The Religious Exemption To Contraceptive Coverage In Obamacare

This note has to do with today's (Friday, June 28, 2013) ruling by the U.S. Department of Health and Human Services regarding the mandate for employers to provide coverage for contraception and the limited religious exemption as reported in this article from Bloomberg and the actual ruling, which is linked in the Bloomberg article.

First of all, why did it take so long for the HHS to make a final ruling, especially since they were ordered by the court to stop stalling and make a ruling?  I think it is because of the timing of the renewal of insurance policies, specifically those that renew during the summer (July 1 and August 1 come to mind) and the employers not having a sufficient amount of time to self-certify that they are an eligible employer to opt out of providing the coverage.  Their failure to self-certify in the first year of the law might even be used against them if they try to self-certify at a later date.

Secondly, it seems that there was no compromise on the definition of a religious employer as promised by the HHS.  The actual ruling states "Based on their review of these comments, the Departments are finalizing without change the definition of religious employer in the proposed regulations."

Thirdly, what insurance law allows for an insurance company to provide a coverage to the policyholders without collecting anything for the coverage?  I cannot think of any insurance company or state department of insurance that would approve of doing what is stated here:

"A nonprofit associated with a religious group that doesn’t want to pay for the coverage must inform its insurer or the company that administers its health plan, if it is self-insured, the government said. The insurer then pays for the services without using any money received from the nonprofit."

The actual ruling discusses this this in more detail.  It still does not appear to be actuarially sound on its own.  Rather, it relies on the cost savings in the insurance plan and allows the insurer to offset these payments with the cost savings.  This cost savings is only realized when one combines the payments for contraception coverage with the insurance policy that specifically excludes contraception coverage.  No matter what the ruling states about not using premiums from these policies to pay for contraception coverage, this is the only way the insurer can offset the losses for providing the contraception coverage free of charge.

If the federal government will be reimbursing third party administrators (TPA) of self-insured companies for this coverage, doesn't this mean the government is paying for it?  And how much will this reimbursement cost?  The government has no idea:

"Third-party administrators, who won’t financially benefit from reduced births, will be reimbursed for the coverage by the government. The administration offered no estimate of what those reimbursements would cost."

In regards to the first sentence of the quote in the last paragraph, why should the TPA's benefit from this?  TPA's contract with the self-insured companies.  The TPA gets their income simply for being the administrator and their fee is negotiated and spelled out in the contract.  The supposed savings would be for the self-insured company, not the TPA.

Keep in mind from where the HHS feels the cost savings will come:

"“We do strongly believe that the cost of contraceptive services will be absolutely cost-neutral and offset by improvements to women’s health as well as reduced pregnancies,” she (Chiquita Brooks-Lasure, deputy director of policy and regulation at the Center for Consumer Information and Insurance Oversight at HHS, which is implementing much of the Affordable Care Act.) said at a briefing with reporters."

The overall impact on women's health of providing contraception may actually increase costs.  Some forms of contraception actually have negative impacts on women's health, such as  increased risk of cancer, so that may cause a net increase.  As with the federal government, I am not providing estimates on this, but I will refer you to the National Cancer Institutes Fact Sheet on Oral Contraceptives and Cancer Risk.

If the offset is in reduced pregnancies, then we are in trouble as public policy is being made on the cost of one's life.  It may cost less to the government, an employer, an insurance carrier, and the family (or in some cases, just the woman) to not go through a pregnancy.  The family should be the one making the decision on whether they can afford another child before going through the act of doing something that could conceive a child.  This should NOT be a decision of the government, an employer, or an insurance carrier.  Using the reduced number of pregnancies resulting from providing another coverage is a dangerous precedent in public policy and can lead to the government making such decisions for all people.

And how is the federal government going to determine how much a company saved by providing contraception coverage for them even though it goes against the beliefs of the employer?  How deep into one's health insurance claims will they dig to determine the cost savings of an insurer providing this coverage?

Finally, there is no way for an individual working at some non-religious employer to opt out.  It is simply up to the employer to decide whether to even offer an option to opt out of having the contraception coverage provided.

This ruling was intentionally delayed to make it difficult for eligible employers opt out, did not compromise on what constitutes an eligible employer, forces insurance companies to pay for contraception coverage out of their own pocket while only offering to make this actuarially sound by violating this ruling, does not have an estimate in the cost to the federal government for reimbursing TPA's for providing this coverage, relies on reduced pregnancies to justify this requirement, and does not allow for all individuals to opt out of the coverage.

The Carpenter's Role In Salvation

Christians know the role St. Joseph had in our salvation.  Non-Catholics may simply dismiss Joseph's role in salvation as he was merely the man that was tasked with raising our Lord.  As we see in Matthew 1:18-24, Joseph was afraid to take Mary as his wife because she was with child.  He loved her and did not want "to expose her shame (and) decided to divorce her quietly."  The penalty for such adultery at the time was death.  Had Joseph divorced her publicly, then Mary would have been stoned to death and our Lord Jesus Christ would not have been born.  The role of Joseph in salvation history is more than just husband to woman who gave birth to Jesus, but that of foster father to and teacher of our Lord.

I am in the minority of lay people that prays the Liturgy of the Hours (or the Divine Office).  Morning Prayer and Evening Prayer are the hinges of the Liturgy of the Hours and perhaps the most well known among the faithful.  I feel that the Office of Readings brings the Liturgy of Hours to its fullness in living the yearly cycle of the Church.

On Saturday's during Ordinary Time the Liturgy of the Hours gives the option for the Memorial of the Blessed Virgin Mary.  One of the options for the second reading comes from a homily by St. John Chrysostom.  In this homily, St. John Chrysostom shows the symbols of our fall and salvation are "a virgin, a tree and death."  In our fall "the virgin was Eve; then there was the tree; and death was Adam's penalty.  And again these three tokens of our destruction, the virgin, the tree, and death, became the tokens of our victory. Instead of Eve there was Mary; instead of the tree of knowledge of good and evil, the wood of the cross; instead of Adam's death, the death of Christ."

The virgins were actors that brought our fall and salvation to us.  They both answered calls to do something.  Eve was called by the devil and Mary was called by God.

The trees were instruments that gave us our fall and salvation.  Consuming the fruit of the tree of knowledge of good and evil brought about our fall.  The cross was used to crucify Jesus Christ.  The fruit of the cross is the Body of Christ, which we receive in Holy Communion.

The death of Adam was the penalty that was given to mankind.  We were all doomed to death because of Adam.  Yet when Jesus Christ was put to death and rose from the dead, all were given a chance of salvation, "even those who were born before" Jesus' death and resurrection.

A significant difference in these three symbols is that the tree that brought about our fall was alive and the tree that brought about our salvation was dead.  The work of a carpenter is to build and repair structures of wood.  How did the tree become a cross?  Obviously someone took the wood of a tree and made a cross to crucify Jesus Christ as well as the two thieves next to him and many others that the Romans put to death.  Was it simply the work of human hands that made the cross the symbol of our salvation?  Anyone skilled in carpentry to make a cross for crucifixion.  But to make the cross a symbol of our salvation required the work of a special carpenter.

Joseph, the foster father of Jesus Christ, was a carpenter (Matthew 13:55).  As the foster son of a carpenter, Jesus likely learned the trade of carpentry.  It is this skill that allowed Jesus to do with the cross something that no other carpenter could do.  He took the work of the carpenters, the cross, and by allowing Himself to be put to death on the cross, He transformed the cross into the symbol of our salvation.  Joseph taught Jesus the carpentry skills that allowed Him to transform wood into structures and other useful items and decorations.  Without the carpentry skill learned from Joseph, could Jesus have turned the wood of the cross into the symbol of our salvation?  Although Jesus, as the Son of God, could do anything, I think it was necessary that as the Son of Man He also had to learn something from His foster father, Joseph, to bring about our salvation.  And that something is the carpentry skill.

Congratulations To Pope Francis

Congratulations to Pope Francis (Cardinal Jorge Mario Bergoglio, S.J., Archbishop of Buenos Aires, Argentina) on his election to the Papacy.

Many may have forgotten that he was supposedly a contender in 2005.  I had dismissed him as being too old to be considered this time.  Either this was not an issue for the Cardinal Electors or they believe him to be in good health.

Others may be wondering why a Latin American was elected to be Pope.  About 42% of the Catholic Church is in Latin America and his election reflects this.

Yesterday I was discussing possible Pope names with my wife.  I mentioned that it had been a while since we had a Pope take a name that had not yet been used by a Pope.  My research shows that the last Pope to take an original name was Pope Lando in 913.  I later recalled that John Paul I in 1978 took an original name.  Considering that John Paul I chose the two names together to honor both of his predecessors, so it is not as original as taking a name like Francis that had not been used as a Pope's name.

Pope Francis looks like a Pope to me.  A few days ago I had an image of John XXIII appear to me.  This image appeared to me when looking at an image of the Sacred Heart of Jesus.  Although Francis is not as large as John XXIII, the image that appeared to me reminds me more of Francis that John XXIII.

Finally, I am certain the Holy Spirit guided the College of Cardinals in selecting Pope Francis and I am sure he will guide the Church well.

Congratulations to Pope Francis, our new Pope!