The Obama Administration is seeking comments by April 8, 2013, on proposed rules to cover birth control under the Affordable Care Act.*
The rules would permit religiously-affiliated non-profit organizations like hospitals, universities and charities, as well as churches, to withhold coverage for contraception. They can self-declare that they are religious institutions that oppose providing coverage for contraception. Employees would be issued individual insurance plans that cover contraception at no additional cost.
The proposed rules continue to stigmatize contraception, which is widely used and accepted, but too often inaccessible, especially to lower-income women. They would leave millions of women – and their families – subject to as-yet poorly defined financial and administrative arrangements, dependent on the compliance and goodwill of private health insurance plans.
* If link does not work, copy and paste into your bowser:
From Catholics for Choice:
“The Obama Administration did the right thing the wrong way. According to the proposed rule, some women whose employers have a religious objection to providing contraception will still be able to get access through a third party provider.
“That’s the good news, but the proposed rule’s expansion of which employers can be exempted from providing comprehensive preventive healthcare, including contraception, is appalling. Women who work at Catholic schools, hospitals and social service agencies are wondering whether they’ll be able to get the same coverage as millions of other women, or if their healthcare just isn’t as important to the president as their bosses’ beliefs about sex and reproduction.
“It’s obvious that once again, the administration listened to the lobbyists for the Catholic bishops and their big business interests, instead of Americans of every faith and of none who support the separation of religion and state and believe that public policy should not impose or privilege any religious viewpoint. Allowing such a wide exemption gives religious extremists carte blanche to trump the rights of others, based merely on the assertion of a belief about contraception even if that belief runs contrary to science or the widely-held convictions of co-religionists.
“While protecting contraceptive access under the ACA is a win for women, the administration’s caving in to lobbying from conservative religious pressure groups is a loss for everyone. American Catholics who support contraceptive coverage, who believe in the separation of church and state and who were hoping for change in Washington are disappointed today.”
Seventh Circuit stays contraception insurance mandate in second case. A federal appeals court has issued a second ruling staying the health care reform law’s requirement that health insurance plans cover contraception and related services.
From the Obama Administration: Women’s Preventive Services Coverage and Religious Organizations
Thanks to the Affordable Care Act, most health plans cover recommended women’s preventive services, including contraception, without charging a co-pay or deductible. The scientists and other experts at the independent Institute of Medicine provided recommendations to the Department of Health and Human Services (HHS) regarding which preventive services help keep women healthy and should be covered without cost-sharing. The IOM recommended covering contraception without a co-pay or deductible because there are tremendous health benefits for women that come from using contraception. In fact, nearly 99% of all women have relied on contraception at some point in their lives, but more than half of all women between the ages of 18 and 34 have struggled to afford it.
Today, the Obama Administration moved forward to continue to implement provisions in the health care law that would provide women contraceptive coverage without cost sharing, while taking into account religious objections to contraceptive services by certain religious organizations. The Notice of Proposed Rulemaking (NPRM) released today reflects the public feedback from comments on the Advance NPRM issued in March 2012.
Today’s proposals build on the ideas we laid out last year to provide women with coverage for recommended preventive care, including contraceptive services, without cost sharing, while also ensuring that non-profit organizations with religious objections won’t have to contract, arrange, pay, or refer for insurance coverage for these services to their employees or students.
Details on these proposed policies are outlined below. The Administration is seeking comment on these proposals and welcomes feedback from all Americans through April 8, 2013.
Exemption for Religious Employers
Group health plans of “religious employers” are exempted from having to provide contraceptive coverage, if they have religious objections to contraception.
Today’s NPRM would simplify the existing definition of a “religious employer” as it relates to contraceptive coverage.
The NPRM would eliminate criteria that a religious employer:
- have the inculcation of religious values as its purpose;
- primarily employ persons who share its religious tenets; and
- primarily serve persons who share its religious tenets.
The simple definition of “religious employer” for purposes of the exemption would follow a section of the Internal Revenue Code, and would primarily include churches, other houses of worship, and their affiliated organizations, as defined by Section 6033(a)(3)(A)(i) or (iii)
This proposed change is intended to clarify that a house of worship would not be excluded from the exemption because, for example, it provides charitable social services to persons of different religious faiths or employs persons of different religious faiths. The Departments believe that this proposal would not expand the universe of employer plans that would qualify for the exemption beyond that which was intended in the 2012 final rules.
Creating Accommodations for Non Profit Religious Organizations
Consistent with the Advance NPRM, the NPRM proposes accommodations for additional non profit religious organizations, while also separately providing enrollees contraceptive coverage with no co-pays. An eligible organization would be defined as an organization that:
- opposes providing coverage for some or all of any contraceptive services required to be covered under Section 2713 of the PHS Act, on account of religious objections;
- is organized and operates as a nonprofit entity;
- holds itself out as a religious organization; and
- self-certifies that it meets these criteria and specifies the contraceptive services for which it objects to providing coverage.
Under the proposed accommodations, the eligible organizations would not have to contract, arrange, pay or refer for any contraceptive coverage to which they object on religious grounds.
In addition, under the proposed accommodations, plan participants would receive contraceptive coverage through separate individual health insurance policies, without cost sharing or additional premiums. The issuer would work to ensure a seamless process for plan participants to receive contraceptive coverage.
With respect to insured group health plans, the eligible organization would provide the self-certification to the health insurance issuer, which in turn would automatically provide separate, individual market contraceptive coverage at no cost for plan participants. Issuers generally would find that providing such contraceptive coverage is cost neutral because they would be they would be insuring the same set of individuals under both policies and would experience lower costs from improvements in women’s health and fewer childbirths.
With respect to self-insured group health plans, the eligible organization would notify the third party administrator, which in turn would automatically work with a health insurance issuer to provide separate, individual health insurance policies at no cost for participants. The costs of both the health insurance issuer and third party administrator would be offset by adjustments in Federally-facilitated Exchange user fees that insurers pay.
The NPRM also proposes that an eligible religious non profit organization that is an institution of higher education that arranges for student health insurance coverage may avail itself of an accommodation comparable to that for an eligible organization that is an employer with an insured group health plan.
The NPRM on women’s preventive services coverage is available here: http://www.ofr.gov/inspection.aspx.
For more information on women’s preventive services coverage, visit: http://www.healthcare.gov/news/factsheets/2011/08/womensprevention08012011a.html.