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Obama administration offers compromise on contraceptives

This article first appeared in the St. Louis Beacon, Feb. 10, 2012 - Following a wave of criticism, especially from the Catholic church and its health-care leaders, the Obama administration announced this morning that it would exempt religious employers from being required to provide contraceptive services. Instead, women who work for church-affiliated employers, such as universities and hospitals, will be able to get contraceptives free through insurance companies.

One senior White House official painted the policy change as "an issue on which people of good will on both sides of the debate have found a solution that works for everyone. With today's announcement, we think we've done that."

It remains unclear, however, whether the new policy will satisfy all church-based organizations. Start of update: "While there may be an openness to respond to some of our concerns, we reserve judgment on the details until we have them," said Cardinal-designate Timothy Dolan, president of U.S. Catholic Conference of Bishops, in a statement.

"Today's decision to revise how individuals obtain services that are morally objectionable to religious entities and people of faith is a first step in the right direction," Dolan continued. "We hope to work with the administration to guarantee that Americans' consciences and our religious freedom are not harmed by these regulations." End of update.

Start of update 2: Archbishop Robert J. Carlton called the development "positive" but said it remained to be seen whether the announced action would ultimately lead to a resolution of the issues..

"Unfortunately, what this accommodation really means is that religious groups will still be forced to purchase health care coverage that includes contraception and abortifacients," he said. "The fact that the responsibility is now on the insurance companies is simply a matter of semantics.  It does not appear that there is any substantive change from the original regulation requiring health plans sponsored by religiously affiliated entities to provide contraceptives, sterilizations and abortion inducing drugs to which we have objected."

He said the real issue involved "the protection of one of our most basic freedoms -- the freedom of religious rights. What President Obama's administration presented today does not yet appear to be the best possible solution to this gravely important matter." 

A similar reservation was expressed by Mike Panicola, vice president of ethics for SSM Health Care. He said the system was "pleased that the president took this important initial step. (But) the changes announced still do not apply to the type of health insurance plans SSM Health Care and many other faith-based organizations provide to their employees." End of update 2.

Other local Catholic groups have yet to announce whether they will accept the new policy, which exempts religious organizations from covering contraceptives due to religious objections.

The change also means that religious organizations will not be required to subsidize the cost, and contraception coverage would be offered directly to women through their employers' insurance companies. The insurers would be required to offer the coverage free of charge.

Because contraceptive services not only help women but reduce overall health costs of "potentially unintended and unhealthy pregnancy," employer health-care costs without contraceptive coverage could be 15 percent to 17 percent higher, according to the administration.

Senior White House officials, speaking before President Barack Obama made the announcement, said they believed the administration could sell the new policy.

"The insurance companies, not the hospital, not the charity, will be required to reach out directly to women and provide contraceptive care free of charge," one official said, "so those institutions will not have to offer contraceptive coverage directly and they will not pay for it."

He said the change means "women who work at these institutions -- nurses, teachers, janitors, doctors -- and others will have access to free contraceptive services. They will not have to reach in their pockets anymore and struggle to pay for it. That's important. Obviously they could use that money in other important ways."

The administration is also insisting that the compromise has protected what is important for women. The officials said 99 percent of all women in this country have relied on contraceptives at some point in their lives. Other studies have suggested that more than 90 percent of Catholic women fit that picture.

"The announcement adheres to two core principles: that women deserve preventive health services that are available and affordable, and in instances where religious employers have objections, this allows the employees to have the same access and affordability that any other employee has in any other work place. That's the core principle."

Obama extended an olive branch to church leaders by noting that his first job when moving to Chicago involved work with Catholic parishes in poor neighborhoods. There, he said, he observed that local churches did "more good for a community than a government program ever could."

He acknowledged the strong objection among religious institutions to directly providing insurance that covers contraceptive services and said that's why the initial policy exempted churches.

But he said there was a "more cynical desire on the part of some to make this into a political football."

That concern, he said, made him realize that spending months "hammering out a solution was not going to be an option."

He said he decided last week to ask Health and Human Services officials to "speed up the process," adding "we weren't going to spend a year doing this; we're going to spend a week or two doing this." The new policy, he says, marks a "decision on how to move forward."

Many states have contraceptive mandates

It remains to be seen whether this change will be an easy sell even though it is similar to rules already in place in some states. In fact, some states have rules with no exemptions and have not seen anything like this week's uproar.

Thirteen years ahead of the new policy, for example, Georgia began requiring insurance plans to cover prescription contraceptives, and it offered no exemptions for religious employers.

Georgia's policy stresses the value of family planning. Its website says the law's goal has been to reduce unintended pregnancies, improve birth outcomes and promote the health of mothers "by providing reproductive health care to women in need."

A similar law went into effect in Wisconsin in 2009 and in Colorado last month. The reaction was relatively quiet when these three states began implementing their laws.

"I don't believe we've gotten any complaints about it," says Jim Guidry, a spokesperson for the office of the commissioner of insurance in Wisconsin.

Likewise, spokeswoman Marianne Goodland of the Colorado Division of Insurance, said furor erupted when the law was proposed but no religious groups testified during a rulemaking hearing last October on carrying out the state's new mandate for coverage of FDA-approved contraceptives.

That's not to say groups with church-based missions, such as the nation's Catholic hospitals, are happy with those laws.

Broad reach of Catholic hospitals

What these hospitals decide will matter because of their huge impact on the health system. Catholic hospitals are said to employ about 765,000 people nationwide and provide care to roughly one in every six patients. Like the Catholic Church itself, many of these hospital systems object to the federal mandate. The displeasure among some of these hospitals is one reason the administration now wants to exempt them from having to provide direct coverage for contraception.

Earlier, in trying to sell the old policy that exempted churches but not church-based hospitals, the administration noted that the proposed federal policy was similar to laws in 28 states, including Missouri. Its law exempts health carriers "owned and operated by religious entities." The administration also noted that the federal rules weren't as strict as the no-exemption policies in place in Georgia, Colorado and Wisconsin.

Even so, the administration apparently wasn't winning over leaders of Catholic hospital systems, including SSM Health Care, which employs about 11,500 in the St. Louis area and 24,000 nationwide. It wants the administration to revise the church-exemption rule to include "organizations sharing common religious bonds and convictions with a church," says Panicola.

But that system's existing policy is a little more nuanced than it appears. Suzy Farren, SSM's corporate vice president of communications, says that while SSM Health Care doesn't cover "elective contraception or sterilizations," such services can be provided "when a physician determines that they are medically necessary."

Some Catholic colleges already cover contraception for their workers. One example is Fontbonne, where a spokesperson says the "policy allows each employee to make health decisions that reflect their own consciences." In spite of several inquiries from the Beacon, officials at Saint Louis University, the area's largest Catholic college, never provided information about health insurance for its employees or students.

It's also unclear what percentage of the tens of thousands of employees at Catholic hospitals are non-Catholics. A typical response to that question comes from the SSM's Farren who says, "We do not ask employees what their religious beliefs are, so we do not know how many Catholics we employ."

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.