Whose feelings are hurt by mandated contraception coverage?

screen shot of E.J. Dionne column in Washington PostE.J. Dionne, Jr., a progressive Catholic columnist for the Washington Post, who wishes “the Church would be more open on the contraception question,” nonetheless accused President Obama of lacking “sensitivity to the feelings and intellectual concerns of religious believers” in backing up the Health and Human Services regulation that contraceptives will need to be covered by all insurers. I am perplexed. To whom does Dionne refer? Whose feelings are so deeply violated?

Is it the doctors? It cannot be, because this new regulation does not require any doctor to provide contraception.

Is it Catholic women? I doubt that: Dionne acknowledges that “this teaching is widely ignored by the faithful.” In fact, 98% of Catholic women use contraception.

Who’s left? Oh, the “religious employers.” So who are they? “Religious employers” are huge providers of health care in our country. One in six patients is treated in Catholic hospitals, and four out of the ten highest-revenue health systems in the United States are Catholic-affiliated. And though these systems serve and employ religiously diverse Americans, their hospitals are required to abide by the Ethical and Religious Directives for Catholic Health Care Services (written by the U.S. Bishops) that prohibit contraception, abortion, sterilization (tubal ligation/vasectomy), fertility treatment and some obstetrical emergency care. They will still be able to prohibit all these things in their institutions.

But when the hundreds of thousands of Catholic health care employees seek contraceptives in non-Catholic health care settings, their insurance plans will have to reimburse for contraceptives, unlike now. For example, a colleague of mine who formerly worked for a Catholic hospital said, “I didn’t choose to work in a Catholic hospital. But my hospital got bought by a Catholic hospital. Then my insurance stopped covering my pills, and my health care costs went up by more than $400 a year.”

So, again, whose feelings are hurt?

The people who administer insurance plans? Who are those people? Well, they are the diverse group of people employed by the enormous Catholic-affiliated health networks.

So who is left? The U.S. bishops? Their lawyers?

At the end of the day, this is an issue of corporate and papal power, not individual religious belief. In fact, individual physicians and employees are not even allowed to practice according to their beliefs. They must practice according to the Directives because their institutions require it. Perhaps this is only one more battle in the abortion wars, instead of a real crisis of conscience.


In the recent decades of massive expansion of Catholic hospital ownership, Catholic health networks have found ways to compromise over some issues. Some have created a non-Catholic room in their hospital for tubal ligations… some have allowed contraceptive services in certain clinics (all this I know from my ongoing research with physicians working in Catholic health care settings). Hundreds of lawyers, ethicists, administrators, and clergy have been involved in these backroom deals.

This is one of those times that Catholic health entities will need to work on compromise. Create a workaround. Find a loophole. Whatever’s needed. While this assertion may seem insensitive to the feelings of the bishops and their lawyers, respecting the rights of those whose health care they control is the ethical thing to do. At the end of the day: American women use contraceptives.

  • Kate Cockrill:

    Thanks for this post Lori. I think your points are very well made in this blog post. I think it’s frustrating that Dionne notes Obama’s good faith efforts toward communication and compromise with religious groups, but then calls it ‘bad faith’ him when the bishops don’t get everything they want. Isn’t that the nature of compromise!

  • Carole joffe:

    Great post!

  • Erin Armstrong:

    Great post, Lori! Thank you.

  • Thanks everyone, I’m still astounded at the kind of misinformation and painful spins going on about this on PBS (Shields and Brooks, Feb 3) and at the Washington Post by other opinion writers beyond Dionne. People don’t seem to be making any distinction between the consciences of large institutions and the consciences of individuals health care practitioners and patients. It’s so sad how willing people are to see women’s contraceptive access as such a disposable issue.

  • I don’t know whose feelings are hurt but I find the administration’s actions outrageous. Where does the federal government get the power to dictate what must be in a health insurance plan? The answer is that it does not have the authority and is simply arrogating to itself that power. In doing so it acts in a lawless manner and those who would enforce the law are acting as nothing more than thugs.

  • Erin Armstrong:

    I agree, Lori. It’s very troubling. Thanks for doing your part to combat the spin. For those interested, I suggest another great piece by NHeLP’s Executive Director, Emily Spitzer, in the Huffington Post last week: http://www.huffingtonpost.com/emily-spitzer/take-a-pill_b_1251001.html?ref=fb&src=sp&comm_ref=false

  • Well said, Lori! And tonight the pundits are preening, because “balance” prevailed. We will certainly be hearing more about these issues. Looking forward to your further thoughts.

  • Thanks Ellen and Everyone for your comments. It has been a whirlwind of a couple of weeks of politics in women’s health! It looks like Obama’s Hawaii style accommodation has been to the satisfaction of the Catholic Health Association president (but not the bishops) and some major reproductive health advocates. Amanda Marcotte wrote an interpretation of events that I wanted to share indicating that perhaps all this was part of a grand Obama plan. I don’t know if I agree that it was all so intentional, but it’s certainly entertaining to imagine it that way: http://tinyurl.com/78du9av

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