By Noam N. Levey
3:53 PM EDT, June 28, 2013
WASHINGTON -- The Obama administration made a final attempt Friday to quell the controversy over a requirement in the president’s healthcare law that insurance plans offer contraceptive coverage to women, issuing regulations that exempt churches and religiously affiliated organizations from paying for the benefits.
The final rule issued Friday largely hews to a proposal the Department of Health and Human Services unveiled in February. But administration officials said they hoped small changes in the regulations would satisfy critics. Those changes are designed to simplify the process of ensuring that nonprofit religiously affiliated employers do not have to pay for contraceptives while their female employees have access to them.
“There is a much brighter line, a simpler line,” said Mike Hash, who heads the Office of Health Reform at the health department.
The final rule appears unlikely to quiet critics, however. The framework in the regulation has drawn strong criticism from Catholic bishops, Republican lawmakers and private companies with devoutly religious owners, several of whom are suing to block the requirement.
“Unfortunately, the final rule announced today is the same old, same old,” said Eric Rassbach, deputy general counsel for the Becket Fund for Religious Liberty, which represents several plaintiffs suing to overturn the contraceptive mandate. “As we said when the proposed rule was issued, this doesn’t solve the religious conscience problem because it still makes our nonprofit clients the gatekeepers to abortion and provides no protection to religious businesses.”
For-profit businesses with more than 50 employees will be required to provide health coverage that includes contraceptive benefits, even if the employer has moral objections to such benefits.
The Obama administration's efforts to accommodate religious objections to contraception has been one of the most delicate tasks of implementing the Affordable Care Act. The law requires health plans to cover many preventive services without any cost-sharing for patients, such as cancer screenings and physicals. Also included are FDA-approved contraceptives for women, including emergency contraceptive pills.
That has generated controversy almost from the moment the president signed the legislation in 2010. The administration proposed a solution in 2011, but church leaders said it was too restrictive. It exempted religious organizations only if they met several tests, including a requirement that they primarily serve people who share their faith. That could have posed a problem for churches that run schools or operate soup kitchens.
Under the final regulations, a house of worship is exempt from the contraceptive mandate, as long as it qualifies as a tax-exempt religious employer.
The administration took a different approach to try to address concerns from hospitals, charities and universities that have religious affiliations but primarily provide nonreligious services to people of many faiths. Many of these employers object on moral grounds to providing contraceptive coverage.
The administration designed a complex system to insulate these employers from having to pay for the contraceptive coverage or even arrange for it.
Employers that object to contraception will notify the insurance companies that provide their coverage. The insurer will then have to offer the employees a separate contraceptive benefit at no cost to the employees.
The process will be even more complicated for self-insured religiously affiliated employers that provide health benefits themselves and rely on insurers only to administer their health benefits. In these cases, the insurance companies will also have to provide a separate contraceptive benefit. But the companies will be able to recover some of these costs from the federal government.
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