THE RELIGIOUS CONSULTATION
on population, reproductive health & ethics

The New York Times, September 27, 2004

U.S. Health Plans Include One With Catholic Tenets

By Milt Freudenheim

The Bush administration has broken new ground in its "faith-based" initiative, this time by offering federal employees a Catholic health plan that specifically excludes payment for contraceptives, abortion, sterilization and artificial insemination.

The new plan, announced last week, combines two White House priorities. It is part of a $1 billion project seeking to involve religious organizations in all types of federal social programs. At the same time, the plan is a new form of coverage - a health savings account combined with high-deductible coverage - that is being promoted as a centerpiece of President Bush's health care policy.

The plan, which will begin enrolling federal workers in 31 Illinois counties in November, is sponsored by OSF Health, a unit of the Sisters of the Third Order of St. Francis, which runs the St. Francis Medical Center in Peoria and five Roman Catholic hospitals in Illinois and Michigan.

This is the first plan for federal workers "that has tailored its benefits in line with a set of tenets that are supported by the Catholic church," said Abby Block, a senior official in the Office of Personnel Management, which manages the Federal Employee Health Benefits Plan, the nation's largest purchaser of health insurance. It is also the first to be to marketed as "faith-based.''

Trent Duffy, a White House spokesman, said the Office of Personnel Management was one of a number of federal agencies, including the Housing and Urban Development, Justice and Agriculture Departments, that were directed to seek opportunities for faith-based programs.

"Over $1 billion has been made available to faith-based programs," he said. Faith-based organizations have, for example, been involved in job training and transitional services for former prisoners.

Ms. Block said that until now all federal employee benefit plans offered similar standard options and exclusions. Under a 1984 law, plans in the federal program are prohibited from covering abortions, except in cases involving rape, incest or danger to a woman's life. And while a 1999 law requires the plans to offer contraception coverage, Congress has repeatedly exempted insurance plans affiliated with Catholic organizations from that provision.

None of those restrictions, however, have been promoted as a way to appeal to a specific religious audience.

Kay Coles James, the director of the Office of Personnel Management, said last week that the new additions to federal employees' health benefits would "empower" workers to control their medical spending. Ms. James, a former spokeswoman for the National Right to Life Committee, which advocates anti-abortion policies, added that the program gave federal employees "more opportunities to make choices in the private sector."

But some critics expressed concern that this trend in health care might grow into a wider phenomenon. Is this "explicit denial" the first step in "denying federal employees a normal benefit that has been traditional for 30 years?" asked Philip R. Lee, a professor of social medicine at the University of California, San Francisco and a former assistant secretary for health in the Clinton administration. "Is this simply the opening wedge?"

Four million federal workers across the country will have 249 choices of health plans for 2005. Those plans are sponsored by dozens of insurers, including Catholic health systems in Missouri, South Dakota, Texas and Wisconsin, as well as Illinois. Federal workers in Illinois can, of course, still select a health plan that does not have religious-based restrictions. But the OSF plan will be the only health savings account plan available to them.

The Bush administration has promoted health savings account plans as a way to hold down costs, give consumers greater control of health spending and increase personal savings.

The OSF plan has two parts. It couples a tax-free savings account for enrollees to use to pay for routine care with a high-deductible health plan that offers coverage only after the annual deductible has been reached - $1,050 for individual or $2,100 for family coverage. As part of the benefit, a portion of the premium that the government will pay to OSF will be deposited into each enrollee's savings account.

The government's total contribution to the new OSF plan will be $240.89 a month for individuals and $599 a month for families. The employees' monthly premium contribution will be $80.30 for individuals and $199.66 for families. By comparison, federal workers enrolling in a more traditional preferred provider plan in Illinois will pay $89.09 for individuals and $299.96 for families.

The federal program will announce the amount of the health savings account allotments late next month. Employees will be allowed to make pretax contributions of their own into their accounts, but the total in each account each year may not exceed the deductibles.

Ms. Block said that the reproductive- care exclusions in the OSF plan would be explained in brochures distributed to federal workers in Illinois when they choose their coverage for 2005 in November.

The vast majority of health plans sponsored by private employers now pay for various types of contraceptives prescribed by a doctor, according to surveys by the Kaiser Family Foundation and the Alan Guttmacher Institute, a nonprofit research organization that studies reproductive rights and care.

Currently, 23 states require contraceptive coverage, although 14 states provide for an exemption for employers or insurers that object on religious grounds.

A number of Catholic health plans have covered reproductive services including contraception; vasectomies; tubal ligation, which prevents pregnancy; and sometimes abortion, often under Medicaid laws and typically through a non-Catholic partner like a Blue Cross plan.

Indeed, members of other OSF Health plans in Peoria, including one with 4,067 federal employees, have access to contraceptive coverage, although not abortion coverage, through a separate third-party payer.

In line with the administration's policy of encouraging faith-based organizations, however, the new OSF health savings account plan will not cover contraceptives. But because the money in the savings account itself is controlled by the enrolled member, the member could use the account to pay for an abortion or for contraceptives, according to federal officials.

An abortion costs about $375 in Peoria, Ill.; the morning-after contraceptive pill, including the visit to a clinic, costs about $70 at the local Planned Parenthood office, said Joyce Harant, the organization's regional president.

Frances Kissling, president of Catholics for a Free Choice, an independent organization of Catholics who support reproductive choices, criticized the inclusion of a plan with such restrictions in the federal program.

"I don't think substandard medical care should be offered through the federal government," she said.

Although many health plans do not cover abortion, Ms. Kissling said, "when it comes to contraceptives, assisted reproduction and voluntary sterilization, these services are generally covered within our society.''

"These are services that federal employees need," she added.

The level of disclosure of the restrictions also remains a concern for critics. "A lot of these religious restrictions do reduce access to health care, and people don't even know about it," said Elena Cohen, a senior counsel at the National Women's Law Center in Washington.

Representative Pete Stark of California, the senior Democrat on the health subcommittee of the House Ways and Means Committee, said in a telephone interview: "Medical care is a science. Getting medical care and religion mixed together is just as bad as getting church and state mixed together."

But Jeff Koch, a spokesman for OSF Health, said that it was "a good thing for federal employees to have the option" of a plan that would adhere to Catholic Church policy.

This is the first plan for federal workers "that has tailored its benefits in line with a set of tenets that are supported by the Catholic Church," said Abby Block, a senior official in the Office of Personnel Management, which manages the Federal Employee Health Benefits Plan, the Catholic health plan nation's largest purchaser of health insurance.