CHA Weighs in On New Women's Health Regs

The Catholic Health Association has joined the discussion regarding new guidelines issued by the Department of Health and Human Services that require, among other uncontroversial preventive service additions, new health care plans after August 2012 to include FDA-approved contraception methods and contraceptive counseling for women without co-pays. The C.H.A.’s response is more measured than yesterday’s consternation-enriched reaction from the U.S. bishops, describing itself as “both pleased and concerned by the … recent actions on preventive services for women.”

The statement reads: “We are delighted that health insurance coverage must include critical screening services without any cost-sharing. What to some may seem like small amounts as co-pays for mammograms, pap smears, etc., has proven to be an effective barrier to care for women who have low incomes…. Our hope is that eliminating this barrier will result in earlier diagnosis at a treatable stage of many diseases such as cancer and diabetes.”

But like the U.S.C.C.B, the C.H.A. pronounces itself “very concerned about the inadequacy of the conscience protections with respect to the coverage of contraception. As it stands, the language is not broad enough to protect our Catholic health providers. Catholic hospitals are a significant part of this nation's health care, especially in the care of the most vulnerable. It is critical that we be allowed to serve our nation without compromising our conscience.”

There is cause for concern. According to the guidelines: “Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.” Fair enough so far, but then: “A religious employer is one that: (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets …. ”

Sister Mary Ann Walsh, the U.S.C.C.B.’s director of media relations, went to town on the narrowness of these terms: “Health and Human Services must think Catholics and other religious groups are fools,” she wrote. “That’s all you can think when you read HHS’s recent announcement that it may exempt the church from having to pay for contraceptive services, counseling to use them and sterilizations under the new health reform in certain circumstances. As planned now, HHS would limit the right of the church not to pay for such services in limited instances, such as when the employees involved are teaching religion and in cases where the people served are primarily Catholic.

“HHS’s reg conveniently ignores the underlying principle of Catholic charitable actions: we help people because we are Catholic, not because our clients are. There’s no need to show your baptismal certificate in the hospital emergency room, the parish food pantry, or the diocesan drug rehab program. Or any place else the church offers help, either.”

Walsh complains, “The exemption is limited, to say the least. The pastor in the Catholic parish doesn’t have to buy the Pill for his employees, but the religious order that runs a Catholic hospital has to foot the bill for surgical sterilizations. And diocesan Catholic Charities agencies have to use money that would be better spent on feeding the poor to underwrite services that violate church teachings.

According to H.H.S. documents, the department relied on model policies in 28 states and I.R.S. definitions of religious organizations in crafting its “interim” language. It has opened a 60-day public comment period on the new guidelines and has specifically invited comment on the definitions it is using in its religious exemption. That would appear to suggest that it is open to rewording the document in a manner more agreeable to Catholic and other pro-life religious entities.

The C.H.A. statement notes that opportunity and reports that it is planning a formal response. The C.H.A. and the bishops seem to agree that the language as it now stands is insufficient and may force Catholic health, education and other institutions to either offer employees health plans that include contraception or cease operations to avoid such a conscience clash.

In addition to formally commenting on this aspect of the exemption language, the C.H.A. statement suggests it may challenge the administration for including morning after “emergency contraceptive” drugs as part of contraceptive services that health plans must offer.

“We appreciate that the Administration does not intend to include abortifacient drugs as covered contraception,” the C.H.A. says. “Our comments will address our concerns about the mechanism of action of certain FDA-approved contraceptive drugs,” presumably Plan B and ella.

How receptive H.H.S. director Kathy Sebelius and by extension the Obama administration is to the revisions on the religious exemption language suggested by the C.H.A., the U.S. bishops and other Catholic, Christian and pro-life organizations will likely be viewed as a test of the sincerity of administration’s commitment to keep federal funding for abortion out of the health care reform. At some personal cost, C.H.A. President and C.E.O. Sister Carol Keehan played a pivotal role in the concluding, sometimes rancorous debate before the passage of the Obama administration’s health reform package in March 2010. It would be a significant betrayal of Keehan’s effort if the next two months do not produce revisions of the guidelines more amenable to Catholic sensibilities.

At the same time, the Obama administration is already being criticized from some quarters for making any room at all for a religious exemption on contraceptives. It is likely that it will hear more of that argument during the comment period even as Catholic voices weigh in for broader conscience exemptions. That puts it in something of a no-win situation already. If it commits to rewriting the exemption language to the satisfaction of Catholic leaders, it can anticipate a scorching from Planned Parenthood and women’s organizations. And since it is unlikely to reverse the F.D.A. classification of Plan B and “ella” as contraceptives, pro-life groups will remain skeptical of the administration’s intentions on health care reform going forward. If past performance is a reliable predictive, the administration will probably seek a course somewhere in between in a compromise that will probably leave all parties dissatisfied.