“Peacemaking On Contraception”: An Olive Branch To The Catholic Church On Contraception Coverage
America’s Big Religious War ended on Friday. Or at least it ought to.
A little more than a year ago, the Obama administration set off a bitter and unnecessary clash with the Roman Catholic Church over rules mandating broad contraception coverage under the Affordable Care Act. The Department of Health and Human Services’ announcement of new regulations is a clear statement that President Obama never wanted this fight.
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.
But more importantly, the final HHS rules are the product of a genuine and heartfelt struggle over the meaning of religious liberty in a pluralistic society. The contraception dispute was difficult because legitimate claims and interests were in conflict.
The vast majority of Americans believe that health insurance should cover contraception. At the same time, the Catholic Church has a theological objection to contraception, even if most Catholics (including regular churchgoers) disagree with its position. The church insisted that its vast array of charitable, educational and medical institutions should be exempt from the contraception requirement.
The church made a mistake in arguing its case on the grounds of “religious liberty.” By inflating their legitimate desire for accommodation into a liberty claim, the bishops implied that the freedom not to pay for birth control rose to the same level as, say, the freedom to worship or to preach the faith. This led to wild rhetorical excesses, including a comparison of Obama to Hitler and Stalin by one bishop and an analogy between the president’s approach and the Soviet constitution by another.
But the church had good reason to object to the narrowness of the original HHS definition of what constituted a religious organization entitled to exemptions from the contraception requirement. If an organization did not have “the inculcation of religious values” as its purpose and did not employ or serve primarily those who shared the faith, it got no exclusion at all.
The problem is that the vast charitable work done by religious organizations to help millions, regardless of their faith, is manifestly inspired by religion. The church could not abide the implicit reduction of its role merely to private expressions of faith. Don’t most Americans devoutly wish that religious people will be moved by their beliefs to works of charity and justice?
The HHS rules announced Friday scrapped this troubling definition in favor of long-established language in the Internal Revenue Code. In an interview, HHS Secretary Kathleen Sebelius showed a becoming humility, and it would be nice if this rubbed off on her critics. However defensible the original rules might have been, she said, “they really caused more anxiety and conflict than was appropriate.”
“What we’ve learned,” she said, “is that there are issues to balance in this area. There were issues of religious freedom on two sides of the ledger” — the freedom of the religious institutions and the freedom of their employees who might not share their objections to contraception.
This is where the other accommodation kicked in: Many Catholic institutions self-insure. While the administration rightly wants broad contraception coverage to include hospital workers, teachers and others at religious institutions, it also seeks to keep religious organizations from having “to contract, arrange, pay or refer” for coverage “to which they object on religious grounds.”
Under the new rules, employees who want it will be able to get stand-alone coverage from a third party. Some of the costs will be covered by small offsets in the fees insurers will have to pay to participate in the new exchanges where their policies will be on sale. It’s an elegant fix.
There are two reasons for hope here, particularly for Catholic progressives. First, the administration recognized the problem it had created and resolved it. Vice President Biden played a key role here, keeping lines of communication with the church open.
Second, many bishops have come to realize that the appearance of a state of war with Obama not only troubled many of the faithful — Obama, after all, narrowly carried the Catholic vote — but also threatened to cast a church with strong commitments to immigrants, social justice and nonviolence as a partisan, even right-wing organization.
This war has been bad for everyone involved. Obama has moved to end it. Here’s a prayer that the bishops will also be instruments of peace.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, February 3, 2013
“You Can’t Fix Stupid”: Birth Control Is Different Than Starbucks
The controversy over contraception has faded a bit. Congressional Republicans are rethinking efforts to overturn a requirement that would make birth control coverage a mandatory part of health insurance. Rush Limbaugh has stopped talking about the issue, at least for the moment.
But the issue hasn’t gone away entirely. The administration is still working on ways to accommodate the wishes of some large religious institutions opposed, for reasons of faith, to sponsoring employee benefits that cover contraception. (On Friday, it unveiled a few options and announced it was seeking public comment on them.) Conservatives, meanwhile, continue to press their case.
With that in mind, let’s talk about a conservative argument that isn’t simply about religion or the morality of birth control. It’s the suggestion that birth control coverage simply doesn’t belong in health insurance, because it’s not an expense that all of us should be subsidizing.
Among those making that argument recently was syndicated columnist Mona Charen. After arguing that contraception costs “less than the cost of a weekly trip to Starbucks” and that a variety of programs, public and private, make free contraception available to the poor, Charen draws a distinction between birth control and other types of drugs:
Contraceptives are not a matter of life and death. But even if they were, such as cancer drugs are, is that an argument for forcing insurance companies to provide them free? Why not force free distribution of all medicines? The mandate makes no economic, social or moral sense.
Actually, it makes economic, social and moral sense.
Let’s put aside the question of whether contraception coverage should be “free,” because that’s not really the issue anymore. Republican Senators Roy Blunt and Marco Rubio, along with the Conference of Catholic Bishops, have said they oppose any requirement that forces employers to cover contraception, regardless of whether such coverage requires out-of-pocket expenses.
And, one more time, let’s dispense with this notion that every woman can get birth control for less than the weekly cost of Starbucks. As noted here previously, the cheap drugs at Target, Walmart, and the other big chains are great if you take the standard combination hormonal pills, which combine estrogen and progestin. But some people cannot or should not take those pills. They’re not good for postpartum women who are breast-feeding, for example, and they cause side effects for many others. They may not be as effective, for some women, as methods like intrauterine devices, depo-provera, or surgical sterilization.
How many women fall into those categories? It’s a minority of the population, to be sure. But that’s always the story with health care and health insurance. At any one time, most people don’t require expensive medical care. Only a small number of people do. It’s precisely for the sake of that group – the ones who face high expenses, and could face financial or medical turmoil without assistance – that insurance exists.
Keep in mind that, at some point or another, pretty much everybody falls into that category. Maybe you’re not a woman who needs expensive birth control. You might still be a woman, or a man, who ends up with heart disease. Or allergies. Or a chronic gastro-intestinal problem. Or cancer. Insurance is there to take care of you, so why shouldn’t insurance be there to take care of a woman who needs more expensive forms of contraception?
No, birth control isn’t treatment for an acute condition. It’s routine, preventative care. But that hardly undermines the case for coverage. Think about eye exams for a moment. Or blood pressure checks. Both of these are widely available, for very low cost. In fact, if you do the math, over the course of a year either one would cost less than a year’s supply of even generic hormonal contraception. But insurance typically covers those costs and, under the Affordable Care Act, insurance must cover those costs – because this sort of care keeps people from getting serious medical conditions and, quite possibly, saves money in the long run.
The very same things are true of birth control. Pregnancy is a wonderful thing, but it’s also a serious medical condition that requires serious medical attention. (Those of you unfamiliar with what pregnancy entails might want to consult this page from the American Academy of Family Physicians – or ask a woman who has been pregnant.) Don’t forget, too, that some women take contraception to control their menstrual cycles or for reasons that aren’t really related to avoiding pregnancy.
Some critics insist there’s a difference between screening for hypertension or vision problems, on the one hand, and controlling the timing of pregnancy, on the other. Non-procreative sex, they say, is a purely voluntary act, for which others should not have to pay. “No one is touching your birth control, ladies,” conservative writer Amanda Carpenter tweeted on Friday. “We just don’t want to be forced to pay for it.” But, according to statistics from the Guttmacher Institute, 99 percent of women use birth control at times during their reproductive years. Based on that, I think it’s safe to assume that non-procreative sex is an activity in which virtually everybody engages, at some point or another, and for which a large majority will need birth control.
And so we’re back to the question that’s always been at the very heart of our health insurance debate: Do we think responsibility for medical expenses should lie primarily with individuals, even if that means some won’t be able to afford it? Or is it a burden we wish to spread more broadly, across society, so that everybody can get the care they need, at a price they can afford?
You know where I stand on that question.
P.S. When the administration announced its options for accommodating religious institutions on Friday, it also released a rule about health plans for college students – and, in so doing, revealed that, for legal reasons, it does not have the authority to regulate all the plans. Sarah Kliff has the story. It doesn’t sound like a huge deal, but, as she notes, it’s yet another reminder of how complex insurance regulation is in the U.S.
By: Jonathan Cohn, The New Republic, March 16, 2012
Arizona’s “20th Century Boss” In 2012: Using Birth Control? You’re Fired!
First, a bill that gives immunity to doctors who lie to couples about the results of their prenatal tests in order to prevent them from getting an abortion. Now, a bill that would give your boss the green light to fire you for using birth control. You think I am kidding? I wish. For a decade now, Arizona insurance companies have been required to provide coverage for contraception just like other prescriptions. But, because they saw an opening to score some political points, some politicians there are suddenly moving to take that coverage away from women and their families.
And we aren’t talking here just about exemptions for religiously affiliated employers like Catholic hospitals and universities. We are talking about authorizing secular, for-profit employers to deny a woman coverage for birth control if the employer doesn’t believe that she and her partner should be allowed to have sex without getting pregnant. Yup, that’s right. If the owner of the Taco Bell where you work opposes birth control, Arizona legislators want to give him a legal right to deny you insurance coverage for your pills.
Sadly, that isn’t even the half of it. You may want to sit down for this one. Arizona legislators know that whether or not her insurance covers it, a woman may get the prescription she needs to prevent an unintended pregnancy. They want to give her boss the right to control that too. The bill they are pushing would not only allow employers to take the insurance coverage away, but it would also make it easier for an employer who finds out that his employee uses birth control to fire her. You heard me right . . . to fire her. And I thought Rush Limbaugh’s comments were as low as you could go on this one.
The Arizona bill has, incredibly, already passed one house, but we can still stop it. We’ve seen what can happen if we make our voices heard. So, if you’ve had enough; if you think the decision about whether to have a child is one for you and your partner, not your boss and your senator, I urge you to speak up now. Tell the legislators in Arizona to stop playing politics with women’s health and put personal and private decisions back in the hands of a woman and her family.
By: Jennifer Dalven, Reproductive Freedom Project, ACLU Blog, March 12, 2012
Celebrating Women’s History Month: The Republican’s “Vagina Monologue”
When will Republicans stop their vagina monologue?
March is federally recognized as Women’s History Month, and Republicans have been celebrating the occasion in a most unusual style: with a burst of interest in women’s private parts.
On Thursday, the Senate took up an amendment proposed by Sen. Roy Blunt (R-Mo.) that would allow employers to deny women birth-control coverage if the employer found contraception morally objectionable.
About 100 miles south of Washington on that same day, Virginia legislators passed a measure requiring a woman to be offered an ultrasound image of her fetus before aborting it. The legislation, which opponents say could also require some women who have miscarriages to be offered ultrasonic images of their dead fetuses, is the successor of a bill that would have required women to undergo an invasive “transvaginal ultrasound.”
Still on Thursday, the industrious Virginia House of Delegates also approved legislation bestowing rights on people, including a father, to bring a lawsuit over the death of the fetus.
On Wednesday, conservative radio host Rush Limbaugh, a powerful influence among Republican lawmakers, described as a “slut” the law-school student invited by House Democrats to testify in support of birth control. “It makes her a prostitute,” Limbaugh said of the woman, blocked last month by House Republicans from testifying on what became an all-male panel. “She wants to be paid to have sex.”
On Tuesday, Oklahomans held a protest at the state capitol to oppose a bill, passed by the state Senate and now being taken up by the House, that would bestow “personhood” on fetuses — one of many such efforts across the nation. Democrat Judy McIntyre, one of just four women in the 48-member state Senate, was so upset that, according to the Oklahoman newspaper, she held a protest sign proclaiming: “If I wanted the government in my womb, I’d [expletive] a senator.”
Democrats think they have a political winner in the Republicans’ fascination with reproduction at a time when economic production is what voters have in mind. The party is raising money with a petition against the “Republican War on Women,” and 11 Democratic women running for the U.S. Senate are using the occasion to launch a fundraising tour.
They are attempting to tie together everything from last year’s effort to defund Planned Parenthood to the proposed repeal of Obamacare (which expanded coverage of mammography and birth control). And Obama campaign strategists tell me they are confident that the two leading Republican presidential candidates, a Mormon and a devout Catholic, will have difficulty beating the rap that the party is obsessed with reproduction.
Evidence that the Republicans realize they’re in a pickle: Mitt Romney spontaneously flip-flopped on his initial opposition to the Blunt amendment, which would also provide employers with a moral opt-out from other elements of Obamacare. Romney first said that “questions about contraception within a relationship between a man and a woman, husband and wife, I’m not going there.” But he quickly reversed himself in favor of the amendment, aligning himself with Rick Santorum, who has voiced doubts about the constitutional protections for birth control.
More evidence: After championing the Blunt amendment, Republican leaders backed away from their demands for a vote on the provision. And Sen. Marco Rubio (R-Fla.), an early proponent of the amendment after hearing about the issue during a Catholic Mass, disappeared from the debate. So Majority Leader Harry M. Reid (D-Nev.) wound up forcing a vote on the provision, which was narrowly defeated Thursday afternoon.
“Today, the Senate will vote on an extreme, ideological amendment to the bipartisan transportation bill,” Reid said, kicking off Thursday’s debate. “This amendment takes aim at women’s access to health care.”
The Republican Senate leader, Mitch McConnell (Ky.), made no mention of birth control in his reply, countering that “it is not within the power of the federal government to tell anybody what to believe, or to punish them for practicing those beliefs.”
Most other Republicans followed McConnell’s lead in avoiding mention of contraception. Sen. Orrin G. Hatch (Utah), however, said the provision in the health-care law requiring preventive medical coverage for women is “questionable policy,” and he accused the administration of “deferring to its feminist allies” by mandating contraceptive coverage.
After the amendment went down to defeat, its sponsor gave a General MacArthur. “I’m confident this issue is not over,” Blunt said. “It won’t be over until the administration figures out how to accommodate people’s religious views as it relates to these new mandates.”
The monologue will continue.
Mitt Romney Says He Opposes “Blunt-Rubio Contraception Bill”, But His Campaign Says Otherwise
Republican presidential candidate Mitt Romney told a reporter Wednesday that he opposes a measure being considered by the Senate that would allow employers to decline to provide contraception coverage to women.
“I’m not for the bill,” Romney said during an interview with Ohio News Network reporter Jim Heath. “But, look, the idea of presidential candidates getting into questions about contraception within a relationship between a man and a woman, husband and wife, I’m not going there.”
However, Romney’s campaign quickly denied that the governor opposes the so-called Blunt bill, charging that the question Heath asked was confusing.
“Gov. Romney supports the Blunt bill because he believes in a conscience exemption in health care for religious institutions and people of faith,” Romney spokeswoman Andrea Saul said in a prepared statement.
The differing accounts came on the eve of a planned Senate vote on the Blunt amendment, which has prompted contentious debate both on and off Capitol Hill.
The amendment is intended to overturn Obama administration regulations that would require most health insurance plans to provide FDA-approved contraceptives and sterilization services with no additional copayment or deductible.
But critics argue that the amendment is so broadly written — allowing opt-outs for those with “religious or moral objections” — that it would let employers decline to provide virtually any health benefit for virtually any reason.
Heath, reached by phone at Ohio News Network offices in Columbus, said his question to Romney was clearly asked and was specifically about the Blunt amendment.
“I explained the bill as allowing employers to deny female contraception coverage,” Heath said, characterizing the governor’s statement of opposition as “exactly what he said.”
“What I immediately thought, in all honesty,” Heath said, “was that he was pivoting toward the middle, toward women voters” who may have been put off by Romney rival Rick Santorum’s anti-contraception views.
“I wasn’t expecting a definitive answer,” Heath said. “But having been covering this campaign for months now, I thought he must be looking at Ohio and beyond, and how Santorum has been raked over the coals on this issue.”
“It was a very definitive response, combined with a slap at Santorum,” Heath said. “I was surprised he went there.”
Here’s a transcript of the part of the interview that’s in dispute:
HEATH: “He’s brought contraception into this campaign. The issue of birth control, contraception, Blunt-Rubio is being debated, I believe, later this week. It deals with banning or allowing employers to ban providing female contraception. Have you taken a position on it? [Santorum] said he was for that, we’ll talk about personhood in a second; but he’s for that, have you taken a position?”
ROMNEY: “I’m not for the bill, but look, the idea of presidential candidates getting into questions about contraception within a relationship between a man and a women, husband and wife, I’m not going there.”
HEATH: “Surprised that he went there?”
ROMNEY: “You know, I made it very clear when I was being interviewed by George Stephanopoulos in a debate a while ago: Contraception is working just fine, let’s just leave it alone.”
HEATH: “And the Personhood Amendment could potentially be on the ballot in Ohio this fall. What’s your position on this effort, personhood?”
ROMNEY: “Well it’s interpreted differently by different states, so I’d have to look at the particular provision. We had a provision in my state that said that life began at conception, that’s a provision that I protected. The legislature passed a bill saying that no longer would life be determined to begin at conception, I vetoed that. So we can have a provision that describes life beginning when it in fact begins. At the same time, allowing people to have contraceptives.”
Update at 7:45 p.m. ET: The Romney campaign released audio and transcript in which it directly addressed the earlier comments. Romney made the comments on the Howie Carr Show on Wednesday.
Here’s the transcript:
CARR: Listen I got to ask you here about there’s a — the Washington Post has got a blog out here, saying that Jim Heath, a reporter for a TV station in Ohio just tweeted a remarkable piece of news: Mitt Romney told him he does not support the Blunt amendment which would empower employers and insurers to deny health coverage they find morally objectionable. What happened here, did you –
ROMNEY: I didn’t understand his question, of course I support the Blunt amendment. I thought he was talking about some state law that prevented people from getting contraception so I was simply — misunderstood the question and of course I support the Blunt amendment.
CARR: Okay so that should be taken off the table.
ROMNEY: Yeah.
CARR: That’s running around the world in ten seconds as you know that’s how these things go.
ROMNEY: Yeah exactly right. No, I simply misunderstood what he was talking about. I thought it was some Ohio legislation that — where employers were prevented from providing contraceptives, and so I talked about contraceptives and so forth, so I really misunderstood the question. Of course Roy Blunt who is my liaison to the Senate is someone I support and of course I support that amendment. I clearly want to have religious exemption from Obamacare.
CARR: And Rubio is one of your potential vice-presidential candidates is also — his name is also attached to the bill and Scott Brown here in Massachusetts is supporting it as well.
ROMNEY: Yeah exactly, I think every republican is supporting it, and I actually understand that, I may be wrong on this, but my recollection is that Ted Kennedy even wrote a note to the Pope about religious exemptions from matters of this nature for purposes of conscience. So this is something I really think all Americans ought to be able to get around this religious exemption.
CARR: Yeah well you haven’t been around here lately but that’s been a big controversy here with patches Kennedy saying that you know – telling Scott Brown well you can’t use my father’s letter to the Pope cause he was just sending a letter to the Pope he didn’t really believe anything he said in the letter. I mean that’s what it boiled down to.
ROMNEY: I must admit I hope that when you send a letter to the Pope you believe what you wrote in it.
By: Liz Halloran, NPR News, February 29, 2012
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