Ruling doesn’t end mandate showdown

by Joe Bollig

KANSAS CITY, Kan. — The U.S. Supreme Court’s ruling on June 28 largely upholding President Barack Obama’s Affordable Care Act was a political and legal stunner.

For all the storm and fury, however, nothing has changed for Catholics.

Barring a change in heart by the Obama administration, or a political change in November, it’s full speed ahead for the health care law and its problematic contraception mandate that is opposed by the church.

Bottom line: The church and the administration remain locked on a collision course.

“Many people were putting hope in that the U.S. Supreme Court would overturn the whole health care reform act and that would solve this problem, but they didn’t and that makes our cause even more important,” said Archbishop Joseph F. Naumann at the Rally for Religious Freedom in Topeka on June 29.

The contraception mandate, part of the women’s preventive services provisions issued by the U.S. Department of Health and Human Services, requires that all health care plans (except those meeting a narrow religious exemption or plans with grandfathered status) cover contraception, sterilization and abortion-inducing drugs without cost to the consumer.

Religious employers who do not meet the religious exemption, as well as private employers who have moral objections to the coverage, are not protected from the contraception mandate unless they are participants in a plan with grandfathered status.

Grandfathered status means the plan has maintained minimal changes in plan design and out-of-pocket costs within the restrictions of the health care reform act since its inception in March 2010.

A private health plan year that begins on or after Aug. 1 of this year must comply with the contraception mandate.

Nonexempt religious employers have an extension until Aug. 1, 2013, to comply with the mandate. Nonexempt religious employers participating in a plan with grandfathered status will remain exempt as long as their plan remains grandfathered.

The Archdiocese of Kansas City in Kansas is protected both under the religious exemption and by the fact that it has a self-insured health care plan that has grandfathered status.

“This exemption extends to all institutions participating in the archdiocesan health plan, including Catholic Charities, Benedictine College, Santa Marta and other institutions that may not otherwise qualify for the religious exemption under the Women’s Preventative Services Mandate,” said Kathleen Thomas, archdiocesan director of human resources.

The archdiocese will do everything it can to maintain the plan’s grandfathered status, but nothing lasts forever — especially a self-insured, grandfathered health care plan.

If any significant changes are made the grandfathered status will be lost, and those nonexempt Catholic entities will be forced to comply with the contraception mandate.

“Ultimately, in the long term, [grandfathering] is not the answer,” said Thomas. “At best, it’s said that a group could maintain grandfathered status for three to five years. We’re already at two years. By the end of 2013, we’ll be three years into grandfathered status. We understand that we may be presented with financial challenges we just can’t overcome.”

The Affordable Care Act was a large and complicated piece of legislation, and it presents a lot of unknowns and unanswered questions.

“The nitty-gritty details of the health care reform law are still unfolding, so we really don’t know what other issues will arise in the future to challenge our Catholic beliefs,” said Thomas. “We have to continue to pray that our religious freedoms are respected, so we can protect our families with health care insurance without compromising our beliefs.”

The pivotal year for employer compliance with the Affordable Care Act is 2014, said Thomas. It requires the so-called “play or pay” mandate.

Employers with 50 or more employees will be required to offer adequate financially subsidized group health coverage to all full-time employees or pay significant penalties. These penalties are $2,000 per year per employee.

Also, these employers must automatically enroll all new full-time employees in the health plan unless they specifically opt out of the plan.

“Neither of these requirements pose difficulties for us,” said Thomas. “Our plan is more than adequate in terms of the law and we believe ours will remain a competitive and cost-effective plan even when other health care options are available on the insurance exchanges.”

There is another factor in this struggle over health care and religious freedom, however: lawsuits.

Twelve lawsuits by 43 Catholic plaintiffs, several of them dioceses, have been filed against the U.S. Department of Health and Human Services contraception mandate. And an additional seven Catholic entities, plus a number of private Catholic employers, have also filed lawsuits.

“I think we have to press forward on all fronts,” said Archbishop Naumann. “We need to educate people about this issue — not just Catholic people, but the whole society and culture. And we’re hoping to get relief in the courts.

“But we saw yesterday [with the Supreme Court decision] how that’s risky. And part of what the courts said is: ‘Don’t look to us to solve problems because of the people you elected to serve in the Congress.’”

“So I think our people have to be very attuned to who they send to Congress,” he continued, “and what their views are on religious liberty and conscience rights.”

Additional reporting by Jessica Langdon

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