The National Catholic Review

Reactions from other sources continue as we wait to hear from the U.S. bishops, the Catholic Health Association and Catholic Charities USA on the latest revision of the Department of Health and Human Services mandate on contraception. One of the more exhaustive considerations of the various political/cultural ebbs and eddies swirling around the mandate can be found at National Catholic Reporter where Michael Sean Winters picked apart many of the issues raised by the revision of the revision and the likely response of the bishops, including whom they should be listening to—everybody—and why.

E.J. Dionne expressed his satisfaction with the latest “olive branch to the bishops” at the Washington Post. Though they were right to resist the attempt by government to define religious identity, the bishops were wrong on the nature of the conflict—improperly elevating it to a dispute over religious liberty, Dionne argued, and prone to excessive rhetoric on the matter. He wrote: “The decision, the administration’s second attempt at compromise, ought to be taken by the nation’s Catholic bishops as the victory it is. Many of the country’s most prominent prelates are inclined to do just that — even if the most conservative bishops seem to want to keep the battle raging.

We’ve already published Archbishop Chaput’s less enthusiastic take on the latest proposal. Yesterday he said that the H.H.S. mandate “remains unnecessary, coercive and gravely flawed” and urged episcopal fortitude against compromise in “the weeks ahead,” suggesting a decision from the bishops may not come anytime soon. At U.S. World News and World Report, Carl Esbeck, professor at the University of Missouri Law School weighed in: "How many more organizations will be able to fit under the definition of religious employer now that it's broadened remains to be seen, but from a constitutional standpoint, that's good," he said. "The bad is nothing's changed. What these religious organizations object to … is that their securing of a health insurance plan and the payment of the premiums is what triggers, ultimately, the contraception coverage.

“It looks like they changed something, but [they] didn't," he said, arguing that none of the lawsuits filed against the administration are likely to “go away" because of this latest effort to calm the seas on contraception.

While H.H.S. has dropped the problematic limitations on its definition of an exemption-eligible religious entity, one of the main complaints of the bishops regarding the mandate initially, it is the clear intention of the Obama administration to find some way to realize the recommendations of the Institute of Medicine that contraception services be provided as part of women’s preventative care without out-of-pocket expenses. To keep objecting employers out of that loop, H.H.S. has now agreed that such entities may self-certify as objecting religious employers, guided by long-standing I.R.S. regulations, but that they notify their insurers or, in the case of self-insured entities, their third party administrators, of their intention to seek exemption from the contraception mandate. It will then be up to the insurer or administrator to arrange a separate, cost-free policy on contraception with individuals who seek out those services.

The moral onus for connecting those individuals, whether a student at a Catholic university or an employee of a Catholic social services agency, with contraception services, following the administration’s logic, is thus lifted from the employers and deposited with the insurance companies and third party administrators themselves. Though this may not be enough to satisfy all or even most religious employers, someone at the White House is apparently doing their homework on remote material cooperation.

With so much riding on the backs of insurers, morally and practically, I wonder why we have heard so little from them about the complex plans being made at H.H.S. on contraception. The administration’s argument is that providing contraception, by reducing the number of unplanned pregnancies, is actually a cost-benefit to insurers—pregnancies and births being so much more costly than contraception—so they can assume the responsibility of the extra services without passing on additional, morally tainted fees to employer-clients. In the case of third party administrators for self-insured employers, H.H.S. plans to offer “payment” in the form of reductions in the user fees that will be established to participate in the forthcoming Affordable Care Act insurance exchanges. U.S. taxpayers as a whole then may “pay for” the contraception in a backhanded manner by way of lost revenue, not too different from the way taxpayers and health insurance plan members already “pay” for acts and services that individuals among them may find morally objectionable.

At Mother Jones, Kevin Drumm took a shot at trying to figure out if providing contraception services really offered savings to insurers as did Factcheck.org. Their conclusion? It’s hard to say. The Obama administration is more certain and produced a fact sheet supporting its cost/benefit analysis last year.

Now insurers don’t generally have any moral qualms about contraception, but they have been known to care deeply about the bottom line. And they may not be speaking out on the H.H.S. proposals for a couple of reasons: they may be as confused by them as the rest of us and are awaiting further clarification and they probably don’t want to ruffle feathers at the H.H.S. when it will be the ultimate authority on state insurance marketplaces. But when asked to comment anonymously on the assumptions inherent in the H.H.S. plan, last year they were a little more forthcoming.

In a survey conducted by Reimbursement Intelligence, an industry consulting firm, none of the 15 companies surveyed said they expected the contraception mandate to result in costs savings. Forty percent of the companies, in fact, expected costs to increase through higher pharmacy expenditures (though just under ten percent said that while pharmaceutical costs would increase, medical costs would go down). Another 20 percent said they thought assuming the responsibility for contraception care would be cost neutral. More than 30 percent couldn’t say one way or the other. Factcheck.org quoted Mickey Herbert, a former CEO of the insurance company Connecticare. Speaking in February 2012 when the notion that insurers would assume the costs was first proposed, he said this is “not the way insurers operate…. If we know contraceptives cost $600 a year, that $600 by all rights needs to be built into the premiums. I take offense at the president or anyone else who says [contraceptive services] are free.”

“We’re talking nickels and dimes here,” insurance consultant Robert Laszewski of Health Policy and Strategy Associates told Kaiser Health News. “The Obama administration is correctly assuming that the cost is going to be a rounding error." But it is a trivial expense that will be passed on by insurers to consumers, he added, suggesting that the latest proposal remains unlikely to satisfy religious employers for whom the conflict was never about cost.

Comments

Vince Killoran | 2/9/2013 - 6:21pm

Correction: "has--and never had" should read "has never had"!

Vince Killoran | 2/9/2013 - 5:13pm

Your blanket understanding of "religious liberty" has--and never had-- a place in civil society. Your insistence that our public tax dollars go to those who discriminate is baffling. Would you draw a line at racial and gender discrimination? The argument the USCCB and their allies make is thin cover for conservative politics.

You quote Thomas More but better to quote John Locke, the architect of classical liberalism, who argued that, when faced with a conflict of private religious demands and the requirements of civil society one ought to disobey the law and take their punishment in order to preserve civic realm.

Tim O'Leary | 2/9/2013 - 9:18pm

"no place in civil society" - you have a totalitarian streak in you - and you are far removed from US jurisprudence on the understanding of the first amendment. Your second sentence shows you have confused the issue. It is not about taking tax dollars at all. It is about being forced to pay for someone else's private insurance.

Vince Killoran | 2/9/2013 - 10:34pm

Tim, really!? Resorting to name calling? You can do better than that.

I haven't confused a thing. The tax dollars reference was to giving groups that discriminate public monies; religious groups have never had carte blanche at any time in American history.

We could do away with all of these debates is we had a single-payer, Canadian style health care system. Do you think health care is a human right and should not be for-subject?

Vince Killoran | 2/9/2013 - 11:09am

The government isn't coercing you into taking contraception Tim. But, seriously, we've been over this ground many times--once you accept the Taco Bell Catholic employer argument then many, many employers can handpick what their employers can't have in their insurance. Christian Scientists can nix blood transfusions, Scientologists can delete mental health coverage, etc. It seems like this is really more about your opposition to the idea of health care as a human right.

Oh, and the whining about adoption & gay couples: if you receive government funds to facilitate adoptions then you need to follow local, state, & federal anti-discrimination laws. Southern segregationists resisted this in the mid-twentieth century.

Tim O'Leary | 2/9/2013 - 11:41am

Vince. For the sake of religious liberty for all, I would let those refuse to pay for blood transfusions if it was against their faith. Anyone who wanted to work for them would just have to be informed of their beliefs and decide if they wanted to take a job without that insurance. It is not as if they would be prevented from getting blood transfusion, just as there is no obstacle today from anyone getting contraception or abortion. All this would be solved if the employer was taken out of the insurance business, which would be my preference. But, we are stuck with the religiously compromising ObamaCare.
You think contraception or gay marriage is a good so you want to force Christians to comply. But all government oppression or coercion starts with baby steps, to draw in allies and weaken a principle, before making the infringement more obvious. To paraphrase again from Thomas More: "Why Vince, it profits a man nothing to give his soul for free healthcare... but for contraception?"

Tim O'Leary | 2/7/2013 - 11:53pm

Ed. The first point I was making that you missed is that once the government wins the right to coerce a service/procedure against the religious understanding of an institution/individual, it can expand that coercion to the next phase of "healthcare." the Institute of Medicine is totally under the sway of its NARAL and PP members and abortion will be the next fight. My second point was that evil in power soon demands that the good succumb to its definitions, such as is happening in the UK, where adoption agencies and marriage counselors have been fired (approved by the Hague court ruling last month) for refusing to accept gay couples. While you are a fan of gay marriage, there is very little to stop the government, by the same principle, from moving to firing doctors and nurses for refusing to counsel abortion.

John Hayes | 2/7/2013 - 10:37am

"Reactions from other sources continue as we wait to hear from the U.S. bishops, the Catholic Health Association and Catholic Charities USA on the latest revision of the Department of Health and Human Services mandate on contraception."

They have until April 8, 2013 to submit their written comments to HHS. One strategy would be to say nothng before that time.

John Hayes | 2/6/2013 - 12:16pm

It seems to me to be a mistake for us or the USCCB to get involved in the discussion of the deal between the government and the insurance companies. If the current ideas don't work out, the government has many options on how to get free contraceptives to people.

As I understand it, the proposed HHS regulations will provide:

1. “Religious Employers” do not have to include contraception coverage in their health insurance plans

2. “Non-Profit Religious Organizations” do not have to include contraception coverage in their health insurance plans.

3. The government will arrange for insured employees and students of (2) but not (1) to receive free contraceptives, if they want them. This will not require any action or payment by the employers.

As long as the regulations include (1) and (2), it seem to me that we have all that we or the USCCB need. How the government makes (3) happen is their problem as long as it doesn't involve employers.

Marie Rehbein | 2/6/2013 - 12:08pm

It makes very little sense to continue with this custom of having employers buying health insurance for their employees. Why does the Catholic Church and its subsidiaries not simply give its employees the money to buy their own insurance?

Tim O'Leary | 2/6/2013 - 4:39pm

I agree that conscripting the employer to pay for health insurance is the crux of this religious freedom problem. Contraception is mostly cheap. The government could have set up a voucher system. That is unless the purpose includes the desire to coerce the Catholics or push them out of the healthcare business. Contraception now, then abortion later, then euthanasia... Thomas More was not beheaded because he openly obstructed the goverment of his time. He was beheaded because he wouldn't endorse Henry's decision. Sometime evil is not satisfied to have its way. It demands approval for its actions.

ed gleason | 2/6/2013 - 5:48pm

Tim, you mention abortion later, euthanasia, beheading and evil... you left out the black helicopters part..

Grant Gallicho | 2/5/2013 - 5:29pm

The Reimbursement Intelligence survey, while widely cited by groups opposing the contraception-coverage mandate, hardly seems dispositive. Only fifteen people were surveyed, and the whole thing was conducted online. As you note, Kevin, half of them are not convinced that the mandate will increase costs to insurers. What's more, a pharmaceutical director is not responsible for her or his employer's bottom line. Actuaries study the costs of an entire health-care policy, not just the prescription-drug benefit. Every study I've seen confirms the common-sense observation that covering people who want babies ends up costing more than covering those who don't.

In 1999, Congress required Federal Employees Health Benefits plans to cover contraception. At the time, the pricing had already been agreed upon, so insurers were granted a reconciliation process for those who found the mandate too expensive in light of the previously set premium pricing. Yet no one wanted a price adjustment because they didn't see any cost increases--and this was for the largest employee health plan in the country.

Much more here: http://aspe.hhs.gov/health/reports/2012/contraceptives/ib.shtml#_ftn12