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A modified mandate.

Byline: The Register-Guard

Both Planned Parenthood and the Catholic Health Association applauded the Obama administration's attempt to dampen the furor that arose after the White House ordered that contraception be included among the mandated services covered by employer-provided health insurance plans. That's evidence of a good compromise. But not everyone will be satisfied, because the contraception mandate has become a surrogate for other targets - Obama, his health care reform law, government's presumed hostility toward religion, and contraception itself.

The Catholic Church, whose doctrine forbids artificial contraception, led the opposition to the mandate, which was announced on Jan. 20. The White House was not demanding that contraception coverage be offered to employees of any church - churches are exempt. The conflict involves institutions such as the Catholic Church's network of universities and hospitals. Catholic institutions run 629 hospitals, including PeaceHealth's hospitals in Lane County, that employ 14 percent of the nation's hospital workers. The church refused to be compelled to pay for contraception for those employees.

Except it already does. Twenty-eight states, including Oregon, mandate contraceptive coverage by employer-provided health plans. Eight of those state mandates include no exemption for religious institutions. In others, the exemption is narrow. Oregon, for instance, exempts "religious employers" whose purpose is "the inculcation of religious values." To qualify for an exemption such employers must primarily employ people "who share the religious tenets of the employer," and mainly serve people who subscribe to those tenets.

PeaceHealth doesn't meet those standards. Though PeaceHealth won't comment on whether its employees have access to contraception as part of their health care coverage, its employee benefits handbook mentions no exclusion. Other Catholic hospital systems and universities across the country quietly cover contraception, either on their own or in response to a state mandate.

Despite the prevalence of state mandates, Obama announced a compromise Friday: Insurance companies, not employers, will be required to pay for contraception services. Of course, insurers will have to cover the costs of contraception somehow, and the money will come from the insurance premiums paid by their customers, including those who object to contraception. But the revised mandate places the Catholic church and others at one remove from direct financial support for contraception, which from their point of view should be an improvement.

Whether the mandate is direct, as in Oregon, or indirect, as Obama now says it will be, no employee is required to use contraception. Those who share the church's position are free to follow its proscriptions. It's hard to see how this is an "assault on religion," as Republican presidential candidate Mitt Romney claims - even though while Romney was governor Massachusetts required all hospitals, religious and secular, to provide emergency contraception to victims of sexual assault, a more intrusive mandate than Obama's.

Viewed as a public health issue, contraceptive coverage is a valuable benefit, both financially and in terms of women's well-being. And as a practical matter, the great majority of Catholic women practice artificial contraception at some time in their lives. An attempt to ensure broad access to contraception is in accord with the findings of the Institute of Medicine, an affiliate of the National Academy of Sciences, which says contraception promotes women's health, leads to lower insurance premiums and reduces the incidence of abortion.

But opponents of contraception are emboldened by resistance to Obama's health care reform, support from prominent anti-contraception figures such as Republican presidential candidate Rick Santorum and a recent U.S. Supreme Court decision granting a Lutheran school a broad exclusion from anti-discrimination laws. Opponents continue to characterize the contraception mandate as an attack on religious liberty. Some say no employer, secular or religious, should be required to pay for contraception coverage.

Yet in an earlier decision, the Supreme Court ruled that two Oregon members of the Native American Church could be denied unemployment benefits after being fired for using peyote in a religious ritual. Justice Antonin Scalia, writing for the majority, said that religious belief does not free citizens from their obligation to obey the law.

Clearly, the degree to which religious people and institutions must follow laws that conflict with doctrine or conscience lies somewhere between full exemption and universal compliance. The president's modified mandate succeeds in striking that balance - but a balanced approach between public health and religious liberty is not what some are seeking.
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Title Annotation:Editorials and Letters
Publication:The Register-Guard (Eugene, OR)
Date:Feb 11, 2012
Words:718
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