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USA: The Truth About Religious Freedom
The United States Conference of Catholic Bishops (USCCB) rarely lets the facts get in the way of their story.
In press releases during the past months, in alerts by state Catholic Conferences, in statements that they have made in various media outlets and in their official comments to the Department of Health and Human Services (HHS), the bishops have explained why they oppose the HHS decision supporting access to no-copay contraception. In making their case, they have relied on spurious claims about religious liberty, conscience and science to attempt to mislead policymakers and the public.
The bishops' arguments are italicized. The reality follows.
The mandate does not exempt Catholic charities, schools, universities, or hospitals.
- Schools, universities, hospitals and Catholic charities will have a workaround under which insurers, not employers, must offer employees coverage for contraception when their employers object. Employees at these institutions deserve to benefit from the same access to healthcare as everybody else, and they should not be subject to discrimination just because of where they happen to work. Religious institutions or entities, like houses of worship, including Catholic ones, received an exemption, and do not need to comply with the law.
This is not about contraception; it's about religious freedom.
- The reality is that this debate is about both. It is about whether individuals have the right to follow their own consciences in making their own healthcare decisions, and it is about whether individuals have the right to freedom of and freedom from religion. Individuals have consciences, have healthcare needs and have religious liberty, and deserve to have these rights and needs respected and protected.
- The question that matters in this debate is: Whose religious freedom are we talking about? It is the job of the government to protect both individual rights in healthcare decisions and individual religious liberty, and to protect them both from institutional intrusion. This debate absolutely is about protecting the freedom of an employee, no matter where she works, to exercise her personal beliefs without the bishops imposing theirs upon her.
- The bishops would have us believe that a school, a Taco Bell or a hospital has a "conscience" and "freedom of religion." They do not. Individuals, according to our Catholic tradition, have consciences and deserve to exercise them without coercion. Individuals also deserve to have their freedom of and freedom from religion protected. Institutions -- both secular and "religious institutions," as well as "religious organizations" -- do not have the right to claim "consciences" in order to trample on the conscience rights that properly belong to their employees.
- This debate means a lot of things to a lot of different people. It may not be about contraception for the bishops, but for the everyday person who utilizes contraception, having affordable access to such services can mean many things. No-cost contraception for the average woman, including many Catholic women, can mean following her religious beliefs, following her conscience, protecting her health, saving money for her family, protecting her future or a myriad other things that we cannot be privy to. If the bishops succeed in eliminating coverage, it will most definitely be about contraceptive access, and all of the things that access means, to millions of Americans.
- The debate is about both religious liberty and contraception, but the bishops' end goal is clear: having failed to convince Catholics in the pews to follow their ban on contraception, they are attempting to eliminate all access for all people. One only has to look at a comment made by Archbishop William Lori of Baltimore, then Bishop Lori, during a Congressional hearing this spring, to glean where attempting to follow the bishops' policy priorities on contraception would lead us. While he implied that workers whose employers refuse contraceptive coverage could simply go elsewhere to receive these services, such as family planning clinics supported by Title X or other public funds, Lori failed to mention that the bishops have opposed such programs for years. When President Nixon created Title X in 1970, the director of the United States Catholic Conference (USCC) Family Life Division (later a bishop himself) testified before Congress that the bishops opposed such programs. In 1978, The USCC Secretary for Social Development and World Peace testified that the bishops supported universal health care -- except for coverage of contraception. In 1989, Richard Doerflinger, who still serves as a spokesperson for the bishops, testified before a House committee that the bishops "have problems with" Title X. In 1991 and 1992, the bishops' stated list of public policy priorities included "oppose reauthorization" of Title X.
The mandate forces these institutions and others to pay, against their conscience, for things they consider immoral.
- It is incredible to suggest that an institution has a conscience. Institutions do not have consciences, individuals do. This rule merely evens the playing field by allowing individuals to decide whether or not to utilize contraceptive coverage.
- In regard to individuals' expenditures, our tax dollars go toward many things that we may not agree with, and the money from our insurance premiums likely goes toward coverage of many medical services that we may not agree with or need ourselves.
- The institutional Catholic church enjoys a tax-preferred status and has a long history of seeking government funding streams -- including support for Catholic schools, hospitals and programs run by Catholic Charities. Some politicians have claimed that tax-preferred status for organizations that provide reproductive healthcare services constitutes public funding of abortion or contraception. By this logic, the same tax breaks and government grants given to Catholic churches and charities for non-religious purposes would also qualify as direct government funding of religion -- a constitutionally impermissible use of state funds. Catholic organizations cannot have their cake and eat it, too.
The mandate forces coverage of sterilization and abortion-inducing drugs and devices as well as contraception.
- These regulations require coverage of all FDA-approved methods of contraception, but they do not require coverage of abortion medications, such as RU-486. Emergency contraception (EC), such as Ella or Plan B, does not terminate existing pregnancies -- it prevents a pregnancy from occurring, hence, it is a contraceptive. The bishops themselves have acknowledged that the provision and use of emergency contraception is permissible. Directive 36 of The Ethical and Religious Directives for Health Care Services explicitly allows Catholic-sponsored hospitals to provide emergency contraception to sexual assault survivors. Likewise, in 2010, the Catholic Health Association included a series of journal articles in its flagship publication, Catholic Health World, which dispelled the myths about emergency contraception and reiterated that organization's commitment to providing EC in Catholic hospitals as part of compassionate care for survivors of sexual assault.
Catholics of all political persuasions are unified in their opposition to the mandate.
- Each of the individuals cited by the USCCB as evidence of "liberal" opposition to the mandate has traditionally opposed contraception and other reproductive healthcare services. There is no diversity of opinion or liberalism in repeating the talking points and toeing the line of the USCCB on this issue, as each of them has done. The majority of Catholics do not look to their bishops for how to vote -- in fact, a mere 10 percent consider the bishops to be the sole arbiter in whether to should use contraception.
- The Catholic bishops are not the same as the Catholic church. The Catholic church in the United States has 68 million people. Only about 300 of them are bishops. The bishops represent themselves, and not the majority of Catholics, when they give their opinions on healthcare policies and other social and political issues. American Catholics can and do speak for themselves, and they overwhelmingly support insurance coverage of preventive care for women, including family planning.
- One only has to look at the recent Catholic-affiliated lawsuits against contraceptive coverage to recognize that there is certainly not a unity among Catholics on this issue, even among the bishops' own dioceses. There are 43 plaintiffs in 12 lawsuits, but only 13 of these plaintiffs are dioceses. Meanwhile, there are 191 Catholic dioceses, 629 Catholic hospitals, 251 Catholic colleges and universities, many other Catholic-affiliated schools and charities and 68 million individual Catholics in the United States. Even if one includes the additional, individual lawsuits from Catholics and Catholic organizations filed by groups such as the Becket Fund, the number of those shouting the loudest against contraception is a drop in the bucket compared to the number and scope of Catholics and Catholic institutions in this country.
- The majority of Catholics support equal access to the full range of contraceptive services and oppose policies that impede upon that access, including access to EC. Two-thirds of Catholics (65 percent) believe that clinics and hospitals that take taxpayer money should not be allowed to refuse to provide procedures or medications based on religious beliefs. A similar number, 63 percent, also believes that health insurance, whether private or government-run, should cover contraception. A strong majority (78 percent) of Catholic women prefer that their hospital offer emergency contraception for rape victims, while more than half (57 percent) want their hospital to provide it in broader circumstances. This support for the full range of contraceptive services is unsurprising, as restrictions such as refusal clauses or prohibitive costs affect Catholics just as often as non-Catholics -- 98 percent of sexually active Catholic women have used a modern method of birth control, mirroring the rates of the population at large (99 percent).
Many other religious and secular people and groups have spoken out strongly against the mandate.
- Many religious and secular organizations, including Catholic ones, have also spoken out in favor of the regulations. A letter signed by representatives from more than 20 denominations and religiously based organizations supporting the birth control regulations was issued in February.
The federal mandate is much stricter than existing state mandates.
- In those states with refusal provisions similar to those in the HHS regulations, institutions affiliated with the Catholic church, including hospitals and universities, have provided contraception to their employees without having to shutter their doors. Catholic Healthcare West, operating healthcare facilities in California and Arizona, has been providing contraceptive coverage to its employees since 1997 -- two years before the state of California passed legislation requiring employers to cover contraception and well before the California Supreme Court required institutions such as Catholic Charities to do so. Catholic Healthcare West's employees were able to access contraception, and the system certainly didn't shutter its doors. New York and California have refusal clauses identical to that contained in the HHS rule, and the sky has not fallen in either state for hospitals, schools or other institutions -- or for the church.
The "accommodation" from the Obama Administration does not change anything.
- While it is true that the administration did not choose to cave completely to the bishops' demands, the reality is that the compromise announced on Feb. 10, resulted in real changes -- a possibility of loss of some insurance coverage -- for millions of women and for the female dependents of all workers. By opening the door to a workaround for hospitals and schools, and by leaving the door closed to contraceptive coverage for women employed by churches, the final regulations announced by the Department of Health and Human Services allowed the bishops to place one foot over the threshold of denying contraceptive access to everyone.
- The compromise announced by the administration will indeed result in a wait-and-see game -- until August 2012 for some organizations and until August 2013 for others -- but we disagree about whose wing and a prayer we should be worried about. For women working for Catholic hospitals, universities and other institutions who hope to gain access to contraception, or those who hope to continue to have access to coverage, it remains to be seen whether their consciences and private, moral decisions will be respected by a workaround that places the onus on insurers to do the right thing -- and on employers to let insurance companies do it.
The second-class-citizen religious institutions that object to coverage but aren't exempted will still have to pay for contraception and violate their beliefs.
- Just as institutions do not have a conscience, they are not citizens. Individuals have a conscience, and they enjoy citizenship. The only "second-class citizens" created by laws allowing employers to refuse coverage for medical services are women workers. It is absolutely discriminatory to allow the beliefs of employers to violate those of employees.
For-profit religious employers, secular employers, insurers and individuals are all stakeholders whose religious freedoms are threatened and who cannot escape from paying for things they don't believe in.
- We recognize the right of individual medical professionals to decline to provide services they consider immoral. However, it goes too far to grant such rights to an entire institution -- such as a hospital or managed-care provider -- or, for that matter, to allow blanket exclusions of coverage for certain healthcare services. The bishops would like to grant these exclusion rights to all institutions -- as a top advisor to the USCCB stated, they will not rest until the owner of a "Taco Bell" can refuse coverage to his or her employees. This is not in keeping with our Catholic understanding of conscience.
The bishops did not pick this fight in an election year -- others did.
- In truth, the bishops were quite strategic about the decision to "pick this fight." On the same day that the Department of Health and Human Services public comment period regarding the then-pending contraceptive coverage rule closed (Sept. 30, 2011), the USCCB announced the creation of their new "Ad Hoc Committee for Religious Liberty." At the top of the list of "concerns" that provided the impetus for that committee's creation was the contraceptive coverage requirement, despite the fact that the final rules had not been established and that public comments were still being processed.
- If the bishops did not "pick this fight," then they have an odd way of assuring the public that their opposition to contraceptive coverage is not, at least in part, political. The bishops, after all, have made it so. Bishop Thomas J. Tobin of Providence, Rhode Island, claimed that President Obama was "devious" in pursuing reproductive healthcare access and alleged that sexual equality efforts, which he opposes, were "driven by the Democratic agenda" in his state. Archbishop Peter Jenky of Peoria, Illinois, infamously compared President Obama to "Hitler and Stalin" due to the President's support for contraceptive coverage.
- The bishops have led the charge against contraception and have not been shy about promoting the rhetoric of those who hope to continue that campaign. Likewise, other conservatives have supported the bishops' rhetoric. There is a reason why Mike Huckabee chose to state "We are all Catholics now" rather than courting the leaders of another faith, and it does not seem accidental that Cardinal Timothy Dolan, President of the USCCB, at one point chose to wade into the same hyperbolic speech regarding prostitution begun by Rush Limbaugh in a speech at a Catholic college in New York.
- To understand the bishops' mindset regarding the timing of the contraceptive battle, one has only to look to one of their grievances with the regulations: "If they turn out badly, their impact will not be felt until August 2013, well after the election."
Contraception doesn't decrease unplanned pregnancy or abortion, and it is not cost-neutral.
- Numerous social science studies have demonstrated that contraception does indeed prevent unplanned pregnancy, and therefore abortions. To claim otherwise is patently false.
- It is correct to state that contraception is not cost-neutral for insurance companies and employers: it is cost-saving. On the critical issue of cost-saving, however, a more important point is the fact that contraceptive coverage without copays puts money in women's pockets. No-cost contraception allows women to act as moral agents in making the health decisions that are best for themselves and their families regardless of cost. Particularly for those women struggling during these tough economic times, no-cost contraceptive coverage frees women to direct the money they would otherwise spend on co-pays or the out-of-pocket cost of contraceptives towards putting food on the table, saving for their children's or their own educations or other basic necessities.
Ninety-eight percent of Catholic women have not used contraceptives.
- In 2008, the National Survey of Family Growth, a well-respected social science study from the Centers for Disease Control, found that 98 percent of sexually active Catholic women had used a modern contraceptive method. This fact was corroborated by the Guttmacher Institute, a similarly well-respected research institution, in 2011.
About the author: Jon O'Brian is the president of Catholics for Choice.