Obama tweaks birth control rule

Richard Wolf

Document Publication: USA Today - McLean, VA

Publication Date: February 10, 2012

President Obama announced a plan today that attempts to accommodate certain religious employers opposed to a rule that would require them to provide access to birth control for women free of charge.

Obama announced that the rule would be tweaked so that in cases where non-profit religious organizations have objections, insurance companies would be required to reach out to employees and offer the coverage directly. The U.S. Conference of Catholic Bishops called it "a first step in the right direction."

President Obama is joined by Health and Human Services Secretary Kathleen Sebelius as he makes a statement on Friday.
CAPTIONBy Mark Wilson, Getty Images
"Under the rule, women will still have access to free preventive care that includes contraceptive service no matter where they work," Obama said. "That core principle remains.

"But if a woman's employer is a charity or a hospital that has a religious objection to providing contraceptive services as part of their health plan, the insurance company -- not the hospital, not the charity -- will be required to reach out and offer the woman contraceptive care free of charge without co-pays, without hassle."

With that distinction, those organizations won't have to provide the coverage, pay for it or refer their employees to it. The requirement will rest with insurers -- who issued a statement expressing reservations.

"Health plans have long offered contraceptive coverage to employers as part of comprehensive, preventive benefits that aim to improve patient health and reduce health care cost growth," said Robert Zirkelbach, spokesman for America's Health Insurance Plans, a trade group. "We are concerned about the precedent this proposed rule would set."

Obama and Health and Human Services Secretary Kathleen Sebelius said they always had planned on working with religious institutions to get the mandate right. But they moved up their timetable after hearing vehement objections from the Catholic Church and others.

"We weren't going to spend a year doing this," Obama said in brief remarks to reporters.


The U.S. Conference of Catholic Bishops called it "a first step in the right direction" Friday afternoon but reserved judgment while looking into the details.

Obama personally reached out Friday morning to Archbishop of New York Timothy Dolan, Sister Carol Keehan, CEO of the Catholic Health Association of the United States, and Cecile Richards, president of Planned Parenthood Federation of America, to alert them to the change.

"While there may be an openness to respond to some of our concerns, we reserve judgment on the details until we have them," Dolan said in a statement.

"The past three weeks have witnessed a remarkable unity of Americans from all religions or none at all, worried about the erosion of religious freedom and governmental intrusion into issues of faith and morals. 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. We hope to work with the administration to guarantee that Americans' consciences and our religious freedom are not harmed by these regulations."


The change, loosely based on a regulation in effect in Hawaii, still leaves some unanswered questions. How will women be referred to insurers if they don't think of it themselves? Will the cost of contraceptives get added to premiums? And will other employers -- say, a strict Catholic who owns a restaurant -- be allowed the same exemption as hospitals, schools and charities?

Officials said that while the final rule goes into effect today, it will not be enforced on religious organizations that object until August 2013, leaving additional time to work out details.

The administration announced last month that religious-affiliated employers had to cover birth control as preventive care for women. Churches and houses of worship were exempt, but all other religiously affiliated organizations were ordered to comply.

The White House received backlash to the measure from Catholic clergy as well as Republican leaders this week. Obama cited "many genuine concerns" expressed by conscientious objectors.

"My first job in Chicago was working with Catholic parishes in poor neighborhoods, and my salary was funded by a grant from an arm of the Catholic Church," Obama said. "And I saw that local churches often did more good for a community than a government program ever could, so I know how important the work that faith-based organizations do and how much impact they can have in their communities.

I also know that some religious institutions -- particularly those affiliated with the Catholic Church -- have a religious objection to directly providing insurance that covers contraceptive services for their employees."

On the other hand, he cited "the more cynical desire on the part of some to make this into a political football."

"I understand some folks in Washington may want to treat this as another political wedge issue, but it shouldn't be," he said. "I certainly never saw it that way."

White House officials took pains to avoid the word "compromise," noting that under the accommodation, no woman who wants access to contraceptives should be denied.

Experts on religion said the accommodation isn't enough. "It's a shell game," says Robert Destro, law professor at Catholic University.

Frank Pavone, National Director of Priests for Life, said he remained unsatisfied.

"A resolution to this issue cannot only cover 'religious' employers," Pavone said. "Religious freedom, which includes freedom of conscience, does not belong only to religious entities but to every American. There are many non-religious reasons to object to the administration's policy."

Marie Hilliard, director of bioethics and public policy at the National Catholic Bioethics Center, a registered nurse and a canon lawyer, noted that the administration has not changed its definition of who is exempt. Instead, Obama just established a special provision for "non-exempt religious groups."

It's still a narrow definition focused on churches that employ and serve people of their faith, not schools, hospitals, social services or other ministries that are recognized under the tax code as exempt religious organizations. Until that's changed, Hilliard said, the government is still "cherry-picking to see which groups will be seen by our government as worthy of exemptions and which won't. "

Many Catholic institutions are self-insured and not covered under the mandate unless they update or alter their plans. No one knows how many health policies are held by Catholic agenicies, because every diocese and Catholic institution makes its own decisions in hundreds of thousands of separate corporations.

Within minutes of announcing the change in policy, the White House began rolling out endorsements from some Catholic organizations, including the Catholic Health Association and Catholics United. Planned Parenthood also applauded the action.

In a memo to reporters Friday morning, the Republican National Committee said Obama is trying to "ride the fence" on the issue.

"It's a dangerous game when dealing with a fundamental American right protected by the Constitution such as religious freedom," the RNC said in the memo.

House Speaker John Boehner this week called the mandate "an unambiguous attack on religious freedom" in a rare House floor speech and vowed legislative action to reverse it.

"If the president does not reverse the attack on religious freedom, then the Congress, acting on behalf of the American people and the Constitution we are sworn to uphold and defend, must," Boehner said. "This attack by the federal government on religious freedom in our country must not stand and will not stand."

On Friday, his office stuck by that plan, but the rhetoric was less volatile.

"The Catholic Church and others in our nation's religious community are not yet convinced the president's mandate doesn't constitute an attack on religious freedom, which has been a fundamental American right for more than 200 years," said Boehner spokesman Michael Steel. "It's clear that these organizations were not included in developing the so-called compromise."

Republican leaders have been joined by a few Democrats -- such as Sens. Robert Casey of Pennsylvania and Joe Manchin of West Virginia and House Democratic Caucus Chairman John Larson of Connecticut -- in calling for changes in the policy. Vice President Biden vowed in Ohio on Thursday that a solution would be forthcoming.

The White House has pointed to 28 states with similar laws, including eight without the religious exemption contained in the federal rule, as proof that requiring free access to contraceptives is workable.

The rule goes into effect Aug. 1, but if objections are raised, another year's extension is possible.

That's been no consolation to Catholic leaders. The White House is "all talk, no action" on moving toward compromise, said Anthony Picarello, general counsel for the U.S. Conference of Catholic Bishops.

"There has been a lot of talk in the last couple days about compromise, but it sounds to us like a way to turn down the heat, to placate people without doing anything in particular," Picarello said this week. "We're not going to do anything until this is fixed."

That means removing the provision from the health care law altogether, he said, not simply changing it for Catholic employers and their insurers. He cited the problem that would create for "good Catholic business people who can't in good conscience cooperate with this."

"If I quit this job and opened a Taco Bell, I'd be covered by the mandate," Picarello said.

Senate Democrats who met with Obama on Wednesday came away convinced he would not back down on requiring some form of access for all women, regardless of where they work.

"We support the right of women in this country to have access to birth control through their insurance policies, and anybody who stands in the way is going to have to deal with us and our friends," said Sen. Barbara Boxer, D-Calif., flanked by four colleagues. Boxer said she had spoken to Obama adviser David Axelrod, who assured her that the administration would not weaken its position.

More than 600 physicians and medical students from 49 states signed a letter to Obama and Sebelius on Wednesday, urging them to stand firm in defense of the rule. They said millions of women rely on birth control pills for other medical conditions.

Roman Catholic leaders showed no sign of backing down, either.

"There's no room for compromise on this. The mandate has to go," said John Allen, senior correspondent for the National Catholic Reporter and author of numerous books on the Catholic Church. "There's not much room for a conversation here."

Contributing: Cathy Lynn Grossman and Aamer Madhani

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