Catholic Church Voices Concern About Women's Health Care

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Host Michel Martin speaks with the United States Conference of Catholic Bishops' general counsel Anthony Picarello about the church's concern over the mandatory coverage of women's preventative care. The Catholic Church is concerned that preventative care, broadly defined, could include contraception and sterilization, putting faith-based employers in a tight spot between compliance with the law and their religious convictions.

MICHEL MARTIN, host:

Now we'd like to turn to another matter at the intersection of health and policy. As we mentioned on this program last week, new provisions of a health-care reform bill went into effect last week. And among them is the requirement that new health policies provide coverage for preventive services, including things like standard vaccines, breast and colon cancer screenings, screenings for diabetes, and so on.

But the United States Conference of Catholic Bishops has sent a letter earlier this month to the Department of Health and Human Services, urging the exclusion of contraception and sterilization from that list of mandatory services of preventive care for women.

We wanted to talk more about this, so we've called Anthony Picarello. He is general counsel for the United States Conference of Catholic Bishops. And he's with us now from our Washington, D.C., studio.

Welcome. Thank you for joining us.

Mr. ANTHONY PICARELLO (General Counsel, United States Conference of Catholic Bishops): Thanks for having me.

MARTIN: So is there a standard definition of what qualifies as preventive care yet?

Mr. PICARELLO: Not yet.

MARTIN: Or is that what you're arguing about?

Mr. PICARELLO: Yeah. Essentially, preventive services is kind of a broad term. And the Department of Health and Human Services recently proposed a list of things that it ought to include. And it includes all the sensible things that you just described. It includes pap smears and colonoscopies and vaccines - and all kinds of things that have in common that they are designed to prevent disease, first of all, and that they, themselves, also bear very little risk.

The benefit of this is obvious because what it tends to do is it's the classic, you know, ounce of prevention is a pound of cure. You put money into the front-end. You require those things to be covered. And as a result, you have fewer sick people, and in turn you have lower cost down the line. So it's bending the cost curve is the...

MARTIN: So what's the basis for your objection to including things like contraception and sterilization? Under the new...

Mr. PICARELLO: Sure.

MARTIN: And just to clarify, this wouldn't require people to have those. It would require health plans to offer them or to cover them.

Mr. PICARELLO: To cover them.

MARTIN: And so what is the Catholic bishops' objection?

Mr. PICARELLO: Sure. Well, there are essentially three arguments we have in our comments. The first is that preventive services are designed to prevent diseases. Pregnancy is not a disease. Contraception and sterilization prevent those things. Therefore, they're not preventive services. That's the first piece of it.

In addition, preventive services are designed not to create risks of their own. In other words, they're just basically tests and screenings, and things like that. But contraception does have some pretty well-known health risks, including risks of a sort that other preventive services are designed actively to prevent - things like stroke, heart attack, things along those lines.

And the third reason that we lay out is that essentially, because the preventive services mandate does not have a conscience clause exception, what you're doing by construing it broadly to encompass contraception/sterilization, is you're creating a needless religious freedom problem.

MARTIN: For who? I mean, do insurance companies, as a rule - are there religiously driven or religiously run insurance companies?

Mr. PICARELLO: The short answer is yes. And in addition to that, you have the religious freedom concerns of employers, Catholic employers - and there are gobs of those, of course. And if insurers are prohibited from offering the coverage, then employers are prohibited from getting the coverage. In other words, if they can't purchase coverage that excludes these services, then they're in a bind.

Now, the obligation,strictly speaking, falls on the insurer. But the law's prohibition basically prevents Catholic employers from getting insurance that is consistent with their beliefs.

MARTIN: Well, why shouldn't, though, the burden of conscience be on the individual herself or himself, to not purchase these items if they are prohibited by his or her faith? As opposed to globally, persons who may not share those religious beliefs, to be prohibited from having access to those services based on a religion which they may not adhere to.

Mr. PICARELLO: Well, individually, folks can choose to purchase services or not. Of course, if those services are mandated, even individuals down the stream don't have a choice.

MARTIN: But don't non-Catholics work for Catholic hospitals?

Mr. PICARELLO: Yeah. Mm-hmm, that's true. But the point is, the mandate falls on the employer. The mandate falls on the insurer. In other words, it's not as if this particular rule affects everybody's consciences all at once. It's specifically directed to that of the insurers, and that of the employers. And so we're kind of interested in making sure that it doesn't create a problem in that realm.

MARTIN: What kind of response have you gotten from the Department of Health and Human Services from this letter that you sent? Have you received any response to this point?

Mr. PICARELLO: No. I mean, just the way comment process works: We submit it, we commented on what are called Final Interim Regulations - so they've already gone into effect. The regulations, as they were proposed, didn't include contraception, so it wasn't as if we're specifically calling for an exclusion.

It's that when these regulations were proposed, listing the sensible things that they did, Planned Parenthood came along and said, we intend to fight to have contraception included in that - essentially in the second round of preventive services to be defined; that's going to happen around next year.

So the comments are essentially responsive to that...

MARTIN: I do take your point. But obviously, one person's common sense is another person's...

Mr. PICARELLO: Well, Michel, I mean, I think...

MARTIN: ...sort of line in the sand.

Mr. PICARELLO: Well, see the...

MARTIN: So the question, then: How do you think, in a religiously diverse country like this, an issue like this should be resolved?

Mr. PICARELLO: Addressed?

MARTIN: Yeah.

Mr. PICARELLO: Yeah. Well, the problem is not new. The solution is not new either, and that is to basically provide some sort of conscience exemption in the statute to the mandate. I mean, when you kind of step back from this, what you're dealing with is a situation where, in a post-health care reform world, you've got a lot more mandates than you had before.

And when you have the government compelling the coverage of certain services in a religiously diverse society, you can reasonably expect that different groups are going to have different objections to different services. I mean, the first one out of the gate that's getting attention happens to be Catholics vis-a-vis contraception, sterilization.

But the point is, these are just sort of little iterations of a broader issue. And the broader issue is when you have mandates, it's good to have conscience exception to avoid religious freedom problems. When you've had contraceptive mandates in other context, there have been those sorts of exceptions.

In the context of the discussion about the legislation before it was passed, the bishop's conference did raise the need for conscience protection, and that was not addressed at that time. And lo and behold, we're having these problems beginning to emerge already.

So at this stage of the game, the way to avoid the problem is just to construe preventive services so that pregnancy isn't a disease, and so forth. And that all makes sense. And that, incidentally, is consistent with avoiding needless religious freedom conflicts.

MARTIN: And when will this decision be made?

Mr. PICARELLO: Well, the ultimate decision on this question will come down in August of '11 - is our understanding, based on the regulations. But the regulations that we commented on, like I said, are already in effect now. They don't encompass contraception or sterilization.

The second round will relate specifically to preventive services for women. That's when the issue will be engaged more directly. And then the decision comes out August 11th.

MARTIN: Anthony Picarello is general counsel for the United States Conference of Catholic Bishops. He joined us here in our Washington, D.C., studio.

Thank you so much for coming in.

Mr. PICARELLO: Thanks for having me.

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