Controversy Over Contraceptives Lingers As New Health Plans Start

Wednesday marks the first day for millions of Americans to be covered by health insurance under the Affordable Care Act. But a lingering controversy over one of the law's required benefits, contraceptive coverage, is still playing out in the courts.

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AUDIE CORNISH, HOST:

Now, to a lingering controversy over one of the health law's required benefits, contraceptive coverage. Last night, Supreme Court Justice Sonia Sotomayor temporarily blocked the federal government from requiring a Catholic order of nuns who operate 30 nursing homes from having to provide the benefits to their workers. NPR's Julie Rovner joins us now to sort some of this out. Hey there, Julie.

JULIE ROVNER, BYLINE: Hey, Audie.

CORNISH: So remind us first, what are the requirements in the law when it comes to covering contraceptives?

ROVNER: Well, this is part of a preventive services package that applies to almost all health plans, most of those provided by employers as well as the new plans that people are buying in the individual market. The benefit, by the way, was developed not by the administration itself, but by the Independent Institute of Medicine and it said that as part of routine healthcare for women, they should have access to all forms of FDA approved prescription contraceptives with no co-pays.

Now, this does not include the controversial abortion pill, mifepristone, but it does include some forms of the morning-after pill and the intrauterine device, which some religious people say cause abortion by blocking the implantation of a fertilized egg, although that's not the medical definition of an abortion.

CORNISH: To be clear, though, some religious groups are completely exempt from the requirement.

ROVNER: That's right. From the beginning, the rules exempted what the administration called a religious employer. That's defined as an organization that has the inculcation of religious values as its primary purpose, that it primarily employees people who share those religious tenets and it primarily served people who share that faith.

But many religious organizations, mostly, but not exclusively Catholic groups, complained that that exemption was way too narrow.

CORNISH: So who did it leave out?

ROVNER: Well, primarily it leaves out religious health and education facilities so hospitals, colleges, schools and social service agencies are all covered by the requirement. Now, after a lot of back and forth, the administration made a lot of changes to the rules. Finally, last summer, it made what it hoped would be a compromise everyone could live with, that religious groups that were not exempt had to make sure their employees get the benefit, but that they wouldn't have to pay for or provide it themselves, that the coverage would be provided directly by an insurance company or a third party provider.

That turned out to be still too much for many religious groups who say they're being made complicit in something that violates their religion and starting today, they can be subject to penalties for not facilitating the benefit, which is why there was a last-minute flurry of legal action. And most of the plaintiffs in this suit, there's about 20 suits that are still in play, have gotten injunctions fairly easily so they don't have to comply with the rules while their lawsuits are being heard.

The only reason this suit reached Justice Sotomayor is that the appeals court in the 10th circuit, where this case was heard, wouldn't grant that injunction and Justice Sotomayor is in charge of that circuit. I doubt we really would've heard much about this case except for that.

CORNISH: So does this ruling tell us anything about what's likely to happen?

ROVNER: I really don't think so. As I said, most of these cases have resulted in those suing getting a stay while their cases are heard and most people think this case will ultimately be decided by the full Supreme Court anyway.

CORNISH: Doesn't the Supreme Court already have this case before it?

ROVNER: Well, yes and no. What the court already has agreed to hear are two cases from for-profit companies about the contraceptive mandate, but those companies are actually required to provide this coverage. These religious groups, remember, don't have to provide it directly so it's a slightly different issue, even though it's the same mandate.

The religious cases have been somewhat delayed in the courts, however, because, as I mentioned, the rules hadn't yet taken effect. Now they are in effect and I expect we'll start seeing this case move a little more briskly.

CORNISH: That's NPR's Julie Rovner. Julie, thank you.

ROVNER: Thank you.

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