Fight over birth-control mandate becomes battle to frame debate

Democrats successfully shifted a debate over religious liberty to birth control last week, but opponents of the contraception mandate are trying to shift it right back. 

The political debate over the birth-control mandate in the healthcare law is largely a fight over how to frame the issue. To the left, it’s about women’s health; to the right, it’s a question of religious freedom. And the battle between those two narratives is far from over.
 

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Religious institutions are beginning to challenge the contraception mandate in court, and the White House faces a key test as it tries to figure out how its policy will work for self-insured employers.
 
It’s a tricky issue with no clear solution in the framework the administration has laid out so far. And no matter what it comes up with, the White House will be back in the position of trying to reconcile a birth-control mandate with objections from religious groups — a smaller-scale version of the same tight spot it squeezed out of just two weeks ago.
 
Some religious employers said there’s little hope for an acceptable policy, and are instead pinning their hopes on legal and congressional challenges.
 
“Right now we certainly hope that this is not a bridge we’re going to have to cross,” said Jane Belford, chancellor of the Washington Archdiocese.
 
The Washington Archdiocese self-insures, meaning it pays for employees’ healthcare benefits out of its own pocket rather than buying a plan from a traditional insurance company. It covers 3,600 employees and does not pay for birth control, Belford said.
 
Under the White House’s proposal, most employers must cover contraception in their employees’ healthcare plans without charging a co-pay. Churches and houses of worship are exempt altogether. Religious-affiliated institutions, such as Catholic hospitals and schools, don’t have to pay for the coverage through their own plans — their employees will instead get contraception directly from the insurer, still without a co-pay.
 
When the employer and the insurer are the same entity, though, no one seems to know what will happen.
 
“This is really unprecedented, to have the government mandate something that would force us to violate our religious beliefs or else suffer a penalty,” Belford said.
 
A White House official said the administration will begin meeting “in the coming days” with religious organizations and insurers to try to hammer out policies “that respect religious liberty and ensure access to preventive services for women enrolled in self-insured group health plans sponsored by religious organizations.”
 
Health and Human Services Secretary Kathleen Sebelius also emphasized last week that the administration is looking for a solution that will not require religious institutions to pay for contraception.
 
Belford said it will be difficult to find a workable compromise because the mandate attempts to define what is and isn’t a religious institution. Its all-out exemption is for entities whose sole purpose is to advance a particular faith. But the Catholic Church also has an outreach mission, she said, which it advances through its work with hospitals and schools.
 
“As long as that language stands, this mandate infringes on our religious liberty,” Belford said.
 
The White House gave itself a year to figure out how to deal with self-insured plans, meaning it won’t have to wade into the issue before the presidential election.
 
In the meantime, supporters of the White House policy still appear to have the political upper hand. Buoyed by images of an all-male panel of witnesses at a hearing on the mandate last week, they’ve aggressively framed the debate as a women’s health issue.
 
That frame has caught on — “Saturday Night Live” skewered Republicans this past weekend for their handling of the mandate, and “The Daily Show with Jon Stewart” spent several minutes on the issue earlier in the week. House Democrats’ campaign arm is fundraising off the controversy, and has gathered nearly 300,000 signatures for an online petition since last Thursday.
 
When President Obama announced “accommodations” for religious employers, some Republican pundits warned that continuing to attack the policy will look like an attack on contraception. His move divided Catholic opposition and helped quell objections from Democrats on Capitol Hill.
 
A new survey from Public Policy Polling also showed strong support for the White House policy. Sixty-seven percent of those polled said all women should have the same access to healthcare, regardless of their employers’ religious beliefs, while 27 percent said employers should be able to deny certain benefits because of their religious convictions.
 
The U.S. Conference of Catholic Bishops opposes the policy, even with the changes Obama announced, and a certain degree of entrenched opposition was always expected. Belford, in addition to arguing that the birth-control mandate infringes on religious freedom, said she’s also worried that the contraception mandate could become a slippery slope, eventually requiring Catholic institutions to provide coverage for abortion.
 
If contraception is a preventive healthcare service, she explained, pregnancy must be a medical condition to be prevented — and treated.

“It’s not too outlandish or unrealistic to think that will be the next mandate,” Belford said.
 
From there, the government could require coverage for embryonic stem-cell therapies or “elective euthanasia,” she said.


— This story has been updated to correct the spelling of Jane Belford's name.