Religious nonprofit groups won’t have to pay for birth control under Affordable Care Act proposals

BMJ 2013; 346 doi: (Published 05 February 2013) Cite this as: BMJ 2013;346:f741
  1. Edward Davies
  1. 1New York

Women who work for nonprofit religious institutions such as hospitals and universities will get free birth control without their employers paying, under new proposals from the Obama administration.

The proposals come after a growing movement of more than 50 organizations challenged the Affordable Care Act’s requirement that employees’ health insurance plans cover contraception. Among the most recent was Hobby Lobby, a national arts and crafts retail chain run by a family with strong religious beliefs.1

Under the new proposals, the eligible organizations “would not have to contract, arrange, pay, or refer for any contraceptive coverage to which they objected on religious grounds.”

Guidance from the Centers for Medicare and Medicaid Services explains that under group health insurance plans the eligible organization would provide the self certification to the health insurance issuer, which in turn would automatically provide separate, individual market (rather than group) contraceptive coverage at no cost to plan participants.

“Issuers generally would find that providing such contraceptive coverage is cost neutral because they would be insuring the same set of individuals under both [group and individual] policies and would experience lower costs from improvements in women’s health and fewer childbirths,” says the guidance.

“With respect to self-insured group health plans, the eligible organization would notify the third party administrator, which in turn would automatically work with a health insurance issuer to provide separate, individual health insurance policies at no cost for participants. The costs of both the health insurance issuer and third party administrator would be offset by adjustments in federally facilitated exchange user fees that insurers pay.”2

The federal notice of proposed rulemaking also proposes that an “eligible religious nonprofit organization that is an institution of higher education that arranges for student health insurance coverage may avail itself of an accommodation comparable to that for an eligible organization that is an employer with an insured group health plan.”

A number of religious organizations and their representatives have issued non-committal responses to the proposals, including Carol Keehan, president and chief executive of the Catholic Health Association of the United States, who said, “Following last year’s proposed rule, the Catholic Health Association had asked during the comment period for some changes in the contraceptive coverage section of the rule on preventive services. Now that a new proposed rule has been released for review and comment, we look forward to studying it in relation to our members’ expressed concerns and sharing our assessment of the changes.”


Cite this as: BMJ 2013;346:f741