Church officials and other religious-based groups are gearing up to fight an order by the Obama administration that they include birth control in employee health plans — a requirement some say could threaten the protection of other moral beliefs and practices.
"Most civilized nations have allowed deeply held convictions by religious groups in these areas to be respected. I don't know why our president is not doing so after speaking [Tuesday] night so wonderfully about compromise and all of us working together and joining together," Cardinal-designate Edwin F. O'Brien, leader of the Baltimore archdiocese since 2007, said Wednesday. "I don't see him doing that. It is a pity."
The U.S. Department of Health and Human Services last week rejected a request by Catholic groups to be exempt from a requirement under health care reform to cover contraception and sterilization, practices their religious teachings oppose. The administration has given religious groups a year to abide by the law, which women's rights groups support.
"We were hoping our religious convictions so deeply held would be reflected," O'Brien said during his first public appearance since his appointment to the College of Cardinals. He described President Barack Obama, who talked about working together in his State of the Union speech the night before, as unwilling to compromise.
David Cloutier, associate professor of theology at Mount Saint Mary's University, said the Catholic church in particular has a lot to lose over the birth-control issue, which has long split liberal and conservative members of the church.
The church in 1968 upheld teachings against the use of birth control and that has been a crucial part of its moral message ever since, Cloutier said. Allowing government action to influence religious beliefs could be seen as a deeper threat, blurring the lines between church and state, he said.
"The state telling the church that it must provide services that the church believes are immoral is the dividing line that doesn't really have a clear precedent," said Cloutier, the editor of catholicmoraltheology.com. "Once you cross this line, then [churches and religious groups] are obviously concerned that the government could force them to cover abortions for their employees. That the government could make them acknowledge same-sex marriage for their employees."
It is unclear what religious groups and churches will do. They could challenge the issue in court or encourage Congress to pass legislation with an exemption. They could also wait the issue out until after the November election — when Obama could be swept from office — or until the Supreme Court rules on the constitutionality of the entire health care reform law.
The Obama administration mandated the coverage of birth control last summer, after developing a list of preventive tests and procedures that should be covered without additional co-pays or deductibles under health care reform. They included exams for breast and colon cancer, and for sexually transmitted diseases — and all Food and Drug Administration-approved birth control — and become effective as plans begin to renew, beginning in August.
Health and Human Services said the decision on contraception was necessary to reduce health costs and provide better access to the most commonly taken drugs by young and middle-aged women.
Many organizations and lawmakers applauded the move, including Maryland Democratic Sen. Barbara A. Mikulski. "I believe the administration has struck the right balance to ensure women have access to needed medical services while also protecting and respecting the rights and beliefs of religious organizations," she said.
David Gibson, the author of books on Catholicism, said many religious groups and churches are still in shock, and some feel betrayed, because it was widely expected the Obama administration would support the exemption.
"It made sense in terms of not just religious freedom, but also in terms of politics," Gibson said. "A lot of these groups that will be affected are groups that essentially support Obama's agenda in terms of social justice, budget priorities and taking care of the poor."
Gibson said it is still unclear how the federal government would enforce the requirement. In states that have similar laws, churches have managed to get around the issue, he said. Often the law is not enforced.
"I think it would be [unusual if Obama] were sending the cops out after a bunch of nuns," Gibson said. "That seems implausible."
Loyola University in Baltimore said it will not make any immediate changes to its health offerings because of the decision. A health maintenance organization plan offered to employees covers prescription contraception, but another plan is more restrictive. The HMO, which has fewer subscribers, covers prescription contraception because of mandates the university was required to follow when the plan was created.
"We are aware the legislation is evolving," said Nick Alexopulos, a university spokesman. "We have not made changes to Loyola's benefits plans as a result of the legislation, but like many institutions we continue to monitor this complex issue."
Organizations such as Catholic hospitals, which say they serve one in six U.S. hospital patients, insist that waiting an extra year for the mandate to take effect doesn't solve their basic dilemma.
"Like the Catholic Health Association and other Catholic organizations, St. Joseph Medical Center is disappointed that the definition of a religious employer was not broadened … " said Vivienne Stearns-Elliott, spokeswoman for the Towson hospital. "The challenges that these regulations pose for many groups now remain unresolved."
The Catholic Health Association, which represents St. Joseph, Bon Secours Hospital, Good Samaritan Hospital, Mercy Medical Center, St. Agnes Hospital and others in the region, called it a "missed opportunity to be clear on appropriate conscience protection."
Catholic Relief Services in Baltimore said it "strenuously objects" to the Obama administration's action. The group hopes the administration will consider over the next year how the decision will hurt it and other organizations.
Good Samaritan Hospital retains its religious affiliation but is part of a non-church-related system, MedStar Health.
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"The benefit is already extended to all employees," said Johnny R. Hagerman, a MedStar spokesman. "The new mandate doesn't affect us. The religious affiliation doesn't extend to human resources."
CareFirst BlueCross BlueShield, the state's largest health insurer, provides for oral contraceptives under its standard benefit offerings, a company spokesman said. Religious organizations have always been given the option of covering or not covering oral contraceptives, and CareFirst will comply with all mandated requirements, the spokesman said.
Thomas J. Reese, director of the Woodstock Theological Center's Religion & Public Policy program at Georgetown University, said time won't help churches reconcile their beliefs with their legal obligations.
"It is a big deal because they feel that the regulations would force them to violate their consciences and their religious beliefs by paying for contraceptive coverage in the health plans since they believe that the use of contraceptives is immoral," he said. "They are not saying that contraceptives should be illegal or that people should not be allowed to purchase them. They are saying that they should not be forced to pay for their coverage in the health plans of their institutions."