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The Final Contraceptive Coverage Rule: Why You Should Stay Away From Any Organization That ‘Self-Certifies’

Written by Bridgette Dunlap forRH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

On June 28, the Obama administration released the final version of the contraceptive coverage rule. Beginning January 1, 2014 women who aren't already benefiting from the Affordable Care Act's mandated contraceptive coverage, like those employed at religiously affiliated organizations that took advantage of the enforcement safe harbor, will be able to receive contraceptive coverage directly from their insurance companies, rather than their employer-provided plans. This "religious accommodation" makes employers' involvement in contraception use even more remote, while ensuring that women still have access. [1]

The bishops and other anti-contraception crusaders will not be happy with the religious accommodation, so expect the lawsuits dismissed as premature or held in abeyance back in court soon. That aside, it is important to understand how far the Obama administration bent for the contraception opponents and how little it demanded in return. Organizations are not even required to make their religiously based objection to birth control public.

Granting the religious accommodation without abandoning women with religiously affiliated employers is possible because of the unusual economics of contraceptive coverage: the Obama administration can tell insurance companies to cover contraception without a co-pay, because providing it is cost-neutral for insurers. All (reasonable) parties can have their way—employers don't have to provide plans with coverage, but employees can still get it, and insurers don't have to pick up "the bill" because there really isn't one. But the problem remains that religiously affiliated employers are being excused from the law without having to make even the smallest disclosures about their organizations in return. This sets an unwelcome precedent for future demands for special treatment.

I argued both in a piece for RH Reality Check and in a comment to the rule that the "self-certification" for the religious accommodation should entail explicit and public disclosures about how the organization "holds itself out as religious," who determines what constitutes the religious beliefs of the organization, and what those beliefs are. In releasing the final rule, the government acknowledged it received comments to that effect, but further reduced the disclosures required for the accommodation. In order to qualify for the religious accommodation, organizations need only fill out a two-page form and file it with their insurer. And the form no longer even requires organizations specify the contraceptive services to which they object.

This is an invitation for organizations to characterize themselves as religious when they want an exemption from the law but secular when they want government funding.

 

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