Administration again tweaks Obamacare contraception mandate

Excerpted from "Administration offers new tweak to birth control rule," Washington Post, August 22, 2014 - The Obama administration, still facing legal challenges to its requirement that employer health plans provide no-cost birth control to female employees, outlined a new policy Friday to ensure that female workers at religiously-affiliated nonprofits can still receive contraception, even if their employers object. The administration also intends to offer a similar work-around to for-profit businesses after the Supreme Court's bitterly debated 5-4 decision in June that owners of closely held firms could refuse contraception coverage if it conflicts with their religious beliefs.

The new federal guidelines address a set of ongoing legal challenges to the contraceptive requirement raised by dozens of religious nonprofit groups, such as hospitals and charities, that could again put the contraception mandate before the Supreme Court. The religious nonprofits are challenging the administration's already existing opt-out, in which the groups can ask a third party to provide the contraception coverage to their employees. However, the nonprofits say that filling out the form notifying the third party violates their religious beliefs.

The nonprofits can now directly inform the Department of Health and Human Services of their religious objections. HHS and the Labor Department will then coordinate contraception coverage with insurers and third party administrators. The nonprofits still have the option to notify a third party directly.

The Becket Fund, a law firm that represents 126 nonprofit plaintiffs ranging from evangelical Wheaton College to Catholic University of Notre Dame, said Friday afternoon it hadn’t yet seen the full text of the rule and thus couldn’t comment on its specifics. Several of the country’s biggest faith groups on Friday said the revised rule was still problematic because it didn’t fully exempt organizations – for-profit or non-profit – with religious objections.

"Here we go again,” said Russell Moore, president of the policy arm of the Southern Baptist Convention, the largest U.S. Protestant denomination. “What we see here is another revised attempt to settle issues of religious conscience with accounting maneuvers. This new policy doesn't get at the primary problem.”

The U.S. Conference of Catholic Bishops said it's worried that the administration's proposal could limit which for-profit businesses can receive a religious exemption.

"By proposing to extend the 'accommodation' to the closely held for-profit employers that were wholly exempted by the Supreme Court’s recent decision in Hobby Lobby, the proposed regulations would effectively reduce, rather than expand, the scope of religious freedom,” the group's statement read.

Commentary

Senior Counsel for the Becket Fund for Religious Liberty Lori Windham’s Statement: "This is latest step in the administration’s long retreat on the HHS Mandate. It is the eighth time in three years the government has retreated from its original, hardline stance that only 'houses of worship' that hire and serve fellow believers deserve religious freedom.

"The new rule holds implications for the 102 cases, including religious charities like Little Sisters of the Poor (see video), Mother Angelica’s Eternal Word Television Network (see video) and religious colleges like Colorado Christian University. Ninety percent of religious ministries challenging the mandate have received relief from the courts, and we are hopeful the administration’s new rule will reflect the robust protections that have always been given to religious individuals in this country.

"Religious ministries in these cases serve tens of thousands of Americans, helping the poor and homeless and healing the sick. The Little Sisters of the Poor alone serve more than ten thousand of the elderly poor. These charities want to continue following their faith. They want to focus on ministry—such as sharing their faith and serving the poor—without worrying about the threat of massive IRS penalties."

Action

1. Urge your U.S. senators to support (or thank your senator for already co-sponsoring) the Health Care Conscience Rights Act - S. 1204 , to protect religious liberty and preserve patient access by providing conscience protections for healthcare professionals. (Note: You will be provided with editable text based on your senator's sponsorship or non-sponsorship of this bill.)
2. Urge your U.S. Representative to support (or thank your Rep. for already co-sponsoring) the Health Care Conscience Rights Act - H.R. 940.

Resources
Read new HHS rule

CMDA's Freedom2Care website: Freedom of faith, conscience and speech
CMDA's Freedom2Care commentaries in national newspapers
CMDA Freedom of Faith and Conscience resources

Response to the Hobby Lobby ruling

Excerpted from “CMA doctors hail Supreme Court mandate ruling, decry ongoing targeting of faith community,” CMDA News Release. June 30, 2014 — The 15,000-member Christian Medical Association, the nation's largest and oldest faith-based doctors' organization, today praised the Supreme Court's ruling in two Health and Human Services (HHS) Obamacare mandate cases but noted "increasing attempts by the government to coerce the faith community." CMA had outlined the medical aspects underlying religious objections to the HHS Obamacare mandate in its friend of the court brief in Burwell v. Hobby Lobby and Conestoga Wood v. Burwell.

CMA CEO Dr. David Stevens said in a statement, "We are very thankful that the Supreme Court acted to protect family businesses from government coercion and fines for simply honoring the tenets of their faith.

"This is a much-needed victory for faith freedoms, because this administration continues its assault on the values of the faith community. We are witnessing increasing attempts by the government to coerce the faith community to adopt the government's viewpoint in matters of conscience," noted Stevens.

CMA also filed a friend-of-the-court brief in another Supreme Court case this term, McCullen v. Coakley, to defend First Amendment free speech and assembly rights of pro-life advocates against a Massachusetts law that prohibited many citizens from entering a public street or sidewalk within 35 feet of an abortion facility.

"There seems to be growing intolerance of the faith community by some government officials who appear to want to extinguish the First Amendment freedoms that allow for a diversity of values," Stevens observed, "We are seeing this antagonism expressed in coercive government mandates enforced with harsh penalties and discriminatory practices that threaten to eliminate the faith community from the public square."

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “I’m appalled that the ruling was five to four. One vote and we would have lost religious freedom, perhaps forever, in this country. It would have impacted us as healthcare professionals most of all, as Judge Alito noted in his majority opinion. He wrote, ‘Under HHS’s view, RFRA (the Religious Freedom Restoration Act) would permit the Government to require all employers to provide coverage for any medical procedure allowed by law in the jurisdiction in question—for instance, third-trimester abortions or assisted suicide.’

“We are already seeing the co-opting of the unwilling as a result of court rulings in the same-sex marriage issue. The courts are requiring participation by family-owned businesses in wedding ceremonies, despite their religious objections. The government is also forcing recognition of same-sex marriages as a condition for federal grants in this country and abroad.

“CMDA’s amicus brief, representing you, affected the decision. It scientifically established the potentially deadly effect of two ‘morning after pills’ and two types of IUDs on nascent life before implantation. That fact was accepted in the majority opinion.

“We won the battle, but the war is not over. We must continue to fight relentlessly locally and nationally to protect healthcare right of conscience. The stakes are just too great to do otherwise.”

Resources

Learn more about CMDA’s efforts to protect the right of conscience
CMDA’s amicus curiae brief

Therapists Explore Dropping Solo Practices to Join Groups

Excerpted from “Therapists Explore Dropping Solo Practices to Join Groups,” Shots: Health News from NPR. October 24, 2013 -- In the corporate world of American healthcare, psychologists and other mental health therapists are still mostly mom-and-pop shops. But the business model for therapists is shifting away from solo practices and toward large medical groups, say mental health experts. That change is propelled by the Affordable Care Act, which mandates mental health benefits in insurance coverage, and by the Mental Health Parity Law, which requires private and public insurers to cover mental health needs at the same level as medical conditions — by charging similar copays, for example.

Organizations that advocate for mental and behavioral health — groups that long complained that they were treated as second-class providers — have applauded the federal laws. But inclusion has come with some unhappy caveats, including less pay and more paperwork. Patients used to paying $150 in cash for a therapy session will, with some limitations, have sessions covered by their health plan. That means many therapists will have to figure out innumerable insurance plans and byzantine billing codes for the first time.

In many ways, therapists are encountering what medical doctors have complained about for years: the confusing, confounding and, some might say, hostile insurance bureaucracy that providers must tangle with in order to get paid. The increasing complexity of running a practice has meant more therapists are taking down their shingles or forming groups with other therapists to share the burden, executives at national mental health groups say. Others have joined large medical groups that offer mental health services as part of comprehensive care.

Commentary

CMDA Member and Psychiatrist Robert Rogan, DO, JD: “This article touches on several current issues in mental health affecting our society. One, the loss of autonomy, may be far more serious than we realize. The freedom to serve as we in conscience believe best is something we need as believing practitioners. Conscience issues are already prominent in current medical practice in general. If we can’t ‘choose our clients,’ we may find ourselves being asked to provide therapy in an area we find morally uncomfortable.

“People do seek mental health services and pay ‘out of pocket’ not just for insurance reasons but also for privacy. The HIPAA regulations with compliance that began on September 23, 2013 seem to reflect this possibility.

“Paperwork issues are not just documentation chores but very concerning potential legal traps. Billing is serious business for more than just reimbursement reasons. We need to be truthful but careful in what we write. Also, we need to be ultra-careful what we sign. We need to know every pitfall in contracts we sign. If there is legal terminology you don’t know, look it up or get legal counsel. A subtle term like ‘hold harmless,’ now in very common use, can be the entrance to a professional minefield.

“On the other side, solo practice can have physical dangers with our changing patient demographics. Group practice can provide more collegiality as ‘iron sharpens iron.’ We can be of great use in practices where mental health service is needed by other non-mental health practitioners.”

Resources
Healthcare Right of Conscience Ethic Statement
Augustine College at CMDA CD Set

Obamacare rollout highlights views of government

Excerpted from "An opening for the right," The Washington Post, commentary by Jennifer Rubin, October 27 - The Obamacare debacle challenges a number of liberal mantras that undergird a whole set of policies and campaign appeals. Here are the top 10 liberal tenets threatened by Obamacare:

1. If there is a problem, the federal government should attack it.
2. Government can compel people to act against economic self-interest by passing laws.
3. There is no downside to big government.
4. The welfare state is the best mechanism to help the poor.
5. Those opposed to big government hate the poor.
6. Government is capable of running highly complex systems effectively.
7. When addressing big problems it is best to centralize and standardize.
8. Unintended consequences of government programs are a small price to pay.
9. People will trust the government with private decisions and personal information.
10. Spending more and taxing more are evidence of concern for the poor.

All of these precepts have been challenged by conservatives, but there is nothing like a real example and personal experience to drive home a message. We don’t have just a few “glitches” or even a time crunch for putting up the exchanges, we have in Obamacare a fundamental misunderstanding of the limits of the government and citizens’ aversion to big, complicated entities. The effort to construct one big system with a highly regulated product (Obamacare-standard insurance) may in fact be the entire effort’s undoing.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics):
“Our healthcare system is broken and badly in need of a fix. The root problem is that healthcare costs too much, so individuals and businesses can’t afford insurance. The Affordable Care Act, unfortunately, is built on the premise that most people’s health insurance programs are not adequate and all perceived inequities must be solved. So the law says preventative services and contraceptives must be free. It doesn’t allow surcharges for age or preexisting conditions. Children can stay on their parents’ plans until age 26. There are no lifetime cost ceilings. Plans must contain psychiatric, eye and other coverages that most insurance plans have not provided.

“I like all those things, just like I like all the bells and whistles on a Mercedes Benz 500 with its great ride and exquisite comfort. But I’ve never owned a Mercedes because I can’t afford one, just like most people in our country. I drive a Honda Civic and, you know what, it gets me there. We can’t afford the Affordable Care Act either. It will add a whopping $2.8 trillion to our healthcare costs over the next 10 years. Already, self-insured individuals are experiencing the reality of that sticker shock but they are no longer in a market-driven healthcare economy. They can’t buy a well-used insurance vehicle at an economical price. Only a Mercedes is adequate.

“We very well may be headed for a debacle. The ‘cure’ may be worse than the disease. If so, everyone may be so traumatized that they refuse to even give a hearing to a real solution.”

Physicians prepare to deal with increased demand, strain on practices under ObamaCare

Excerpted from “Physicians prepare to deal with increased demand, strain on practices under ObamaCare,” Fox News. October 1, 2013 -- As enrollment in ObamaCare begins, physicians throughout the country are preparing to deal with an influx of newly insured patients – as well as the increased financial demands this will place on their practices. While it will take a few years for doctors to fully determine how they will be affected by ObamaCare, some physicians are already anticipating the need to make major changes to the way they run their practices.

One of the most immediate changes that physicians in these areas expect to see is an increase in patients seeking preventive health care – something many avoided when uninsured. However, scheduling more routine check-ups and screenings may place a strain on already short-staffed practices in rural areas. As a result, some doctors are considering handing over some basic aspects of patient care and education to nurses, nurse practitioners, or physicians assistants in order to treat patients more efficiently. Dr. Jason Marker, of Wyatt, Indiana, is already looking to hire additional staff members in order to meet the increased needs in his community.

Rural areas throughout the country already face a shortage of primary care physicians and doctors like Marker fear that this problem might become exacerbated in coming years, as more patients have the means to seek regular care.

“We know definitively that health insurance coverage and access to a physician are what improve health care outcomes.” Marker said. “We’re about to get changes in coverage, but we don’t have a ready way to say, ‘Here’s another million family doctors.’ So there’s a pipeline problem where it will be another five to 10 years where we are able to get the volume of doctors to take all these patients.”

Marker said Congress will need to step up in order to help fix this problem. “The big weak link is whether or not Congress is willing to put additional dollars into family medicine residential training,” Marker said. “That’s the current bottleneck in the training pipeline, is having residency slots. It doesn’t do good to have residents interested if there aren’t slots to do training.”

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): -- “When we went as missionaries to Africa, Jody knew we would be far from the grocery store yet entertaining many guests, so she bought a cookbook called More With Less. That phrase succinctly describes the focus that every healthcare professional will need as we move forward. There are going to be more patients to see than ever before but not enough physicians to see them. Though more medical schools are opening, including two Christian ones, there are not enough residencies being funded. Physician assistant and nurse practitioner schools are expanding to help fill in the gap, but the problem is bigger than that.

According to leading economic John Maudlin, reimbursement rates are going to plunge by 25 percent in the next five years. (I encourage you to read the eye-opening article.) The Cleveland Clinic now collects $6 billion a year and expends $5.5 billion. They are projecting their income to plunge to $4.4 billion by 2018, despite a significant increase in their patient load, as commercial insurance companies on average go from paying $.38 on the dollar billed to $.26. (Medicare now pays $.23 and Medicaid $.18.) Since 60 to 80 percent of their cost is for personnel, that is where cost savings will have to be realized. That is why you are already hearing of hospitals and practice groups laying off staff and if those staff are rehired elsewhere, they probably will be paid less.

CMDA’s Executive Vice President Gene Rudd, MD, told those attending the CMDA Midwest Regional Conference a few weeks ago that they would all need to become missionary doctors…but not necessarily by going overseas. They will have to have a missionary's mentality of working very hard and not getting paid as much, but doing it because God has called them to minister through medicine.

Though we will all being doing "more with less" I believe that the opportunities to minister through healthcare are going to be greater than ever! God does His best work in the midst of crisis and change if we simply rest and trust in Him!

Resources
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Why HR 3200 is No Healthcare “Reform” by Gene Rudd, MD
Affordable Care Act Impact on Doctors and Patients

Doctors Look For A Way Off The Medical Hamster Wheel

Excerpted from “Doctors Look For A Way Off The Medical Hamster Wheel,” Shots: Health News from NPR. August 14, 2013 -- Doctors are on a hamster wheel these days. We're compelled to run faster just to stay in place. It's about to get worse. Obamacare means millions more people will want our services, with not enough primary care doctors to meet demand. Government incentives that are pushing us toward computer-based records mean that doctors now spend as much time documenting our visits with patients as we do examining them.

As the hassles have gotten worse, I've seen many colleagues jump ship. But there might be another way. Dr. Christine Sinsky, an internist in Dubuque, Iowa, has made it her mission to find ways to mitigate the drudgery of modern doctoring. With funding from the American Board of Internal Medicine Foundation, she and four colleagues traveled the U.S. in search of practices that provide top-notch, effective primary care, while making the work satisfying for the doctors and other health professionals. Sinsky and her team found 23 examples of innovative practices from coast to coast, and reported on them in both an academic journal and an in-depth white paper.

Dr. Ben Crocker was so burned out in in 2007 that he lamented, "Working at Starbucks would be better." Now, his practice at Massachusetts General Hospital employs health coaches to work with patients on making the lifestyle changes that doctors recommend but can't adequately teach or monitor. Virtual visits have replaced some in-person visits. Perhaps most incredibly, the practice offers staff downtime each week to come up with innovations.

Sinsky offers examples of tedious tasks that take doctors away from providing undivided attention. No. 1 among them is data entry. "Inbox management" — all the phone calls, emails, forms to sign and prescription refills — can take up to two-thirds of a physician's day. "All of this inbox work can and should be handled by nonphysician personnel, freeing us up," she says. "So many mandatory tasks are crowding out the work of real doctoring.”

Commentary

CMDA Member Julie Griffin, MD: -- “Demanding schedules, flawless precision and an enduring calm in calamity—these are expectations of physicians. We have often placed these ultimatums on ourselves with our detailed, driven personalities pushing us to unattainable perfection. Nevertheless, the culture increasingly demands a new maximum.

Hardly imaginable is Hippocrates rushing around the office, then being paged across town for a delivery. Medicine’s revered father never had to defend his decisions to a third-party payer. We prefer the tableau of a wise, forbearing professional to grateful patients and an engaging professor to eager students. In truth, we were in this picture ourselves as we entered medical school.

Have our dreams run amuck? Perhaps, if we lose the focus of our callings in light of career demands. Yet, if we are confident of our callings and moved with the same compassion which moved Jesus (Matthew 9:36), we will not be distracted from our opportunities to serve.

To be sure, we must employ new methods, including delegation of duties. Medicine is moving to team-based care. This change is neither revolutionary nor futuristic. It is an overdue move toward our biblical heritage. Jesus readily embraced teamwork in ministry, and we as physicians should do likewise.

We must remember our calling and the true Strength by which we fulfill it—paperwork, phone calls and all. We cannot be chased out of our ministries for there is no joy or peace in life apart from our appointments as God’s coworkers in the gospel of Christ (1 Thessalonians 3:2-3).

Resources
In Search of Balance by Richard Swenson, MD
Practical Practice Issues in Today’s Christian Doctor

Obamacare May Trigger Exodus of Christian Doctors

Excerpted from “Obamacare May Trigger Exodus of Christian Doctors,” CBN News. October 1, 2013 -- Thousands of Christian doctors across the nation are considering quitting medicine or working overseas because of concerns over the new healthcare law.

Dr. Gene Rudd, senior vice president of the Christian Medical Association, says they're worried they could be forced to facilitate abortions or prescribe drugs that violate their convictions.

Rudd says many of them have avoided hiring and taking on new patients due to uncertainty over Obamacare.

Thousands of the doctors provide care for the poorest areas of the United States and feel called by God to help the sick, but say they need to be able to do so with a clear conscience.

Commentary

CMDA Senior Vice President Gene Rudd, MD: “I rarely view or read media reports after I have been interviewed. (In part, this is because someone else at CMDA does that.) But being asked to comment on this article that was based on what I said to a reporter reminded me of how the media uses their perspectives and agendas to create the news. Too frequently I find a failure to report ‘the truth, the whole truth and nothing but the truth.’

“Timed to coincide with the beginning of the enrollment for Obamacare, my interview with this AP reporter covered many perspectives on healthcare reform, perspectives I classified as ‘the good, the bad and the ugly.’ My limited comments about Christian doctors were almost an afterthought. But only those comments made the news.

“Among the many perspectives I cited, one ‘good’ aspect of reform is that some of our neighbors who previously couldn't obtain health insurance coverage would now have some basic level of protection. A ‘bad’ aspect is that now healthy individuals and families who did not have coverage and had little healthcare costs will now have to pay either a penalty for failure to participate or pay premiums. Even with subsidies, one estimate placed the average family premium at more than $5,000. That will be a substantial burden to most family budgets.

“One of the ‘ugly’ aspects of the current reform bill is the permission assumed by the Administration to usurp individual rights and undermine the First Amendment. Already we have seen HHS interpret and implement legislation in a way that attempts to force employers to provide coverage that includes provisions they find morally objectionable. And under the guise of providing required services, we will be required to fund abortions. Only with the use of smoke and mirrors do they attempt to claim otherwise.

“Will reporters continue to filter the news to suit their agendas? Of course. But we will continue to speak the truth in love. Will Obamacare survive? I don’t know. But we will continue to contest provisions that are morally unacceptable and dangerous to our foundation of freedom."

Resources
Voice of Christian Doctors Media Training
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Nationalized Healthcare – Prescription or Problem?

ObamaCare rollout faces physician shortage

Excerpted from "Get ObamaCare, while supplies last," USA Today, column by Paul Howard, July 11, 2013 - On Oct. 1, the uninsured can start signing up for coverage under ObamaCare. But should every policy be sold with an asterisk: Guaranteed access to care ... while supplies last?
Maybe. The unpleasant truth is that we don't have enough doctors to offer quality care to a growing number of Americans, never mind the nearly 30 million uninsured who'll begin to gain coverage under ObamaCare starting in 2014.

Changing demographics and perverse reimbursements are the main culprits. But ObamaCare didn't do much to address the underlying problems. Estimates vary, but the Association of American Medical Colleges predicts the U.S. will be short 130,000 doctors across all specialties by 2025. In fact, about one-third of all doctors plan to retire in the next decade.

Today, nearly 20 percent of Americans lack adequate access to primary care because there aren't enough physicians. About 30 percent of doctors won't accept new Medicaid patients. About one-third of ObamaCare's insurance expansion will come through expanding Medicaid.

ObamaCare relies on primary care providers to coordinate care in the hopes of lowering costs and improving outcomes. After adjusting for population growth, aging and demand for care created by the newly insured, we estimate that by 2025, the U.S. will face a shortage of 30,000 primary care physicians, nearly 5,000 of which are attributable to the expansion of insurance under ObamaCare.

Medicare grossly underpays primary care doctors compared with specialists and pays nurse practitioners 85 percent of what it pays doctors for the same services. And medical students are leaving school with crushing debt.

ObamaCare's focus on expanding health insurance left many of our biggest access-to-care challenges untouched. Get ready for Health Care Reform 2.0, starting next year, when many of America's newly insured realize that they have to get in line to see a doctor when they need one.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics):"Why go to school for seven or eight years to become a primary physician when you can make 85 percent of a physicians salary as a nurse practitioner by adding just a couple more years of schooling to your undergraduate degree? You also will come out with a lot less debt. The median debt for a public medical school in 2012 was $160,000 and for a private $190,000.¹ It is no surprise that only 25 percent of allopathic school graduates are going into primary care, but even that statistic may be misleading since 75 percent of students matching to internal medicine programs go into specialties.² That is one of the reasons that osteopathic schools are prospering. Their number has grown from 19 campuses in 2000 to 37 in 2013.³ More than half their graduates go into primary care.⁴ Unfortunately, their debt load average on graduation is higher than allopathic schools by almost 25 percent.

"Economic disincentives have seriously damaged primary care and, if surveys are right, it will be worsened by the large number of physicians planning to retire early due to their concerns about Obamacare.⁵ Ultimately, patients will pay the price with decreased accessibility and poorer health.

"The ranks of mid-level professionals are increasing dramatically to fill in the gaps, but we should be concerned that a significant drop in primary care physicians will leave a dangerous knowledge and experience void between what mid-levels can provide and what specialists should handle.

"This cloud does have a silver lining! With the need for more physicians, it has opened the door for two Christian osteopathic schools to be up and running by this fall and two more are in the planning stages. I’ve also noted that there seems to be a higher percentage of Christian students on secular osteopathic campuses than allopathic ones and they seem to maintain a more balanced life."

1.https://www.aamc.org/download/152968/data
2.http://sphhs.gwu.edu/abouttheschool/news/?d=12544
3.http://www.aacom.org/about/colleges/Pages/default.aspx
4.http://www.princetonreview.com/medical/osteopathic-medicine.aspx
5.NewsMax “Sixty percent of the doctors responding to the Deloitte Center for Health Solutions survey are likely to will retire sooner than planned in the next one to three years, irrespective of age, gender or medical specialty.”

Opt-out of contraception

Excerpted from "Obama proposal would let religious groups opt-out of contraception mandate," CNN, by Dan Merica. February 1, 2013--The Obama administration proposed updated guidelines on February 1 that would allow religious-affiliated organizations opposing contraception to opt out of a federal mandate requiring that they provide their employees with insurance coverage for birth control. The draft rule would give women at non-profit, religious-based organizations, like certain hospitals and universities, the ability to receive contraception through separate health policies at no charge.

As part of the new initiative, groups that are insured -- such as student health plans at religious colleges -- would be required to let their insurer know that certain participants would like contraception coverage. "The insurer would then notify enrollees that it is providing them with no-cost contraceptive coverage through separate individual health insurance policies," the HHS statement said. Although the agency has not estimated final costs of the plan, it said that offering free coverage would actually lower expenses over the long term, partly due to improvement in women's health and fewer childbirths. Because the insurer would be covering the costs, the changes would allow religious organizations morally opposed to contraception to avoid paying for it.

An original mandate on providing contraception was part of the new federal healthcare law spearheaded by Obama, the Affordable Care Act. It required that insurers provide, at no cost to those insured, all forms of contraception approved by the Food and Drug Administration. Houses of worship were exempt immediately and the administration widened those exemptions last year to include other religiously affiliated organizations, like universities and hospitals. That still left groups across a wide spectrum of faiths, many of which teach that contraception is morally wrong, covered by the mandate. They denounced it as an infringement of religious liberty. A group of 43 Catholic organizations challenged the rules in federal court in May.

Not all groups characterized it as a compromise, however. Frank Pavone, National Director of Priests for Life, a group that launched a federal lawsuit against the mandate last year, said he was far from happy with the update and welcomes the opportunity to provide feedback. "We at Priests for Life remind the administration that religious liberty does not just belong to religious groups and individuals; it belongs to all Americans," Pavone said. "We see only one acceptable change regarding the mandate: rescind it completely." The Family Research Council, a conservative pro-life group, released a similar statement. "The proposal does not expand religious freedom to all organizations and does nothing to change the current policy that forces religious entities to pay for insurance plans that include abortion-inducing drugs, sterilizations and contraception," said Anna Higgins, director of the group's Center for Human Dignity. Full story can be found here.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “In CMDA’s news release on the new 'accommodation,' I said, 'This latest version of the contraceptives and sterilization mandate remains unacceptable. Since when does the government get to pick and choose which groups will get to enjoy First Amendment protections?'

"The amended regulations give no conscience exemption to businesses run by people of faith including Hobby Lobby and Tyndale House. It gives no exemption to individuals having to buy insurance that pays for abortifacients like Ella.

"For non-profit religious organizations, this is only smoke and mirrors as the administration employs verbal engineering to make sure every woman in the country has free so-called 'contraceptives.' HHS will require every insurance company to issue a separate policy that provides 'free' contraceptives and sterilization. Using its own government staff as 'experts,' it claims that there is no net cost to insurance companies in that mandate. That is a very debatable point, but this new process is just a smoke screen to obscure the moral complicity it imposes.

"Imagine this. You are required to put bottles containing lethal prescriptions on a shelf in your break room for your employees who may take the drugs if they decide their lives are not worth living. Co-pays or deductibles are not a hindrance as the medicines are a 'free benefit' provided by your health insurance provider by order of the government. They say it will save healthcare costs.

"Are you morally complicit? Of course you are. If you hadn’t bought the insurance, they would not have had this 'lethal benefit.'

"Religious freedom advocates are not fooled by this phony accommodation. The lawsuits brought against the government—more than 40 in total—will continue to go forward. So far, the government has lost cases 10 to 4, but it is clear that the Supreme Court will make the final decision.

"Why is this important to you and me? Our religious freedom that our forefathers fought and died for is under broad attack and this is just one of the battlefronts. We dare not lose this battle or our freedom of religion will become merely a freedom to worship behind church doors. Woe to anyone who then tries to carry their conscience into the pubic square where government is god.

"And woe to us if we fail to stand up in these perilous times. With God’s help, CMDA will fight to maintain our religious freedom in the courtroom, in Congress, before the administration and in the halls of public opinion. You have my commitment on that—because we dare not do less."