In a call for broader religious exemptions, the Catholic Health Association has backtracked from its initial support for the Obama administration's compromise on a rule that mandates employer coverage of contraception and sterilization.
The association said it is "imperative" that the administration abandon its "narrow" definition of religious employer and exempt not only churches but also Catholic hospitals, health care organizations and other Church ministries.

It said it is "deeply concerned" by the administration's approach to "contraceptive services, especially abortifacient drugs and sterilization."

The Catholic Health Association represents over 600 hospitals and 1,400 other health facilities in all 50 U.S. states. It is the largest group of nonprofit health care providers in the U.S.

The June 15 letter from CHA president and CEO Sister Carol Keehan and other association board members addressed the Department of Health and Human Services about the proposed rulemaking to implement the Obama administration's intended accommodation announced on Feb. 10.

However, when the accommodation was initially presented, Sr. Keehan said in a Feb. 10 statement that the Catholic Health Association was "very pleased" with the White House's proposal and that it "protects the religious liberty and conscience rights of Catholic institutions."

"The framework developed has responded to the issues we identified that needed to be fixed," she said.

"We are pleased and grateful that the religious liberty and conscience protection needs of so many ministries that serve our country were appreciated enough that an early resolution of this issue was accomplished," Sr. Keehan stated.

The CHA statement was circulated by a White House official before the Obama administration announced the proposed accommodation, a fact that prompted speculation the CHA had input into the proposal.

But in its June 15 letter, the CHA changed its tone. It said the announcement had seemed to be "a good first step" but further study "has not relieved our initial concerns."

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The HHS mandate requires employers with 50 or more employees to provide insurance coverage for sterilization and contraception, including some abortion-causing drugs, as "preventive care" for women. Its religious exemption applies only to employers whose primary purpose is the inculcation of religious values and who primarily employ and serve co-religionists.

Catholics and other believers have objected that the exemption does not include many religious employers such as health care systems, colleges, and charities.

Initial outcry after the Jan. 20 announcement of the mandate caused the Obama administration to propose that insurance companies, not employers, be required to provide the coverage.

The proposed accommodation was deemed unacceptable by the U.S. bishops and many legal experts, college professors and religious freedom advocates from a variety of political and religious backgrounds.

The CHA's June 15 letter reiterated the association's support for the Patient Protection and Affordable Care Act, which gave the Department of Health and Human Services the power to mandate the controversial coverage.

The association said it had objected "strenuously" to the narrow definition of religious employer in September 2011 when the mandate was being formulated.

Its letter does not mention the conscience rights of objecting Catholic employers who run secular businesses, though the general counsel of the U.S. bishops conference has noted this problem.

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The association said that if the government intends to provide access to contraceptive services to all employees, it should "find a way to provide and pay for these services directly without requiring any direct or indirect involvement of 'religious employers,' as broadly defined."

The Catholic Health Association was a major backer of the 2010 health care legislation. Sr. Keehan received one of the pens that President Obama used to sign the bill into law as a token of thanks. The bishops opposed the bill on several grounds, including what they said was a lack of sufficient safeguards against abortion funding.