President Obama’s 2010 health care law requires large employers to provide health insurance and, according to the Department of Health and Human Services, that contraception be covered by those policies. From a policy perspective, the contraception mandate makes sense. But when the employers in question are affiliated with religious groups that object to birth control, balancing their religious liberty against public health is far from simple.
On Friday, the Obama administration elaborated on its attempt — in our view, a successful one — to strike a sensible balance.
The group health plans of religious employers such as houses of worship would be exempt from the mandate. Nonprofit organizations associated with a religious group — a Catholic university, say — would not be required “to contract, arrange, pay or refer for any contraceptive coverage to which they object on religious grounds.” Instead, insurance companies would be on the hook. HHS would require insurers to provide contraceptive care to employees through individual insurance policies, cordoned off from the organization’s group plan. This would be no great burden on the insurance companies; they will likely save money because they won’t have to pay the costs associated with unintended pregnancies. Employees at institutions that self-insure, meanwhile, would gain access to contraceptives through unaffiliated insurance companies, which would get a small break on some fees for their trouble.
Critics say that these arrangements are simply a numbers trick; religious employers, they argue, would still, in some way, facilitate access to contraceptives. But they would be about as insulated from the provision of contraceptive coverage as they could reasonably expect to be while participating in a big health insurance pool.
The public health case for widespread access to contraceptives is compelling. In an authoritative review published in 2011, the Institute of Medicine reported that unintended pregnancy is “highly prevalent” — accounting for half of all pregnancies in 2001 — and that unintended pregnancy is associated with higher rates of preterm birth and low birth weight. Unintended pregnancy also leads to abortion; in 2001 nearly half of unintended pregnancies were terminated. Access to free contraception would combat these effects, particularly among the poor, for whom copayments present a barrier.
The Obama administration’s original plan did not show sufficient sensitivity to the theological concerns of religious employers. Its latest efforts get a hard question right.