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Insurance claims.

Last week, in a tour de force of intellectual humility, Matthew J. Franck treated First Things readers to a catalogue of my confusions. He didn't take kindly to my analysis of Cardinal Timothy Dolan's response to HHS's new proposals for the contraception mandate. First, Franck claims that I am "confused...about what the government actually announced." Second, he says that my analysis of the moral culpability of religious employers is unreliable because I am "confused about the economic reality of insurance." This confusion, Franck informed me via Twitter, is profound: He sees "no sign from you either of an argument, an ability to read, or an understanding of arithmetic." Given those impairments, I may not be able to formulate a successful response to Franck's confident critique, but I beg your indulgence as I give it a shot.

Let's start with the Franck's first complaint. Do I have the foggiest idea of what HHS actually announced? Here's how I summarized the latest proposals: "The new rule scotches the previous iterations much-maligned four-part definition of 'religious employer,' and proposes arrangements to make sure religious employers including colleges, hospitals, and charities wont have to pay for or refer for contraception coverage in their employee health plans." Later in the post, I wrote that "any religiously affiliated employer that has nonprofit status simply has to self-certify with HHS in order to opt out of the contraception mandate."

Franck alleges that I conflated the categories of religious employers proposed by HHS: "Gallicho fails to understand that the new, tax code-derived definition of 'religious employer' is perfectly irrelevant when it comes to the new second category, and insists, quite wrongly, that 'any religiously affiliated employer that has nonprofit status simply has to self-certify with HHS in order to opt out of the contraception mandate.'" But that isn't my only error, according to Franck. No, I've made "several mistakes at once":

First, the tax codes borrowed language does not apply to "any religiously affiliated employer that has nonprofit status,' but to a much tighter category of churches and their 'integrated auxiliaries." Second, the employers in the new second category who are nonprofits that 'hold themselves out as religious' do not get to 'opt out' at all, if by that is meant that their employees are not covered by the mandate; they get the new (essentially fake) "accommodation."

What is he talking about? When HHS floated its initial proposal for the contraception mandate, it counted as "exempt" only those employers that had religious inculcation as their purpose, that employed and served "primarily" co-religionists, and that operated as a nonprofit. I joined the bishops and many others in criticizing that definition of "religious employer."

A few weeks later, the Obama administration announced a new proposed rule that would "accommodate" religiously affiliated employers that failed to qualify for the narrowly defined exemption by allowing them not to include contraception coverage in employee health plans. Instead, the insurance company would offer employees of such institutions separate contraception coverage at no cost. (At the same time, the administration floated a series of complex arrangements that might address the situation of "self-insured" companies that pay directly for employees' medical care; those have been distilled in the latest HHS proposals.)

So, on the one hand there were "exempt" employers (dioceses, parishes, parish schools) -- their employees would not be eligible for the proposed free contraception coverage. And on the other hand there were "accommodated" institutions (hospitals, colleges, charities) -- they wouldn't have to contract for, pay for, or refer for contraception coverage, but their employees would be able to receive it at no cost from a third party. That difference is preserved -- but clarified in such a way that could expand the range of exempt employers -- in the most recent proposed rule, and that's what upsets Franck. He believes that there is a significant moral difference between a religious employer whose employees will not receive contraception coverage at all and a religious employer whose employees will receive contraception coverage from a third party. He thinks the only true "opt out" is available to fully exempt employers, whereas I see a moral significance in an "accommodated" employer's ability to choose not to contract for contraception coverage. I could have been clearer about this in my post, but in the final analysis, it makes little difference to the moral calculus because neither exempt nor accommodated institutions will have to include contraception coverage in their employee health plans. I agree with Bishop Robert Lynch that this arrangement amounts to "a distinction without difference." More on that in a moment.

Back to Franck: "When the Obama administration claims that employers will not 'fund' the contraceptive coverage provided by insurers," he alleges, "it speaks falsely." He continues:

When it [the Obama administration] claims that the free contraceptive coverage can be afforded by the insurer because cost-savings will result from improvements in womens health and fewer childbirths, the administration is admitting that the contraception is already being paid for by the employer, if its policy covers childbirth and womens health in general. The insurer is not being told to lower its premiums because of the cost-savings on procedures and ailments already covered; it is being told that it can put the cost-savings toward the expense of providing contraception. The existing premiums, paid by the employer, will be the funding source.

Leave aside, for the moment, the fact that actuarial studies have already shown that adding contraception coverage doesn't end up costing insurers extra -- it's not relevant to the moral question. What matters is who pays for it and why. Franck says that "the existing premiums, paid by the employer, will be the funding source." Unfortunately for his argument, that's not how health insurance works.

When a group like, say, EWTN pays monthly premiums to its insurance provider, the insurer does not take the money, deposit it in an account used only for the TV network's premiums, and then pay EWTN employees' medical bills out of that account. Rather, the insurer pools EWTN's payments with those from other customers. So when an EWTN employee gets an X-ray, the money that pays the bill may or may not come from EWTN. It may come from a company whose insurance coverage includes abortion. The insurer's risk assessment of its policyholders determines whose monies fill the pools. If the same insurer covers EWTN and NARAL, the two organization's monies will be mingled. Indeed, it's the pooling of premiums that provides the incentive for insurers to offer contraception at no cost to their customers. (In 2002, the Kaiser Family Foundation published a useful primer on health insurance [.pdf]. If you have trouble getting your head around our strange health-insurance system, it's well worth reading.)

So, pace Franck, when it comes to determining who's really funding contraception for employees of accommodated organizations, "the existing premiums, paid by the employer" will not "be the funding source." It may be one of the funding sources. It may not. The point is, there's really no way to know, because insurance companies are in the business of spreading risk. It would be like trying to determine whether any of Matthew Franck's federal tax dollars ended up paying for an abortion for a rape victim. Once he's paid taxes, that money is no longer his. It's collected with other people's money and dispensed by someone else. He's not on the hook for what's done with that money unless he's willed something evil. That is, of course, the point of money. Did the change I got from Starbucks this afternoon come from a drug dealer? I don't know. Was the banana I had this morning picked by a child? I hope not, but did I try hard enough to find out? Did the money I saved by not buying organic cover life-saving medical treatment for a loved one? An electric bill? An iPad mini? The Catholic tradition accounts for the complexity of moral agency in a fallen world. We are never disentangled from sin. So the tradition helps us think through these difficult questions: What did I intend? What was the effect? Could it have happened without me?

Franck doesn't give those questions their due. He seems to suggest that every time someone pays an insurance company he has illicitly cooperated with evil, regardless of intent. After all, major insurers cover abortion for at least some of their customers. (Would he also say "self-insured" religious employers that engage the services of an insurance company to administer their health plans are morally culpable [most do]?) Franck says the latest contraception-mandate proposals are no good because they still involve religious employers in morally illicit arrangements. But everything the Obama administration has proposed is designed to distance the religious employer from the coverage it objects to. It frees religious employers from having to say, "Yes, I want to include contraception coverage in my employee health plan." It allows "self-insured" religious employers to say, "No, we won't pay for contraception out of the monies we've saved to cover our employees' medical care." It transfers responsibility to a third party. If an employee of an "accommodated" religious institution avails herself of the contraception provided by a third party, her employer is no more responsible than it would be were she to use her wages to purchase condoms. In the United States, benefits are considered part of an employee's compensation.

Franck is hung up on whether the HHS proposals will actually work, whether insurers will recoup the upfront costs of providing contraception, even to people who aren't in their risk pools. But who cares? For "self-insured" companies, not a dime from their health-care kitties will pay for contraception. For companies that pay insurance premiums, they won't have to contract or refer for contraception coverage. Might their premiums end up paying for services to which they have religious objections? Yes. But they already are. That they don't intend to fund such services is what frees them from moral culpability.

And that's precisely why I believe the latest proposals for the contraception mandate pass moral muster. If Franck wants to counter my moral argument, he'll have to acquire a clearer understanding of how insurance works.

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Mark--I appreciate your spirit of charity. But I wonder whether it might be possible that your objection really isn't about contraception or about culture? Perhaps there is something else at work here. To illuminate it, as you kindly observe, is something to which I should not give much time.

John Hayes, thanks for posting the link to Bishop Lori's letter. Unfortunately, I am not able to access it. So I can't say any more about it. Nonetheless, your posting it was a service. Again, thanks.

"The notice would be provided directly to plan participants and beneficiaries by the issuer"John Hayes --Isn't "the issuer" of the policy the insurance company? If so, then this means that it will be the ins. co. that notifies the individuals covered that that contraceptives are available under another policy. The ins. co. wlll, of course, already have the names of all of the individuals covered.This means that the hospital, university, whatever, will not be involved at all in offering contraceptives insurance. Problem solved.

Matthew Franck has responded at First Things. That hole he's digging just keeps getting deeper! "I must still look at the situation, if I am one of these employers, and say 'I am arranging and paying for my employees to have contraception in their health insurance coverage.'" Well, no, you really mustn't.It's touching that there are people still attempting to find consistency in the bishops' shifting objections. But the "illicit coverage" thing is a tell: at this point they seem to be objecting first and then making up the reasoning after the fact. Stephen Millies is right: the bishops and their right-wing allies missed their chance to advocate for the single-payer system that would have taken this concern off the table. It's time to stop claiming absolute exceptional status as an injured party, admit that religious-freedom claims are complicated matters in a democracy, and work within the system like we have so many times before.

Well, no, you really mustnt.Forgive me, but this sounds tantamount to shut up, she explained. I dont understand all the intricacies of the insurance mechanism, but Francks conclusion that employers are effectively arranging for and paying for this coverage for their employees sounds about right. If the employers are not paying for it/arranging for it, then who is?

His conclusion makes a strong point, though:

Remember, the Obama administration itself recognizes there is a genuine religious freedom claim here, overriding any compelling interest in the employer provision of contraception coverage, when it wholly exempts one class of employers. The existing exemption amounts to a recognition that the fullest expression of religiously conscientious opposition is fulfilled by the ability to purchase coverage that really does not include (and is not merely said not to include) contraception coverage for any of ones employees. . . . There is no good argument for not exempting every other party seeking an identical exemption on religious freedom groundsthose like Belmont Abbey College and those like Hobby Lobby. All, as I have previously argued, are identically situated where their religious freedom is concerned. Why does the Obama administration think it is within its power to parcel out full religious freedom in one place, less of it in a second, and none at all in a third? And why does it have any defenders among those who wish religious freedom well?

If Obama's defenders really believe what they are saying about how the accommodation completely erases any connection between the employer and the coverage, such that no claim of conscience can still exist, then why exempt anyone, even churches?

20% of America's children lack food security. Wouldn't it be so much more productive for the USCCB to oppose child poverty with the same aggressiveness it is opposing contraceptive access? Why would people want to have children they can't afford to feed? Let's drop the Fortnight of Freedom stuff and have a Year of the Child; something we can all get behind.

Ann Olivier wrote: "Isnt the issuer of the policy the insurance company? If so, then this means that it will be the ins. co. that notifies the individuals covered that that contraceptives are available under another policy. The ins. co. wlll, of course, already have the names of all of the individuals covered."Yes, the insurance company is the "issuer"However, Bishop Lori complains that the employer is involved because it provided he names to he insurer:"Second, if a religious organization is not exempt, its insurance company or third-party administrator will impose the full mandate automatically on the organizations employees and their female children, using the personal information that the employer had entrusted to them solely to provide a plan consistent with the organizations faith."That does't make sense to me. It's a variation on an earlier argument that the employer was involved because if it hadn't employed these people they wouldn't be able to get this free contraception.They both sound like real stretches to me.

Why don't we see the USCCB in a similar snit about vasectomies, Viagra (Cialis, Levitra, whatever) and IVF?Health plans most certainly include the 1st 2 categories and, if not the 3rd, then employee benefits plans usually cover that if the cover adoption services.

Irene Baldwin wrote: "Who is Matthew FrancK? I googled and found a lawyer. Is that him? Does he have any expertise in insurance?"He's the director of a program at Robby George's Witherspoon Institute in Princeton. See: http://www.winst.org/corac/scholars/franck.phphttp://www.winst.org/corac...

Franck's argument doesn't work for self-insured plans because the administrators who provide the separate contraception policy are paid for it by HHS*. It's easy to demonstrate that the employer isn't paying for it. It would simplify things a lot if HHS did the same for insurers of employers who don't self-insure. The current scheme in which they provide the contraception coverage free in return for savings they make in reduced maternity costs on the employer's policy is not something that people can grasp intuitively and leaves the door open to the kind of arguments Franck is making.

*The mechanics are that they get a credit against fees that they have to pay to sell insurance though the state insurance exchanges

"Francks conclusion that employers are effectively arranging for and paying for this coverage for their employees sounds about right. If the employers are not paying for it/arranging for it, then who is?'Mark -- The issuer, the ins. co., is simply *not requiring payment* from anybody. In other words some employees will get the coverage free. It is to the insurer's advantage to do so because it thereby eliminates having to pay for the possible babies that will come without such coverage.

"However, Bishop Lori complains that the employer is involved because it provided he names to he insurer:"John Hayes --Sheesh. OF COURSE THE EMPLOYER GIVES THE NAMES OF ALL THE COVERED PERSONNEL TO THE INS. CO. BUT the free contraceptive coverage is independent of the coverage that the employers and employees pay for. The ins. co. will know which employees will get contraception coverage independently of the others because THOSE employees fill out a form and ask for it. It looks like the employers themselves won't know who is getting the free coverage. Excuse the shouting. Bishop Lori drives me up the wall, back down, then back up...

Ann--You're avoiding the question. Who's paying for the contraception? There's no such thing as a free lunch. Someone's bearing the cost.

Mark --Oh, c'mon. Many things do not call for payment, e.g., when you're given a free sample of a new product, or when you get some water from a public fountain, or when a kind soul gives some money to a beggar, etc., etc., etc., etc.......

And don't forget Wikipedia, shareware, etc., etc., etc., etc............

"Why dont we see the USCCB in a similar snit about vasectomies, Viagra (Cialis, Levitra, whatever) and IVF?"In a sense, the church has been "in a snit" over these things for years. But they don't have the same level of engagement right now because the government isn't mandating that employers or insurers provide coverage for them.Maybe the way for the Democratic Party to accomplish its goal of eviscerating the GOP would be to capture the male white vote by forcing employers to provide free Viagra.

Mark Proska, the company that sells health insurance to he employer pays for the contraception out of its own pocket. Them employer sends the insurer a "self-certiication" that it is exempt from providing contraceptive services.As the proposed regulations say:"The proposed rules would direct the issuer receiving the copy of the self-certification to ensure that the coverage for those contraceptive services identified in the self-certification is not included in the group policy, certificate, or contract of insurance; that such coverage is not reflected in the group health insurance premium; and that no fee or other charge in connection with such coverage is imposed on the eligible organization or its plan.The proposed rules would further direct the issuer receiving the copy of the self-certification to provide contraceptive coverage under individual policies, certificates, or contracts of insurance (hereinafter referred to as individual health insurance policies) for plan participants and beneficiaries without cost sharing, premium, fee, or other charge."The Notice of Proposed Rule Making asks fr comments on his poposed rrangement, so we should hear from inurance companies as to whether they agree this is fair to them. HHS explains why jt thinks this is fair:"Actuaries, economists, and insurers estimate that providing contraceptive coverage is at least cost neutral, and may result in cost-savings when taking into account all costs and benefits for the insurer. [12] In this instance, contraceptive coverage without cost sharing would be provided to plan participants and beneficiaries through individual health insurance policies, separate from the group policy through which all other coverage would be provided to plan participants and beneficiaries. The Departments believe that issuers generally would find that providing such contraceptive coverage is cost neutral because they would be they would be insuring the same set of individuals under both policies and would experience lower costs from improvements in women's health and fewer childbirths."

John has offered a clear, concise explanation of why the costs argument is off the table.I cannot understand how opponents are left with anything better than an objection to the fungibility of money, the sense in which we all are remotely culpable for every evil thing done with money because we participate in the financial system. I'll ask a question I've asked many times since 2001--How many abortions-via-smart-bomb have our tax dollars funded? It's an unknowable number, largely because our government won't collect that data. All we can know is that zero is an improbable number. The debate about the mandate has reached a point where this moral problem is greater than anything being proposed by HHS. Can we not simply accept that and move on to greater concerns??

I agree that providing the list of names to the insurer constitutes a form of cooperation; cooperation in evil may take any number of forms and needn't be strictly monetary.But, as Grant has pointed out many times, the Catholic moral tradition recognizes degrees of cooperation: such as direct, formal, mediate, remote. I remotely but unintentionally cooperate with contraception because I purchase non-contraceptive prescriptions from a pharmacist that also dispenses contraceptives, so to the extent that my purchases keep the pharmacist afloat financially, I'm enabling the distribution of contraceptives. But I view that cooperation as sufficiently remote that I don't have any moral qualms about my participation in contraceptive distribution by patronizing that pharmacist.I believe it's reasonable for an exempted Catholic employer to conclude that it is remotely and unintentionally cooperating in the distribution of contraceptives to its employees by providing the list of benefits enrollees to its health care insurer. It's not for me to say so; each employer should have the freedom to make that determination to the best of its ability, and to the extent it no longer has that freedom, the mandate is unjust. If the actuarial case for subsidized contraception is as compelling as the White House claims, then we should expect that, even without the HHS mandate, the marketplace would provide similar arrangements on its own. (I believe we saw Obamacare give the marketplace similar nudges while the recent Supreme Court case was pending; a number of insurers had announced that, even if the Supreme Court overturned Obamacare, they would continue to allow the children of policyholders to be enrolled as dependents through age 26.). Perhaps after 2016 we'll get the opportunity to test that hypothesis, but I doubt it.

...the company that sells health insurance to he employer pays for the contraception out of its own pocket.JohnThanks, but I dont think it can be that simple. Health insurance companies are not charitable organizations; they dont simply provide employers with a free lunch. Lets say the healthcare cost for an employee who contracepts is $700, plus $100 for the free contraception (so $800 in total), and its $1200 for an employee who does not contracept. To recoup its costs, the insurer must charge the employer, in total, $2000 for the 2 employees. So it must be the employer whos paying the $100 for contraception. If the insurer only charges $1900, he goes out of business, because his costs are $2000.Direct cooperation, no?

Jim Pauwels, a company that provides health insurance (even without contraception coverage) for its employees has to tell the insurance company the names and particulars of each person to be covered under the employers no-contraception policy. The employer adds and removes people from that list during the year. There is no list that the employer has to provide to the insurance company in connection with the free contraception program. The insurer already knows who it insures under the employees policy. The HHS proposed regulations authorize the insurer to use that information it already has to contact those people and provide free contraception to them. The employer has nothing to do with that.

Mark Proska, back several posts ago, I said that it would be simpler if HHS paid for this contraception in the same way they propose to pay for self-insured plans - because this system opens the door to endless arguments of the kind you've proposed.It may come to that, but, in the meantime, the HHS explanation isEmployer Premium to insure one employee with no dependentsA. $600/month including free contraceptionB. $600/month excluding contraception. (Possibly more than $600)In other words, excluding contraception but paying for more maternity care is at least as expensive as paying for free contraception.Therefore, the insurance company can afford to provide contraception because it will reduce he amount of money it would otherwise have to pay out under its policy with he owner.If the insurance companies don't agree, then HHS may need to pay them. But that's an argument between the insurers and HHS hat we don't need to be involved in.

"the HHS explanation is" should have been "my understanding of the HHS explanation is"

Therefore, the insurance company can afford to provide contraception because it will reduce he amount of money it would otherwise have to pay out under its policy with he owner.JohnI am fairly certain your last comment only supports my point. You are saying, and I would agree, that with the free contraception coverage, the employer, instead of paying the insurer for maternity services, would be paying the insurer for contraceptive services. Though the cost to the employer may not increase, in fact, it may even decrease (as in the example of my earlier comment), the reality is that the employers premium now goes not to provide maternity services but to provide contraceptive services.I think the Bishops have this one right.

According to this way of thinking, which does not even come close to comporting with the Catholic moral tradition, the bishops whose diocese do not self-insure have been illicitly "funding" abortions for years.

Mark, no. The Catholic employer has paid the insurer for an insurance contract that excludes contraception. Independently of the employer, HHS has set up a program that provides free contraception to people whose employers exclude contraception for religious reasons. That is absolutely clear in the case of employers who self-insure. HHS pays for the contraception.In the case of employers who don't self-insure, HHS is is trying to use the savings the insurance company realizes from providing contraception to reduce HHS's bill. This is rational, but creates a lot of confusion.

"Jim Pauwels, a company that provides health insurance (even without contraception coverage) for its employees has to tell the insurance company the names and particulars of each person to be covered under the employers no-contraception policy. The employer adds and removes people from that list during the year. There is no list that the employer has to provide to the insurance company in connection with the free contraception program. "I guess if we want to get more in the weeds on this, we could think about the 'providing lists of employees to the insurers.' My own experience as an employee is that I enroll - the employer doesn't enroll me. There is no doubt that the employer enables it in various ways (in the old days, by holding employee meetings; nowadays, by providing web links to enrollment sites). Would an employee who doesn't enroll in the group insurance be eligible for the direct-from-the-insurer subsidy?"The HHS proposed regulations authorize the insurer to use that information it already has to contact those people and provide free contraception to them. The employer has nothing to do with that."I would expect (and hope!) that the agreement between my employer and my insurer includes non-solicitation language. I guess the HHS regulation would have super-powers that override that private agreement.

Jim Pauwels wrote:" My own experience as an employee is that I enroll the employer doesnt enroll me.In order for you to enroll, your employer has to tell the insurance company that you are its employee and enough information so they can verify that they are dealing with the right person. If you leave your job, he company will notify the insurance company when to terminate your coverage. And "Would an employee who doesnt enroll in the group insurance be eligible for the direct-from-the-insurer subsidy?Employees can refuse the employer's insurance. This happens most often when your spouse or parent works for a company that provides a better deal. If you refuse your employer's plan, the individual mandate requires you to obtain health insurance from some other source. As I understand it, you only get free contraception if you are enrolled in the plan of an employer who is exempt from providing contraception coverage. And also wrote:"I would expect (and hope!) that the agreement between my employer and my insurer includes non-solicitation language. I guess the HHS regulation would have super-powers that override that private agreement."Whether the language is on paper or not, i suspect that an insurance company that sells insurance to a Catholic hospital wouldn't solicit its employees for contraception coverage without being required by the HHS to do it. They would worry that the hospital wouldn't renew with them - or might even sue them for using the information.

"As I understand it, you only get free contraception if you are enrolled in the plan of an employer who is exempt from providing contraception coverage."John Hayes - just to clarify this sentence: as I understand it, this mandate sets up at least four classes of consumers:1. Employees of employers who employ a certain minimum number of employees (50?), and who aren't exempt or accommodated for religious reasons. I believe that all of these employees who enroll in the group plan are eligible to receive free contraception - that is, free to the employee, but funded by the employer. This is the category Hobby Lobby falls into.2. Employees of religiously exempt institutions. They don't receive free contraception.3. Employees of accommodated institutions. They'll receive free contraception, paid for by the insurer or, in the case of self-insured accommodated institutions, by the third party benefits adminstrator (who in turn will be subsidized by the government).4. Employees who don't meet any of the above criteria. I guess they'll go to the insurance exchanges or pay the fine.

GrantFirst, you would need to explain how basic economics does not even come close to comporting with the Catholic moral tradition. Second, youve (tellingly, in my view) not explained how it is that you think that bishops who purchase health insurance have been funding abortion for years. Im sure you must agree that an insurance company will not charge the bishops a premium for abortion services, if it does not in fact provide those services to the bishops.What, exactly, is your point?JohnFrom the way youve explained it, the HHS is taking savings that belong to the employer/Church (the $500 in my earlier example) and using those savings to fund contraception. So the employer/Church pays the HHS (in terms of the HHS taking the savings that rightfully belong to the employer/Church) and the HHS then uses those funds to reimburse the insurance company for providing the contraceptive services to the Church employees. I agree that the HHS is removing transparency by inserting itself into the process (likely on purpose) but it gets back to the basic economic reality that the Church is now paying for contraception where it had paid for maternity services.

Hi,Jim. You're right. I should have spelled out that if you are an employee of an organization that qualifies for the accomodation and has self-certified as exempt, you only get free contraception from that organization's insurer or plan administrator if you are a participant or beneficiary of that organization's employee health insurance plan. The HHS Notice says:"the health insurance issuer providing group coverage in connection with the plan would assume sole responsibility, independent of the eligible organization and its plan, for providing contraceptive coverage without cost sharing, premium, fee, or other charge to plan participants and beneficiaries.

Have you read anything I've written about this? Do you know how insurance works? Read the Kaiser document.

Mark, a Catholic university (or whatever) that doesn't self insure is not paying hospitals, doctors or pharmacies for anything. It is paying an insurance company an agreed amount per month for each employee to take the risk of paying for whatever medical care that employee may require that is described in the contract between the employer and the insurer. If he insurer spends more than it gets from the employer, it is the insurer who takes the loss; if it spends less, it is the insurer who makes a profit. The contract between the employer and the insurance company does not require the insurance company to provide contraception (the employer insisted it not be included). If the insurance company provides free contraception to the employees at the insurer's own expense and that increases its profit, that is not money that belongs to the employer (or the Church).

GrantI may not be an expert in how insurance works, but I dont need to be an expert to see that you are avoiding the question. You're just flailing now.JohnThat is simply not correct. If the insurance company is using the Churchs funds (premiums) to provide contraception to the Churchs employees , so that it does not have to use the Churchs funds (premiums) to provide maternity services, thereby increasing profits, then the Church is indeed paying for the contraception (regardless of what the contract language tries to obscure). To work with the figures of my earlier example, the insurer is taking the $500 extra the Church is paying and using $100 to pay for contraception services and pocketing the rest as profit. The Church is paying for free contraception for its employees.

Try this: If paying insurers anything counts as funding whatever they cover for anyone, then any diocese, any person, has been "funding" abortion, because insurance companies cover abortions for some of their customers. There is no "abortion premium."

Mark.Insurance is a competitive marketplace. The employer should buy the insurance from whichever insurer offers the best balance of qualifications and price based on the same coverage (in this case, not including contraception).Once the employer has agreed to the price and paid it to the insurer, it is no longer the employer's money.

"If paying insurers anything counts as funding whatever they cover for anyone..."That's not what I said, it's just what you wish I had said. I will give you one more chance: Will insurance companies that do NOT provide abortion services to an insured (Archdiocese) jack-up the premium as if they were providing abortion services to the insured? Please don't tell me to read some other report, just answer that simple question.

JohnThat is true, but not relevant. When an insurer says to the Archdiocese: Look, I will now provide contraceptive services and not charge you any additional premium for itIll just give it to you as a freebie then, since (as you say) insurance is a competitive marketplace, it will only do that if it can take the premium the Archdiocese is already paying and use the funds to cover the insurers costs of providing free contraception. What it is doing it using the premiums paid by the Archdiocese and, instead of using them monies for maternity care, it is using the Archdioceses money to provide contraception, and increase the insurers profit.

"The reality is that the employers premium now goes not to provide maternity services but to provide contraceptive services." That is not the reality, and if you had the weakest grasp of how insurance works, you wouldn't say such a thing. I don't think you really want to know. Or admit to knowing. You think premiums are determined mainly by services covered. They are in fact governed mostly by risk assessments. So your question will illuminate precisely nothing.

Does anyone have an attempt at a response to the argument I highlighted above, viz., that if conscience arguments are so ridiculous here, then why bother to exempt churches? One can't have it both ways, after all -- one can't suggest on the one hand that conscientious objections are completely nullified if the contraceptive coverage is "free," while suggesting on the other hand that churches' right of conscience must be preserved. To bring forth such a combo package is to be disingenuous at least once.

Mark, saying the bit of dialog you propose would never happen. The insurance company is not providing contraception to the employer. It's excluded from the employer's policy.As I said in an earlier post, the problem with this part of the HHS proposal is that it lends itself to endless discussionsI'll stop here.

Mr. Gallicho -- your Kaiser link does not support the surprising conclusion that insurance companies set rates without reference to what services are covered or not covered. The opposite, in fact: it says that insurance companies set rates based on claims histories, and also treats government coverage mandates as if they are somehow relevant (which would not be the case on your view).Notice, if you will, that claims histories are always tied to some actual product or service, and do not occur in the abstract -- it's not as if a company says, "Oh, this group of people files 50 claims per person while this other group files 100 claims per person," without noticing that the first group is filing claims for heart transplants while the second group is filing claims for basic checkups. The claim that increasing or reducing coverage is irrelevant to pricing isn't believable. Moreover, as Mr. Proska has said, the mere fact (if indeed it is one) that an insurance policy with contraceptive coverage is just as cheap (or cheaper) than a policy without such coverage does NOT nullify the fact that the insurance company is quite literally making payments to drug companies for contraception. Where do you suppose this money comes from? Handwaving about fungibility is no answer, unless you mean to take the radical position that because money is fungible, you can buy an insurance policy for absolutely anything and then claim that you have no moral connection to the coverage because after all the dollars weren't labeled.

You're putting words in my mouth, Mr. Time.

You said, "You think premiums are determined mainly by services covered. They are in fact governed mostly by risk assessments."Risk of what, one might ask? Risk of losing a job? Risk of being lost at sea? Risk of having one's house burn down? Or, perhaps, risk of needing reimbursement for the "services covered"? Anyway, it makes no sense to deny that money will be flowing in exactly the way I and Mr. Proska described (from Hobby Lobby, let's say, to the health insurance company, and from there to the drug company to pay for contraceptive and possibly abortifacient drugs). The fact that one can't trace the exact dollars is neither here nor there.

What is gratuitously asserted may be gratuitously denied.

Some of the arguments here seem to presuppose that insurance companies are in a position to make fixed profits regardless of what the demand for their products are. When demands are lowered, profits are lowered. If the Archdiocese says to its ins. co., "We're not going to pay you for contraceptive coverage", then it simply is not true that the ins. co. will pay for the contraceptives AND increase the Archdiocese's premiums to cover the cost. The ins. co. could well be willing to absorb the costs rather than lose the lesser profits when the Archdiocese takes its business elsewhere.

Ann, I agree with you that there probably isn't a direct line between subsidizing contraception and an increase in the premium. At any rate, my observation is that group health care insurance policy rates have been rising at a rate considerably higher than the inflation rate, for many years now - for years before the HHS mandate kicked in. If insurers raise their rates due to the contraception mandate - how would we know?

Mr. Gallicho -- you haven't denied anything (except for the claim that I misinterpreted you in some unspecified way).

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