Unless the rule is overturned, we Catholics will be compelled either to violate our consciences or to drop health coverage for our employees and suffer the penalties for doing so. —Bishop Robert J. McManus

The contraception mandate, a growing point of contention between Catholics and the Obama administration, suffered a blow last Friday when the Catholic Health Association walked back on its earlier support for the White House's birth control compromise.

The dissension removes a key ally from Pres. Obama's court in the debate over the administration's rule stating that most health insurance plans must cover contraceptives for women free of charge. The rule includes coverage for sterilization, contraception and some abortion-causing drugs, which some Catholics have charged is a violation of their fundamental right to religious freedom.

Certain religious employers are exempted from the requirement, but "religious employer" is defined so as to exclude Catholic hospitals and health organizations as well as other religious institutional employers.

"The administration has cast aside the First Amendment of the Constitution of the United States, denying to Catholics and people of other faiths our nation's first and most fundamental freedom, the free exercise of religion," Bishop Robert J. McManus said in a February letter. "As a result, unless the rule is overturned, we Catholics will be compelled either to violate our consciences or to drop health coverage for our employees and suffer the penalties for doing so."

In February, the administration offered a compromise, saying that Catholic institutions would not have to pay for the birth control coverage or refer their employees to it, but that it would all be covered directly by the insurance companies.

Timothy Dolan, archbishop of New York and president of the U.S. Conference of Catholic Bishops, said the rule forces insurance companies to provide services without a co-pay, wrongfully suggesting the services are "free."

"There is no free lunch, and you can be sure there's no free abortion, sterilization or contraception," he wrote in The Wall Street Journal. "There will be a source of funding: you."

On May 21, 43 Catholic institutions filed lawsuits asking federal judges to declare that the rules violate free exercise of religion and the Religious Freedom Restoration Act.

In its five-page letter Friday, the Catholic Health Association, which represents about 600 hospitals and hundreds of nursing homes and other health-related organizations, said that while the government's insurance compromise seemed to be a good first step at the time, further examination of the proposal did not alleviate the group's concerns.

"The more we learn, the more it appears that the (Advanced Notice of Proposed Rulemaking) approaches for both insured and self-insured plans would be unduly cumbersome and would be unlikely to adequately meet the religious liberty concerns of all of our members and other church ministries," the letter stated.

The letter was signed by Daughter of Charity Sister Carol Keehan, who originally supported the compromise.

The letter also suggested changes to the rule to make it more acceptable. The changes included broadening the exemptions for employers in order to address "serious constitutional questions created by the Department's current approach," which separates religious organizations into secular and religious components.

"To make this distinction is to create a false dichotomy between the Catholic Church and the ministries through which the Church lives out the teachings of Jesus Christ," the letter said. "Catholic health care providers are participants in the healing ministry of Jesus Christ. Our mission and our ethical standards in health care are rooted in and inseparable from the Catholic Church and its teachings about the dignity of the human person and the sanctity of human life from conception to natural death."

Critics who say the Catholic Church is fighting to restrict access to birth control are missing the mark, Notre Dame Law Professor Richard Garnett said in May, when the lawsuits against the government were filed.

"Religious institutions are not seeking to control what their employees buy, use or do in private; they are trying to avoid being conscripted by the government into acting in a way that would be inconsistent with their character, mission and values," Garnett said.

The Franciscan University of Steubenville in Ohio announced in May that it would drop health care coverage for students rather than violating the teaching of the Catholic Church, and Ave Maria University in Florida later followed.

In a Feb. 26 column, Cardinal Francis George of Chicago warned that if the current mandates are not rescinded, Catholic institutions will have to choose between upholding religious beliefs, secularizing, paying fines, selling institutions or closing down.

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If the Obama administration insists on enforcing its mandate, George concluded, "two Lents from now" the listing of Catholic hospitals and health-care institutions would be empty. This would create a disaster for the delivery of health care in the United States, Edward Morrissey wrote in a The Fiscal Times column.

A May Washington Post article called Catholic voters the bellwether in the 2012 presidential election, and a May Gallup poll showed Catholics split between President Barack Obama and Republican Mitt Romney, 46 percent to 46 percent, with 8 percent undecided. In 2008 Obama carried Catholics by nine points.

The backlash against the mandate is not just taking place among the leaders of the Catholic Church, as more than 160 protests against the new rules took place across the U.S. on June 8. The Media Research Center reports that tens of thousands of people attended the rallies.

The mandate debate may be answered without any movement from the administration in the next few weeks, with the Supreme Court due to rule on the constitutionality of the president's health care overhaul.