Q&A: Obama and the birth control controversy

But that didn't keep the Obama administration from landing in a political mess over a side issue to a new policy that will soon make contraceptives available free of charge as preventive care for women enrolled in workplace health plans.

The big question: How the rules would apply to nonprofit institutions such as hospitals, colleges and charities that are affiliated with a religion but serve the general public.

Here are some questions and answers on President Barack Obama's proposal on Friday to find a way out of the problem, and how his administration got there in the first place:

Q: Was the Obama administration going to require churches to cover birth control?

A: No, churches, synagogues, mosques and other houses of worship were not being required to cover the pill. That was never the issue.

Instead the battle is over nonprofit institutions affiliated with a religion. For example, a Catholic hospital or a college chartered by a denomination but open to students of all faiths or no faith. The Roman Catholic Church is opposed to artificial birth control methods, but polls show that the faithful in the pews generally use contraceptives anyway.

Q: Well, what was going to change for the hospitals and soup kitchens?

A: Previously the administration had said that such affiliated institutions were basically going to be treated like all other employers and insurance plans. They would have to cover birth control as part of a package of preventive services for women. The only concession was one more year to phase in the changes.

Obama has now walked that back. Employers affiliated with a religion will not have to provide birth control coverage if it offends their beliefs. However, the insurers that cover their workers will be required to offer birth control directly to women working for the religious employer, and do so free of charge.

Q: Wait a minute, there is no such thing as a free lunch. Insurers are going to pay for birth control themselves?

A: They may not have another alternative, but eventually they'll figure out how to pass on the cost.

Administration officials say providing birth control is going to save money in the long run for insurers, because it's a lot cheaper than the costs of labor and delivery. They also say the government has the power to order insurers to do so under Obama's health care overhaul law.

That may not sit well with the industry. Insurers point out that unless drug makers stop charging for pills, and doctors decide to prescribe them pro bono, birth control coverage isn't free.

Q: How are women who don't work for a church or a Catholic hospital going to be affected?

A: They're not.

Beginning next Jan. 1, in most cases, women will have access to birth control at no additional charge through their job-based coverage, as part of a package of preventive services that also includes HIV screening and support for breast-feeding mothers.

(Some employers won't have to provide the added coverage, but not for religious reasons. They are considered "grandfathered" under provisions of the health care law. The number of grandfathered employers will decline over time as they make changes to their health plans.)

The birth control coverage requirement applies to all forms approved by the Food and Drug Administration. That includes the pill, intrauterine devices, the so-called morning-after pill, and newer forms of long-acting implantable hormonal contraceptives that are becoming widely used in the rest of the industrialized world.

The morning-after pill is particularly controversial. It has no effect if a woman is already pregnant, but many religious conservatives consider it tantamount to an abortion drug.

As recently as the 1990s, many health insurance plans didn't cover birth control. Protests, court cases, and new state laws led to dramatic changes. Today, almost all plans cover prescription contraceptives - but usually impose copays. Medicaid, the health care program for low-income people, also covers birth control.

Birth control pills are the most common drug prescribed to women, and medical experts say that planned, optimally spaced pregnancies are good for the health of mothers and infants alike.

Q: What's been the reaction to Obama's concession?

A: It will take time to see if it tamps down the furor.

Some conservatives say it doesn't go far enough. They would like a conscience exemption for any employer, not just religious ones.

Women's groups are relieved that Obama has proposed a plan that maintains access for all women.

Catholic hospitals are saying they can support the compromise, as are anti-abortion Catholics who helped pass the health care overhaul in Congress. The bishops say they're still concerned but are reserving judgment until they talk with the administration.

Q: How did the administration get itself into such a mess in the first place?

A: Maybe they should have listened to people like Sister Carol Keehan, the head of the Catholic Hospital Association.

She and other prominent Catholics defied the bishops to support passage of Obama's health care overhaul at a critical stage of the congressional debate. Democratic Catholic lawmakers thought they had an iron-clad deal with the administration to protect the conscience rights of religious employers.

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