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In Roman Catholic churches across the country this weekend, priests are reading statements from their local bishops urging the faithful to fast, pray, protest, and take action against a new health-care mandate issued by the federal government.
Related documents: Bishop Leonard Blair's Letter
The Jan. 20 ruling by the U.S. Department of Health and Human Services will require virtually all employers, including Catholic hospitals and educational institutions, to provide health insurance that includes surgical sterilization and prescriptive contraceptives without charging employees a co-pay or a deductible.
That would be in direct conflict with Catholic doctrine, which has consistently condemned all forms of contraception except natural methods. The nation's Catholic bishops are gearing up for a fight, calling the mandate "literally unconscionable" and "an unprecedented attack on freedom of conscience and of religion."
Bishop Leonard Blair of Toledo, in a letter to be read at all 131 parishes in the 19-county diocese, called the ruling "an alarming and serious matter … that strikes at the fundamental right to religious liberty for all citizens of any faith."
The letter says the debate is not about Catholic doctrine or the morality of contraception, but religious liberty and freedom of conscience for all citizens.
"We cannot -- we will not -- comply with this unjust law," Bishop Blair said in his letter. The bishop declined requests from The Blade to be interviewed for this story.
The Health and Human Services mandate was issued as an "interim final rule" in August, 2011, and takes effect for most employers on Aug. 1. The department gave a one-year extension, to Aug. 1, 2013, for nonprofit employers who for religious reasons do not currently provide contraceptive coverage.
"In effect, the President is saying we have a year to figure out how to violate our consciences," Cardinal-designate Timothy Dolan, archbishop of New York and president of the U.S. Conference of Catholic Bishops, said in a statement.
Kathleen Sebelius, secretary of health and human services, said the decisions were made "after very careful consideration, including the important concerns some have raised about religious liberty. I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services."
She said the department "will continue to work closely with religious groups during this transitional period to discuss their concerns."
Concerns among religious groups are many, touching on a complex array of constitutional, moral, ethical, and cultural grounds.
Some say that if the federal government can order religious groups to go against their own teachings, what will be the next step and where will it end?
"To force a religious institution to perform those services strikes me as an egregious violation of conscience," said Peter Feldmeier, professor of Catholic studies at the University of Toledo. "I think the government is overstepping its bounds in a big way."
Sister Christine Schenk of Cleveland, a Sister of St. Joseph and director of FutureChurch, a coalition of parish-based Catholics, said she believes the issue is "much more complex" than the religious freedom concerns voiced by U.S. bishops.
She said the bishops should consult employees at Catholic institutions, many of whom are not Catholic, and ask how they feel about birth control.
"I believe 98 percent of Catholics think use of birth control to be moral, and that the decision is best left up to them," Sister Christine said. "I have real serious trouble with church leaders who make decisions without any immediate experience of the consequences of the decisions that they are now making that will be impacted on every Catholic employee and every non-Catholic employee at every Catholic institution."
A 2005 Harris Poll found that 93 percent of all adults, including 90 percent of Catholics, support birth control and contraception.
Dusty Tyukody, a layperson from Toledo who is active in peace and justice causes, said the bishops should consider the needs of employees, including non-Catholics, at church-run institutions.
"Maybe these people are sweeping the floors and trying to make a living and raise their kids and pay their bills, and maybe they cannot afford any more kids," Ms. Tyukody said. "Why should they be punished? I honestly think the President's team threaded the needle on this one in as fair a way as possible."
John L. Allen, a Catholic author and Vatican correspondent, said U.S. bishops perceive the mandate as yet another attack in a mounting war on religious freedom and First Amendment rights.
"The mainstream American bishops are convinced that religious liberty in the United States is under assault, and specifically the ability of church-run institutions to be true to themselves and to the teaching of their traditions," Mr. Allen said. "The bishops' argument is that the government is forcing them to act against their conscience. This government mandate presents the Catholic Church with a kind of Faustian choice: Do something it regards as evil or get out of the business of providing health insurance, which it says will end up leaving more people uninsured and therefore undercut health care in the long run."
Last week, Pope Benedict XVI told visiting U.S. bishops that core values of American culture are being threatened by "radical secularism." In an apparent reference to the Health and Human Services' ruling, the Pope said many bishops had told him of "concerted efforts" against "the right of conscientious objection … to cooperation in intrinsically evil practices."
The mandate grants an exemption to religious groups only if they employ and serve those who share their beliefs. That would apply to many churches and temples, but not to the vast majority of Catholic hospitals, schools, or universities that hire a diverse work force and serve the general public.
"The mandate is so narrow that it basically only covers religious orders and churches," said Hannah Smith, a lawyer for the Washington-based Becket Fund for Religious Liberty. "It does not cover social-service organizations, soup kitchens, schools, colleges, or hospitals. All of those entities are not going to be protected."
She said the Becket Fund last year filed two lawsuits against the mandate, one representing the Benedictine Catholic monks of Belmont Abbey College in Belmont, N.C., and another representing the interdenominational, evangelical Colorado Christian University near Denver.
The lawsuits cited a range of constitutional and legal issues, but the overall concern is "government coercion," Ms. Smith said. "It's about the government coercing these religious institutions to pay for abortion drugs that are against their religious convictions. This is not about access to contraceptives for free, it's really about these religious groups having to pay for the services."
Although 28 states have some form of mandate on health-care policies and contraceptives, "none of those is as sweeping as the federal one. Most of the states have a much more robust exemption," Ms. Smith said.
Indeed, many Catholic leaders had been expecting a final ruling that would grant an exemption to church-run hospitals and universities.
Cardinal-designate Dolan met privately with President Obama at the White House in November and felt the President was sympathetic to giving a wider exemption, said Mr. Allen, whose most recent book was a series of interviews with the cardinal-designate.
"And behind the scenes," he said, "a lot of church people had that impression. To some extent, they feel a little blindsided."
The U.S. Catholic Church surely will challenge the new mandate in court, he said.
American bishops in September established an ad hoc committee for religious liberty, "and their first act was to hire a team of lawyers, which tells you what their game plan is," Mr. Allen said.
He said he expects the mandate to become a campaign issue in the 2012 presidential election.
Drop health care?
Among the difficult options Catholic institutions are now considering are eliminating all health-care coverage to employees, refusing to obey the federal rules and facing the penalties, or cutting their direct ties to the church, as did the 60,000-employee Catholic Healthcare West. That San Francisco-based group, which changed its name to Dignity Health, has been adding non-Catholic medical centers and says on its Web site that it is "rooted in the Catholic tradition, but is not an official ministry of the Roman Catholic Church."
The largest Catholic employer in northwest Ohio is Mercy, with 7,500 employees at hospitals and medical offices throughout the area as well as at Mercy College of Ohio. Medical Mutual of Ohio administers Mercy's self-funded health plan, which has different tiers of coverage with varying deductible and co-pay levels so employees can go outside the Mercy system for care.
As a religious employer, Mercy does not provide coverage for contraceptive services, but it will be required to once the ruling goes into effect even though the services are not consistent with the system's religious beliefs, Mercy said in a statement. Patient care at Mercy facilities will not be affected, only the insurance benefits for employees, it said.
"As a faith-based organization, we are disappointed with the ruling by the Department of Health and Human Services that failed to broaden the definition of a religious employer to include Catholic health systems like Mercy," Mercy said in the statement.
Catholic health-care systems nationwide, including Mercy and Cincinnati parent Catholic Health Partners, are working with the Catholic Health Association to determine how best to respond to the ruling, according to Mercy.
The challenges the regulations pose for many groups remain unresolved, and more discussion on appropriate conscience protections is needed, according to the Catholic Health Association.
"We do believe there's a need for a national conversation on this," said Fred Caesar, association spokesman.
Bobbi Schelkun of Toledo, a senior nursing student at Mercy College of Ohio, is not Catholic but said she believes that Catholic schools and hospitals should not have to provide health care that conflicts with their religions teachings.
Nurses and other employees have the right to use contraceptives, but that doesn't mean a Catholic organization should have to pay for it, said Ms. Schelkun, a member of Mercy's Nursing Advisory Board, a panel of students that meets with nursing program directors.
"I don't think they should have to go against their values as organizations," she said.
The Rev. Barry Lynn, executive director of Americans United for Separation of Church and State, said his group supports the new Health and Human Services rule on contraceptive coverage.
He said the Obama Administration's recent record on medical decisions influenced by religion is mixed, citing a decision late last year in which Ms. Sebelius overruled the Food and Drug Administration's recommendation that the Plan B One-Step emergency contractive, commonly called the morning-after pill, be sold without a prescription to girls 16 and younger.
Overruling the FDA recommendation was favored by the Catholic Church, Mr. Lynn said.
Penalties for noncompliance with the new federal rules can be substantial.
Ms. Smith of the Becket Fund said the federal government is fining Belmont Abbey College $300,000 and Colorado Christian University $500,000 for the first year they violate the mandate by not providing contraceptives to employees. Penalties would increase each year, she said.
"These fines are very severe, and we feel they violate the Religious Freedom Restoration Act, which is a law put in place by Congress that prohibits the federal government from placing a substantial burden on a religious individual or institution," Ms. Smith said.
Howard Friedman, a UT professor of law emeritus who specializes in First Amendment issues, said he feels the government needs to keep a narrow range for exemption from the rule.
"Once you go to health-care reform and you make the decisions as they did, you need to prescribe certain basic minimums for all policies," he said.
"Once you start down that road, do you grant an exemption for anything that has religious concerns? What about religions that believe in faith healing? Are you going to make them pay for health care? The Catholic Church employs so many people in schools, universities, and hospitals, if you start carving out an exception you end up with very large numbers of people who don't have this coverage."
Mr. Friedman said the next issue is whether the government will force churches and other religious groups to provide medical coverage in same-sex marriages.
The New York-based Center for Reproductive Rights believes there should be no exemptions except for minis- terial employees, said Laura MacCleery, director of government relations.
But the final rule strikes a good balance, she said.
"We believe that women should have the right as moral agents to make their own decisions concerning their health," Ms. MacCleery said.
Threatening to drop health-care coverage is a petulant reaction, Ms. MacCleery said. That hasn't widely happened in California, one of several states already requiring employers that provide coverage to include birth control, she said.
The Rev. Tadeusz "Tad" Pacholczyk, director of education for the National Catholic Bioethics Center in Philadelphia, said the HHS mandate raises a number of moral and ethical concerns.
"We have a pretty long tradition in this country of respecting conscience rights, and I think that is an essential element of everybody getting along in a democracy," Father Pacholcyzk said.
"When you have a situation where the government forces those of a religious persuasion to engage in behaviors that are directly opposed to their own religious beliefs, then you have an inherent injustice occurring. … The Catholic hospital is being mandated to pay for contraceptives in a way that forces it to underwrite what it considers to be an immoral activity."
Leonard "Jack" Nelson III, author of the 2009 book Diagnosis Critical: The Urgent Threats Confronting Catholic Health Care, said he believes the Obama Administration intentionally was targeting Catholic institutions with this mandate.
"This is a very deliberate decision they've made, and they know how it's going to affect Catholic institutions. The conscience exemption they gave was very narrowly drawn," said Mr. Nelson, a professor at Samford University's Cumberland school of law in Birmingham, Ala.
Bill seeks changes
A bill introduced in Congress last March, the Respect for Rights of Conscience Act, would broaden the exemption and cover most Catholic hospitals and schools.
The bill, introduced in the House by Rep. Jeff Fortenberry (R., Neb.) and in the Senate by Sen. Roy Blunt (R., Mo.), would amend the Patient Protection and Affordable Care Act "to permit a health plan to decline coverage of specific items and services that are contrary to the religious beliefs" of the institution, without penalty. U.S. Rep. Bob Latta (R., Bowling Green) was one of 102 co-sponsors of the bill, which has been referred to the House health subcommittee.
In his letter being read at churches this weekend, Bishop Blair is urging Catholics to contact Congress to support legislation that would reverse the HHS decision.
Contact David Yonke at: firstname.lastname@example.org or 419-724-6154.