WASHINGTON — Health-insurance plans must provide birth control and surgical sterilization as “preventive care” for women, with no co-pays, according to a directive issued by the Department of Health and Human Services.

The U.S. Conference of Catholic Bishops, pro-life groups and religious-freedom advocates immediately criticized the Aug. 1 decision, expressing alarm about its narrow exemptions for religious groups, and calling on supporters to back a bill before Congress that would strengthen exemptions for employers who oppose surgical sterilizations and contraception.

“Although this new rule gives the agency the discretion to authorize a ‘religious’ exemption, it is so narrow as to exclude most Catholic social-service agencies and health-care providers,” said Cardinal Daniel DiNardo, archbishop of Galveston-Houston and chairman of the USCCB Committee on Pro-Life Activities.

“For example, under the new rule, our institutions would be free to act in accord with Catholic teaching on life and procreation only if they were to stop hiring and serving non-Catholics,” Cardinal DiNardo noted in a published statement.

Marie Hilliard, director of bioethics and public policy at The National Catholic Bioethics Center, expressed dismay at the “apparent utter disregard for the protection of conscience exhibited in the final regulations, implementing the rules for group health plans and health-insurance coverage under the Patient Protection and Affordable Care Act.

“Every insured, insurer, employer and policy implementer included under the health-care reform mandates would be coerced into cooperating through insurance premiums, tax dollars or through actualizing policy mandates in these state-driven and ideologically based violations of a true understanding of human reproduction,” said Hilliard.

“These regulations reflect an utter disregard for the foundational principle of the very government promulgating them, that is, that conscience is sacrosanct. We are left to ask, When did we lose the respect for conscience which drove the very founding of our country?” she added.

Unanswered Questions

The HHS guidelines were slated to be released on Aug. 1, and religious organizations and pro-life groups had already taken note of troubling signs that the federal government would ignore their moral concerns and approve new directives that might force Catholic institutions to close their doors or end medical benefits for their employees, as some agencies have done.

Still, Church organizations and pro-life groups scrambled to issue a timely response to the new standards, and acknowledged that several key questions had not been answered. For example, the HHS statement noted that the department would consider comments about religious freedom and conscience issues — even as HHS noted that the deadline for comments had passed.

Further, while the new standards will take effect in January 2013, health plans that do not already provide such services may not have to provide them for some time — at least until the plan undergoes some changes.

Meanwhile, even as some medical experts noted that “free” contraceptives would not effectively stem the problem of unintended pregnancies, federal authorities promised to promote the new services to increase awareness that they were available.

In his public statement, Cardinal DiNardo expressed the frustration of many bishops who had initially applauded efforts to expand health coverage to an estimated 30 million uninsured patients — until concerns about the funding of abortion under the proposed health bill prompted their opposition.

“Could the federal government possibly intend to pressure Catholic institutions to cease providing health care, education and charitable services to the general public? Health-care reform should expand access to basic health care for all, not undermine that goal,” said the cardinal.

The administration backed the new standards as a breakthrough for women.

“These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” said Kathleen Sebelius, the secretary of the Health and Human Services Department, in a published statement.

That argument was embraced by family-planning groups. In a fundraising letter, Cecile Richards, president of the Planned Parenthood Action Fund, told supporters, “It’s a sweet victory, but we need your help with one more thing. For the next 60 days, HHS is accepting public comments on their ruling, as well as a proposal that would allow some religious employers to deny women access to this vital health-care service.” In the letter, Richards urged supporters to ask HHS to block the exemptions: “Tell them that you wholeheartedly support no-co-pay birth control and that all women, regardless of their employer or insurer, should have access to birth control if they want or need it."

Religious Exemption

But Catholic coalitions and pro-life groups charge that the administration’s approach to establishing the contraception mandates ignored their concerns, while giving priority to family-planning groups like Planned Parenthood, which was formally invited to participate in public hearings that reviewed expert testimony on proposals for mandated services. USCCB representatives at the hearings sought to challenge the suggestion that “pregnancy was a disease” and thus required “preventive services.”

The Aug. 1 statement from the U.S. bishops noted that the full range of contraceptives approved by the Food and Drug Administration that would be available without any co-pay included “drugs which can attack a developing unborn child before and after implantation in the mother’s womb.”

For religious-freedom experts, the HHS directives reflect a disturbing legislative and legal trend that increasingly seeks to exclude Church-affiliated organizations that serve nonbelievers as well as Catholics. In recent cases involving Catholic Charities in California and New York, religious exemptions have been limited to programs that exclude nonbelievers. Subsequently, religious-freedom advocates were dismayed when the Supreme Court declined to consider appeals.

The HHS rule “contains a feeble religious exemption that protects only institutions that employ and serve members of their own faith. It offers no protection for the vast majority of religious schools, hospitals and charities that are open to all, as if teaching children, healing the sick and feeding the hungry weren’t religious practices. And it does nothing to protect individual believers,” said Seamus Hasson of the Becket Fund, which provides legal counsel on religious-freedom cases.

“By offering religious exemptions only to organizations that do not reach out to the world, Secretary Sebelius may not have cured the common conscience, but she has certainly done her best to quarantine it,” said Hasson.

He echoed Cardinal DiNardo’s call for Catholics to back the passage of the Respect for Rights of Conscience Act (H.R. 1179), introduced by Reps. Jeff Fortenberry, R-Neb., and Dan Boren, D-Okla. The legislation would “prevent mandates under the new health-reform law from undermining rights of conscience.”

Cardinal DiNardo stated that the “administration’s failure to create a meaningful conscience exemption to the preventive-services mandate underscores the need for Congress to approve the Respect for Rights of Conscience Act.”

Joan Frawley Desmond writes from Chevy Chase, Maryland.