiate a rulemaking to require issuers to offer insurance without contraception coverage to such an employer (or plan sponsor"Does not support the bishops' statement:"the coverage would be provided as a part of the employers policy, not as a separate rider.

John Hayes and Grant,To me, this is the critical piece: the Departments plan to initiate a rulemaking to require issuers to offer insurance without contraception coverage to such an employer (or plan sponsor) and simultaneously to offer contraceptive coverage directly to the employers plan participants (and their beneficiaries) who desire it, with no cost-sharing. But of course, just writing rules cannot force this to happen. As virtually everyone agrees, this is impossible to make happen in a self insured plan making this sentence completely worthless:The Departments intend to develop policies to achieve the same goals for self-insured group health plansJust standing up and giving a speech, or printing up deal points does not mean the deal actually works. Many times, working out the all details of a deal shows the initial agreement is unworkable.

Grant, you keep moving the target. E.g. you write:

If Obama was planning all along to force Catholic hospitals, universities, and charities to pay for contraception coverage for their employees, then last weeks press conference and press briefings were an elaborate ruse.

But I am not saying that there is any such plan. Rather my suggestion is that employers may end up being forced to sponsor a single plan that includes coverage for contraception. And that possibility is entirely compatible with the letter of what you quote.Look, here is another way to put the difficulty. I think it has come out in this discussion that the question of what does or doesn't count as sponsoring an insurance plan that includes coverage for X is pretty hotly contested. I have tried to fix a criterion that would settle this. Why should I be confident that the officials you talked to had this strict sort of criterion in mind rather than some looser one, or even that they were attuned to the importance of this strictness? Does the administration employ a fleet of moral philosophers and theologians?And John Hayes, it is simply not the case that the line you quote is in any sort of tension with the bishops' description of the policy. The employer can be offered a plan without coverage for contraception that is then changed into one that does have such coverage, at the employee's request. Grant himself has insisted that the coverage for contraception won't take the form of a rider.

Stuart is wrong to claim the codified regulations don't promise anything. They say that a rule will be issued that will allow religious objectors to offer contraception-free coverage to employees and that employees will be able to obtain contraception coverage from insurers with no cost-sharing.He is not wrong to say that if the rulemaking described in the code never happens, then nothing will have changed. At which point I will happily criticize the Obama administration for trying to force religious employers to pay for coverage that violates their religious values. Again.

John: Of course, I can't predict the future. It's possible that the administration will screw this up, just as it screwed up the original regulations. But is it likely? We have reason to believe they heard the message of offended Catholics and are serious about codifying a policy that responds to that criticism. Sr. Carol Keehan, president of the Catholic Health Association, believes the plan does just that. She consulted with the administration before Friday's announcement. I have no doubt that she pointed out why the original regulations were unacceptable. It doesn't take a fleet of moral philosophers, or moral theologians, to get that point across.

Again, Grant, this just shows that you have a lot more confidence in the administration's ability to engage in careful moral reasoning, not to mention its good will, than do many of the rest of us. And given the seriousness of these issues, it seems fair for those of us who weren't privy to the private conversations to wish for a written statement from the administration that clarifies these issues.I hope I will not be regarded as a cynic if I also point out that if the administration does mess this up, it will be post-2012, and so too late for there to be any real political consequences.

John Schwenkler, speculating about language that doesn't exist yet isn't very useful. Your post started from the bishop's statement that:the coverage would be provided as a part of the employers policy, not as a separate rider.I don't see anything in the Federal Register that suggests that. So let's wait to see what the draft language actually says when it is released for public comments.

But, John, you need not be privy to private conversations to see my point that the politics of the matter weigh heavily against the USCCB's theory that nothing is really going to change. And you need not be privy to those conversations to read the many news reports about the plan.Just because the grace period goes to 2013 doesn't mean the revision won't be codified before then.I understand why people are skeptical of the administration, and I would never caution unfounded trust. it just happens that you and I differ on the likelihood of the administration keeping its word. Something a skeptic might keep in mind as he weighs these matters: During the health-care-reform debate, the USCCB sent out a stream of missives predicting that the executive order promising no federal dollars would pay for elective abortions as a result of the new law was not good enough, and that abortions would be federally funded. Yet, when New Mexico and Pennsylvania tried to cover abortions with Affordable Care Act subsidies, HHS (under Sebelius) issues orders forbidding them from using federal dollars to pay for abortions, citing the president's executive order. Sometimes politicians keep their word.

"But companies like Aetna and United Healthcare are not mutual companies. They are businesses with investor shareholders. They make a contract with you that you give them a certain amount of money and they will take the risk of paying all the claims that fall within the terms of the policy. You are not involved in any pool. If claims are high, they bear the loss; if claims are low, they make a profit. You do not share in their profits or losses unless the contract has some special provision for that."John Hayes --This cannot be repeated often enough. There is NO problem of the monies of the premium payers being pooled and then used to buy other people contraceptives, for the very simple reason that the money they give the ins. co. is no longer theirs. What they now have in exchange for the monies are their rights to have the ins. co. pay the medical bills that they contracted for.Treating a nothing ("my" premiums in the ins. co's pool) as a something always leads to ridiculous implications. In this case it leads to saying that the employees of the Catholic NGOs, etc. are paying for other people's contraceptives, sterilizations, and abortions.

Bernard,First, the Supreme Court is the body tasked with determining Constitutional limits. The Legislative and Executive do not have that authority. Second, I quoted you both the recent Supreme Court decision and the Administrations original carve out for religious institutions to show you that both these arms of the government have acted recently in a way that shows they see a first amendment argument which belies your absolute 'if you have employees then the government sets all rules' position.Finally, governments exist to serve the governed. As Lincoln said, our is '...of the people, by the people, and for the people...' And the Declaration of Independence notes '...that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed...'One of the unalienable rights is Freedom of conscience and worship and as such it preexists and stands above any law, including the constitution. And the law must recognize and defend that freedom to have any claim at legitimacy.

The question has been asked, many times now, why the Administration doesn't just give contraceptives directly to consumers, if it is that important a health policy. My question is, can the Presidency promulgate what is in effect a brand-new federal entitlement without Congress' consent? If not, that may explain why the President keeps ordering that someone, anyone other than the federal government, pay for contraceptives.

Jim,I hope the obvious answer to your question is the correct one: he cant. And he cant get Congress to appropriate funds.I recommend this article as well worth reading. President Obama, the Right Not to Do Wrong, and the Politics of Ruse and Delayby Matthew J. Franckhttp://www.thepublicdiscourse.com/2012/02/4716

Jim Pauwels, I suppose because 85% of employees already have contraception included in their health benefit plans.No reason for the government to take that cost off of the hands of employers who are already paying it. Congress did require the mandatory inclusion of women's preventative services in health benefit plans when they passed the Affordable Care Act. They left the definition of specific preventitive services to be established by HHS regulations. Contraception is only one of a list of items. I haven't heard any objections to any of the other items.

The other reason for the government not to give away contraceptives is that the insurance company can make money by giving them away free.The insurance company has already signed a contract that it requires it to pay for all pregnancies of employees of St. Joseph's Hospital. The amount of oney it will get is fixed, regardless of no much it spends. It's actuaries say that if the insurance company gives away free contraception, it will save more money on pregnancy costs thn it will lend on contraception. Right now, it can't do that because the bishop won't allow them to solicit the hospital employees. The new regulations will require them to do it, so the bishop can no longer prevent it. Please notice that the insurance company is using its own money to do this. As Ann Olivier has explained, once the hospital paid the premium, it became the insurance company's money. The proposition that contraception is cheaper than pregnancy care has been put forward by the government and they have provided some data for that. I don't think we I'll really know until the insurance companies get into the discussion.

Typos"The amount of money it will get is fixed, regardless of how much it spends".Lend = spend

Right now, it cant do that because the bishop wont allow them to solicit the hospital employees. The new regulations will require them to do it, so the bishop can no longer prevent it.Richard Doerflinger objects to that:

These organizations may voice an objection to the coverage that violates Catholic moral teaching, but insurers will ignore this objection and offer that coverage to the organizations employees anyway, without a rider or extra payment. In short, the federal government will insert itself between the religious organization and its own employees to make sure that, in President Obamas words, womens health coverage includes contraceptive services no matter where they work. Obviously this proposal raises grave moral concerns for anyone who thinks religious organizations have a right to conduct their internal life consistent with the teachings of their faith. We hope this approach will ultimately be rejected by lawmakers in favor of a policy that truly respects the religious freedom of these organizations.http://americamagazine.org/blog/entry.cfm?blog_id=2&entry_id=4930

What the USCCB wants:

If President Obama wishes to respect religious institutions that serve the poor, he will recognize them as authentically religious and give them an exemption. Then we can move on to discuss the religious freedom rights of insurers, other employers, and individuals who want a plan that does not violate their beliefs.

Mr. Gallico believes the administration may issue a final rule explaining the unacceptably unanswered questions about this hypothetical compromise before election day. Fine--the question for Mr. Gallico is simple: what month and day will be accept that the President has not kept that promise and not acted before election day. What is Mr. Gallico's deadline for when the President has waited so long that he can avoid ANY ELECTORAL CONSEQUENCES for breaking his promise, a promise that is already is unacceptable (to the self-insured, to religious groups that must not be forced to accept Mr. Gallico's moral theology calculus, and for other reasons). What is your deadline? Remember that the rulemaking process allows the President unlimited discretion to change the rule until the very final day--so even if he begins rulemaking to do x (he literally has not done so), and lets the public comment on it, there is absolutely no requirement, none at all, that the final rule say x. If the final rule is not out by election day, there is zero requirement that it ever become law, or in any particular form. So what is your deadline? If your answer is, you don't mind if the process runs after the election, when the President is no longer accountable, then stop telling John that the President may keep his word before the election, because you are defending support of the President even if he runs the process out until he has no accountability, none whatsoever. If your answer is that the President must finish the process by October 15, fine. But if you state no position on that, your present status is support of the President, which necessarily means supporting him even if he does not finalize any rule before the November election. Until you set a pre-election deadline that's what you are asking people to do, write the government a blank check to force everyone to agree with the moral cooperation analysis of Grant Gallico or be fined and punished.

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