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.