Religious Employer

In 1968, Pope Paul VI spelled it out. Any act specifically intended to prevent getting pregnant — other than timing sex for the infertile part of a woman’s cycle — is unlawful, he wrote. Not only that, it was "an evil thing," he said, to make it easy to break moral law.

That puts Catholic organizations in a tough spot. If contraceptives must be offered without a co-pay, that means the cost is spread among employers and all insured employees whether they use the coverage or not, bishops argue. Catholics would end up paying for birth control, breaking moral law.

So the U.S. Conference of Catholic Bishops is leading the political charge to overturn the administration’s decision. A religious exemption that applies primarily to churches is too narrow, bishops argue. Two Catholic colleges have sued; new laws have been proposed in Congress; and bishops are urging parishioners to write to lawmakers.

A quarter of the U.S. population is Catholic. That’s not to say all Catholics oppose the Obama administration's rule. A Guttmacher Institute study based on government data shows that most Catholic women use birth control at some point in their lives, nearly the same as all women. Meanwhile, two recent polls show a slim majority of Catholics favor the rule.

Sticking point: definition of ‘religious employer’

So, about that religious exemption, which Catholic bishops argue is too narrow. Here’s how it works: Organizations have to meet a four-part test for   what the government calls "a religious employer."  It’s not simple to say which types of religious organizations will have to offer co-pay-free birth control coverage, and which won’t, because it depends.

The test:  A religious employer:

• Is a nonprofit organization
• Has the inculcation of religious values as its purpose
• Primarily employs persons who share its religious tenets
• Primarily serves persons who share its religious tenets

Case by case: It hasn’t yet been decided how that test will be applied, though it will likely be case by case. That will come with final HHS rules on the larger issue of preventive care later this year. Meanwhile, nonprofits that haven’t offered birth control because of religious beliefs have an extra  year to comply with the new rule — by Aug. 1, 2013, instead of this summer.

How the rule might apply

Catholic nun working in a Catholic church:  Assuming the church primarily employs and serves other Catholics, it wouldn’t be required to offer coverage for birth control to its employees, including nuns.

Jewish classroom aide at a Catholic primary school: A Catholic primary school that employs primarily Catholic instructors and teaches mostly Catholic kids wouldn’t have to offer contraceptive coverage to its employees, so this aide, no matter her religion, wouldn’t get co-pay-free birth control unless her school decided to offer that coverage.

Catholic custodian at Catholic primary school: On the other hand, if a Catholic primary school hired diverse employees and taught non-Catholic kids alongside Catholic ones, it would have to offer co-pay-free coverage. A Catholic worker would have the option to get birth control without paying   extra.

Atheist office worker at a Catholic university: A Catholic university that hires based on merit rather than religion and admits students of all faiths would have to offer contraceptive coverage — for its Catholic employees along with its non-Catholic employees.

Catholic nun working as a Catholic hospital administrator:  A Catholic woman who works as an administrator for a Catholic hospital that employs  and serves non-Catholics would have coverage that included co-pay-free birth control. So, yes, even nuns with employer-provided health care would   have birth control coverage.

What if non-exempt organizations say no?

Some Catholic leaders, such as St. Petersburg Bishop Robert Lynch, have said that if the rules don’t change, they’ll stop offering employee health coverage in protest. Lynch said he might stop providing health care for his diocese’s 2,300 employees. (It’s not yet clear whether the diocese would  qualify for a religious exemption.)

What would happen? Well, the law doesn’t require employers to offer health insurance. But starting in 2014, if their employees qualify for premium tax credits to buy their own insurance, available to low- and middle-income people, employers must pay a $2,000 assessment per full-time employee past the first 30 employees.

Meanwhile, their employees would find that most available health plans would be required to cover contraception.
In June 2012 U.S. Supreme Court reached its decision by recognizing what has been known; i.e., the government is involved in health care, that Congress has the right to regulate it, and the broken system needs to be fixed.
There is no doubt how the U.S. Catholic bishops should respond. Although they opposed the law initially, believing its anti-abortion provisions were insufficient, they have never once called for the law's repeal.

Court rulings since the Affordable Care Act was passed have said the law, on its face, does not provide for taxpayer-funded abortions. Yes, the U.S. bishops' conference should continue to press for a resolution on the federal mandate requiring coverage of contraceptives in health care plans that too narrowly outlines the definition of a religious employer.
But that issue cannot blind the bishops, or any Catholics,to the blessings the act will  bring. The U.S. bishops have supported universal health care for decades. They should not -- they cannot -- back away now.

The U.S. bishops' own teaching document "Faithful Citizenship" rightfully points out: "A lack of health care [is] a serious moral issue that challenges our consciences and require[s]us to act."

The goal of universal and affordable health care has been one of the most frustratingly elusive policy objectives of the Catholic bishops and others committed to social justice for decades.

However, every industrialized country in the world has found a better fix to the issue of health care than has the U.S.  Therefore, no matter the complicated intricate policy aspects of Affordable Care Act that appears to confuse actuarial tables, the conflicting  legal principles at stake---the moral issue is as clear as day; only the U.S. is beholden to powerful, entrenched corporate interests that past Congresses' have failed to achieve universal access to health care. In 2010 along came a President who had political will to defend the principles that defined the Affordable Care Act.

Affordable care for all. Access for all. Lower costs for all. That is the recipe for a decent society and any continued obstruction is indecent.