Contraception controversy round up

Updated: President Obama announced a compromise solution to the controversy over contraception controversy. Catholic institutions won’t have to pay for contraception coverage for their employees and employees–that is to say, women– who work in these institutions won’t have to go hunting for separate coverage nor pay for them out of pocket. Because offering these services to women will part of the cost of the insurance company.

So what to make of the firestorm over the administrations plan to ensure that women can have contraception covered under their employers health insurance plans, even if they work for a religious institution? Why this fight and why right now? Roman Catholic bishops have picked this issue to underscore their take that they, the largest Christian denomination in the country and on the planet, are being persecuted if social policy concerning women and gays does not go their way.

PBS Newshour discussed the change that President Obama announced today.

The new plan allows employers with religious objections to offering contraceptive coverage to turn the responsibility over to their health insurance company. Those insurers will be able to offer contraceptive coverage directly to employees without co-pays or other charges.

The original mandate issued last month drew sharp criticism from many Catholics, conservatives and even some Democrats, who argued that it was a violation of religious freedom. Churches, mosques and synagogues were exempt — but other religious institutions that serve and employ people of other faiths were not eligible for exemption.

The new rule grew out of a report by the Institute of Medicine last year that recommended an expansion of birth control services to women as part of the health reform law. The Department of Health and Human Services issued a ruling that contraception should be provided free-of-charge as an “essential health benefit” in their insurance coverage.

The initial reaction to today’s changes seemed to satisfy some key players on both sides on the debate.

The AP says that President Obama’s compromise will probably satisfy no one because the priority to offer health care to all women will mean that Catholic institutions will somehow have to face the fact that their employees use this medical technology…whether they pay for it or not.

President Obama will announce a plan to accommodate religious employers outraged by a rule that would require them to cover birth control for women free of charge, according to a person familiar with the decision.

Obama was expected to make the announcement at the White House Friday.

The shift is aimed at containing the political firestorm that erupted after Obama announced in January that religious-affiliated employers had to cover birth control as preventative care for women. Churches and houses of worship were exempt, but all other affiliated organizations were ordered to comply by Aug. 2013.

ABC News reports:

The move, based on state models, will almost certainly not satisfy bishops and other religious leaders since it will preserve the goal of women employees having their birth control fully covered by health insurance.

Sources say it will be respectful of religious beliefs but will not back off from that goal, which many religious leaders oppose since birth control is in violation of their religious beliefs.

White House officials have discussed the state law in Hawaii, where religious groups are allowed to opt out of coverage that includes birth control, as long as employees are given information whether such coverage can be obtained. But this accommodation would not go that far.

Laurie Goodstien of the New York Times writes about how the Catholic Bishops were ready to pick this fight to protect what they see as their hard won place in society as well as to define the moral tone of the nation. The risk is that, in highlighting their political power, they have chosen an issue over which the majority of Catholic laity–particularly women–disagree and even defy the official line. Further, they have chosen an issue that most non-Catholics take for granted. They risk losing moral authority even if they win the political fight.

Hours after President Obama phoned to share his decision with Archbishop Timothy M. Dolan of New York, who is president of the United States Conference of Catholic Bishops, the bishops’ headquarters in Washington posted on its Web site a video of Archbishop Dolan, which had been recorded the day before.

“Never before,” Archbishop Dolan said, setting the tone, “has the federal government forced individuals and organizations to go out into the marketplace and buy a product that violates their conscience. This shouldn’t happen in a land where free exercise of religion ranks first in the Bill of Rights.”

The speed and passion behind the bishops’ response reflects their growing sense of siege, and their belief that the space the Catholic church once occupied in American society and the deference it was given are gradually being curtailed by an increasingly secular culture.

The conflict puts not just the White House, but also the bishops to the test. Will their flock follow their lead? And are they sufficiently powerful, now that they have joined forces with evangelicals and other religious conservatives, to outmuscle the women’s groups, public health advocates and liberal religious leaders who argue that the real issue is contraceptive coverage for all women, and that the Obama administration was right?

On the day of the decision, bishops across the country posted similarly dire statements on their Web sites, and at Mass on the following Sundays, priests read the bishops’ letters from their pulpits and wove the religious freedom theme into their homilies. By the bishops’ own count, 147 bishops in the nation’s 195 dioceses have now issued personal letters on religious freedom, which are trickling down to Catholics through their local parish bulletins and diocesan newspapers.

Of course, the Bishops may speak for the Church officially, but most of the laity believe that it is quite possible to both a faithful Catholic and use contraception. Catholics for Choice published a poster illustrating the situation here.

While it has been widely reported that 98 percent of sexually active Catholic women use a method of contraception banned by the US bishops, and that the bishops represent the views of very few people other than themselves, it appears that some people still haven’t had it explained to them in terms they can understand; they don’t get the math. Catholics for Choice has remedied this, with a simple graphic that shows exactly what is at stake, over the slogan: Thinking about the Catholic vote? Do the math. It appears in the Washington Post today, and will appear in newspapers around the country over the weekend. Politicians, on both sides of the aisle, who think they can attack a woman’s right to access contraception, or worse, sell out for presumed political gain, will suffer the consequences.

The New Republic published an essay by Jonathan Cohn who says that, besides the fact that many Catholic hospitals, universities and agencies already provide for contraceptive coverage for their employees, the idea that employers should control what employees do with their insurance is as backwards as telling them what they can do with their pay.

As I suggested the other day, a key issue is the nature of health insurance – in particular, whether it belongs to the employer or the employee. Proponents of making contraceptive coverage universal tend to take the latter view. Here, for example, is Adam Sonfield, a senior policy associate at the Guttmacher Institute, writing for the American Medical Association’s Virtual Mentor:

It is difficult to see why an employer has any more right to veto an employee’s use of her health benefits than it does to veto her use of her salary, sick leave, or other aspects of her compensation for the same contraceptive services.

I agree with that. The checks to your insurance plan may have the name of a religious institution on them. But, as a matter of economics and of principle, the money is (or should be) yours.

It can be debated whether the insurance your employer offers belongs to the employee or the employer–confidentiality rules suggest the former, contract law suggest the latter.

But the line the bishops have drawn in the sand is an important one. It marks a shift in the official application of Catholic moral teaching not just in health care but in social justice as a whole.

While the issue is framed in terms of religious freedom, the problem is really a tension between two competing goods. (How much they actually compete of course will vary from group to group and person to person.) This is such a rudimentary part of Catholic moral theology that the choice of the Bishops to double-down on the religious freedom meme is odd. And it should cause any one who attended Catholic school or studied Catholic theology to scratch their heads and ask deeper questions.

Here at the Cafe, our house economist suggested one path forward: “Obama should mandate that Catholic institutions withhold the cash equivalent of the Pills cost out of the employee’s pay and put it in account that the employee can spend as they wish (narrow it to prescriptions and co-pays if you want).” The actual solution is that the insurance companies will pay for the service for everyone who has health insurance, regardless of where they work.

But compromise will depend on which is more important to the Bishops: to make points that win or to create policy that works.

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