RHRealityCheck.org

President Obama: Contraception Mandate Statement

Fiona Carmody — Fri, 10 Feb 2012 19:19:39 +0000

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President Obama announced a compromise today to a controversial policy requiring certain religious organizations cover contraception services for employees. The institutions will now be able to shift responsibility for contraception coverage to health insurance companies.

Don't Take it Back

Brady Swenson — Fri, 10 Feb 2012 15:41:09 +0000

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Healthcare Reform has meant a lot to people who need access to health care and as the law is fully implemented, it will mean even more. Over the last year, we’ve watched as some leaders have tried to take it back. Check out this ad by Family Planning Health Services to find out how health care reform helps people and what we stand to lose.

BREAKING: White House Amends Birth Control Mandate: Contraceptive Coverage to be Offered Directly from Insurers

Jodi Jacobson — Fri, 10 Feb 2012 15:38:54 +0000

UPDATED: 10:54 AM

10:36 am, February 10th, 2012: Important: Check back here for updates as more details are forthcoming in the next hour.

See all our coverage of the 2012 Contraceptive Mandate here.

Today, the White House did the right thing for women, public health and human rights. Despite deep concerns, including my own, based on what transpired in the past under health reform, the White House has decided on a plan to address the birth control mandate that will enable women to get contraceptive coverage directly through their insurance plans without having to buy a rider or a second plan, and without having to negotiate with or through religious entities or administrations that are hostile to primary reproductive health care, including but not limited to contraception.

Under this plan, every insurance company will be obligated to provide contraceptive coverage. Administration officials stated that a woman's insurance company "will be required to reach out directly and offer her contraceptive care free of charge. The religious institutions will not have to pay for it."

Moreover, women will not have to opt in or out; contraceptive care will be part of the basic package of benefits offered to everyone. Contraceptive care will simply be "part of the bundle of services that all insurance companies are required to offer," said a White House official.

"We are actually more comfortable having the insurance industry offer and market this to women than religious institutions," said the White House official because they "understand how contraception works" to prevent unintended pregnancy and reduce health care costs. "This makes sense financially."

The way it works is this: Insurers will create policy not including contraceptive coverage in the contract for religious organizations that object. Second, the same insurance company must simultaneously offer contraceptive coverage to all employees, and can not charge an additional premium. This provides free contraceptive coverage to women. The reason this works for insurance companies is because offering contraception is cost-neutral and cost-effective; companies realize the tremendous cost benefits of spacing pregnancies, and limiting unintended pregnancies, planned pregnancies and health benefits of contraception.

White House officials, speaking on background, said that the accommodation--which they stress is not a compromise--fulfills two principals. One is that all women will have access to the health care they need no matter where they work; their access to contraceptive services is guaranteed. "No longer will they have to struggle to pay for it," said the White House official. At the same time, "we are able to respect the beliefs of religious institutions." These are two principals, the official said, "that the White House holds dear."

The rule will be applied to all but the original institutions that were exempted—those for which religious inculcation is their primary purpose—and will not be expanded to include other entities such as hospitals, clinics, or social service organizations.

It most certainly will not, according to White House officials, exempt private employers. The Bishops had made clear earlier this week that their ultimate goal was to get rid of contraceptive coverage in health reform entirely.

The White House said that they plan to publish the final rule as soon as possible, and that it would go into effect on August 1, 2012, the original date, removing the one-year grace period from the original plan.

A White House official described the plan as providing "seamless coverage" to women for contraceptive care and crafted to allay concerns about privacy and confidentiality in accessing such coverage.

White House spokespeople pointed to support from two sides of the debate.

On one hand, Sister Carol Keehan of the Catholic Health Association applauded the policy, although I could not find her statement at this time.

And in a statement, Cecile Richards, president of Planned Parenthood Federation of America said:

“We believe the compliance mechanism does not compromise a woman’s ability to access these critical birth control benefits.

“However we will be vigilant in holding the administration and the institutions accountable for a rigorous, fair and consistent implementation of the policy, which does not compromise the essential principles of access to care.

“The individual rights and liberties of all women and all employees in accessing basic preventive health care is our fundamental concern.

“Planned Parenthood continues to believe that those institutions who serve the broad public, employ the broad public, and receive taxpayer dollars, should be required to follow the same rules as everyone else, including providing birth control coverage and information.

“As a trusted health care provider to one in five women, Planned Parenthood’s priority is increasing access to preventive health care. This birth control coverage benefit does just that.

“The birth control benefit underscores the fact that birth control is basic health care, and is fundamental to improving women’s health and the health of their families.

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President Obama: Contraception Mandate Statement

The Hawaii Compromise? White House to Announce Change In Birth Control Mandate

Jodi Jacobson — Fri, 10 Feb 2012 14:14:15 +0000

See all our coverage of the 2012 Contraceptive Mandate here.

This morning, news reports indicate an announcement may be imminent from President Obama on a "compromise" on the birth control mandate. To recap, the mandate requires that all employer-based health insurance offer coverage without a co-pay of all FDA-approved contraceptive methods. The basis for this mandate is a mountain of public health and individual medical evidence supporting the benefits of access to contraception as well as another mountain of legal precedent, at the base of which sits the basic human rights of all people to determine whether, when, and with whom to bear children.

Under the current rule, which goes into effect officially on August 1, 2012, churches and other institutions whose primary purpose is the inculcation of religious beliefs are exempt. Religiously-affiliated hospitals, universities and social service organizations whose primary purpose are medicine, education, or services and who employ people of many faiths are not.

This rule has thrown the United States Conference of Catholic Bishops into a tizzy the likes of which have not been seen since... oh yeah... 2010 and the health reform debate when they made insisted that women lose all coverage for abortion care they now have, and when they tried to remove contraception from the primary health care benefits package. The Bishops not only want religiously-affiliated institutions to be exempt no matter what their purpose; they've now made clear they want individual employers to be able to exempt themselves based on their "conscience."

Now, the Obama Administration, having completely fumbled an issue they have repeatedly fumbled and from which experiences they have apparently not learned a thing, is purported to be on the verge of announcing a "compromise."

Early reports are that such a compromise may at least to some degree be based on a law in Hawaii.

In 1999 Hawaii passed a law (which went into effect in 2000), that says as follows:

Hawaii Rev. Stat. § 432:1-604.5 and § 431:10A-116.6 (1999) direct that employer group health policies, contracts, plans or agreements must cease to exclude contraceptive services or supplies, including FDA-approved contraceptive drugs or devices to prevent unwanted pregnancy, and must not charge unusual co-payments or impose waiting requirements. (1999 Hawaii Sess. Laws. Act 267; SB 822)

Hawaii Rev. Stat. § 431:10A-116.7 (1999) defines a religious employer and states that such an employer may request a health insurance plan without coverage for contraceptive services and supplies. If so requested, the health insurer must provide a plan without such coverage. Each religious employer that invokes this exemption must provide written notice to enrollees upon enrollment a list of services the employer refuses to cover and provide written information describing how an enrollee may access contraceptive services and supplies. (1999 Hawaii Sess. Laws. Act 267; SB 822)

And the problem here, especially in this climate is as I said yesterday. It legitimizes a false argument about religious freedom that now will be used again and again to limit reproductive rights. It separates out a form of basic primary preventive care as though it were not basic primary preventive care, and it re-stigmatizes contraception. It gives Church administrators power over women that they have shown time and again to abuse and puts women in a subservient position to administrators at their place of work. And it requires individual women to ensure accountabiity to vague laws and statutes, creating a nightmare for them. It gives more power to people who are spending their entire lives working to take reproductive health care away from women.

Sarah Posner, cited at FiredogLake, quote Jon O'Brien of Catholics for Choice as follows:

“It may seem reasonable on the surface,” said O’Brien, “but it sends the wrong message, namely: that an employer’s personal beliefs may interfere with an employee’s conscience and therefore make it more difficult for him/her to access the healthcare coverage that he or she needs.”

In New York, which allows for this “self-insurance,” O’Brien said, “we have heard horror stories” of how it operates in practice. Imagine, he said, working at a Catholic school and going to your employer to request this special coverage. “We’ve heard anecdotal evidence that some workers at certain religious institutions have had to sign testimonials stating that they understand that contraception is against their employers’ beliefs, thereby bullying them into either not seeking insurance that covers contraception or into jumping through hoops to try to access it,” O’Brien said.

Finally, a national law will ostensibly over-ride state laws, many of which right now in fact require universal coverage of contraception in their plans with the exception only of institutions for which religious inculcation is their primary purpose. This means that untold numbers of women will lose coverage they already have.

Compromise? For whom on behalf of whom?

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An Open Letter to the President of Georgetown University on the Battle Over Contraceptive Coverage

Erin Matson — Thu, 09 Feb 2012 21:07:06 +0000

See all our coverage of the 2012 Contraceptive Mandate here.

Mr. John J. DeGioia

President, Georgetown University

204 Healy Hall

37^th and O Sts, NW

Washington, DC 20057

Dear Mr. DeGioia:

As a graduate of Georgetown University and advocate for women, I write to express my horror with the actions of the U.S. Conference of Catholic Bishops on the matter of contraceptive coverage for students, employees and dependents of religiously-affiliated institutions, including my beloved alma mater. I write you for the first time after years of comprehensive and thorough disagreement with the all-male Catholic hierarchy's view of a subordinate, secondary role for women -- in the church, and under the law.

Nearly every woman in this country will use a contraceptive during her lifetime, including 98 percent of Catholic women. The bishops have already secured a birth control refusal loophole for churches and religious institutions. Catholic churches already can refuse to provide health insurance that offers contraceptive coverage. At issue is whether to create another birth control refusal loophole, this time for religiously-affiliated institutions, including Georgetown. Doing so could take contraceptive coverage away from three million women.

As you surely know, The New York Times published an article titled "Ruling on Contraception Draws Battle Lines at Catholic Colleges" on January 29. In that story, an unnamed recent Georgetown law graduate shared that she was prescribed birth control pills to treat polycystic ovary syndrome. As Georgetown doesn't offer contraceptive coverage for students, her choice was to pay for her pills out of pocket. When she could no longer afford to pay more than $100 each month, she stopped filling the prescription and developed a large cyst that led to surgical removal of an entire ovary.

The same article also quoted a Georgetown law professor openly wishing Catholic institutions would 'have more open conversation' about bans on birth control. I am asking you directly to initiate that conversation within the Georgetown community, as well as with the bishops who claim to speak on the behalf of women students, employees and our dependents.

A majority in this country believe students, employees and dependents of religiously affiliated institutions should offer contraceptive coverage, including a majority of the employees at Catholic hospitals and universities. Respectfully, a Georgetown student taking a birth control pill is not an assault on religious freedom in society. This graduate recommends her beloved community not entrust the important matter of a woman's health to an all-male Catholic hierarchy that pronounces pedophilia and the ordination of women priests as equally 'grave threats.' It seems more appropriate to open this matter to the perspectives of students themselves. I am hopeful you will do so.

Sincerely,

Erin Matson

Action Vice President, National Organization for Women

Birth Control Coverage Is Basic Preventive Care... Except...

Will Neville — Thu, 09 Feb 2012 18:38:55 +0000

See all our coverage of the 2012 Contraceptive Mandate here and of the 2012 Birth Control Refusal here.

Religious Freedom? Let the Chimes of Freedom Ring

Lon Newman — Thu, 09 Feb 2012 15:23:48 +0000

See all our coverage of the 2012 Contraceptive Mandate here.

The US Conference of Catholic bishops (USCCB) are incensed at the decision by the Obama administration to guarantee that the preventive health care benefit package in the Affordable Care Act (ACA) includes contraceptive care. In a USCCB video, Cardinal-designate Timothy Dolan, the former Archbishop of Milwaukee, wags an index finger as he invokes religious freedom protected by the “very first amendment.” The archbishop calls upon his flock to contact their elected officials and let them know that “religious liberty must be restored.”

Under a cloak of reverence for religious freedom, the bishops say reproductive health care must be denied. As do the rights to millions of American women, millions of people of other religious faiths, and even to millions of American Catholics – most of whom disagree with the archbishop.

Before we ask President Obama to reverse his administration’s decision, there are some troubling questions we should ask the bishops and ourselves lest we destroy religious freedom in the name of preserving it:

A patient who takes birth control pills, under the USCCB’s code of conscience, with the intention of preventing pregnancy commits a sin. If that same patient takes the same prescription for another health purpose, it is permissible. Is there any way that respects a patient’s right to privacy that also enables insurance companies and employers to deny birth control pills to prevent pregnancy while it permits them for regulation of menstrual cycles?

In Wisconsin, we have a Medicaid family planning to prevent unintended pregnancy. It has been very successful. It saves taxpayer dollars by reducing unwanted pregnancies and abortions among participants. Medicaid payment records show that many Catholic hospitals, clinics, physicians, and pharmacists are participating in the program. These institutions provide birth control services and receive public insurance (tax) dollars in payment. There is no reason for the bishops to wait to exercise their conscience “rights.” They could stop accepting payment for family planning services now. Why wait?

Many people of sincere faith disapprove of childhood immunizations even though they are, like family planning, on the top ten list of major public health benefits. Under the religious exemption based on an employer’s conscience that the USCCB is asking for, an employer with a conscientious objection to immunization might deny its employees’ children insurance coverage for measles, mumps, polio, Pertussis, and rubella vaccines. What would be the public health impact on children when so many are not immunized?

Many Catholic employers throughout the country have family planning and birth control coverage in their insurance policies right now. Is there a reason to wait for ACA permission to exclude contraceptive care from the insurance coverage of their employees? If the bishops implement the limits on insurance coverage they are asking for in their own clinics and hospitals and pharmacies -- which even though they haven’t, they say they must -- will these employees continue to provide birth control and family planning services to patients and receive insurance reimbursement while they no longer have insurance coverage for that care themselves? Will employees be forced to seek out non-sectarian health care and pay for it out-of-pocket?

In Cardinal-designate Dolan’s former diocese, there is a nettlesome question of who is an employee of the archdiocese and who is not. Today, diocesan attorneys will argue that sexual assault claims against priests working in diocesan religious orders should be thrown out because the priests were not employees. The bishops need to clarify how they are accountable and responsible for the sexual health and morality of the employees of these separately-incorporated religious affiliates – until they engage in criminal sexual behavior.

Those of us who revere the constitution and the individual right to exercise freedom of religion enabled by the separation of church and state must stop the mass media procession that is now engaged in a responsive reading from the archbishop’s hymnal. These sounds you hear are not the chimes of freedom.

Old Boys' Club Dictating "Wisdom" on Contraceptive Coverage?

Fiona Carmody — Thu, 09 Feb 2012 15:20:04 +0000

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Rachel Maddow plays a video of Rick Santorum speaking to a conservative website saying contraception is "not okay." She discusses the absurd fact that this point of view is the current norm amongst GOP candidates, not the obviously furthest right-wing view, as it has been in the past.

Who's Zoomin' Who? Moving on From "Religious Freedom" Diversion, USCCB Wants to Exempt All Employers From Birth Control Mandate

Jodi Jacobson — Thu, 09 Feb 2012 14:21:34 +0000

See all our coverage of the 2012 Contraceptive Mandate here.

As I noted in a piece on the contraceptive mandate published last night, the real goal of the United States Conference of Catholic Bishops is not to exempt just religious institutions from the contraceptive mandate, but to eliminate such coverage completely. For everyone.

On the Diane Rehms Show on Wednesday, February 8th, for example, Barry Lynn, executive director of Americans United for Separation of Church and State noted that:

"David Stevens... the CEO of a group called the Christian Medical Association... [b]elieves that one of the problems with this rule now is that it should be expanded not just to Catholic hospitals or other big institutions, but that individual employers should be allowed to say, no coverage of contraceptions for their individual employees."

And now, Anthony Picarillo, general counsel of the USCCB confirms that this is indeed the goal. USA Today reports that a compromise is "no consolation to Catholic leaders."

The White House is "all talk, no action" on moving toward compromise, said Anthony Picarello, general counsel for the U.S. Conference of Catholic Bishops. "There has been a lot of talk in the last couple days about compromise, but it sounds to us like a way to turn down the heat, to placate people without doing anything in particular," Picarello said. "We're not going to do anything until this is fixed."

That means removing the provision from the health care law altogether, he said, not simply changing it for Catholic employers and their insurers. He cited the problem that would create for "good Catholic business people who can't in good conscience cooperate with this."

"If I quit this job and opened a Taco Bell, I'd be covered by the mandate," Picarello said.

Which of course is what they want. To remove it for everyone.

I'm waiting to see what the members of the Bishops' Boys Club, i.e. E.J. Dionne, David Brooks, Morning Joe, and other men who can't stop making the case against women whenever the USCCB beckons, will say about this one regarding "religious freedom."

Can we discuss health care, public health, and women's rights now, boys?

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The White House's Dangerous Dance With the Birth Control Mandate

Jodi Jacobson — Thu, 09 Feb 2012 04:04:46 +0000

See all our coverage of the 2012 Contraceptive Mandate here.

This week, on MSNBC's Morning Joe, Obama campaign senior advisor David Axelrod signaled that the White House, having finally decided to include coverage of birth control as part of primary health care benefits under health reform after studying it for well over a year, is now "willing to compromise."

Translation? The White House is considering "accommodations" to the policy.

Many of my colleagues disagree with my take on the situation. Many have pointed me to, and I have read, the so-called clarification on Tuesday by White House Press Secretary Jay Carney of what Axelrod really meant. I also read the further clarification made on Wednesday. I don't find either very clarifying. In fact, I find them worrisome.

In Tuesday's White House press conference, for example, ABC's Jake Tapper asks Carney:

Is there a middle ground somewhere where perhaps some of these religious organizations that aren’t specifically houses of worship, but are Catholic or Jewish or Baptist hospitals, charities, of a smaller size could be -- could receive the same exemption as the houses of worship? We’re talking about people who think that some methods of birth control are murder, are a sin, and the Obama administration is forcing them to be party to that. I mean, that’s the crux here.

And Carney responds:

Well, let’s be clear -- and first of all, we understand the religious concerns here. That is why this balance was sought. That’s why the process going forward includes a transition period where this discussion will continue to see if there can be ways found that ensure that women get access to these preventive services and that those services are covered -- as they will be for all other women -- and that also takes into account these religious concerns. But let’s be clear, the rule does not require any individual or institution to provide contraception. It requires coverage for women who work there of different faiths, or of any faith.

He continues:

I’m not going to negotiate all the different possibilities of how this rule could be implemented in a way that might allay some of those concerns. That’s what the transition period is for.

Then on Wednesday, Carney said:

“The commitment to make sure that all American women no matter where they work have access to the same health care coverage and same preventive care services, including contraception, is absolutely firm. That’s the President’s commitment, that's explicit in the policy proposal. The discussion, and it's an important one, but the discussion is how can we, in implementing this policy, try to allay some of the concerns that have been expressed? And the President is very sensitive to that. As is Secretary Sebelius and others. But that's the issue. So, describe that as you will but there is no change in the commitment to ensuring that women have access to these important services.”

Why does this worry me? Two main reasons.

One, none of these statements says what needs to be said--what has needed to be said by the White House from the time of the birth-control-in-the-stimulus-plan fight throughout the fight over health reform and on to this day. And that is as follows:

Contraceptive use is normal. It is used by 98 percent of sexually-active women in the United States at some point in their lives, including 98 percent of Catholic women; indeed many women rely on it for most of their reproductive lives. It is a public health issue, it is a medical issue, it is an individual health issue. Contraception is about maternal, infant and child health; it is about desired family size, family formation, and the most basic and profound choices individuals can make--whether, when and with whom to bear and raise a child. It is also about medically-indicated conditions which women face for which birth control is prescribed. It is a foundational issue for the social and economic participation of women. It is an individual human rights issue. And every domestic and international medical body with any legitimacy recognizes it as such. It is not about the religious freedom of religious corporations institutions a la Citizens United, but about the health and religious freedoms of individuals, the vast majority of whom clearly disagree with the teachings of the Catholic Church.

This needs to be said, over and over, to put the discussion about contraception to rest, to place it back in the realm of public health, and to stop the stigmatization of all reproductive health care, which has not surprisingly gone well beyond abortion to include contraception.

And yet the White House seems unable to say any of it. In fact, as the New York Times noted earlier this week, key members of the Administration (all of them men) are "squeamish" about the issue, and there has been a battle inside the White House with women on one side and men (Vice President Biden, former Chief of Staff William Daley and other Catholic men) on the other. These men find it hard to stand up to the Bishops, despite the fact that the majority if not all of them have almost certainly relied on their wives to use contraception. Tell you something?

This point has also been made by Glenn Thrush at Politico:

So far, the White House and HHS have dug themselves a very deep hole by doing a lousy job of getting out their side of the story out – Obama says he did this to protect women’s reproductive rights – but the West Wing has projected defensiveness instead of making that case forcefully… just like on health care reform, the stimulus, etc. etc. etc.

Thrush interviewed several female Democratic consultants, and writes about one:

The problem, she said, is that Obama-land, using a roster of middle-aged male surrogates, has been in a narcoleptic, deer-in-headlights zone since the story went nuclear a week or so ago.

"That part seems to be true," he continued.

"I have talked to a lot of administration types about this over the last week, and not a one of them has owned the decision." Moreover, he continued, "the contrast between [the] passion [of female Democrats] and the tone of detached deliberation used by male Obama-ians, when they have spoken publicly, is striking."

The Administration writ large also seems incapable of asserting the primacy of medical evidence over personal belief in the creation of health care policy. The USCCB believes that everything from masturbation and the "spilling of seed," to the use of contraception that prevents implantation of a fertilized egg is a sin and that contraceptives are abortifacients. It not only wants its assert its own theologically-driven definition of when pregnancy begins on employees of any entity associated with Catholicism, it wants that definition to override the actual medical definition for every woman in the United States.

One can believe individually what one wants to believe but at some point, rationality and evidence must hold sway in the creation of public policy or we are in deep, deep trouble. My religion may dictate that the earth is flat or the moon made of cheese, but I would be wrong in the eyes of geographers, astronomers, astronauts, and the vast majority of people; moreover, my request that public policy accommodate my beliefs would rightly be viewed as insane. The conversation about contraception right now--at a time when states are cutting access right and left and when we should be talking about jobs, energy, global warming, education and any number of other things--also is insane.

If the Administration had any understanding about the politics of these issues from the very beginning, we might not be in this position today. Take the stand, make the case, move on. Be firm. But it keeps trying to play all sides, allay all concerns, be pals with the Cardinal on issues like contraception. You can't do it. This is not about what a group of men and patriarchal religious institutions think, it is about sound public health, about science and evidence and policy-making based on rational, factual data.

By not--indeed by never--saying any of these things, this Administration has allowed contraception to be stigmatized by male religious leaders who can not even convince their own followers that what they preach is morally salient. And by waiting til the eve of an election year to make the decision, it has allowed this issue to boil over into the current media frenzy, which the media is of course delighted to treat as a "culture war," when in fact it is a war between science, health, medicine, and human rights on one hand, and the beliefs of a very few being imposed on the very many on the other, with the very few crying, as they always do, about being "victimized." Tapper's biased articulation of his question above just shows how far from an objective, science-based resource the world of journalism has become.

And let's remember one thing: Well before the issue of the exemptions came up, the Bishops were fighting inclusion of contraception per se in the definition of preventive care. They did not want contraception to be included as part of the primary preventive care package of insurance coverage for anyone under any employer. So this is about their attempt to control public health a la Nicaragua, Peru, Bolivia, Ecuador, Kenya and other countries where they have succeeded in severely diminishing women's access to care across the board and where, as a consequence, unsafe abortion and other causes of maternal death are among the leading causes of death among women ages 15 to 49. For this reason as well, this decision has implications for women's lives not just in the United States, but literally throughout the world.

A second reason I don't find the "clarification" to be very comforting is Axelrod and Carney, respectively, imply and suggest that a) the grace period of an additional year, which only gave the religious right more time to stir up a panic, was for "finding ways around" covering contraception directly under employee health plans, which is not my reading of the original rule; b) that there are in fact "acceptable workarounds" for contraceptive coverage that will mollify the right-wing religious uterine police and that won't leave women having to deal with separate policies for "health coverage" and another for that "dirty nasty contraception," c) and that having found said workarounds, the issue will go away.

Does anyone believe this?

Let's take these one by one. If what I am hearing from Carney and Axelrod is in fact Administration policy, then the original rule as per the Department of Health and Human Services itself is already moot.

The original rule is clear. It states:

[R]egulations specify that, for purposes of this policy, 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; and (4) is a non-profit organization under section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii) of the Code. Section 6033(a)(3)(A)(i) and (iii) refer to churches, their integrated auxiliaries, and conventions or associations of churches, as well as to the exclusively religious activities of any religious order. The definition of religious employer, as set forth in the amended regulations, is based on existing definitions used by most States that exempt certain religious employers from having to comply with State law requirements to cover contraceptive services.

The policy as it now stands already exempts institutions with the specific purpose of religious inculcation--i.e. the United States Conference of Catholic Bishops (USCCB) and churches.

They don't have to comply in a year; they don't have to comply ever.

But this is not what the fight is about. The fight is about universities, hospitals and social service institutions which serve many people, employ many people, do not have as their primary purpose the inculcation of religious values, and which, by the way, collectively receive billions of dollars in tax payer funds, and in tax exemptions. Moreover, an increasing number of Catholic hospitals are ending their governing board affiliations with the Catholic Church but partnering in large systems with both Catholic and non-Catholic hospitals.

According to Kaiser Health News, for example, Catholic HealthCare West "has $11 billion in revenues, making it the fifth largest in the country, [and] is seeking to triple in size and build a national footprint. It treated 6.2 million patients last year. [T]he system's new name [is] Dignity Health. [The CEO] said the system's change to a nondenominational board will create "a tremendous opportunity that will help accelerate our growth."

The system's Catholic hospitals will continue to adhere to Catholic directives and have relationships with the religious orders of nuns that governed the system. Those orders will retain final authority should Dignity want to sell a hospital, change its name or make other substantial alterations. In addition, the secular hospitals will continue to adhere to some rules based on church doctrine, such as a ban on abortions except when a mother's life is in danger. Still, the system's governance change is more dramatic than those made at some other Catholic hospital systems.

So in this scheme, non-Catholic of numerous denominations must operate under are now under Catholic doctrine.

The primary purpose of a hospital is to provide medically-sound health care. The primary purpose of a university is to teach. They employ millions of women and men--Catholic and non-Catholic--who need contraceptive coverage for reasons of individual health, family health, and economic well-being. That is the reason they are not exempt. Whether or not someone under a health plan goes to a doctor that prescribes and a pharmacy that fills a prescription for birth control is no business of the hospital administration. And experience indicates that even when in theory such institutions are willing to provide contraception for health reasons, in practice they shame and harass women before actually providing care, if they ever do.

But the policy is not about making them provide contraception. Its not about making them prescribe it. Still the Bishops want a policy that says even if and when you work for us and even if and when you get an insurance plan, and even if you are paying part of that coverage, you will not be able to go to your own doctor for your own personal and health needs and get a prescription for modern contraception.

While these are not organizations for which inculcation of religion is their main purpose, they do, under the current regulation, have a year from the date on which the regulation goes into effect (i.e. a year from August 1, 2012), to comply with the regulations.

But they don't want to do so. At all. Ever. Under any conditions.

Here, for example, is what Anthony Picarello, associate general Counsel of the United States Conference of Catholic Bishops said Wednesday on the Diane Rehms show when asked by Rehms what compromises might be acceptable to the USCCB:

Well, my reaction is basically, you know, the way to fix the problem is to fix the policy. I mean, there's a lot of talk about trying to work this through and so forth over the one year. But if the one year is simply, as we've been told, just to provide more time for full compliance with the current policy, then that's not accommodation at all. What we need is a change in the policy. That's the only way we'll get an (word?) of the concerns.

Some have floated the "Hawaii solution." Hawaii law mandates that religious employers that decline to cover contraceptives must provide written notification to enrollees disclosing that fact and describing alternative ways for enrollees to access coverage for contraceptive services. There are three problems with this. First, it places the burden of two policies, two sets of costs and payments, two sets of regulations, and two sets of hassles with insurers on women for a valid, medical and public health intervention, a circumstance in which there is no rationale for putting women.

Second, it continues the stigmatization and "separation" of contraception and health care, which is the core of the problem to begin with.

And third, I guarantee that the Bishops, who encouraged passage of the Let Women Die Act of 2011, under which "church-affiliated" hospitals could not only refuse to perform a life-saving abortion but also refuse to refer a dying woman for a life-saving abortion are not going to be running around happily informing people of their rights and alternatives to access to contraception. It's an accountability nightmare that will be suffered by millions of invisible women whose stories will never make the papers after all is said and done. These sorts of policies can only be thought up by people who really do not get what it is like for a low- or middle-income woman to manage a family, a job, health care, long hassles with your insurance companies for accurate coverage and long-lines for prescription drugs.

The only change in the policy acceptable to the USCCB and the far right is to not allow women and men who work for them to access contraception at all.

Moreover, the USCCB and other religious right organizations have now made clear that they don't even want to stop at religiously-affiliated organizations, but also believe that individual employers should not have to provide coverage of contraceptive care if they don't feel like doing so because "their conscience is against it."

On the Diane Rehms Show with Picarello was Barry Lynn, executive director of Americans United for Separation of Church and State. He noted that:

"David Stevens... the CEO of a group called the Christian Medical Association... [b]elieves that one of the problems with this rule now is that it should be expanded not just to Catholic hospitals or other big institutions, but that individual employers should be allowed to say, no coverage of contraceptions for their individual employees."

In other words, Lynn continued:

"...allowing the employer at the bookbinding store or the grocery store to say, we -- I do not believe in birth control, and I am going to refuse insurance coverage for any of my employees who might want it because I -- my rights, my claim of religious freedom trumps that of my employees. This is absolutely shocking. We're talking about trumping already, in Anthony's model, the rights of individual women who are parking attendants, cafeteria workers, nurses or physicians at what is nominally a Catholic hospital, but it serves the whole community."

"Religious liberty" is a red herring if ever there is one. But the White House has played right into this by constantly either refusing to engage reproductive health issues as health issues, or by repeating tropes like "religious liberty" as if these were both rational and legitimate, thereby strengthening the hand of the Bishops and of the GOP, which as we know will look for any cudgel to beat up on Obama.

The White House and many allies in the House and Senate are now under tremendous pressure from a small minority of religious leaders who are not in line either with public opinion or their own followers. New polling data reveal that a majority (55 percent) of Americans agree that “employers should be required to provide their employees with health care plans that cover contraception and birth control at no cost,” and rougly six-in-ten Catholics or 58 percent believe that employers should be required to provide their employees with health care plans that cover contraception. Fifty-two percent of Catholic voters, support for this requirement is slightly lower at 52 percent.

Given all of the above, what the White House is doing now is grossly unclear to me. And given this administration's troubled history with women's health and rights (see: Health reform, abortion, Stupak, Nelson, Executive Orders, Hyde), these "clarifications" without finality are not reassuring. At each point in the past instances above, the Administration was not going to change its mind, and then it signaled conciliation, and then, voila, the White House changed its mind. Now, they are continuing to feed rather than combat an underlying narrative that basic reproductive health care is not part of basic primary health care, that there is something wrong with it, that it is in fact sinful, and that it is stigmatizing. This is a bad omen at a very bad time. Given that no compromise is acceptable to the USCCB or to any of the far right fundamentalists seeking to control all of women's health, there is nowhere for the White House to go except to stand up and say no more, or to cave.

The Administration has nothing to lose by putting its foot down. It is the right thing to do, morally, economically, and from the vantage points of public health and human rights. The majority of women are for it; the majority of Catholic women are for it; the majority of voters are for it.

The Administration simply has to man-up on birth control, or better yet, let the women in the Administration take this one over, because they, for obvious reasons, get it and the men don't. By not doing so, the White House is inviting more contention, more wrangling, more press and media. It also is helping re-stigmatize a form of modern medicine for decades to come.

And if they can't stand up, perhaps what Axelrod really should more honestly have said was this:

The White House is considering changes to a policy that will compromise the health, well-being, human rights, social participation and economic security of women because it is afraid to stand up to a minority of old white men who believe that women have no rights or role in society.

Video:

David Axelrod on Morning Joe Talking About HHS Decision