The Obama administration promised a year ago that it would address the concerns of religiously affiliated institutions that object, on religious grounds, to providing free contraceptive care to their women employees, as mandated under the Affordable Care Act. The compromise proposal outlined Friday by Secretary of Health and Human Services Kathleen Sebelius appears to reasonably fulfill that pledge by shifting administrative and cost responsibilities for such care to insurers.
Under the proposal, religiously affiliated entities would not be held accountable for administration and costs for such coverage. That would be organized and provided by insurance companies in return for credits on the fees that will be charged to insurers when they begin participating in the state health insurance exchanges that will open in January 2014.
In a larger view, the proposal might seem to be simply passing along the costs of such free reproductive care to the general insurance market, and hence to all who pay for insurance. In fact, however, expert health care analysts say that broadening the reach of free contraceptive care will actually reduce the overall cost of health care, because women who fail to receive such care — and many cannot now afford it — generally create greater costs in the nation's overall health care system.
Simply put, the more women who receive contraceptive and reproductive care, the lower the overall costs on the health care system for unplanned pregnancies and miscarriages, menstrual dysfunction and abortions.
In that perspective, the ACA mandate should never have caused any controversy. Churches, temples and other purely religious institutions which objected on religious and moral grounds to providing contraceptive care to women employees were not included under the ACA mandate from the beginning. And the mandate for free contraceptive care was not considered an onerous burden, if a burden at all, for most nonprofit religiously affiliated entities such as universities and hospitals. That's because these entities generally organize health insurance for students and workers from a variety of faiths, backgrounds and beliefs.
Representatives of religiously affiliated organizations and their Republican representatives, however, deliberately conflated their religious views with their political opposition to the ACA. They did so initially to try to defeat the ACA in the Supreme Court, and then to defeat President Obama in the November elections. And even now, some seem certain to continue lawsuits over their view that the ACA's contraceptive mandate somehow intrudes on their religious and moral views and administrative responsibilities.
At this juncture, it's hard to see how they could make a viable case that the latest proposal violates their religious views and responsibilities as employers. Whether they pay for or subsidize their employees' health insurance, they would not be required to do anything other than inform their insurer that they will not provide free contraceptive care. The insurer would then proceed to organize such care independently.
There continues to be resistance to the contraceptive from some secular employers as well, but the administration is not expected to offer special accommodations to this sector, nor should it. Such a retreat is not necessary on legal and constitutional grounds for laws that mandate rules of general application. Any retreat from that standard could rapidly unravel broad participation in the Affordable Care Act. American women deserve comprehensive care, and the administration's approach is well suited to provide that.