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The Pill, the President, the Policy: a Primer

| February 12, 2012

A display at the now-closed Science in American Life exhibit at the Smithsnonian's National Museum of American History. (Zak Hubbard)

The Obama administration, stung by fierce opposition from Catholic leaders to a new rule requiring that insurance plans offer free contraception, announced it is revising the regulations so that religious-affiliated groups don’t have to pay for the coverage. But President Barack Obama insisted that all women must still be covered. “No woman’s health should depend on who she is or where she works or how much money she makes,” he said in making the announcement.

Here are some common questions and answers from KHN that help explain the policy.

Q: What action did the president take and how is it different from earlier policy?

A: The announcement shifts the responsibility for providing insurance coverage of birth control expenses for religious-affiliated organizations opposed to contraception. Last month, the administration announced that all insurance plans would be required to cover contraception as part of the list of free preventive services mandated by the 2010 federal health law. That regulation exempted houses of worship, like churches, from the requirement to provide contraceptive services at no cost to employees, but religious-affiliated institutions, such as universities and hospitals, would have to provide coverage for contraception.

Some religious groups, including the United States Conference of Catholic Bishops, objected on the basis that it violated their religious freedom. The resulting furor quickly engulfed the White House and even some Democrats and Catholic groups that had supported the health law, such as the Catholic Health Association, turned against the policy.

The compromise detailed by the president stipulates that insurers – not the religious-affiliated employers — would have to contact individuals directly about how to obtain contraceptive services, which would be provided at no cost, in accordance with the health care law. The administration will submit a regulation detailing specifics of the policy.

Q. What was the nature of the opposition to the initial rule?

A. Catholic religious leaders and Republican presidential candidates characterized the rule as an attack on religious liberty and another example of an overreach by the Obama administration. The U.S. Conference of Catholic Bishops led the opposition, with dozens of bishops all over the country making statements against it. Several bishops said that they would have no choice but to stop insuring employees altogether if the contraception mandate goes into effect.

The Catholic opposition is rooted in a tenet of the faith that holds that life begins at conception and therefore anything that prevents conception is a sin. Though surveys have shown that as many as 98 percent of Catholic women have used birth control at some point, a more recent survey found that voters are split over the question of whether employers such as Catholic hospitals and universities should be required to provide contraceptive insurance coverage for employees.

Q: Wouldn’t this mean that the religious institutions would still pay for birth control as part of the insurance they provide to their workers?

A: Administration officials say no. While birth control will be covered, by not requiring employers to pay anything additional or to tell employees how to get the services, the administration believes it has brokered a satisfactory compromise.  White House officials said actuaries they consulted said that covering contraceptive services would not increase costs for employers and could actually save insurers money by preventing pregnancy. “Covering contraception saves money for insurance companies by keeping women healthy and preventing spending on other health services,” according to the administration fact sheet. The document states that there was “no increase in premiums when contraception was added to the Federal Employees Health Benefit System and required of non-religious employers in Hawaii.” The administration  noted that one study found covering contraception lowered premiums by 10 percent or more.

The trade association for insurers, America’s Health Insurance Plans, issued this statement from Press Secretary Robert Zirkelbach: “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. We are concerned about the precedent this proposed rule would set. As we learn more about how this rule would be operationalized, we will provide comments through the regulatory process.”

Q. How does the new federal rule and religious exemption compare with contraceptive coverage laws currently on the books in states?

A. The big difference is that under the federal rule birth control will be available without the employee being responsible for a copayment. That is currently true in just a handful of states. Some 28 states have mandated coverage of birth control, and 20 of those have some sort of exemption for religious employers. According to a report by the Guttmacher Institute, the state exemptions range from very narrow definitions, such as only for churches, to broader exemptions, including religious elementary and secondary schools. The most expansive state exemptions allow religiously-affiliated colleges and hospitals not to provide birth control coverage.

The federal compromise announced Friday cleaves closely to laws on the books in Hawaii, Connecticut and West Virginia. In all of those states, insurers must cover contraceptives for employees of institutions who choose not to do so for religious reasons. The federal rule, though, is unlike state laws that require the religious employers to tell workers where contraception coverage is available.

Q. What is the reaction to this proposal?


After initially calling the decision a “first step in the right direction,” the United States Conference of Catholic Bishops later released a statement that said that the rescission of the mandate was the only “complete solution.” The statement said that the president “has decided to retain HHS’s nationwide mandate of insurance coverage of sterilization and contraception, including some abortifacients. This is both unsupported in the law and remains a grave moral concern. We cannot fail to reiterate this, even as so many would focus exclusively on the question of religious liberty. Second, the President has announced some changes in how that mandate will be administered, which is still unclear in its details. … the lack of clear protection for key stakeholders—for self-insured religious employers; for religious and secular for-profit employers; for secular non-profit employers; for religious insurers; and for individuals—is unacceptable and must be corrected.”

Meanwhile: “The Catholic Health Association is very pleased with the White House announcement that a resolution has been reached that protects the religious liberty and conscience rights of Catholic institutions,” the group’s president, Sister Carol Keehan, said in a statement. The Catholic Health Association broke with the U.S. Conference of Catholic Bishops two years ago to support the health law, but had opposed the Jan. 20 rule.

Planned Parenthood President Cecile Richards said the administration had “reaffirmed its commitment to ensuring all women will have access to birth control coverage, with no costly co-pays, no additional hurdles, and no matter where they work.”

Congressional Republicans said the compromise fell short, however. “This is about religious freedom, and anything short of a full exemption is no compromise,” said Sen. Orrin Hatch, Republican of Utah. “The White House has shown time and time again that nothing will stand in the way of politics, and their actions on this mandate reflect that.”

Concerned the fight would continue, several birth control advocacy groups said they planned to closely monitor implementation. “These groups and their allies in Congress want to take away contraceptive coverage from nurses, janitors, administrative staff and college instructors — and that agenda is out of touch with our country’s values and priorities,” said NARAL Pro-Choice America’s Nancy Keenan.

Q: On Capitol Hill, Republicans have been pushing legislation to overturn the regulation. How might today’s announcement affect those efforts?

A: Republicans in both chambers called the administration’s move a “gimmick” and said the policy still interferes with religious groups’ constitutional rights to refuse to pay for coverage of contraceptive services and they have promised legislative action to repeal it.

“Today’s announcement is not a compromise on policy – it simply pretends to shift costs away from religious employers, but it doesn’t fix the problem and is another call for individuals and institutions to compromise on principle,” House Energy and Commerce Committee Chairman Fred Upton, R-Mich., said in a written statement. Upton had previously announced plans to introduce legislation to reverse the contraception rule.

In the Senate, Roy Blunt of Missouri, a member of the GOP leadership, said “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.” Sen. Joe Manchin, D-W.Va., who opposed the Jan. 20 rule, has introduced legislation with Sen. Marco Rubio, R-Fla., to repeal the health law’s requirement that employers cover contraception for employees.

While efforts in the House are still likely to pass, in the Senate Majority Leader Harry Reid has already rebuffed legislation to reverse the initial Jan. 20 rule. Today, he said “I will oppose Republican efforts to move the goalposts on this issue, including their extreme legislation that would allow any employer to deny coverage for a range of critical health services for women based on vaguely defined personal objections. American women have a right to make their own health decisions, and Democrats will fight to protect that right.”

–Kaiser Health News

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26 Responses for “The Pill, the President, the Policy: a Primer”

  1. Doug Chozianin says:

    Obama (LD), the wannabe dictator, needs to be impeached.

    America wake up! These left-wing not-so-looney Democrats are trying to steal our freedom one “announcement” at a time. Don’t let them.

    Vote this November 6th.

  2. Katie Seamore says:

    Why not allow the women to decide if they want help with birth control instead of letting others decide it for them?

  3. Think first, act second says:

    This is just another reach of the government in trying to dictate to the citizenry, companies and others how to live our lives, that they know better than we do what is best for us. Why then if they are so interested in the health of the people do they also not dictate that insurance companies provide free blood pressure medicine, cholesterol, diabetes and acne medicine to us, it is definitely needed by a cross mixture of all races and genders. Come on people, the issue here is not the provision of drugs, it is the over reach of the government into our daily lives and in this case tramples on the constitutional separation of government and religion.

    • jespo says:

      You’re right…religious organizations should seperate themselves from discussions involving government regulation of state run business. And this is about birth control, a preventative medicine, not treatment medications.

  4. Yellowstone says:

    It’s an hypocrisy to think anyone would go to work for a religious organization that preaches non-contraception and at the same time take birth control; ie, medications, condoms!

    But on the other hand this is a country that guarantees every person freedom of choice; especially as it relates to their health. And now choices to gain healthcare. Unless that’s intended to be another hyprocricy: healthcare for only those that can afford it – to heck with you

    Why would any other person interfere with that choice?

    Why, too, would an insurance company reimburse male subscribers for Erectile Dysfunction for an often used recreational (and not re – creational) drug. It’s just another hypocrisy!

    Wake up folks – you’re being drawn away from the real focus: Let’s get everyone back to work now!

    Vote for those who have demonstrated and have an effective plan to put you back into gainful employment.

    • Katie Seamore says:

      There are Catholic hospitals where people of all faiths, and of no faith work. All the employees are not Catholics. Besides I know plenty of Catholic women who take the pill.

    • Layla says:

      Gainful employment working for the very government which is about to choke the life out of us????

    • Begonia says:

      Why would the federal government suddenly say women don’t need mammograms? That’s exactly what they are doing.

  5. w.ryan says:

    Why can’t a woman have a choice in what affects her most. Freedom of choice is what is at stake here, not religious freedom. If the Catholic church was to conduct themselves in a truly faith based manner they would have faith in the faith of their employees and not dictate and enslave them to the will of the Catholic Church. They may get some converts. As for religion in America…there was a time when church leaders stood up in this country and fought for the rights of the people black, white or whoever. Women are being attacked in the Guise of religious freedom. The GOP and the Church are allies. Once again it’s over money and power. Get back to fundamentals and lead a righteous fight. The above posts ( both the rich and the foolish) need to stop their hypocrisy.

  6. Prescient33 says:

    There was no accommodation to the churches’ objections to the mandate of the Obama Regime’s mandate requiring that all religious institutions, Catholic, Orthodox Jewish, Evangelical Christian, etc., provide insurance covering matters antithetical to their core beliefs. The coverages that still must be offered are required to cover birth control devices and the abortion pills, only through the smoke and mirrors of a leftist progressive reasoning are these alleged not to cost the institutions anything. We are to believe the insurance companies are going to provide them from the kindness of their hearts. The bulk of the resting insurance premiums will be borne by the institutions, not the employees. Not only that, but the new plan makes no provision for the many self insured institutions embraced by this dictatorial decree.
    Lost in the smoke created by regime sycophants in the media is the fact that Obama has no authority to decree insurance companies provide contraceptive and abortion services. His fiat has no basis in law, under the constitution, nothing but his inflated sense of power. It is raw ego on his part.

  7. frank burns says:

    These bishops are TOO hypocritical — to think that of all things the big thing weighing on their consciences is whether their women workers are using insurance for contraception. I just don’t believe it. They are just trying to make themselves look persnickety and good, but really coming off as silly.

  8. Liana G says:

    Unbelievable! The VERY SAME situation played out in the Philippines a few years ago between the gov’t and the Catholic Church, and their spineless gov’t did exactly the same. The results? A country now mired in poverty brought on by a surge in unsustainable population growth.

    Single mothers are the poorest demographics in this country next to Native Americans (this one really makes my blood boil, but I am not going there now, except to say that this is atrociously shameful). Why on earth are we enabling this cycle of poverty? The morally just and fiscally responsible thing to do here would be to stem population growth and reduce foreseeable long term debt by not incurring expenses for Medicaid, foster care, food stamps, WIC, education, welfare, prison construction, Medicare, etc.

    This is not about gov’t going too far. This is about the Church clamoring for relevance in an increasingly secular and civilized world. We are no longer reliant on the church to provide governance and dictate to us how to live our lives; we, the people, have established our own courts and gov’ts and enacted our own laws and ordinances to do this. Let our gov’t do what is sound! However, I am in favor of going back to the days of castration for men of the cloth, especially with the ever rampant church sex abuse scandals.

    • Layla says:

      Liana, you don’t think a government forcing its citizens to pay several hundred dollars a month for insurance premiums many cannot afford isn’t going too far?

      • Liana G says:

        Layla, where did you get this? The mandate called for employers/insurers to provide coverage for contraception free of charge. There is no forcing citizens to pay ” several hundred dollars a month for insurance premiums”. What we have going on now is that religous employers are even refusing to this. Why?

        …”On Feb. 10, Obama said religious employers could decline to cover contraceptives if they were morally opposed to them, but the health insurers that provide their health plans would be required to offer contraceptives free of charge to women who requested such coverage.”…

        http://www.catholicnews.com/data/stories/cns/1200643.htm

  9. jespo says:

    Health insurance is not a religiously afilliated business and should be unencumbered by dogmatism where human physiology is concerned. Religious organizations should adhere to the seperation of church and state and leave the welfare of the human body those more adept at its care, in this case, insurers; actually, in any case, the other guy. The hypocracy of the church is in full force again; protect the unborn so they may grow to be children to be abused; they are no one to demand that health care be kept from women. Furthermore, women seeking employment from these catholic organizations should question whether they wish to work for an employer that would withhold medication or medical treatments or terminate their employment for out of wedlock pregnancies or other life changes/choices incompatible with church doctrine. Let the positions be filled by those who believe medical care involves candle lighting and incense burning.

    • Begonia says:

      Health insurance should not be government related either, Jespo. This is about birth control, something that should be up to the individual.

      What next? The GOVERNMENT decides you are too expensive to maintain after 50, so they refuse to treat some of your ailments?

      Jespo, we are guaranteed religious freedom in this country. I can only say at this point that it’s too bad the government didn’t force many to stay in school much longer than they did.

  10. Outsider says:

    Seriously? The church should seperate itself from the government affairs? May e the go ernment should seperate ITSELF from the affairs of the church. This has nothing to do with the Catholic church; it has everything to do with this administration destroying the Constitution. For those of you saying the Catholic church should respect the “seperation of church and state,” that’s exactly what they’re trying to do. What will this p resident do next; require the Baptist church to pay for alcohol? It would be the same thing. It’s also another example of this president attempting to make more and more people dependent on go ernment for everything. If you can afford the six pack that made you so eager to unzip your pants, then pay for own damned condoms.

    • jespo says:

      It has everything to do with the church….and this President may not be all that people hoped for but he’s no George Bush who pee’d all over the constitution after ripping it up.The church has no standing, no say whatsoever in deciding what should or should not be covered expenses outside the domain of their churches…none. Who are they to impose their will on secular employees of a hospital or other institution? The church simply wants the baby mill going strong to keep new followers flowing and to heck with the consequences. This is not about dependence on government but protection from ideology that is detrimental to people’s health. There are enough unplanned pregnancies in this world, we don’t need more of them. Birth control is used by most women, 98% of catholic women who are at risk of pregnancy within normal child bearing age use it; married, single, young, and not so young for many reasons, not just sexual intercourse, and no one should deny a women the right to acquire it. Lastly, your last comment denotes an angry juvenile attitude towards sex…grow up…it can be fun you know without the beer.

  11. Outsider says:

    I HATE typing on nn iphone…..it makes you like like……shall we say, an “illiterate?”

  12. w.ryan says:

    Church and State? Right of the individual trumps religion!!!

  13. YAAS says:

    If the church wants exception to federal and state laws concerning anything that involves the rights of individuals then they should stop employing people and rely on volunteering! Then they wouldn’t have to worry about it at all!
    The constitution makes rights for INDIVIDUALS, NOT institutions!

  14. YAAS says:

    @Outsider – your argument is faulty. You would have been better off saying something like requiring the Jehovah’s Witness to take a blood transfusion. It is their perspective that it is morally reprehensible but the rest of the world sees no problem.
    Again, nobody is asking the nuns and purists to take the pill… just to allow their employees access to it as required by any other EMPLOYER. Because sometimes the pill helps women who aren’t even sexually active deal with pretty rough times each month. I know this because of women in my family. The hormone regulation can help.

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