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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.

About the Author

Grant Gallicho is an associate editor of Commonweal. You can follow him on Facebook and Twitter.

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The CHA (Catholic Health Association) has issued a pretty favorable statement about the HHS proposals. Thy say "CHA is also aware that the issues that we have as a ministry are narrower than the broader concerns of the Bishops' Conference."http://www.chausa.org/CHA_Seeks_Members_Input_On_HHS_Proposed_Rule_for_C...

Who is Matthew FrancK? I googled and found a lawyer. Is that him? Does he have any expertise in insurance?

The First Things/USCCB position, as it evolves, is a disgrace to serious moral reasoning. It is a result of the same pathology that afflicts the political right, a commitment to a contrary worldview so all-encompassing that every intrusive fact, any inconvenient complexity must avidly be ignored. I could laugh if it weren't so damn sad.

There are some further misunderstandings detailed in the Public Discourse piece Franck links to. Same very certain tone, though.

Well, Grant, I think you've more than adequately answered the first two deficiencies he charged you with. But you didn't directly address the claim that you lack an understanding of arithmetic. So let's see, shall we?2 + 5 = ?8 - 6 = ?4 x 4 = ?9 3 = ?Then we should be able to move on.

Is this guy associated with The Becket Fund - my guess is that by the time a few of these cases wind up at SCOTUS, the Becket Fund will lose. (know that is different from a moral question but he seems to have failed high school morality class in double effect and the various levels of cooperation. But, it is par for First Things these days.

To repeat a part of a Krugman quote from an earlier thread: "One side believes, at least in principle, in letting its policy views be shaped by facts; the other believes in suppressing the facts if they contradict its fixed beliefs.

OK, lets try it this way:I cant say Im an expert on actuarial studies, but I would bet such studies do not incorporate the costs of there being fewer children in our society, even considering only the mere economic value they add.I do indeed think it is a moral question whether we want to support a government program the encourages Americans to be barren and divide, just so insurance companies can amass greater profit.

I'm not persuaded the mention of fewer children is germane. The regulation of births, itself, is permitted. The moral question pertains to method. For whatever reason there are fewer children, to account for the difference between those absent by licit versus illicit means is so difficult, so remote a question I cannot imagine how it would bear on a meaningful analysis of these problems. Better to keep the focus on health effects and more measurable costs.

StevenI see the issue is much larger than mere method. Consider a hypothetical 1% couple that religiously practices NFP and has no children, so that the husband can, say, take an annual vacation golfing in Florida and the wife can, say, take an annual vacation in skiing in Colorado. Do you think there is no question of morality here, in a Catholic sense? Doesnt it contravene the first commandment in the Bible?

Weak as I am on this topic, it seems to me mathematics is a grand, remarkably lucid adventure until one runs into that darn infinity thing. At which point, it seems to me even the best of us can only say "well, seems likely".

Mark --Your argument doesn't hold. If the insurance companies encourage people not to have children, then there will be no money from those children to pay the old-age insurance bills of their parents. it is to the advantage of the ins. cos. to at least have a stable population.

The first commandment in the Bible? Be fruitful and multiply? That was a commandment? Now you tell me! I thought it was a blessing, a counsel, an exhortation, or maybe a wish, like "have a nice day."But I think, Mark, that you've hit on an insuperable argument against a celibate clergy. So there's that.

AnnI cant tell if your comment was tongue in cheek or not. Do you really think most insurance companies, most any kind of companies, think as long term as that? Not more interested in the quarterly numbers?John--It was in the imperative mood, no? Doesn't that make it a command? Though I can accept blessing/counsel/exhortation. But never, ever, could I liken it to "have a nice day."Live long and prosper.

Wouldn't say it encourages Americans to be barren and divide. When I was on the pill, it wasn't in order to never have children, it was just so I could time my family so I could be in a position to care for those children and support them financially.To be honest, there is something very, very skewed about our views on birth control being driven by a group of elderly male virgins. I don't mean that disrespectfully, but I just think birth control is an issue completely outside the expertise of our church leadership.

"Is this guy associated with The Becket Fund my guess is that by the time a few of these cases wind up at SCOTUS, the Becket Fund will lose."Weren't a bunch of these suits just dismissed in the lower courts?

I'm not really interested in getting sidetracked by a contraception argument. Grant's treatment of the First Things/USCCB line is more interesting. I would say though that HV says that the regulation of births is permitted and that nowhere does the Theology of the Body worry about a hypothetical like Mark's. So long as his hypothetical couple is 'open to life' while practicing NFP faithfully there is no moral problem. So far as that couple's INTENT is no different from a couple practicing artificial contraception, it seems to me we've found the problem with HV's, JPII's, and Christopher West's argument, and I don't begrudge Mark's worrying about that. But as long as we're here discussing the complex intricacies of intent, we ought to notice Grant's good point. Even when my insurer pays for someone else's contraception or abortifacient, I don't intend that outcome when I simply pay a premium. If we can handle the complexity of worrying about that hypotheical couple's intent, we ought not to worry too much about the HHS mandate.

Kevin Drum of Mother Jones on the claim that insurance carriers would be required to provide contraceptive riders at no cost:"And, let's be honest, it is a kludge. There's no such thing as 'no cost.' If an insurance carrier covers contraceptives, that's a cost they're going to make up somewhere else. And that somewhere else is in the premiums for the main policy. There's really no way around that."In other words, money is fungible, a subject that liberals and conservatives alike treat with abandon depending on whether they happen to like the consequences. In this case, liberals are willing to accept the fiction that the money for contraceptive coverage is somehow 'segregated,' and conservatives aren't. When bailed-out bankers pay themselves big bonuses and swear that not one dime is coming from bailout funds, the roles are reversed. All good fun."http://www.motherjones.com/kevin-drum/2013/02/money-fungible-contracepti... also examines the alleged cost savings from free contraception. Coming from a leftist his skepticism cannot be dismissed as an anti-Obama rant.http://www.motherjones.com/kevin-drum/2013/02/contraceptive-coverage-pro...

...nowhere does the Theology of the Body worry about a hypothetical like Marks. So long as his hypothetical couple is open to life while practicing NFP faithfully there is no moral problem.StevenIm certainly no expert on the TotB, but Im quite certain you are incorrect that it does not address, and head-on, the contraceptive mentality. It is a constrained view of the TotB to think its focus is on method, and to think what we do with our bodies does not influence, for good or bad, our intent. JPII wrote quite eloquently on the inseparability of the body and the spirit, and how they are inextricably linked. My understanding is that one of the reasons NFP is considered by the Church to be morally superior to artificial contraception is that it is much better at helping couples avoid the trap of the contraceptive mentality, though of course no method is foolproof.I understand that Grants thread is focused only on the narrow issues of who pays for it, but I think the Churchs view is that we all will pay for it.Where have all the flowers gone? Long time passing...

Grant - when you wrote this: 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 - you were doing some pretty condensed summarizing: everything before the "and" refers to exempt organizations, and everything after the "and" refers to accommodated organizations. I think Franck honestly misread your meaning in this sentence, and thought that the entire sentence referred only to exempt organizations. (To be really tedious about it: I believe the antecedent of "proposes arrangements" is "new rule", but Franck interpreted the antecedent to be "four-part definition". If this combox allowed one to put diagrams in it, and if I knew how to diagram a sentence, I'd illustrate it.)He then used that misunderstanding as a club to try to beat your credibility to a pulp, and I don't blame you for being sore about it.

At Mass, in the bulletin literature, and at parish missions, I'm told NFP is "just as effective." That's why we should trust it! TotB does address the contraceptive mentality. Thus the emphasis on 'openness to life' even while practicing natural contraception. The NFP argument is trapped in HV's provision for the legitimate reasons to regulate births. And here comes the real point.There are no flowers here. They haven't gone anywhere. They never were here. This is public policy--prose, not poetry. This is about feeding and caring for a family you can manage. This is about the affordability of basic, life-saving (life-affirming) healthcare. A poetic understanding of the lillies of the field quickly becomes an extravagance amid preventable suffering, deprivation, and death. That's why we institute governments to deal in the dirty, prosaic business of solving problems that the idealized thinking of some theology and philosophy cannot handle. It is why, for all its compromising and compromisedness, the Tradition has taught that government is an honorable, noble, holy thing. That's why we sanction double-effects. That is the strength of Grant's argument.

While I agree talking about the merits of contraception sidetracks the discussion of "who pays for it", aren't we missing the forest for the trees? We only care about who pays for it, because we're ducking the issue of whether its essentially a good thing that it be paid for. The institutional Church is wasting all kinds of time, money, credibility and political capital opposing something most of us actually support. And this time and treasure could be better spent on much more critical issues. Or at least on issues American Catholics support.

For the political scientist, there may be no flowers, but at the root of politics is culture, and at the root of culture is cult...religion, or poetry, as one might call it. I actually agree with Irene on this...to a point.

Mark ==You're changing the subject. The subject is not whether the ins. cos. are most interested in profits, the subject is whether or not it is to there advantage to have fewer people in following generations. Obviously it is to there disadvantage because that would reduce their possible profits per capita.As Krugman has notably put it, you are ignoring evidence to fit your ideology.

There is a place for the poetry, and more than you know I depend on the cultural argument. The question is of priority when we address a particular question, the very problem with TotB and much of the USCCB political engagement. Flowers aren't food for a child. Our beautiful arguments cannot be permitted to become the enemy of the good because they are perfect. Or, to paraphrase Justice Jackson, the Magisterium was never intended to be a suicide pact.

AnneI do not see how your 10:31 am comment responds to mine of 7:06 am. Your comment assumes that insurance companies always act in their long term best interests. I disagree. Disagreement is not changing the subject. As they say in certain circles, the first person who resorts to citing Krugman loses the argument.StevenWell, if you are saying the Churchs argument is perfect, lets stand on that. ;-) Seriously, though, I sense your comments are motivated by the immediate concern of feeding hungry mouths. A more than legitimate concern, but in a fallen world it is impossible to avoid contingency, or the need for faith.

BIG Ooops -- Should be: Obviously it is NOT to their disadvantage because that would reduce their possible profits per capita.

Mark --Merely disagreeing does not address the subject. Further you have made an assumption -- that insurance companies don't think 30 years ahead. but that does not describe what I've seen of ins. cos. Smart companies think 50 years ahead at least.And I didn't say the ins. co. *always* act in their own interest. Wht I said is tht they think at least a generation ahead in order to make profits.Where is ungidon when we need him :)

I'm motivated by a concern that the political order be an order of prudence. I reject all perverse outcomes most especially when they follow perfectly realized, ideal philosophical or theological arguments.

StevenBy perverse, I assume you mean parents having more children than they can afford to raise? Do you have any support for your conclusion that those who currently strive to follow Church teaching are more prone to that than the rest of us?

A short piece in our local, not terribly reliable, newspaper reported that Archbishop Lori has written to Congress urging that an exemption for the "Taco Bell" owners of this world be made part of the deliberations concerning the debt ceiling issue. Does anyone know more about this? If this report is accurate, then Archbishop Lori's attempt to clutter this very important, and very contentious matter with this fundamentally extraneous "contraception" issue is outrageous. Either he is hopelessly naive about our political situation, which I doubt, or he is playing a cynical game.

Mark, this back-and-forth already has gone far past any hope of illumination. I'm no more interested in being drawn into a debate on the merits of contraception than I was this morning. I'm trying to maintain a discussion of what makes good public policy--policy that is as moral and effective as is possible. But let me thrash the straw man. Perversity here is an argument about contraception thwarting the extension of healthcare. I would be the first to agree that a single-payer system would be the best solution, far better than the ACA and its suite of weird compromises. Unfortunately, political leaders who also happen largely to be identified as "pro-life," leaders whom my bishops tell me I should support, have rejected the single-payer option as the unacceptable path toward socialism. In this political climate. the ACA is what we can get. And despite the suite of weird compromises that are packaged together under its aegis, it still just might reduce the cost of healthcare and make its advantages more widely available. I would prefer the perfect solution. I will accept the good one. What I won't do is sit idly by and watch the same bishops who support those political leaders who keep us from a single-payer system now peel apart the ACA based on concerns about contraception and abortion that grow increasingly remote from our actions and intentions. I see no good in it at all.

Regarding insurance premiums of accommodated religious institutions, and whether they are really paying for the insurer-direct-to-customer contraception policies: Franck's argument, in whatever tone it is presented, is logical. On the other hand, I agree with Grant that insurance premiums go into a general "bucket" of money that the insurer uses to pay claims, run the business, etc. But on the third hand, insurers do (or should do) account-by-account profit and loss analysis to determine whether a client institution is profitable (or maximally profitable) and we can be sure that these analyses are used in pricing policies. That suggests that the "one giant bucket of money" concept has limits; for certain of the insurer's purposes, the premiums coming in from a specific account are expected to "match up" with the claims and other expenses going out to that account.I agree, too, with Grant's consistent point that, even if Franck's argument is valid, it constitutes remote material cooperation. Finally, I continue to agree with a point I've made in the past in these discussions: employers should be free to make their own determination as to whether or not this arrangement constitutes remote material cooperation or something more culpable, and the HHS mandate puts substantial burdens on that freedom.

SteveYes, I sense some exasperation. But, for the record, its not me youd be agreeing with that a single payer system would be the best solution. Until your last post, I did not realize how important to you more government control of healthcare in America is, and why youre taking such a negative view of attempts to resist that.Thanks for exchange, I regret it was more illuminating for me than it was for you.

Glad to oblige.

Jim Pauwels says: "[E]mployers should be free to make their won determination as to whether or not this arrangement constitutes remote material cooperation or something more culpable, and the HHS mandate puts substantial burdens on that freedom."I ask: Does every claim that some law 'burdens" my freedom have to be a legally accepted claim? If not, then what is so special about this particular "burden" that necessitates its legal acceptance?

"Where is ungidon when we need him :)"Ditto Peter Nixon who works for one of THE most successful health agencies, Kaiser Permanente (my insurer).

"I ask: Does every claim that some law burdens my freedom have to be a legally accepted claim?"No, I don't think so. Why do you ask?

Jim, I ask because of your remark about the the "substantial burdens" that the HHS mandate supposedly puts on the employers freedom. Is this burden morally, or legally, defensible? Perhaps I misunderstand what you are saying about this burden.

Bernard Dauenhauer wrote "A short piece in our local, not terribly reliable, newspaper reported that Archbishop Lori has written to Congress urging that an exemption for the Taco Bell owners of this world be made part of the deliberations concerning the debt ceiling issue. Does anyone know more about this?"Here is Bishop Lori's February 15 letter to members of Congress:"The 112th Congresss inability to enact appropriations bills for Fiscal Year 2013 left many tasks unfinished. One of the most vitally important of these tasks is to restore a tradition on rights of conscience in health care that has long enjoyed bipartisan consensus, but is now under greatly increased pressure. I urge Congress to address this problem when it considers proposals for continued funding of the federal government in the weeks to come."He urges Congress to include two provisions that were proposed for a House bill in December.At the end of the letter, he summarizes the USCCB objections to the latest HHS proposal:"What seems to be at issue instead is a new, more grudging attitude in recent years toward citizens whose faith or moral principles are not in accord with the views of the current governing power."it permits no free choice by a female employee to decline such coverage for herself or her minor children, even if it violates her moral and religious convictions.""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""individuals and families, nonprofit or for-profit organizations that are not explicitly religious, insurers, third-party administrators will have the mandate imposed on them without any recoursehttp://www.usccb.org/issues-and-action/religious-liberty/conscience-prot...

That's my abridgment of Bishop Lori's three-page letter. I have provided a link to he full letter.

it permits no free choice by a female employee to decline such coverage for herself or her minor children, even if it violates her moral and religious convictions.

Is this true? The insurance company is obliged to extend (er, "impose") the extra coverage at no cost to all employees, but does that mean the employees can't call and opt out of it if they should want to? To keep it from their kids, as Lori suggests? I can't think of any other reason someone would bother to do so, since a Catholic's "moral and religious convictions" would not be "violated" simply by having coverage for services no one is forcing her to take advantage of.

Mollie Wilson O'Reilly. as I recall, the language of the proposed regulations says that if the employer doesn't provide contraceptive coverage in its policy, the insurance company will "automatically" enroll all "employees and dependents" in a separate policy that will cover contraception only.I don't recall ever hearing about this issue from the USCCB before the latest draft regulations were issued. Now that the issue has been raised, it may be that HHS would be willing to let a female employee opt out for herself. Whether or not an employee could reject contraception coverage for dependents may raise more complicated issues.AB Lori has clarified that he is now talking about "minor" children. If that means daughters aged 18 to 26 could accept or reject for themselves, that would reduce the issue to whether a parent could reject contraception coverage for daughters under 18.

Cardinal Dolan's News Release of February 7 didn't have he "minor""Cardinal Dolan highlighted problems with the proposed "accommodation.""It appears that the government would require all employees in our 'accommodated' ministries to have the illicit coveragethey may not opt out, nor even opt out for their childrenunder a separate policy," he said."http://usccb.org/news/2013/13-037.cfm

Here's HHS's explanation of the proposed regulations. Sounds as if each person (employee and dependents/beneficiaries) gets a separate notice. Seems as if this notice could have a section that says "If you don't want his coverage, sign here and mail this notice back to us". The question would be which dependents the parent could sitgn for. "The issuer would automatically enroll plan participants and beneficiaries in a separate individual health insurance policy that covers recommended contraceptive services.""The proposed rules would direct a health insurance issuer providing separate individual health insurance policies for contraceptive coverage at no additional cost to participants and beneficiaries in plans of eligible organizations to provide a written notice to plan participants and beneficiaries regarding the availability of the separate contraceptive coverage. Issuers providing such contraceptive coverage would be responsible for providing the notice of availability of such coverage to participants and beneficiaries in both insured and self-insured group health plans of eligible organizations. The notice would be provided directly to plan participants and beneficiaries by the issuer..."For more details, see https://www.federalregister.gov/articles/2013/02/06/2013-02420/coverage-...

, 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 employees compensation,,This statement is false. The employer is providing and controlling the insurance benefits, once the wages are paid, control and moral responsibility transfers to the employee. The fact that both are compensation is not the deciding factor; their forms are different and that is the crucial factor affecting moral culpability

Mark, I think your observation about encouraging barrenness is the critical point. It is a prescription for the slow death of humanity

BruceThanks. From Father Imbellis thread, the Popes homily warns:[The Tempter] does not spur directly toward evil, but toward an illusory good. He would have us believe that the true realities are power and what satisfies our primary needs. In this way God becomes secondary, a mere means; God no longer counts and thus disappears. In the last analysis, what is at stake in the temptations is faith itself: God is at stake.So while we carefully nuance the double effects regarding the HHS mandate, lets be mindful that the Tempter has his own version of double effect.

I'm sorry. What? Obamacare is a temptation from the devil? Did I connect the dots correctly? Because I try to be a kind person, one who would find it difficult to believe that I have. But the code here seems pretty clear.It seems to me that we ought to return to the point of this thread and the original post, that the contraception debate is a sideshow that grows more and more distantly remote from any substantive debate over the merits of the ACA. That is, despite the increasing volume of those who object. If we want to litigate whether artificial (or, natural) contraception is good or bad, it seems to me that debate belongs elsewhere. Arguably, in 1968.

Did I connect the dots correctly?StevenNo, not exactly, it runs a bit deeper than that. I thank you for trying to be a kind person, but Im afraid I must agree with you now that our exchange has gone beyond the point of illumination.

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).

You said I concluded "that insurance companies set rates without reference to what services are covered or not covered." I did not say that. That would be absurd. You alleged that I claimed "that increasing or reducing coverage is irrelevant to pricing isnt believable." I agree. That's why I didn't say anything of the sort. "Where do you suppose this money comes from?" According to the actuarial studies cited by HHS, it comes from the cost savings over the life of a policy. No one is claiming there is no upfront cost. Of course there is. The idea is that insurers will not lose money in the long run because pregnancies and babies are more expensive than no pregnancies and no babies. "Risk of what, one might ask? Risk of losing a job? Risk of being lost at sea?" How do you think insurers determine premium? They look at a patient or group's history, age, past medical costs, etc. -- all part of a patient's or group's risk profile -- and offer a range of pricing options accordingly. Lower deductibles for higher premiums. Vice versa. They don't arrive at a price simply by tallying covered services. "The fact that one cant trace the exact dollars is neither here nor there." It certainly is both here and there -- at least if one is interested in making a Catholic moral argument.

So what would you say about the purchase of insurance contracts that came with a separate provision for "free" euthanasia for one's child that gets too sick?The exact same defenses could be made:1) Euthanasia absolutely saves money for the health insurance company in the long term, and therefore can be provided in a separate "free" arrangement.2) Once your dollars flow into the insurance company, all money is fungible, so who knows whether your actual dollars were used to pay a doctor who actually performs euthanasia. Catholic moral arguments require tracing the exact dollars, and since this can't be done, you can buy an insurance policy that comes with a free rider for absolutely anything.

You're still misunderstanding the point: religious employers will not have to contract for contraception coverage. Catholic moral arguments certainly do not require "tracing the exact dollars," whatever that means. Someone is wrong online.

"religious employers will not have to contract for contraception coverage."OK, so imagine that someone generously says, "You don't have to contract for euthanasia coverage for your employees' or your own children if they get sick. We'll just add that in separately as a automatic accompaniment to the health insurance policy that you did buy. You don't need to do anything extra; euthanasia is free."Problem solved? No moral issue? "Catholic moral arguments certainly do not require tracing the exact dollars, whatever that means."Hmm. Within the space of 40 minutes, you went from saying that tracing exact dollars "certainly is both here and there" to make a Catholic moral argument, to saying that tracing exact dollars is "certainly" not necessary to a Catholic moral argument. The only thing I'm certain of is that you could be clearer on specifying a stable point of view.

Or, perhaps, risk of needing reimbursement for the services coveredThe accuracy of this statement is so self-evident that even someone with the weakest grasp of how insurance works can see it. So Im going to make like this is a prize fight, and stop it.

Try to focus on the actual policy, Mr. Time. If you want to make a slippery-slope argument then make one. I don't see euthanasia being covered by insurers (it's illegal in most states, for one thing, because the culture has not arrived at a moral consensus on euthanasia in the way it has on contraception).I don't know what "tracing exact dollars" means. A Catholic moral argument has to take account of several things: the intent of the moral agent, the effect of his act, whether that outcome would have been likely without his action. An accommodated employer does not will his employee to use contraception. The employer does not ask for contraception coverage. The employer pays premiums that are pooled with the premiums of other customers, many of whom have contracted for contraception. If the employer were to stop offering health benefits to his employees, those employees would seek coverage with spouses or on the state exchanges, where they will almost certainly receive contraception coverage. The employee is not required by anyone to use this coverage. If the employee does, it is not the employers fault. If the employee does not, it does not redound to the moral purity of the employer -- just as an employer cannot be blamed when an employee pays an abortion clinic with her wages. Continuing to offer employee health coverage is therefore licit remote material cooperation with evil under duress. Providing health coverage to employees is the proportionate good.Mark: It's one aspect of pricing. All insurers care about is how much a policyholder is going to cost them. Birth-control pills make up a small fraction of an insurance company's annual costs. That is the most common form of birth control used by women who are twenty-nine and younger.

I think there's a bit of confusion between an analogy and a slippery slope argument. Indeed, what I wrote wasn't even strictly an analogy: I was asking one to imagine the exact same regulatory policy and arguments in support thereof, just with a slightly different subject matter.

So you've now gone from saying that tracing dollars is certainly necessary to saying that it's certainly not necessary to saying that you don't know what it means. Hmm. Anyway, I'm merely trying to discuss the same point on which you spent several paragraphs in your post (where you claimed that we can't know what happens to dollars after they are sent to insurance companies). If your real point is that the employer's will isn't directly involved, then talking so much about tracing dollars may have been a distraction, even to the point of causing you to forget what your own argument was!

Does anyone have a problem with the HHS proposal for Catholic hospitals, etc. who self-insure?(That means that instead of buying insurance they contract with a "Plan administrator" to manage heallth benefits using the hospital's money to pay the bills. The administrator is paid a fee for its management services). As proposed by HHS.1. The hospital's self-insured plan excludes coverage for contraception.2. HHS pays the same company the hospital chose as its Plan Administrator to provide "contraception-only" insurance to the hospital's employees and their dependents. This arrangement is between HHS and the Administrator and doesn't involve the hospital. That's a simplified description. For complete detail, see: https://www.federalregister.gov/articles/2013/02/06/2013-02420/coverage-... don't see any problem in that. Do you?The difference between this plan for self-insured employers and the one we have been discussing for employers who buy insurance is that it makes clear where the money to pay for contraception is coming from.

Mr. Time: I'm afraid you've lost me. Where did I say "tracing dollars" was certainly necessary? When I said I don't know what "tracing dollars" means, I was telling you I don't know what you mean by "tracing dollars." Buying insurance is not like buying bananas. There is not a 1:1 ratio between money spent and goods received. This fact seems to confound you, but grasping it is essential to having an intelligent conversation about the contraception mandate.

"The idea is that insurers will not lose money in the long run..."Grant --To be picky about this, perhaps losing money and not making as much money are not the same thing. Maybe the point here should be that the insurance companies simply won't make quite as much if they pay for the contraceptives, and that is not the same thing as losing money We say a company "is losing money" when it makes no profits at all.

A direct quote from your own post:

The fact that one cant trace the exact dollars is neither here nor there. It certainly is both here and there at least if one is interested in making a Catholic moral argument.

If you didn't know what I meant by tracing dollars (or rather, if you had forgotten since writing your post's several paragraphs about tracing dollars), what made you state such a certain opinion about its relevance to Catholic moral argument? This seems an argumentative strategy designed to confuse.

That's not from my post; it's from a comment I left responding to your comment, "The fact that one cant trace the exact dollars is neither here nor there." I was guessing at your meaning, but this is a sideshow. Either you know how insurance works and you can engage in Catholic moral reasoning on this issue or you can't. Looks like the latter to me. I think we're done now.

I do know how insurance works, which is why I was surprised to see the claim that insurers set prices based on "risk assessment" rather than "services covered," as if the risk assessments in question aren't focused entirely on the risk that insured people will make claims for, well, the "services covered."

Anyway, Catholic moral reasoning is itself a sideshow. It might well be the case that if someone holds a gun to your daughter's head and says, "Choose between stealing a piece of bread or letting your daughter be shot," you can steal the piece of bread legitimately without willing the moral evil of theft. But that in no way answers the question here, which is whether you should be able to say, "I don't like stealing and I'd rather not be forced to make such a choice in the first place." So too here. Hobby Lobby is paying money to an insurance company and, by virtue of that payment, that insurance company is going to turn around and reimburse drug companies for contraception for Hobby Lobby employees (this is actual money flowing around, it's "free" only from the perspective of the Hobby Lobby employee when at the drugstore). The fact that Catholic moral reasoning might say, "OK, Hobby Lobby guy, you're not actually sinning," doesn't mean everything is cool. The Hobby Lobby guy still has the right to say, "I don't want to be put to such a choice in the first place."

Is this really so hard to grasp? Two groups have exactly the same policy. Group A comprises mostly people middle-aged and older. Group B comprises mostly people middle-aged and younger. Which group will have the higher premiums? That is what I'm talking about.Most insurers cover the same things. Premium pricing is governed by several things, including the likelihood of policyholders' requiring expensive medical treatment, whether they have already required expensive medical treatment, what kind of deductibles the group policyholder wants. If pricing were determined solely by services covered, buying insurance would be like buying lunch at McDonald's. In fact, it's a good deal more complex.

Now I see. If you think Catholic moral reasoning is a sideshow, then you're reading the wrong blog.

I don't think anyone ever said that premiums are determined solely by services covered, or even if they did, that it would have any moral relevance. That's a straw man. The moral objection to contraceptive coverage (or euthanasia coverage, or any other type of coverage to which you might imagine objecting) consists of this: "I'm paying money to an insurance company, and by virtue of that payment, the insurance company is offering reimbursement for something that I think evil." This moral objection has nothing to do with how the insurance company sets its prices. The objection is the same whether the insurance company raised its prices, lowered its prices, or charges everyone a flat fee. It is also the same even if the insurance company is "saving money" by offering the new coverage -- even if the company saves money on some other coverage item, the fact remains that it is spending money on the reimbursements here and now. There is no known economic principle whereby I get to claim that spending money on X is "free" merely because it prevents me from having to spend as much money on Y (I might be saving money overall, but that just means that I'm spending money on X rather than Y, it doesn't mean the absurdist conclusion that X is literally "free").

JohnRegarding self-insureds, weve already discussed, at some length, whether Catholic organizations are providing funds to the HHS to pay for contraception services. We have a profound disagreement on that, I think, but lets leave it aside for now.If I understand you correctly, a self-insured employers decision to hire an employee will thereby give that employee free contraception. I dont see how Catholic organizations could do that without directly cooperating in what the Church considers sinful. So, yes, I can see the bishops having a major problem with that. One could say the employee could get the same coverage from another employer, but I dont think that relieves the Church organization of its culpability as the proximate cause.

It seems to me that the most fundamental problem in this whole complex issue is -- and has been for a long time -- the nature of money -- specifically the nature of our kind of money, which has no intrinsic value (except for silver and gold coins) and which can be instantiated by both paper dollars which can be swapped for coins and for entries (numbers below or along side our names) in accounting ledgers of all sorts. (Yes, the figures in your account in your bank's data bank *are* money just as much as the dollar bills and pennies in your wallet.)So it's meaningless to talk about "tracing our money" as it goes into AND out of the pool of the ins. co,'s money. Once in the pool it isn't ours.So what IS ;money? Best I understand it it is proxy for something else. Specifically it is often a symbol (the coins, dollars, data in ledgers and computers etc.) which ultimately signify an agreement to do something or make an exchange. (It's more complicated than that, but for our purposes it might be descriptive enough to at least start a discussion.)The big problem about money in this thread is *the pooling of money*. We tend to talk as if "our" premiums paid by our employers with "their" cash/checks/whatever retain their metaphysical identity when the premiums are pooled in the databank of the insurance company. It seems to me it does not, at least not completely. It is still a symbol of an agreement to do or exchange something, but its character as *our* money or our employer's money had been total lost. The ins. co. is still bound to pay our claims, but the money which was my employer;s money becomes the insurance company's money to do with it as it sees fit. If the executives spend it on contraceptives or for booze for themselves is irrelevant.

In this series of posts, Grant wrote about whether the accommodated client's premium dollars are subsidizing its employee's contraception because he's responding to Matthew Frank. Franck spent a lot of time on this question at the First Thoughts blog. Franck's treatment could lead one to believe that the issue of client premium dollars flowing to the insurance company to the pharmacist is a major issue at stake. But I don't think Grant has ever believed that. His point, almost from the time the accommodation was first floated, is that at some point the cooperation by the employer becomes so remote that it is permissible. As I've commented a number of times, I don't think that's an unreasonable analysis. And inasmuch as the HHS mandate seems to be a fait accompli, I fully expect most Catholic universities and hospitals to reach the same conclusion.

Mark Proska wrote "If I understand you correctly, a self-insured employers decision to hire an employee will thereby give that employee free contraception. I dont see how Catholic organizations could do that without directly cooperating in what the Church considers sinful"Mark, OK, i can understand that view even though I don't agree with it. However, the President has been clear from the beginning that the goal has been to provide free contraception to employees - but to find a way that works best for non-profit employers with religious objections to contraception If you say that no scheme by which employees of Catholic hospitals, universities, etc end up with free contraception is acceptable - even if the employer does nothing other than hire or continue to employ them - I don't see that there is any productive negotiation you can have with HHS. I hope the USCCB doesn't take that approach.

"The big problem about money in this thread is *the pooling of money*. We tend to talk as if our premiums paid by our employers with their cash/checks/whatever retain their metaphysical identity when the premiums are pooled in the databank of the insurance company. It seems to me it does not, at least not completely. It is still a symbol of an agreement to do or exchange something, but its character as *our* money or our employers money had been total lost. The ins. co. is still bound to pay our claims, but the money which was my employer;s money becomes the insurance companys money to do with it as it sees fit. If the executives spend it on contraceptives or for booze for themselves is irrelevant."What's being described here as "the pooling of money" is the most fundamental characteristic of insurance itself: many individual entities who bear a similar type of risk (my ship may sink, my house may burn down, I may contract cancer) pay the insurer a relatively small amount of money (the "premium") with the understanding that some subset of them will make a claim on the insurer, perhaps for a comparatively large sum of money, as a result of a loss. Those premiums, once paid, may be put to any number of uses: some of it is used to pay claims, some of it may be parked as reserves to be ready to pay out expected future losses, some of it may be invested in other investments (insurance companies certainly are among the large institutional investors that essentially control the financial world - cf AIG), some of it covers operating expenses, some of it is paid as profits to the owners, and so on and so on.I suppose the point I am trying to make here is that the relationship between a premium being paid in and a claim being paid out is pretty opaque to an outsider. And as Grant has pointed out, the Obama administration has built a number of protections into the accommodation to shield the employer from culpability. I'm not a supporter of the mandate. It's a pretty raw (but, clearly, effective) scheme to buy votes, wrapped in a kimono of health care and compassion, and it takes away religious freedom from at least one class of employer (Hobby Lobby). It's a bad law. It should never have been enacted, and our society would be more just if it could be repealed. But if we are to measure gradations of persecution - well, things could be even worse.

However, the President has been clear from the beginning that the goal has been to provide free contraception to employees but to find a way that works best for non-profit employers with religious objections to contraception.John--In my view, this can be fairly translated as:The President has made clear from the beginning that he wants this to happen, he wants it to happen via the employer/employee relationship, he wants it to happen in a way that works best for religious organizations that have serious objections, but if they dont accept his view of what works best, he will seek to ram it down their throats.He cant say he wants to find a way that works best with the Churchs objections and then say their objections are baseless. It is for the Church, and the Church alone, to determine what is objectionable to the Church. Lets not forget: It was the Presidents decision to have the employer be the facilitator of this free coverage, not the Churchs. A tactical error on his part, borne of hubris. I hope the USSCB stands firm.

Jim Pauwels wrote : "The big problem about money in this thread is *the pooling of money*. We tend to talk as if our premiums paid by our employers with their cash/checks/whatever retain their metaphysical identity when the premiums are pooled in the databank of the insurance company. It seems to me it does not,"The problem is that most of us, somewhere, ran into a teacher who explained inurance by talking about Benjamin Franklin's insurance company in Philadelphia where 70 building owners got togetherand agreed that rather than each taking the risk that his building would burn down they would pool tneir risks. Each paid in some money and agreed that if anyone's building burned down, the group would pay to rebuild it. After a certain period of time, whatever money hadn't been used to pay claims would be given back to the people who had paid it in and a new group would be formed. The money held by the company really continued to be each person's money.That isn't what's happening whn I send a hevk to Commerce Insurance for fire insurance on my house. Commerce tells me how much they want to take off of my hands the risk that my house will burn down. If I agree to their price I am not entering into some league of homeowners who are sharing the risk that one our homes may burn down. The only one I am involved with is Commerce. i pay them X dollars and they promise to pay the cost of rebuilding my house if it burns down. The X dollars I give then is their money as soon as I hand it to them and isn't pooled with anything - it goes into their bank accounts and they can spend it for anything they want. If my house burns down, they will pay me what is needed to rebuild it, but it's their money they use to pay me, not some specially set-aside pool of money that I still have some interest in.

I'm interested in hearing whether anyone can offer more examples of this unprecedented principle of economics, whereby:1) At Time 1, I spend money on Y;2) At Time 2, I spend more money on X and less money on Y (because X prevents Y);3) Therefore, because the shift in spending is cost-neutral, there is actually ZERO money spent on X and I can say that X is "FREE"!!!!Is this principle like Bush v. Gore, good only for the current case and never to mentioned again?

Mr. Wasting Time, I have not heard anyone propose that principle. The "I" in your points 1 and 2 is an insurance company, not the employerThe version of your point 3 that has been proposed by HHS is:3) If the total spent in point 2 is the same or less than in point 1, I (the insurance company) can give the items purchased with X without charge to people who would otherwise cause me to spend more money on Y. From their standpoint the items are free. Note that the items are not free to the insurance company. It spent X for them.

Nor are the items free to to the employer -- it is paying for the insurance policy by virtue of which the items are being provided to employees.

If you do say the items are free to the employer, of course, then we're squarely within the novel economic principle.

The employer doesn't get any items so there is nothing to be "free"

Going back to your post before that one, the employer is not paying "for the insurance policy by virtue of which the items are being provided to employees."The employer is paying for a policy that excludes coverage for contraceptives. The insurance company provides contraceptives to employees under another insurance policy in which the employer has no part.

But that arrangement is an elaborate charade. After all, it's not as if a given insurance company is going to offer the "free" coverage (for which it pays out money in reimbursements) to any business's employees until and unless the business pays for such a (supposedly separate) health insurance policy for those specific employees.

I suggest Mr. Time change his first name to Justin. I find his comments on point and a breath of fresh air. I encourage him (her?) to visit often.

Mr. Wasting Time. OK, I'll revise my sttement from yesterday to inlude insuranceIf you say that no scheme by which employees of Catholic hospitals, universities, etc end up with free contraception is acceptable even if the employer does nothing other than hire or continue to employ them AND PROVIDE HEALTH INSURANCE EXCLUDING CONTRACEPTION I dont see that there is any productive negotiation you can have with HHS. I hope the USCCB doesnt take that approach.

The health insurance doesn't "exclude contraception" if there is a mandate that all policies are automatically accompanied by contraceptive coverage provided by the same health insurance company that the employer pays and provided to the same employees (no one else) who are covered by the contract. I find it hard to imagine that anyone actually believes this charade, who isn't paid to say so.

Watch your step, Wasting Time. Anonymity has its benefits --including hurling unsubstantiated accusations with impunity -- in many digital quarters. But not here. This is your one and only warning.

Oh my, I didn't mean to cast any aspersions on present company. So sorry if it came across that way.I was just expressing surprise that anyone outside the administration would actually believe the claim that if we merely tell ourselves strenuously enough (a la Dorothy in the Wizard of Oz) that there really is a "separate" policy for contraceptive coverage, then when real insurance companies pay real money to real drug companies for real contraception, that money somehow has no connection whatsoever to the underlying insurance policy by virtue of which this "separate" coverage sprang into existence. It's as if the money that pays for contraception is, from now on, going to be generated out of thin air, as if from an economic perpetual motion machine.

"If you say that no scheme by which employees of Catholic hospitals, universities, etc end up with free contraception is acceptable even if the employer does nothing other than hire or continue to employ them AND PROVIDE HEALTH INSURANCE EXCLUDING CONTRACEPTION I dont see that there is any productive negotiation you can have with HHS."The HHS certainly has remedies at its disposal that would go farther than it has to appease the bishops and others who object to the proposed accommodation.One obvious one would be to expand the definition of religious entities, such that Catholic universities and hospitals are classified as religious entities. That would dispense with the need for any accommodation for them.Another possibility, suggested from a number of quarters, would be to incorporate private employers with faith-based objections, like Hobby Lobby, under the same accommodation being proposed for Catholic universities and hospitals.And of course, best of all would be to rescind the HHS mandate in its entirety.All of these courses of action are available to HHS. That it has shown not the slightest inkling of pursuing any of them suggests to me that HHS is intransigent and obtuse in this alleged negotiation.

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