The Contraception Coverage Debate Isn't Just About the Bishops

By Amy Sullivan

Obama should do right by the progressive Catholics who made his health reforms possible and expand the religious exemption to the new contraceptive mandate in the law.

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If abortion rights advocates are feeling their oats this week, they have good reason. In just two-and-half a weeks, they've claimed two major victories, forcing the Susan G. Komen Foundation to back off its policy change denying grants to Planned Parenthood clinics and convincing the Obama administration to maintain only a very limited exemption for religious employers in the new contraceptive coverage mandate, which is set to go into effect on August 1. Part of Obama's health-care reform bill, the new mandate will for the first time require most employer-provided private health-care plans to cover birth control without a co-pay or deductible.

These and other political fights over the past year have seen women's health activists adopt an increasingly combative stance. So news this week that the White House is considering broadening the religious conscience exemption have activists firing off action alerts urging the White House not to cave in to the Catholic bishops. But they might want to consider another message instead: thank you.

Let me explain. Abortion rights organizations, pro-choice Democrats, and the media have all characterized the debate over this contraception coverage rule as a struggle between the White House and the Catholic bishops. In its editorial supporting the decision, the New York Times praised the Obama administration for "with[standing] pressure from Roman Catholic bishops and social conservatives." But that's not accurate.

The list of Catholics who have lobbied the administration to consider a broader definition of "religious employer" than now exists -- one that would cover institutions like Catholic universities and hospitals -- includes politically progressive Catholics who have been close allies of the White House, like Father John Jenkins, the president of the University of Notre Dame who stood up to conservatives who wanted Obama disinvited from giving the school's commencement address in 2009. It includes pro-life Catholic Democrats like Senator Bob Casey, who now faces an even tougher reelection campaign in Pennsylvania because of his vote in favor of Obama's health reform plan. And it includes precisely those Catholic hospital officials and progressive nuns whose support of health reform provided reassurance and cover for the holdout Catholic Democrats who voted to make it law. In doing so, they made possible the largest expansion of contraception access in U.S. history.

Without the work of women like Sister Carol Keehan, president of the Catholic Health Association, and Sister Simone Campbell of the Catholic social justice group NETWORK, there would be no health reform and therefore no contraception coverage mandate to argue over -- not just for the employees of Catholic hospitals and universities, but for the estimated 24 million other women who will benefit from this aspect of the law.

So, yes, a little gratitude from women's health advocates and other liberals would be appropriate. Instead, when these Catholic sisters and others asked for some flexibility with regard to the mandate, the advocates pooh-poohed as irrelevant their concerns about religious liberty and insisted that "the bishops" were the only ones who had a problem with contraception coverage.

The White House also bears its own large share of the blame for how it has mishandled the issue. Last August, the administration put forward the narrow exemption for religious employers as its starting point, giving it nowhere to go. Abortion rights groups didn't want a conscience exemption -- for anyone -- and Catholics balked at accepting such a limited definition, which covered only organizations that primarily employ and primarily serve individuals who share their religious tenets. This definition excludes most Catholic universities and hospitals, and many social service organizations, although it does include houses of worship. Then in November, Obama met in the Oval Office with Cardinal-designate Timothy Dolan, president of the U.S. Conference of Catholics Bishops (USCCB), and reportedly assured the powerful prelate that he would "be pleased" with the administration's final resolution of the issue. But Dolan is most assuredly not pleased. He had requested the meeting to make clear his objections to the narrow exemption, and said earlier this week that he felt personally betrayed by the outcome.

But the most tone-deaf move -- the one guaranteed to turn the behind-the-scenes debate into a public controversy -- was made by whoever decided the administration should announce the final rule in connection with the anniversary of the Roe v. Wade decision. The rule is not about abortion, so the signal the White House meant to send was unmistakable: this is a gift for our pro-choice supporters. The symbolism alone undercut the feeble attempts of HHS Secretary Kathleen Sebelius and Obama advisers to insist that they had struck "the right balance between respecting religious beliefs and increasing women's access to critical preventive health services."

Until David Axelrod and others began to indicate this week that the president was open to reconsidering the religious employer exemption, White House spinners had doggedly ignored the fact that the relevant issue that troubles Catholics about the rule is religious freedom, not contraception. Religious liberty concerns are why Catholic journalists like E.J. Dionne, Melinda Henneberger, and Mark Shields -- none of whom argue that contraception morally wrong -- have criticized the White House decision. Similarly, religious organizations like the Baptist Joint Committee, Lutheran Church-Missouri Synod, National Association of Evangelicals, and the Orthodox Union all support the use of contraception but have expressed their opposition to the rule as well. More than 90 percent of U.S. bishops, not all of whom are conservative, have spoken out against the rule, and many have sent letters to be read from pulpits in their dioceses urging Catholics to engage in civil disobedience. Meanwhile, while the White House touts lists of doctors and scientists who support the rule, no major religious group has stepped forward to defend the White House's decision.

The question for Sister Keehan and Father Jenkins, for Senator Casey and Sister Campbell, is not whether lay Catholics disagree with the Church's teaching on birth control (a majority do) or whether nearly all Catholic women use birth control at some point in their lives (they do). It is not even whether some Catholic institutions already pay for employee health plans that include coverage for contraception (some do). The question is whether the federal government should be able to require a religious institution to use its own funds to pay for something it finds morally objectionable.

There's no denying that the Conference of Catholics Bishops has made it very difficult for the president to extend a hand and negotiate in good faith. They have made the contraception rule Exhibit A in their claim that Obama is waging a "war on religious freedom," and they continue to provide fodder for Republican presidential candidates who attack Obama as anti-religion. Yet 28 states have passed similar measures mandating employer-provided contraception coverage without prompting cries of a war against Catholics. And even some Catholic dioceses, including the one in Madison run by the very conservative Bishop Robert Morlino, have decided that it is morally acceptable to select health plans that cover contraception when self-insured plans prove prohibitively expensive.

But just because the Conference of Catholics Bishops has effectively declared Obama a political opponent and is spoiling for a fight this election year does not mean that the administration has to respond in kind. And that's why Obama and his supporters in the women's health community would be wise to remember that the contraception mandate is not a showdown with "the bishops." The USCCB's point man on abortion issues, Richard Doerflinger, has already declared that the likely solution to this mess -- the so-called Hawaii compromise -- unacceptable. (In Hawaii, religious employers can invoke a refusal clause that allows them to exclude contraception coverage from employee health plans, while still entitling workers independently to buy contraception coverage from insurers at a cost that is no higher than the price the employer would have paid.)

Obama should ignore Doerflinger and he should ignore any abortion rights groups that say a reconsideration of the rule is "caving into the bishops." He and his administration committed an unforced error with this policy decision, but he can and should correct it. Admitting that the administration's initial solution was insufficient isn't weak. It's doing right by the brave Catholics who made his health reform law -- and this contraception coverage mandate -- possible in the first place.

Image credit: REUTERS/Kevin Lamarque

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http://www.theatlantic.com/politics/archive/2012/02/the-contraception-coverage-debate-isnt-just-about-the-bishops/252780/