When the Department of Health and Human Services announced the rules concerning the scope of the religious exemption for mandatory coverage of contraceptives, sterilizations and abortifacent drugs, there was an uproar. In response, on Friday afternoon, the President announced a compromise meant to allow Catholic organizations to stay true to their values and maintain the Administration’s goal of providing contraception without cost to all.
The compromise fell short.
First, a bit of background on myself. I’m not a conservative using this to reignite the “Obama Hates Religion!” crowd or trying to reignite the health care reform debate as a whole. I’m not really a Democrat, but I’m definitely not a Republican either. I’m a bit everywhere. I thought the health care reform—all-in-all—was a good thing. Ensuring that all insurance plans include maternity coverage, for example, is great thing.
There are plenty of points to debate. Is it really “insurance”, as an instrument to spread risk among a large pool, when it pays out for virtually everything? Would a “warranty” system make sense (to be covered by insurance, you agree to a physical, at a reasonable cost incurred by you, every 24 months or so—”scheduled maintenance” required)? What is the role of the employer-based insurance system? How to handle pre-existing conditions? How to ensure folks don’t want to buy it until they need it?
While not perfect, I believed that the health care reform law was going to do good things and help a lot of people. The Bishops had valid concerns about conscience protection, coverage for abortions and whatnot. I was a bit naive and assumed that would all get ironed out. This is America, after all. Some basic freedoms are sacred, right?
I’m one of those Catholics who supported the health care law. I know it was—and still is—flawed, but it was better than doing nothing, right? I went out on a limb to support the President, took plenty of heat, but in my heart of hearts, felt that it was better than the status quo and no change would be perfect on the first draft.
Well, eggs on my face. The President made me look like an idiot. The President made a lot of people who supported him in this look like idiots.
Back to this compromise.
It isn’t one. Not by a long shot.
Churches are exempt, great, but what outside of the parish and diocese be exempt? Most say local Catholic schools, but that’s not a given. Would a Catholic school be required to provide documentation that at least half of their employees and half of their students are Catholic? Catholic Charities wouldn’t, unless we started a religious test for receiving services. Catholic universities, like St. Edwards, Notre Dame or the Catholic University of America would fail. Religiously-based non-church sponsored organizations, like EWTN, Casa Juan Diego, and the majority of lay-initiated and directed Catholic organization, wouldn’t qualify for the total exemption or the compromised exemption.
At face-value, though, the compromise looks great. Religious organizations can’t in good conscience pay for these drugs, so bypass them. Make the insurance companies spring for them. Perfect!
While it is an extremely valid point, let’s grant that insurance companies wouldn’t use a single cent of premium money from the church to provide those drugs and services. Let’s assume, even though I don’t think we should, that insurance companies would fund that through other premium payment revenues. They claim contraception will reduce overall cost of healthcare, so okay, perhaps, maybe, health insurance companies would spring for that.
I haven’t read the research to back up that claim, so I’ll defer that argument for later.
Even with that massive assumption, the compromise still falls short.
Parishes are independent, in one sense. When I worked in a parish, I was an employee of the parish. It was its own 501(c)3 non-profit, with it’s own legal governing board (at that time in this diocese, the bishop, vicar general and pastor, with the option of two appointed positions, were the legal board of a parish). We set our own HR policies. We decided internally to offer 403(b) (a 401(k) for non-profits) plans or not. My paychecks were from the parish, not the diocese. The diocese suggested some policies, required others, but strictly speaking, we were legally separate.
To pool resources and reduce costs, the diocese and the parishes join into the same health insurance pool. It is done different ways in different places, but one very common approach is the self-insured pool. In such a case, all claims paid by the insurance pool are paid for by money from that pool. A church may contract with Blue Cross Blue Shield to act as a “third-party administrator”, which means the church pays BCBS some to administer the program, the church—through the premiums charged to the parishes and employees—pays all claims while giving employees access to the range of options possible when having coverage through a large insurance operation, like BCBS.
For one, the compromise fails there. If all claims are paid for by the diocesan pool, there’s no way or reason for the insurance companies to offer it. Their risk would not be reduced by those insured being on or off contraception. The diocesan pool would pay those claims either way. Even if they say that the insurance pool itself wouldn’t cover it, but BCBS would, at best case, that would simply mean the administrative cost of the third-party administrator would increase, as would our fee to them.
There might be a world where a company like BCBS, which is non-profit, would make other employers pay for the contested services, not increase the administrative fee and not touch the diocesan pool of money, while seeing no economic benefit, real or perceived, but I was fooled once by this Administration. Fool me twice? I think not.
But, churches and dioceses are fully exempt! That’s just a way to derail the conversation!
Then enter Catholic Charities. I don’t know how it works everywhere. Perhaps some larger operations act as their own employer for insurance purposes, but many are included in the diocesan pool. As Catholic Charities would not be exempt, the diocese would be paying for contraception. Since Catholic Charities premiums wouldn’t pay for it, it would be paid for using everyone else’s premiums. Fantastic.
Then enter organizations like Casa Juan Diego in Houston. They’re not a ministry of the archdiocese on any level. They are not part of any archdiocesan insurance program. They are, without question, a religious organization. They never ask the faith tradition of anyone seeking shelter, food, clothing or medicine from them. Their clinic is free to anyone who shows up and they purchase the medication at their own expense. Morning prayer is part of the daily routine. Mass on site once a week. A shuttle to Mass every Sunday. You don’t have to participate in those religious functions to receive their services, but there is no way to remove the religious aspect to their work.
They have health insurance for their workers through Christian Brothers, a Catholic organization that aimed to help Catholic organizations, like religious orders, schools, related non-profits, pool their resources to obtain a better financial foundation for their insurance, retirement, etc needs. (They’re related, but separate from the Christian Brothers religious order.) Christian Brothers act, in one sense, like a really big diocesan pool, but they serve as their own administrator.
Under the mandate and the compromise, Christian Brothers, under every way you slice it, would have to pay for these services. The compromise falls short.
The only thing the mandate and compromise accomplishes is to cement that while I’m definitely not a Republican, I am definitely not a Democrat either.
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