HHS issues final rule on contraceptive coverage


The Obama administration issued the final rule on contraceptive coverage June 28, in part simplifying some requirements in response to religious groups that have opposed the health law’s mandated contraceptive coverage.

Officials said the rule has simplified the definition of a "religious employer" and is accommodating the nonprofit organizations such as universities and hospitals that object to providing such coverage on religious grounds.

"The health care law guarantees millions of women access to recommended preventive services at no cost," Health and Human Services Secretary Kathleen Sebelius said in a statement. "Today’s announcement reinforces our commitment to respect the concerns of houses of worship and other non-profit religious organizations that object to contraceptive coverage, while helping to ensure that women get the care they need, regardless of where they work."

Kathleen Sebelius

The final rule also extends the effective date of its implementation from August 1 this year to January 1, 2014.

But the rule, which received some 400,000 comments since it was proposed in February and has been facing dozens of lawsuits, is unlikely to appease opponents.

The rule leaves out for-profit organizations, some of which have ongoing lawsuits to overturn the health care law’s requirement to provide birth-control coverage on religious grounds. The arts and crafts chain Hobby Lobby received the green light from a federal appeals court June 27 to move forward with its lawsuit to get the law overturned. In a news conference on June 28, Health and Human Services’ officials said they would not comment on ongoing litigation.

The Family Research Council (FRC), which called the proposed rule an "accounting gimmick" in February, continued its strong opposition to the rule.

"A day after the courts issued temporary relief for Hobby Lobby and Geneva College because of the likelihood of success in challenging the antireligious nature of the HHS mandate, this latest rule shows the administration is tone-deaf to religious freedom," Anna Higgins, director of FRC’s Center for Human Dignity, said in a statement. "The extended safe harbor merely grants nonprofits more time to decide whether to violate their fundamental religious beliefs and shows HHS is trying to buy more time as the courts begin to rule against this violation of religious freedom.

"The mandate does not protect women’s health, either. It threatens women’s health by forcing religious employers into the untenable choice of violating their consciences or dropping health coverage for families and the women they employ. That doesn’t help women’s health; it harms it," Ms. Higgins said.

Meanwhile, the proponents of contraceptive coverage continued their support and celebrated the final rule.

"Today's announcement is a win for civil liberties," Sarah Lipton-Lubet, American Civil Liberties Union policy counsel, said in a statement. "With this rule, the administration continues to stand by women and our families and refuses to let employers use religion to discriminate."

Under the final rule, churches and other houses of worship continue to be exempted from contraceptive coverage requirement. In other words, the religious employers may provide health plans to their employees that do not include contraceptive coverage, officials said June 28.

It also provides accommodations for nonprofit organizations including hospitals, universities, and charities that are opposed to providing birth-control coverage based on religious grounds. Under the rule, these organizations won’t have to "contract, arrange, pay for, or refer contraceptive coverage." Instead, the coverage is provided separately by the health plans of the enrolled women, at no cost.

Such nonprofit groups that have insured and self-insured health plans will have to notify the insurer or third-party administrator that they object to contraception coverage, and the insurers in turn will let the enrollees know that they have access to contraceptive coverage under a separate, no-cost payment.

The rule also provides more details on these accommodations for insurers and third-party administrators, officials said.

"We strongly believe that the cost of contraceptive service will be absolutely cost-neutral and will be offset by improvements in women’s health and reduced pregnancy," Ms. Chiquita Brooks-LaSure, deputy director of policy and regulation at the Center for Consumer Information and Insurance Oversight at HHS, said in a news conference.

Coverage of contraceptive services is part of the recommended preventive care under the health care law and includes all the FDA-approved contraceptive services prescribed by health care providers.

On Twitter @NaseemSMiller

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