When President Obama unveiled the Affordable Care Act, it came with very clear regulations about preventative care - namely, insurers are required to provide it. With no cost at all to the customer, an insurance plan must fully cover cholesterol screenings, Hepatitis immunizations, diet counseling and lots more. Also, because contraception is considered an important preventative health care service for women, Obama noted that insurance plans were also required to fully cover the cost of birth control including hormonal pills, IUDs, and sterilization.
Unsurprisingly, many religious groups were livid about this contraception requirement. The Roman Catholic Church and some Evangelical churches believe that any form of artificial contraception is morally wrong. Although statistics show that 98 percent of Catholic women have used birth control, the Catholic Church and other religious organizations are firm in their anti-contraceptive insurance stance; they do not want to support employees' birth control insurance while at the same time preaching a religious doctrine opposed to it. These churches and religious groups lobbied the White House, but to no avail: In January 2012, Obama reaffirmed his stance that under the rules of the Affordable Care Act, insurers should be required to cover contraception.
In the weeks that followed, however, something changed. The White House saw increased communications with left-leaning Catholic organizations such as the Catholic Health Association who had supported the initial passage of Obamacare; these groups were patently unhappy with the administration's refusal to re-think its contraceptive insurance mandate. Finally, in February 2012, Obama offered a concession - religious-affiliated organizations along with churches would be exempt from the birth control rule. Instead of paying for contraceptive insurance for their employees, these organizations and churches could rely upon the insurance companies themselves to provide that coverage directly to the client. All employees would have free access to contraception, with no funds or involvement coming from the religious employer. Win-win for everyone.
The Roman Catholic Church and other religious groups, however, were still not happy. Obama's new ruling did excuse more groups from the contraceptive mandate, but many religious employers were still required by law to provide birth control. A Catholic hospital or university not serving and employing primarily Catholic people would not be considered a religious-affiliated organization under the February 2012 rules. The fact that these sorts of religious employers would still be required to directly fund contraceptive insurance led to numerous protests and even lawsuits against the government. Now, one year later, the Obama administration has again returned to the issue of mandatory contraceptive coverage. Still seeking a way to respect religious freedom while at the same time giving important preventative health care services to women, Obama has just released yet another set of rules regarding religious employers and contraceptive insurance.
The good news for the anti-contraceptive group is that more employers are now exempt from the insurance requirement - all non-profit religious organizations, including schools and hospitals that serve and employ people of a different faith, are no longer required to cover their employees' birth control. Once again, the insurance company itself rather than the church or religious employer will directly provide contraceptive coverage. A woman will have seamless access to birth control, while her religious employer should be able to rest easy knowing that none of its premiums are paying for that contraception. Instead, the birth control is funded by the insurer, and with part of the fees that insurance companies will soon begin to pay when selling their insurance in online marketplace exchanges. But, aren't insurers upset about having to shoulder the cost of contraception? Not really.
Evidence has shown that when an insurance company adds contraceptive coverage, expenditures do not greatly increase. In fact, providing contraception will often lead to a decrease in insurance spending; research from the U.S. Department of Health and Human Services has found that when public health programs add comprehensive coverage for birth control, the net effect is a decrease in costs. In fact, based on studies conducted in multiple states throughout the 1990s, the Congressional Budget Office estimates that family planning services including access to contraception can save America around $400 million over ten years. The Federal Employees Health Benefits program is another great example of how birth control coverage can improve health care costs in general and costs for an insurance company in particular. Until 1998, this federal employees insurance plan did not cover contraception.
When rules were changed and the Federal Employees Health Benefits plan began to cover birth control, this change led to no net increase in premiums, probably due to the fact that reducing unplanned pregnancies can reduce many health care costs - frequent prenatal checkups, a hospital stay during delivery, or of course the possibility of a procedure much earlier on to abort the fetus. Clearly then, covering contraception is a good move for insurance companies, and the newly released rules from Obama will not have a huge impact on costs and expenditures for insurers. Religious organizations, however, are still far from satisfied. The Roman Catholic Church and other religious groups point out that Obama's new rules say nothing about for-profit religious organizations, which must still fund contraception despite religious oppositions.
Obama opponents have also taken issue with the fact that an employer who happens to be religious himself, but does not run a religiously-affiliated business, has no recourse if he is morally opposed to providing his employees with contraceptive coverage. For people on both sides of the issue, many questions remain. Obama has said that religious institutions that self-insure will be able to rely upon third party insurance agents to provide employees with contraceptive coverage, but details of how this service will function in practice have yet to be fully explained. Another important question is health care versus religious freedom - if opponents of contraceptive coverage manage to take their battle to the Supreme Court, justices will have to decide between the preventative health care rights of a woman according to Obamacare, and the constitutionally guaranteed religious liberty of her employer.