Given the level of controversy and attention attracted by President Obama’s recent announcements concerning mandatory coverage of abortifacients, sterilization, and contraception, it is worthwhile to consider the timeline involved for the decision process that brought the administration to this point. The following timeline, provided to Health Care News by Capitol Hill staff, outlines the nearly two-year process that brought this controversy to its head.
Section 2713 of the Patient Protection and Affordable Care Act (PPACA) mandates that all non-grandfathered health plans must cover 4 categories of preventive services, including care and screenings for women that are identified in guidelines to be issued by the Health Resources and Services Administration (HRSA).
July 19, 2010: The Administration published an interim final rule implementing this section of the law and references the role that HRSA will play in developing comprehensive guidelines relating to “evidence informed preventive care and screening.”
July 19, 2011: Pursuant to an HHS contract, the Institute of Medicine (IOM) published the report titled “Clinical Preventive Services for Women: Closing the Gaps“. The report contained eight recommendations, including recommending all new health plans provide “the full range of FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity” and prohibited plans from charging cost-sharing for these items and services.
August 1, 2011: HRSA released a guideline document adopting all of the IOM recommendations. HRSA noted “group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.” The document also narrowly defined religious employers.
August 3, 2011: the Administration published amendments to the 7-19-10 interim final regulations, adopting the preventive care and screening HRSA guidelines. The amendments exempted a narrow class of religious employers that primarily employ and serve persons who share the employers religious tenets. This exemption would not apply to many religiously affiliated hospitals, schools and charities.
January 20, 2012: HHS issued a press release announcing that religiously affiliated employers who are not covered under the narrow exemption included in the August 3, 2011 amendments will be given an additional year, until August, 2013, to comply with the new contraceptives mandates. The release noted that this additional year will allow these organizations more time and flexibility to adapt to this new rule.
February 10, 2012: The President announced a “compromise” that specified that religiously affiliated employers would not have to pay for contraceptive coverage, but their insurance companies would be required to offer contraceptive services directly to the employer’s workers for free.
That same day, the Administration also published additional regulations, including a final rule which finalized the August 3, 2011 interim final rule, which adopted the preventive care and screening HRSA guidelines and also established the narrow exemption for religious employers. The Administration also released a guidance document, consistent with the January 20, 2012 press release, creating a “temporary enforcement safe harbor,” specifying that non-exempt religiously affiliated employers will have until August 1, 2013 to comply with the new contraceptives mandates.
New Administration Proposal
Neither the February 10th rule nor guidance actually provides any details on the President’s new proposal. Instead, the rule simply states that the Departments plan to initiate a rulemaking to require issuers to offer insurance without contraception coverage to such an employer (or plan sponsor) and simultaneously to offer contraceptivecoverage directly to the employer’s plan participants (and their beneficiaries) who desire it, with no cost-sharing.
A new report from The Heritage Foundation also goes into additional detail concerning the reasons this issue has become so divisive. They offer these three central points:
- Religious freedom goes hand in hand with limited government and with greater freedom in general.
- The basic structure of Obamacare makes these kinds of conflicts both inevitable and recurring.
- Properly designed health reforms would never have produced this situation in the first place.
Regardless of how this process plays out in the coming months, it is clear a line has been crossed in the impressions of the faith and employer communities about what they can be commanded to purchase.