Summary

The arguments in favor of the new Health and Human Services (HHS) rule requiring employers to provide health plans that cover contraceptives with no cost-sharing are overwhelming. Yet, as is often the case in matters concerning women’s health and reproductive rights, what ought to be an issue of effective and practical modern public health policy has been reframed by the right as a threat to religious liberty. Despite an exception to the HHS rule allowing religiously affiliated employers to avoid paying premiums that support contraceptives by shifting the responsibility onto insurers, conservatives remain outraged. But the outside groups and politicians who persist in protesting over the issue are at odds with the American public.

The Origins Of The Uproar Over Contraceptive Coverage

The Affordable Care Act Requires New Insurance Plans To Cover Preventive Services For Free. From The New York Times: “Starting this year, insurers will be required under the Affordable Care Act to completely cover such services as annual physicals, childhood vaccinations and dozens of screening tests for everything from high blood pressure to abdominal aortic aneurysms.” [The New York Times, 9/19/11]

Sen. Mikulski Added An Amendment To The ACA Mandating That Preventive Care Specific To Women Must Be Covered. From RH Reality Check: “By a vote of 61-39, the Senate passed the Mikulski Amendment to the Patient Protection and Affordable Care Act today. The Mikulsi Amendment, submitted by Sen. Barbara Mikulski (D-MD), requires all health plans to cover comprehensive women’s preventive care and related screenings, at no additional charge to women.” [RH Reality Check, 12/3/09]

Since Guidelines For Women’s Preventive Care Did Not Yet Exist, It Was Left To HHS To Determine Which Services Must Be Covered. From the Guttmacher Institute: “The Mikulski amendment is tied by law to guidelines from HRSA [the Department of Health and Human Services’ Health Resources and Services Administration], but in contrast to the category for minors’ care, such guidelines do not currently exist. Accordingly, HRSA must quickly flesh them out in the coming months if they are to be up and running by the time the preventive care provision takes effect in September, or anytime soon thereafter.” [Guttmacher Institute, Spring 2010]

In July 2011, The Institute Of Medicine Recommended That Covered Women’s Preventive Care Include Contraceptives. From the Institute of Medicine, part of the National Academy of Sciences:

Given the magnitude of change, the U.S. Department of Health and Human Services charged the IOM with reviewing what preventive services are important to women’s health and well-being and then recommending which of these should be considered in the development of comprehensive guidelines. The IOM defined preventive health services as measures—including medications, procedures, devices, tests, education and counseling—shown to improve well-being, and/or decrease the likelihood or delay the onset of a targeted disease or condition. The IOM recommends that women’s preventive services include:

• improved screening for cervical cancer, counseling for sexually transmitted infections, and counseling and screening for HIV;

• a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes;
• services for pregnant women including screening for gestational diabetes and lactation counseling and equipment to help women who choose to breastfeed do so successfully;
• at least one well-woman preventive care visit annually for women to receive comprehensive services; and
• screening and counseling for all women and adolescent girls for interpersonal and domestic violence in a culturally sensitive and supportive manner. [Institute of Medicine, 7/19/11, emphasis added]

In August 2011, HHS Adopted The Institute Of Medicine’s Recommendations As Rules Governing New Insurance Plans. From the Department of Health And Human Services: “Historic new guidelines that will ensure women receive preventive health services at no additional cost were announced today by the U.S. Department of Health and Human Services (HHS). Developed by the independent Institute of Medicine, the new guidelines require new health insurance plans to cover women’s preventive services such as well-woman visits, breastfeeding support, domestic violence screening, and contraception without charging a co-payment, co-insurance or a deductible.” [HHS.gov, 8/1/11]

HHS Exempted A Narrow Group Of Religious Institutions – Essentially Houses Of Worship – From Paying For Contraceptive Coverage For Employees. From Ms. Magazine: “The Department of Health and Human Services (HHS), under Secretary Kathleen Sebelius, issued a narrow religious exemption, which the Administration is considering broadening. This religious exemption is applicable to ‘not-for-profit groups that have the inculcation of religious values as their purpose, primarily employ individuals who hold certain religious beliefs and primarily serve a population with those tenants.’ It is interpreted that this religious exemption would only cover employees of the religious institutions themselves, such as employees of churches, synagogues, or mosques. [Ms. Magazine, 11/21/11]

In January 2012, The Obama Administration Clarified That Religiously Affiliated Organizations, Such As Catholic Hospitals, Were Not Exempt From The Contraceptive Requirements. From NBC: “It was just on Jan. 20 that the Obama administration announced that religious-affiliated employers — outside of churches and houses of worships — had to cover birth control free of charge as preventative care for women. These hospitals, schools and charities were given an extra year to comply, until August 2013, but that concession failed to satisfy opponents, who responded with outrage. [NBC, 2/10/12]

After Backlash, The Obama Administration Tweaked The Policy To Require Insurance Companies, Not Religious Affiliates, To Pay For Free Contraceptive Coverage For In Health Plans For Affiliates’ Employees. From CBS News: “In what senior administration officials described as an ‘accommodation’ in the wake of an uproar from religious leaders, President Obama announced Friday that the government will not force religiously-affiliated institutions such as schools, charities and hospitals to directly provide birth control coverage as part of their employees’ health care coverage. Female employees of these religiously-affiliated institutions will, however, still have access to no-cost contraceptive coverage. It will come directly from the employee’s health insurer, who will be required to offer the coverage for free. Religious organizations will not be required to provide the contraception coverage, subsidize it or refer women to it.” [CBS News, 2/10/12]

In March, The Administration Proposed Ideas For How The Contraceptive Compromise Could Work. From Politico:

President Obama announced in February that religiously affiliated employers — such as Catholic hospitals — will not have to cover contraception for their employees. Instead, insurers will be required to enroll their employees into the coverage free of charge. But the final rule issued at the time did not provide any details on how this would work, leaving many questions. The document issued Friday does not fill in those blanks, but it floats ideas under consideration for implementing the policy. […] An administration official explained during a background call with reporters Friday that the administration is considering three options for self-insured plans:

– Require the companies that self-insured plans hire to manage their employee benefits, called third-party administrators, to cover the cost of these benefits out of revenues not connected with the religiously affiliated employer.

– Cover the cost of the benefit by having the new reinsurance program established by the health care reform law pay rebates to third-party administrators.

– Have a separate insurance company provide the benefit to these employees.

The proposal also suggests giving the exemption to religious organizations that cover some, but not all, FDA-approved contraceptives. [Politico, 3/16/12]

The Contraceptive Rule Updates Longstanding State And National Policy

Employers Already Have To Include Contraceptives As Part Of Their Health Plans – The Only Difference Is Now They’re Free. From NPR: “Here’s the rub: The only truly novel part of the plan is the ‘no cost’ bit. […] In fact, employers have pretty much been required to provide contraceptive coverage as part of their health plans since December 2000. That’s when the federal Equal Employment Opportunity Commission ruled that failure to provide such coverage violates the 1978 Pregnancy Discrimination Act. That law is, in turn, an amendment to Title VII of the 1964 Civil Rights Act, which outlaws, among other things, discrimination based on gender.” [NPR, 2/10/12]

• The EEOC Ruling Applies To Employers With 15 Or More Employees. From the National Women’s Law Center: “[T]he federal law prohibiting sex discrimination in the workplace has been held to bar all employers with at least 15 employees from singling out prescription contraception for exclusion from an otherwise comprehensive employee health plan.” [National Women’s Law Center, August 2009]

A Majority Of States Have Laws Requiring Insurance Plans That Include Prescription Coverage To Cover Contraceptives. From the Guttmacher Institute: “28 states require insurers that cover prescription drugs to provide coverage of the full range of FDA-approved contraceptive drugs and devices; 17 of these states also require coverage of related outpatient services.” [Guttmacher Institute, 2/2/12]

The Original Narrow Religious Exemption Has Been Upheld On The State Level. From NPR:

There are now lawsuits challenging the constitutionality of the policy, including a new one filed on behalf of the religious television network EWTN. But the exemptions have already been tested in court, at least at the state level.

In 2004, the California Supreme Court upheld that state’s law, in a suit brought by Catholic Charities, on a vote of 6-1.

The court ruled that Catholic Charities didn’t qualify as a “religious employer” because it didn’t meet each of four key criteria (which, by the way, are the same as those in the new federal regulation):

• The organization’s primary purpose is “the inculcation of religious values.”
• It primarily employs people of that religion.
• It primarily serves people of that religion.
• It’s a registered nonprofit organization.

Two years later, in 2006, New York’s top state court rejected a claim by Catholic Charities and several other religious groups that the state’s contraceptive coverage law discriminated against them because it exempted churches but not their religiously affiliated groups.

“When a religious organization chooses to hire nonbelievers, it must, at least to some degree, be prepared to accept neutral regulations imposed to protect those employees’ legitimate interests in doing what their own beliefs permit,” the justices wrote. [NPR, 2/10/12]

Affordable Contraception Is A Public Health Issue That Benefits Women, Children, And Society

Cost Affects Individuals’ Contraceptive Use

“Cost-Prohibitive” Nature Of Contraceptives Promotes Imperfect Use. From the Center for American Progress:

High costs have forced many women to stop or delay using their preferred method, while others have chosen to depend on less effective methods that are the most affordable.

• Surveys show that nearly one in four women with household incomes of less than $75,000 have put off a doctor’s visit for birth control to save money in the past year.
• Twenty-nine percent of women report that they have tried to save money by using their method inconsistently.
• More than half of young adult women say they have not used their method as directed because it was cost-prohibitive. [Center for American Progress, 2/15/12]

Women Who Don’t Use Birth Control Or Who Use It Inconsistently Account For 95 Percent Of Unintended Pregnancies. From the Guttmacher Institute:

Among the 43 million women at risk of an unintended pregnancy in 2002, 6% did not use a method all year, 10% had a gap in use of at least one month and 19% reported inconsistent use (e.g., skipped pills). This behavior has clear consequences: The one-third of women who do not use a method or who use one inconsistently account for 95% of unintended pregnancies.

Although there are myriad reasons behind these distressing statistics, cost is one important barrier. … A national survey from 2004 found that one-third of women using reversible contraception would switch methods if they did not have to worry about cost; these women were twice as likely as others to rely on lower-cost, less effective methods. According to another recent study of 10,000 women in the St. Louis area, when offered the choice of any contraceptive method at no cost, two-thirds chose long-acting methods—a level far higher than in the general population. Findings like this help explain why rates of unintended pregnancies are far higher among poor and low-income women than among their higher-income counterparts. …  [A]ccording to three recent studies, lack of insurance is significantly associated with reduced use of prescription contraceptives. [Guttmacher Institute, Winter 2011]

Even With Private Insurance, Cost-Sharing Forces Many Women Pay A Significant Portion Of Their Contraceptive Costs. From the Center for American Progress:

Although three-quarters of American women of childbearing age have private insurance, they still have had to pay a significant portion of contraceptive costs on their own.

• A recent study shows that women with private insurance paid about 50 percent of the total costs for oral contraceptives, even though the typical out-of-pocket cost of noncontraceptive drugs is only 33 percent.
• In some cases oral contraceptives approach 29 percent of out-of-pocket spending on health care for women with private insurance. [Center for American Progress, 2/15/12]

Studies Indicate That Even “Seemingly Small Cost- Sharing Requirements Can Dramatically Reduce Preventive Health Care Use.” From the Guttmacher Institute: “Yet, cost-sharing poses a significant problem even for women who are insured. A 2010 study found that women with private insurance that covers prescription drugs paid 53% of the cost of their oral contraceptives, amounting to $14 per pack on average. What they would pay for a full year’s worth of pills amounts to 29% of their annual out-of-pocket expenditures for all health services. Numerous studies have demonstrated that even seemingly small cost-sharing requirements can dramatically reduce preventive health care use, particularly among lower-income Americans.” [Guttmacher Institute, Winter 2011]

Available Contraception Yields Better Health…

Guttmacher: Using Contraceptives To Help Plan Pregnancies Has “Substantial Benefits For The Health And Well-Being Of Women, Infants, Families And Society.” According to the Guttmacher Institute: “An extensive body of research shows that contraceptive use helps women avoid unintended pregnancy and improve birth spacing, resulting in substantial benefits for the health and well-being of women, infants, families and society. The evidence strongly suggests that coverage without cost-sharing of contraceptive counseling and the provision of all methods approved by the Food and Drug Administration, as specified by the guidelines, is a low-cost or even cost-saving means of helping women overcome financial barriers to choosing a contraceptive method they will be able to use consistently and effectively. That may be particularly important with respect to long-acting, reversible methods (such as the IUD and the implant), which are extremely effective and cost-effective in the long run, but have high up-front costs.” [Guttmacher.org, Summer 2011, citations removed]

Using Contraceptives = Avoiding Unintended Pregnancies = Fewer Abortions. From testimony the Guttmacher Institute provided to the Institute of Medicine’s Committee on Preventive Services for Women:

The effectiveness of contraceptive use for individual women and couples translates into lower rates of unintended pregnancy and subsequent abortion among the broader population. Cross-country comparisons provide some evidence for this relationship: Unintended pregnancy in the United States is higher than in other developed countries, and contraceptive use is lower. … International comparisons also provide evidence that contraceptive use reduces women’s recourse to abortion. […]

Trends in unintended pregnancy rates in the United States provide further evidence of the effectiveness of contraceptive use. The proportion using contraceptives among unmarried women at risk of unintended pregnancy increased from 80% in 1982 to 86% in 2002; this increase was accompanied by a decline in unmarried women’s unintended pregnancy and abortion rates over the same period, with the abortion rate for unmarried women falling from 50 per 1,000 women in 1981 to 34 per 1,000 in 2000. [Guttmacher Institute testimony, 1/12/11, citations removed]

In 2006, Publicly Funded Contraception Helped Avoid Almost 2 Million Unintended Pregnancies And Over 800,000 Abortions. From testimony the Guttmacher Institute provided to the Institute of Medicine’s Committee on Preventive Services for Women: “More than nine million clients received publicly funded contraceptive services in 2006, and that national effort helped women avoid 1.94 million unintended pregnancies, including 810,000 abortions. By facilitating access to a more effective mix of contraceptive methods, publicly funded family planning centers enable their clients to have 78% fewer unintended pregnancies than are expected among similar women who do not use or do not have access to these services. Indeed, in the absence of this public effort, levels of unintended pregnancy and abortion would be nearly two-thirds higher among U.S. women overall and close to twice as high among poor women.” [Guttmacher Institute testimony, 1/12/11, citations removed]

Increased Contraceptive Use Is Responsible For Most Of The Decline In Adolescent Pregnancy. From testimony the Guttmacher Institute provided to the Institute of Medicine’s Committee on Preventive Services for Women: “Similarly, increased contraceptive use led to a decline in the risk of pregnancy among adolescents. One study found that from 1991 to 2003, contraceptive use improved among sexually active U.S. high school students, with an increase in the proportion reporting condom use at last sex (from 38% to 58%), and declines in the proportions using withdrawal (from 19% to 11%) and no method (18% to 12%); these adolescents’ risk of pregnancy declined 21% over the 12 years.  Another study found that increased contraceptive use was responsible for 77% of the sharp decline in pregnancy among 15–17-year-olds between 1995 and 2002 (decreased sexual activity was responsible for the other 23%); and increased contraceptive use was responsible for all of the decline in pregnancy among 18–19-year-olds.” [Guttmacher Institute testimony, 1/12/11, citations removed]

Contraceptives Let Women Space Out Pregnancies, Which Means Children Will Be Born Healthier. From testimony the Guttmacher Institute provided to the Institute of Medicine’s Committee on Preventive Services for Women: “The most direct, positive effects of helping women and couples plan the number and timing of their pregnancies and births are those related to improving birth outcomes. Short birth intervals have been linked with numerous negative perinatal outcomes. U.S. and international studies have found a causal link between the interpregnancy interval (the time between a birth and a subsequent pregnancy) and three major measures of birth outcomes: low birth weight, preterm birth and small size for gestational age. For this reason, contraceptive use to help women achieve optimal spacing is important to help them improve their infants’ health.” [Guttmacher Institute testimony, 1/12/11, citations removed]

…Higher Quality Of Life…

Marriages And Relationships Are More Likely To Dissolve After Unintended Pregnancies. From testimony the Guttmacher Institute provided to the Institute of Medicine’s Committee on Preventive Services for Women: “There is also some evidence that unintended pregnancy has significant negative effects on relationship stability. Both marriages and cohabitations are more likely to dissolve after an unintended first birth than after an intended first birth, even after controlling for a range of sociodemographic variables. Moreover, mothers and fathers who have an unplanned birth report less happiness and more conflict in their relationship and more depressive symptoms for the mother, compared with similar women and men who have a planned birth. Unintendedness of the pregnancy by the father, in particular, is associated with greater relationship conflict and has very slight (though statistically significant) negative effects on children’s attachment security and mental proficiency.” [Guttmacher Institute testimony, 1/12/11, citations removed]

Access To The Pill Improved Social And Economic Outlooks For Women. From testimony the Guttmacher Institute provided to the Institute of Medicine’s Committee on Preventive Services for Women: “The advent of the pill allowed women greater freedom in career decisions in two main ways. The first is that having a reliable form of contraception allowed women to invest in higher education and a career with far less risk of an unplanned pregnancy. Secondly, the pill led to an increase in the age at first marriage across the total population; as a result, a woman could pursue a career or education before marrying while facing less of a risk that she would be unable to find a desirable husband later.” [Guttmacher Institute testimony, 1/12/11]

There May Be Links Between Unintended Pregnancy And Child Abuse, Maternal Depression. From testimony the Guttmacher Institute provided to the Institute of Medicine’s Committee on Preventive Services for Women: “Moreover, although evidence is limited, several studies from the United States, Europe and Japan suggest an association between unintended pregnancy and subsequent child abuse. There is also some evidence of an association between unintended pregnancy and maternal depression and anxiety, although the strength of this finding is limited by poor study design.” [Guttmacher Institute testimony, 1/12/11]

…And Lower Health Care Costs

After Congress Mandated Contraceptive Coverage For Federal Employees, Premiums Did Not Increase Because Health Care Costs Did Not Go Up. From the Department of Health and Human Services:

Evidence from well-documented prior expansions of contraceptive coverage indicates that the cost to issuers of including coverage for all FDA-approved contraceptive methods in insurance offered to an employed population is zero.

In 1999, Congress required the health plans in the Federal Employees Health Benefits (FEHB) program to cover the full range of FDA-approved contraceptive methods. The FEHB program is the largest employer-sponsored health benefits program in the United States, and at the time, it covered approximately 9 million Federal Employees, retirees and their family members and included approximately 300 health plans.  The premiums for 1999 had already been set when the legislation passed, so the Office of Personnel Management (OPM), which administers the FEHB program, provided for a reconciliation process.  However, there was no need to adjust premium levels because there was no cost increase as a result of providing coverage of contraceptive services. [HHS.gov, February 2012]

The Direct Costs Of Providing Contraceptive Coverage Would Add Less Than 0.5 Percent To Premiums. From the Department of Health and Human Services: “The direct costs of providing contraception as part of a health insurance plan are very low and do not add more than approximately 0.5% to the premium costs per adult enrollee. Studies from three actuarial firms, Buck Consultants, PriceWaterhouseCoopers (PwC), and the Actuarial Research Corporation (ARC) have estimated the direct costs of providing contraception coverage.  In 1998, Buck Consultants estimated that the direct cost of providing contraceptive benefits averaged $21 per enrollee per year.  PwC actuaries completed an analysis using more recent, 2003 data from MedStat for the National Business Group on Health, and determined that a broader range of services (contraceptive services, plus lab and counseling services) would cost approximately $41 per year.  The most recent actuarial analysis, completed by the Actuarial Research Corporation in July 2011, using data from 2010, estimated a cost of about $26 per year per enrolled female.” [HHS.gov, February 2010, citations removed]

Taking Into Account The Medical And Indirect Costs Of Unintended Pregnancies, Contraceptive Coverage Saves Employers Almost $100 Per Year Per Employee. From the Department of Health and Human Services:

When medical costs associated with unintended pregnancies are taken into account, including costs of prenatal care, pregnancy complications, and deliveries, the net effect on premiums is close to zero. One study author concluded, “The message is simple: regardless of payment mechanism or contraceptive method, contraception saves money.”

When indirect costs such as time away from work and productivity loss are considered, they further reduce the total cost to an employer.  Global Health Outcomes developed a model that incorporates costs of contraception, costs of unintended pregnancy, and indirect costs.  They find that it saves employers $97 per year per employee to offer a comprehensive contraceptive benefit.  Similarly, the PwC actuaries state that after all effects are taken into account, providing contraceptive services is “cost-saving.” [HHS.gov, February 2010, citations removed]

Study Estimated It Costs Employers Up To 17 Percent More To Not Provide Contraceptive Coverage. From the Guttmacher Institute: “Moreover, a 2000 study by the National Business Group on Health, a membership group for large employers to address their health policy concerns, estimated that it costs employers 15–17% more to not provide contraceptive coverage in their health plans than to provide such coverage, after accounting for both the direct medical costs of pregnancy and indirect costs such as employee absence and reduced productivity. Mercer, the employee benefits consulting firm, reached a similar conclusion. And a more recent National Business Group on Health report, drawing on actuarial estimates by PricewaterhouseCoopers, concluded that even if contraception were exempted from cost-sharing, the savings from its coverage would exceed the costs.” [Guttmacher Institute, Winter 2011]

Every Public Dollar Spent On Contraception Saves Almost Four Times That Much On Medicaid Expenses For Unintended Pregnancies. From the Guttmacher Institute:  “Yet, although the costs of contraception can be daunting for individual women, insurance coverage of contraceptive services and supplies—both public and private—actually saves money. Guttmacher Institute research finds that every public dollar invested in contraception saves $3.74 in short-term Medicaid expenditures for care related to births from unintended pregnancies. In total, services provided at publicly funded family planning centers saved $5.1 billion in 2008. (Significantly, these savings do not account for any of the broader health, social or economic benefits to women and families from contraceptive services and supplies and the ability to time, space and prepare for pregnancies.)” [Guttmacher Institute, Winter 2011]

The American Public Supports Contraceptive Coverage

Most Americans Think Employers Should Have To Include Free Contraception In Their Health Plans. From the New York Times: “Over all, 63 percent of Americans said they supported the new federal requirement that private health insurance plans cover the cost of birth control, according to the survey of 1,519 Americans, conducted from Feb. 13 to Feb. 19 for the Henry J. Kaiser Family Foundation. The poll has a margin of sampling error of plus or minus three percentage points.” [New York Times, 3/1/12]

Nearly Two-Thirds Of Americans Think Contraceptive Coverage By Religious Affiliates Is A Matter Of Women’s Health, Not Religious Liberty. According to a Bloomberg poll conducted March 8-11, 62 percent of adult Americans think the “controversy over whether education and health care facilities affiliated with religious organizations, such as the Catholic Church, should provide access to birth control through health insurance plans” is “a matter of a woman’s health and access to birth control.” Thirty-three percent view it as “a matter of religious liberty.” [Bloomberg News Poll, March 8-11, 2012]

About 60 Percent Of Catholics Support Free Contraception In Employer Health Plans. According to the Public Religion Research Institute: “Catholics generally agree with the distinction made by the Obama administration between churches and religiously affiliated institutions: roughly 6-in-10 Catholics report that religiously affiliated social service agencies (59 percent), colleges (60 percent), hospitals (59 percent), and privately owned small businesses (58 percent) should be required to provide health care plans that cover contraception at no cost.” [PRRI.org, 6/27/12]

Fox News Poll: Plurality Of Respondents Support Requirement “That Employer Health Plans Provide Birth Control Coverage.” From a Fox News poll conducted from June 3-5, 2012:

[Fox News Poll, June 3-5, 2012]

Several Catholic Organizations Praised The Administration’s Compromise

Association Of Jesuit Colleges And Universities “Appreciates The Compromise.” From a press release from the Association of Jesuit Colleges and Universities: “The Association of Jesuit Colleges and Universities (AJCU) acknowledges and appreciates the compromise that President Obama has made to accommodate religious institutions in regard to the birth control mandate under the Affordable Care Act. We commend the Obama Administration for its willingness to work with us on moving toward a solution, and we look forward to working out the details of these new regulations with the White House.” [AJCUNet.edu, 2/10/12]

Catholics United Praised Obama For ‘Rising Above The Fray’ And ‘Respecting Religious Liberty.” From a press release from Catholics United: “Today the Obama Administration announced that the President would be issuing a new regulation fully respecting the religious liberty of Catholic organizations while maintaining access to contraceptive services for all employees. … Using the standard of Catholic moral theology, this solution is acceptable because no Catholic or Catholic institution will be directly involved in what the church deems to be an immoral act. ‘Catholics United has been calling on both sides of this heated debate to work towards today’s win-win solution,’ said James Salt, executive director of Catholics United. ‘President Obama has shown us that he is willing to rise above the partisan fray to deliver an actual policy solution that both meets the health care needs of all employees and respects the religious liberty of Catholic institutions.’ [Catholics-United.org, 2/10/12]

Sisters Of Mercy Of The Americas Were “Pleased” With Compromise. From a statement released by the Catholic service organization Sisters of Mercy  of the Americas: “The Sisters of Mercy of the Americas are pleased that adjustments are being made in the new health insurance requirements that will ensure conscience protections for religious-affiliated institutions. We commend President Obama for his openness to dialogue on this issue and his willingness to address these concerns.” [SistersOfMercy.org, 2/10/12]

Leadership Conference Of Women Religious: President’s Resolution “Is A Fair And Helpful Way For Us To Move Forward.” From a statement issued by the Leadership Conference of Women Religious, a Catholic group whose 1500-plus members represent over 80 percent of American nuns: “The Leadership Conference of Women Religious (LCWR) is grateful that President Obama and the administration listened to the concerns raised about providing effective healthcare coverage in a way that respects and honors the conscience rights of religious institutions. We believe the resolution the President made is a fair and helpful way for us to move forward. We are grateful to the many individuals and organizations who courageously voiced their concerns on this critical matter and worked together to find a resolution. Such collaboration and mutual respect model an effective way for our country to deliberate on the many complex issues we face. LCWR supports the full implementation of the Affordable Care Act so that the urgent needs of the uninsured can be met.” [LCWR.org, 2/10/12; LCWR.org, accessed 8/1/12]

But Despite Compromise – And The Health Benefits, Cost-Effectiveness, And Public Support – Conservatives Still Oppose The Policy

Conservative Groups

Heritage Foundation: Compromise Is A “Fig Leaf” Necessitated By Improperly Designed Health Reforms. On the Heritage Foundation’s Foundry blog, Thomas Messner, Edmund Haislmaier, and Ryan T. Anderson write:

Under pressure for trampling religious freedom, last Friday the Obama Administration announced certain potential modifications to the rule. Sort of. What the Administration actually did was post the final rule without any changes. That’s right—they posted the final rule without any modifications from the August 2011 version that caused the furor in the first place. And then they promised that sometime during the next year, they would pursue a new rule to address concerns about religious freedom.

Decide for yourself how much weight to put on the Administration’s promise to protect religious freedom in some future rulemaking process. Even if the Administration does exactly what it says it will do, however, the announced “compromises” are little more than a fig leaf, meaning the forced coverage mandate—on this and future issues—persists as a serious threat to religious freedom.

In short, this issue isn’t going away, as badly as the Administration might want it to. That means more spin from the Administration and its allies in the days and weeks ahead.

Concerned citizens, leaders of religious institutions, and public officials should respond by keeping their focus on three basic points:

1. Religious freedom goes hand in hand with limited government and with greater freedom in general.

1. The basic structure of Obamacare makes these kinds of conflicts both inevitable and recurring.
2. Properly designed health reforms would never have produced this situation in the first place. [The Foundry, 2/14/12]

FRC President Tony Perkins: Compromise Is “Deceptive” And “Fundamentally Wrong.” From a video of Family Research Council president Tony Perkins:

PERKINS: Hoping to quell the uprising, the president announced that a compromise was being put forth that would provide the drugs and services to employees without the religious organization having to pay for them. The insurance company would provide the contraception to the employees free of charge. […]

This latest fig leaf from the Obama administration is not only deceptive, this mandate remains fundamentally wrong and still violates the religious freedoms and conscience rights of Americans. Even if this compromise were legitimate, it applies only to religious organizations. The freedom of religion was granted to every American, not just those who work at religious organizations.

This is yet another example of President Obama’s flawed view of our rights as Americans. He has repeatedly said he supports the freedom of worship. Freedom of worship is what happens within the four walls of a church or possibly under the roof of your own home. The freedom of religion, which our Constitution serves to protect, recognizes our ability to lives our lives according to our faith, just as the Bible instructs us to do.” [Tony Perkins Statement via FRCblog.com, 2/10/12]

Richard Land: “So-Called Compromise” On “Abortion Mandate” Is Obama’s “Attempt To Mollify His Radical Pro-Abortion Supporters.” From a statement from Richard Land, president of the Southern Baptist Convention’s Ethics and Religious Liberty Commission:

“Southern Baptists and people of other various faith communities are outraged with President Obama’s so-called compromise on his administration’s abortion mandate. In his attempt to mollify his radical pro-abortion supporters, President Obama has declared that individual conscience is subject to government edict.

“The president’s failure to grasp the seriousness of this issue reveals a dangerous presidential blind spot concerning First Amendment constitutional religious free exercise guarantees. […]

“Today President Obama let down his fellow Americans of religious faith by dismissing these issues of inviolable conscience as troublesome inconveniences. The president’s so-called compromise tramples the deeply held beliefs of tens of millions of Americans, beliefs that are guaranteed and protected by the U.S. Constitution.

“Mr. President, mere accounting tricks will not suffice. You have given your fellow citizens’ cry of conscience the dismissive back of your hand by offering them not a solution, but a distinction without a difference.”  [ERLC.com, 2/10/12]

American Family Association: Compromise Is A “Shell Game.” From a release put out by the American Family Association:

Last week, President Barack Obama proposed a “compromise” over his administration’s earlier healthcare mandate to force churches and religious organizations to provide abortion inducing drugs and devices, as well as surgical sterilization, in their insurance plans.

What was his “compromise?” Make the insurance companies pay for it instead!

Obama’s latest mandate is nothing more than a shell game. Religious organizations and Christian-owned businesses will still be paying for insurance plans which will, in turn, give “free” contraceptives and abortifacients to their employees. Where in the constitution does any president get the authority to mandate that private companies provide services or products for “free” to consumers?

The American people are not stupid, and realize insurance companies will simply pass the costs on to the insured. That’s you, me, churches, and every other religious institution, including EVERY Christian-owned business, that provides insurance to its employees. [AFA.net, 2/14/12, emphasis original]

• SPLC: The Family Research Council And The American Family Association Are Hate Groups. The Southern Poverty Law Center has designated the Family Research Council and the American Family Association as anti-gay “hate groups.” [SPLCenter.org, accessed 2/23/12]

Conservative Politicians

Romney: Compromise Is “Another Deception.” From the National Journal: “At the event, Romney also waded into the political fray over the decision by the Obama administration today to require insurers, rather than private employers, to pay for coverage of contraception. The move reversed an earlier decision that would have required religious-affiliated organizations, such as Catholic hospitals, to provide the coverage, prompting an outcry from across the political spectrum. ‘Today he did the classic Obama retreat all right, and what I mean by that is, it wasn’t a retreat at all. It’s another deception,’ Romney said, arguing that that religious organizations still will have to pay for contraception after insurance companies pass the costs along to employers. ‘Companies consist of people, and someone has to pay — the owners, the employees or the customers, and they pass those costs on to the customers,’ he said.” [National Journal, 2/10/12]

Santorum: Insurance Companies Shouldn’t Have To Cover Birth Control Because It “Costs Just A Few Dollars.” Rick Santorum made the following statement at the 2012 Conservative Political Action Conference: “[I]nterestingly enough, here is what they are forcing them to do — in an insurance policy, they or forcing them to pay for something that costs just a few dollars. Is that what insurance is for? The foundational idea that we have the government tells you that you have to pay for everything as a business. Things that are not really things you need insurance for, and still forcing on something that is not a critical economic need, when you have an economic distress, where you would need insurance. But forcing them even more to do it for minor expenses.” [Santorum Statement via ThinkProgress, 2/10/12]

Rep. Issa Convened One-Sided Hearing To Attack Contraception Rule From Religious Freedom Angle. From a Los Angeles Times editorial:

When Rep. Darrell Issa, the California Republican who chairs the House Committee on Oversight and Government Reform, convened a hearing Thursday on religious freedom and the mandate that health insurers cover contraception, he ignited a firestorm of protest before he even started.

The first of two panels he assembled was all male — something that a Democratic congresswoman on the committee noted immediately and not favorably, given that women’s health was at the heart of what was being discussed. A photo of the panel of clergymen at a table before the committee went viral on Facebook.

The Democrats who made political hay of Issa’s choice of witnesses were right; surely it says something troubling that the committee didn’t bother to find a single woman to testify on its first panel. (There were two on the second.) But it is at least as troubling that there was no one at all — male or female, on either panel — called to testify in support of the Obama administration’s proposed mandate. […]

The title of the hearing alone was a giveaway: “Lines Crossed: Separation of Church and State. Has the Obama Administration Trampled on Freedom of Religion and Freedom of Conscience?” [Los Angeles Times, 2/19/12]

Sen. Blunt: The Administration’s Compromise Is “Unconstitutional” And “An Accounting Gimmick.” From a statement released by Sen. Roy Blunt (R-MO):

U.S. Senator Roy Blunt (Mo.) released the following statement today in response to President Barack Obama’s announcement regarding the U.S. Department of Health and Human Services’ (HHS) health care mandate:

“It’s still clear that President Obama does not understand this isn’t about cost – it’s about who controls the religious views of faith-based institutions. President Obama believes that he should have that control. Our Constitution states otherwise.

“Just because you can come up with an accounting gimmick and pretend like religious institutions do not have to pay for the mandate, does not mean that you’ve satisfied the fundamental constitutional freedoms that all Americans are guaranteed.” [Sen. Blunt Release, 2/10/12, emphasis original]

• Sen. Blunt Introduced An Amendment That Would Let Any Employer Opt Out Of Covering Any Health Service For Any “Moral” Reason. From Mother Jones:

Obama’s Affordable Care Act requires all health care plans to offer certain services and benefits, including birth control. Last week, Sen. Roy Blunt (R-Mo.) offered a “conscience amendment,” to the law, pitching it as a way to allay religious employers’ qualms about providing birth control to their employees.

But Blunt’s proposal doesn’t just apply to religious employers and birth control. Instead, it would allow any insurer or employer, religiously affiliated or otherwise, to opt out of providing any health care services required by federal law—everything from maternity care to screening for diabetes. Employers wouldn’t have to cite religious reasons for their decision; they could just say the treatment goes against their moral convictions. That exception could include almost anything—an employer could theoretically claim a “moral objection” to the cost of providing a given benefit. The bill would also allow employers to sue if state or federal regulators try to make them comply with the law. [Mother Jones, 2/14/12]