The Health and Human Services Administration issued an “Advanced Notice of Proposed Rulemaking” on Friday afternoon, titled “Certain Preventive Services Under the Affordable Care Act.”
Bottom line: this is an escalation by the administration in enforcing the mandate that employers will provide abortion-inducing drugs, sterilization, and contraception without copay in health insurance plans. There is no compromise here. Employers who aren’t associated at all with religious institutions, but object to providing abortion-inducing drugs, sterilization, and contraception are not addressed. Self-insured religious institutions will have to provide the same “services.” This notice expands the requirement for these “services” to college students, even those at religiously affiliated schools.
This notice contains the rules that will enforce the mandate for religious employers who do not qualify for the extremely narrow “religious exemption” under the HHS definition–such as universities, charities, and hospitals. One question raised over the past weeks of debate has been that of self-insured institutions; many Catholic dioceses, universities, charities, and hospitals are self-insured. Friday’s HHS notice confirms that self-insured employers will also have to provide health insurance for employees that includes abortion-inducing drugs, sterilization ,and contraception.
Before we examine the notice itself, I’d like to offer an example that explains why the so-called “accommodations” don’t fix the problem. The “accommodations” propose that the religious organization itself doesn’t have to pay for the objectionable “services,” rather, the insurance company or third-party administrator pays. Here is an example from a friend who has daughters:
What if someone required that I prostitute my daughters? I, of course, would object. The accommodation basically says Mr. “Smith,” don’t worry, just go to work. You don’t have to take your girls to the brothel, pay for transportation, or even ask someone to drive them. While you are at work, a pimp will come by and pick them up; you won’t even know it is happening. When you come home, your girls will have already been returned. See? We’re accommodating your idiotic scruples!
From the HHS notice:
First, the Departments aim to maintain the provision of contraceptive coverage without cost sharing to individuals who receive coverage through non-exempt, non-profit religious organizations with religious objections to contraceptive coverage in the simplest way possible.
The HHS has no intention to change its purpose in this. Religious liberty and freedom of conscience will not be respected.
Second, the Departments aim to protect such religious organizations from having to contract, arrange, or pay for contraceptive coverage. As described below, the Departments intend to propose a requirement that health insurance issuers providing coverage for insured group health plans sponsored by such religious organizations assume the responsibility for the provision of contraceptive coverage without cost sharing to participants and beneficiaries covered under the plan, independent of the religious organization, as a means of meeting these goals.
This requirement proposed by the HHS has been widely recognized as a shell game. HHS will direct insurers to pay for the cost of abortion-inducing drugs, contraceptives, and sterilization. Where will the money to pay for these services come from? The employer, of course–that is, the religious organization who morally objects to these “services.” An insurance plan for a religious organization can never be independent to the organization.
As noted in the New York Times, this notice is an escalation by the administration. Even the Times sees this for what it is–and it is not a compromise. The HHS is escalating in at least two areas. First, student health insurance plans will provide the same abortion-inducing drugs, sterilization, and contraception for students, even students at religious institutions that find these “services” abhorrent. From the HHS notice:
HHS also intends to propose a comparable requirement with respect to student health insurance plans arranged by such religious organizations.
The other area of escalation is for self-insured organizations. The HHS proposes a shell game that is much the same as that for non-exempt religious employers:
For such religious organizations that sponsor self-insured plans, the Departments intend to propose that a third-party administrator of the group health plan or some other independent entity assume this responsibility. The Departments suggest multiple options for how contraceptive coverage in this circumstance could be arranged and financed in recognition of the variation in how such self-insured plans are structured and different religious organizations’ perspectives on what constitutes objectionable cooperation with the provision of contraceptive coverage.
The notice conveniently leaves a few critical questions unanswered. Who will provide the money for claims for “services”, and who will pay the fees to the “third party administrator?” These are both normally paid by the employer.
As you read this notice, the linked articles, and this author’s comments, keep in mind the context. Politicians, bureaucracies, corporations, and institutions don’t release good news on Friday afternoons. They release news that is meant to be obscured, ignored, and certainly not highlighted. It’s called the Friday close-of-business news dump. A presidential administration releases good news meant for the widest distribution and influence in the beginning or middle of the week and in the middle of the news and business day, and usually with a live press conference.
This notice is news that the administration wants to slide under the radar. They are saying: Watch your basketball games, folks; go the Saint Patrick’s Day parade. Move along, there’s nothing here to concern you.