Catholics Split Again On Coverage For Birth Control

Baltimore Archbishop William Lori gave voice to a letter Catholic groups sent to the administration and Congress to protest insurance rules for contraceptives.

Two prominent Catholic groups are finding themselves, once again, on opposite sides of a key issue regarding the Affordable Care Act.

Three years ago, the Catholic Health Association, whose members run hospitals and nursing homes across the country, backed passage of the health law. The U.S. Conference of Catholic Bishops, which represents the hierarchy of the church, opposed it.

Now the groups are divided over the law's requirement for most employer-based health insurance plans to provide women with birth control.

Both groups say things are different this time around.

Sister Carol Keehan, president and CEO of the Catholic Health Association, said that the administration's final birth control rule wasn't what her organization would have preferred. "But it was a solution that we could make work, because it allows our members not to have to buy, contract for, refer or arrange for contraceptive services," she says.

Under the rule, churches and other houses of worship are exempt. Women who work for Catholic, or other religious hospitals, universities and social service agencies will still get the no-cost birth control. But the religious entity won't have to be involved in providing it. An insurance company or insurance administrator will instead.

But while that's good enough for Keehan, it's not cuttting it withthe U.S. Conference of Catholic Bishops. Last week it hosted what it called a "religious liberty press conference" with representatives of several other faith groups to decry the rules.

Archbishop William Lori of Baltimore read from the letter the groups sent to Congress and the administration urging the rules be overturned. "We stand united in protest to this mandate, recognizing the encroachment on the conscience of our fellow citizens," he said.

Lori said later in the news conference that if women want to have birth control as part of their health insurance plans, they shouldn't go to work for religious employers.

"And I think those employers are pretty upfront about that right at the beginning," he said. "So it's always a person's choice, whether he or she wants to sign onto such a thing."

That outrages people like James Salt, executive director of Catholics United, a liberal Catholic group. "The bishops have staked out a fairly extreme position which we refer to as the Taco Bell exemption," Salt said. "They want every Taco Bell to be exempted from this mandate."

Salt doesn't mean Taco Bell, literally. He means any for-profit company headed by someone with a religious objection to the mandate. "They want those for-profit entities to have the right to exempt themselves," he says.

But unlike the fight over passage of the health law in 2010, when Keehan said it didn't provide new federal funding for abortion and the bishops said it did, both sides are trying to play down this split. The bishops noted that the Catholic Health Association had informed them of its decision before going public, and Keehan says she understands that the bishops have a larger agenda to pursue than she does.

"The whole religious freedom questions they are focused on now; that is a much bigger question," she says.

And the Catholic Health Association's endorsement of the rules wasn't really much of a surprise, particularly given its long-standing support of the law. "The CHA thinks it's OK and God bless 'em it's a free country, they're allowed to do that," says Mark Rienzi, senior counsel with the Becket Fund for Religious Liberty, which is representing many of those suing over the rules. "Other people don't think it's OK and that's why there are 60-some lawsuits that are out there and will continue."

In fact, one of the few things just about everyone agrees on is that this is an issue likely to be resolved only when it gets to the Supreme Court.

"Maybe the administration will back down, but they've shown no signs of it yet," says Rienzi. "So I think the bottom line is the relief will have to be through the courts, where it's been for all the businesses. And the fact of the matter is the businesses have been doing outstandingly well."

By that he means that many of the for-profit firms that have sued have at least had the birth control mandate put on hold while their cases are heard. But like the health law itself, this issue still has a long way to play out.

Tax Break Can Help With Health Coverage, But There's A Catch

Tax credits may help make health insurance more affordable, but can bite back if your income goes up more than expected.

There are two kinds of financial help for people planning to enroll in the online health insurance marketplaces that will open this fall. One could put people at risk of having to pay some of the money back, while the other won't.

That's one big difference between tax credits and subsidies, both of which are intended to help people with lower incomes pay for health insurance through the new health care law.

People with incomes between 100 and 400 percent of the federal poverty level ($11,490 to $45,960 for individuals in 2013) may be eligible for tax credits to reduce the cost of their monthly health insurance premiums.

In addition, people with incomes between 100 and 250 percent of the poverty level ($11,490 to $28,725) may qualify for cost-sharing subsidies that will bring down their deductibles, copayments and coinsurance. The subsidies also reduce the maximum amount they can be required to pay out of pocket annually for medical care.

Instead of waiting until tax time to claim the credit for the premiums on their return, people can apply to get it in advance, based on their estimated income for 2014. In that case, the state health exchange, or marketplace, will estimate the tax credit and send it directly to the insurer.

But there's a catch. When April 15 rolls around, the Internal Revenue Service will reconcile the amount of the advance payments sent to the insurer with the taxpayer's actual income. If a person's income is higher than the estimate, the taxpayer will have to repay the difference.

But there's some good news, too. If a person's income is lower than estimated, the taxpayer will get a credit.

People who quality for the cost-sharing subsidies won't face the same financial risk. The federal subsidies, which reduce consumers' out-of-pocket costs, will be paid directly to insurers. They could cover thousands of dollars of costs, depending on a person's health care usage.

But with the subsidies, if a person's income changes during the year, he or she won't be responsible for any extra costs.

"It's not a reconcilable tax credit, so consumers aren't on the hook if their income changes," says Christine Monahan, a senior health policy analyst at Georgetown Health Policy Institute's Center on Health Insurance Reforms.

So check out both options for cheaper premiums, but be well aware of the differences.

NPR Special Coverage: Court Issues Opinions On Major Cases

Listen to NPR's Special Coverage Of The Supreme Court Decisions
The U.S. Supreme Court issued opinions on four major cases this week that dealt with same-sex marriage, affirmative action in college admissions and the 1965 Voting Rights Act. In an NPR special, journalists and guests discussed the court's decisions and the implications of the rulings going forward.
Host: Linda Wertheimer
Guests: Ron Elving, NPR senior Washington editor; Nina Totenberg, NPR legal affairs correspondent; Tom Goldstein, publisher of and contributor to SCOTUSblog; Wendy Kaufman, NPR correspondent; and Michael Fauntroy, associate professor of political science at Howard University
Fisher v. University of Texas at Austin: The court issued an opinion Monday in a case that was a challenge to the University of Texas' affirmative action admissions process. Abigail Fisher said she was denied admission to the university because of race. In a 7-1 vote, the court sidestepped the underlying issue of the case and instead sent the case back to the lower courts with instructions to conduct a more thorough factual inquiry. The justices ruled that the lower court "did not hold the university to the demanding burden of strict scrutiny articulated" in an earlier Supreme Court ruling — 2003's Grutter v. Bollinger.
(Read the ruling)
Shelby County v. Holder: On Tuesday, the court struck down what is seen as the linchpin of the 1965 Voting Rights Act. By a 5-to-4 vote, the court invalidated the formula — adopted most recently in 2006 — used to determine which states and local governments had to get federal approval for changes in their voting laws. The decision frees nine mostly Southern states from this "pre-clearance." Many voting-rights advocates were angered and dismayed by the court's decision, and critics say it could lead to more lawsuits. (Read the ruling)
United States v. Windsor and Hollingsworth v. Perry: Both of these cases dealt with the issue of same-sex marriage, but in different ways. In United States v. Windsor,
the court ruled 5-4 on Wednesday to overturn the Defense of Marriage Act, the 1996 federal law that confines marriage to a man and a woman. As NPR's Liz Halloran reports, the court's decision does not embrace a national constitutional right to same-sex marriage but makes married gay couples living in states where their unions are legal eligible for federal benefits already enjoyed by married heterosexual Americans.
Hollingsworth v. Perry
involved California's controversial Proposition 8, a 2008 ballot measure that outlawed same-sex marriages in the state. The court ruled in a 5-4 decision, with Chief Justice John Roberts in the majority, that supporters of the law did not have standing to bring the case before the 9th Circuit Court of Appeals to challenge a lower court's ruling that invalidated the law. While this allows same-sex marriages to continue in California, it does not have broader implications across the country, and the justices avoided the underlying issues. (Read both rulings with annotations)