Friday, February 1, 2013


The Administration announced today its long-awaited clarification on exemptions from the so-called "HHS Mandate" requiring employers to cover contraception costs (completely - without even a co-pay!) for their employees. Churches have been exempt from the beginning, but conflict has swirled around the application of this mandate to religious insitutions which serve the larger society and not exclusively their own members - e.g., Catholic hospitals and schools. An earlier compromise permitted such institutions to opt out of directly paying, shifting the direct cost to the insurer. That, however, hardly helped the many religious institutions that are self-insured. One result has been a number of lawsuits by such institutions challenging the mandate on First Amendment grounds. (Some private, for profit companies have also sued, on the grounds that their owners' religious beliefs are infringed upon by being required to conform to the mandate. Today's clarification applies only to religious institutions, not private for-profit ones, which will have to resolve their objections separately in the courts.)
Today's clarification calls for religious institutions which object to the mandate to certify that they are non-profit and that religion is a core component of their mission. In the case of those institutions that self-insure would have a "third party administrator" to provide the controversial coverage through separate individual health insurance policies. How this is to be paid for is not completely clear from what I have read so far. And, of course, the devil is always in the details, as the saying goes. Still, it sounds like the making of a workable political compromise.
In the ideal world, of course, pregnancy would not be considered a disease, and no such coverage would be considered necessary. In a more just and egalitarian society, certainly there would be other medical and health needs which would warrant free coverage (i.e., without co-pay) way ahead of contraception. Think of all the rural poor who suffer all sorts of health problems for lack of ability to afford dental care, for example.
Of course, in the real world, politics is about building coalitions and shoring up the support of specific interest groups. There is no doubt that there is a constituency to be appealed to by providing free contraceptive coverage. Someone (I think it was JFK) supposedly said that the first duty of a great President is to get elected. Getting elected requires creating coalitions of interest groups and successfully shoring up the support of those groups by pandering to issues they particularly care about. There is nothing new or particularly reprehensible about that. It's been with us throughout our entire national history, because it is part and parcel of how a democracy functions. So the mandate itself should have come as no surprise.
What was surprising was the Administration's initial tone-deafness about crafting this in a way which would have allowed religious institutions, which do so much good and important work in the networks of our civil society, to continue to make those contributions - rather than be forced to shut down their social service agencies, schools, etc. Had the thing been better crafted in the first place, all concerned might have avoided the unfortunate conflict that followed.
Of course, the failure to craft a compromise at the outset and the strong pushback it produced form religious institutions created a winning campaign issue. Now that the campaign is over, however, it is time for some fence-mending and compromise in the interest of salvaging the vital network of religious-based voluntary associations which have been so significant a part of American social and civic life for so long.

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