On Friday, Secretary of Health and Human Services Kathleen
Sebelius finalized the requirement that employers offer a full range of
preventative care, including contraception, without deductibles or copays. The
announcement caps a long battle among religious groups, women’s rights
organizations, and medical experts over the role of contraception and the reach
of government within religious-based organizations.
The debate began in 2009 during the chaos over the
Affordable Care Act. After the Stupak-Pitts amendment struck abortion funding
from the massive reform bill, the administration punted the issue of
contraception down the road, successfully avoiding another political battle
that may have imperiled the bill. Last August, the HHS followed a
recommendation from the Institute of Medicine and called for universal
contraception availability. (Find a good timeline, go here.)
Since then, numerous religious organizations have been
lobbying fiercely for a religious exemption, arguing that faith-based
institutions should not be required to pay for care that violates their
beliefs.
Smart money had it that Obama and Sebelius would eventually
relent. Friday’s announcement, then, was something of a surprise. The HHS
exempted non-profit places of worship from the mandate, and gave other
institutions like hospitals, schools and social services an extra year to come
into compliance.
“I believe this proposal strikes the appropriate balance
between respecting religious freedom and increasing access to important
preventive services,” Sebelius wrote in a statement,
adding that “this rule is
consistent with the laws in a majority of states which already require
contraception coverage in health plans.”
The right isn’t buying any of that. “The HHS insurance mandate,” wrote
the editors of the National Review,
“is a direct assault on the religious freedom of individuals and institutions
that cannot, in good conscience, be complicit in such hostility.”
At heart of this “hostility” is whether contraception is a
women’s health issue or an abortion issue. The IOM explicitly
stated that access to birth control was central to reducing the health
risks associated with unwanted pregnancies, and thus necessary as part of
comprehensive coverage; the National
Review characterized some means of preventative care, especially the
so-called morning after pills, as tantamount to early abortions.
The battle is only over for the short term—a change in
presidency could easily lead to the rule’s reversal, as could further debate
over the implementation of the still-controversial ACA. If not, contraception
coverage would go into effect for religious-based organizations no later than
January 1st, 2013.
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