Contraception compromise

The White House's announcement that religious hospitals and charities will not be required to provide contraception coverage in their employee health plans has left many wondering who will really pay for these services—and how?

With HHS Secretary Kathleen Sebelius at his side, President Barack Obama late last week said American women will still have access to free preventive care that includes contraceptive services regardless of where they work. But if a woman's employer has a religious objection to paying for such coverage as part of its employee health plan, then the insurance company, not the employer, will be required to reach out to the woman and offer those services at no charge.

“The result will be that religious organizations won't have to pay for these services, and no religious institution will have to provide these services directly,” the president said during a Feb. 10 news conference in which he took no questions. “Let me repeat: These employers will not have to pay for, or provide, contraceptive services,” he continued. “But women who work at these institutions will have access to free contraceptive services, just like other women, and they'll no longer have to pay hundreds of dollars a year that could go toward paying the rent or buying groceries.”

Last August, HHS issued an interim final rule on preventive services that would require most health insurance plans to cover preventive services for women—including contraceptive services—without a copay, coinsurance or deductible. Then on Jan. 20 of this year, Sebelius issued a statement saying not-for-profit employers who do not currently provide contraceptive coverage in their plans will have until Aug. 1, 2013, to comply.

Specifically, the new policy says religious organizations will not have to provide contraceptive coverage or refer their employees to organizations that provide contraception. Nor will they be required to subsidize the cost of contraception. Contraception coverage will be offered to women by their employers' insurance companies directly, with no role for religious employers who oppose contraception, and insurance companies will have to provide this coverage free of charge.

But the president's recent announcement did more to generate questions than it did to provide answers. Robert Zirkelbach, spokesman for America's Health Insurance Plans, said in a statement that the nation's health plans have long offered contraceptive coverage to employers as part of preventive benefits, but that the group is concerned about the precedent the rule would set. AHIP will provide comments throughout the regulatory process, he added.

“It's undetermined how it will affect self-funded plans,” said Barbara Yoshimura, area senior vice president at Gallagher Benefit Services in Itasca, Ill. “It's a piece of the puzzle, but it's not the whole puzzle. You can have an employer who is fairly small,” she added. “Everyone is monitoring this very closely. And I can't say there won't be some unraveling in how benefits are supplied if this is forced on” insurance companies, she said.

Ed Zurek, vice president of Schaumburg, Ill.-based Assurance Agency, an insurance brokerage firm, also said the president's announcement lacked details on the mechanics of this issue and whether these services will need to be carved out of health plans. “He'd been better off telling the drug companies to give the contraceptives away,” Zurek said. “Why not say it's free to everybody? Somebody has to pay. Insurance companies have to provide it—somebody has to pay for it,” he added. “That's not outlined.”

A White House official said in an e-mail that the administration will “work with faith-based organizations, insurers and other interested parties to develop policies that respect religious liberty and ensure access to preventive services for women enrolled in self-insured group health plans sponsored by religious organizations.”

Meanwhile, Sister Carol Keehan, president and CEO of the Catholic Health Association—which supported the Patient Protection and Affordable Care Act—indicated that her organization viewed the modified rule as an acceptable compromise. The CHA's member hospitals employ nearly 800,000 full- and part-time workers, according to the American Hospital Association. “The Catholic Health Association is very pleased with the White House announcement that a resolution has been reached that protects the religious liberty and conscience rights of Catholic institutions,” Keehan said in a statement.

Although the president said the policy change will both protect religious freedom and women's health in a pluralist society, other lawmakers said the rule still violates the conscience of employers and individuals.

“We do not and cannot begin to compromise on this fundamental right,” Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce Committee, said in a statement. “Today's announcement is not a compromise on policy—it simply pretends to shift costs away from religious employers, but it doesn't fix the problem and is another call for individuals and institutions to compromise on principle.”

A few days before the White House's announcement, Upton said his committee and its Health Subcommittee would move swiftly on legislation to overturn the rule's provision. Similar congressional efforts to block the birth control coverage mandate include bills recently introduced by Sens. Marco Rubio (R-Fla.) and Joe Manchin (D-W.Va.) and Rep. Steve Chabot (R-Ohio). Those measures would bar any requirements on employers to pay for birth control coverage if it violates their religious beliefs. Sponsors of those measures indicated no plans to back off their bills in the wake of the president's announcement.

The possibility of an ongoing legislative fight over the issue was also signaled by vocal advocates of the original coverage mandate, including Sen. Richard Blumenthal (D-Conn.), who promised to fight a legislative rollback. Alternative approaches include one from Sen. Jay Rockefeller (D-W.V.), who urged Sebelius to replace the mandate with one modeled on a West Virginia law, which allows more flexibility for religious employers.

—with Rich Daly and Ashok Selvam