Oregon Right to Life has filed suit against the 2017 Oregon law requiring health plans to cover abortion. In October 2019, the Thomas More Society challenged a similar Illinois mandate. New York and Washington also require abortion coverage in private health plans.
The California rule was so broad that churches and other religious groups could not secure abortion-free California health plans for their employees. Its history, however, was rooted in an effort of Catholic universities to reform their health plans to become more consistent with their Catholic identity.
In August 2014 California's Department of Managed Health sent a letter to seven insurance companies stating that they are required to include elective abortions in their health plans. A 1975 state health care law, the California constitution, and court precedent, it said, prohibits health plans "from discriminating against women who choose to terminate a pregnancy." The law requires all health plans to "treat maternity services and legal abortion neutrally," the state regulator said.
The action came after the autumn 2013 announcements from two Catholic universities, Santa Clara University and Loyola Marymount University, which said that they planned to stop paying for employees' elective abortions. They said their insurers, Anthem Blue Cross and Kaiser Permanente, had secured approval from state officials.
In an October 2013 letter, Santa Clara University president Father Michael E. Engh, S.J., said that the university's "core commitments" are incompatible with abortion coverage. Before the policy was revised, Santa Clara's health plan also provided abortion coverage to dependents of faculty and staff.
The universities' move against abortion coverage drew praise from Catholic and pro-life groups. However, the policy changes drew strong opposition from pro-abortion politicians and advocacy groups, as well as from many faculty and staff at the historically Jesuit Catholic schools. In December 2013, Santa Clara University faculty rejected the anti-abortion changes to the health care plan by a vote of 215 to 89.
Lobbyists from Planned Parenthood wrote to the California Department of Health and Human Services to insist that agency rules be changed to force religious groups to provide coverage for elective abortions. Emails showing this effort were contained in 2017 court filings from the Alliance Defending Freedom legal group but date to the time of the controversy.
The emails specifically named the two Catholic universities.
The insurers and the universities agreed to comply with the state's new pro-abortion requirements. However, the state rules drew strong opposition from the California Catholic Conference, which charged that the state government "directly targeted" the two Catholic universities and violated federally guaranteed civil rights by ordering their health insurance plans to cover abortions.
"This is a coercive and discriminatory action by the State of California," said Bishop Robert McElroy, then an auxiliary bishop of San Francisco and chairman of the state Catholic conference's Institutional Concerns Committee.
McElroy, who became Bishop of San Diego in 2015, characterized the decision as a demand "directly targeted at Catholic institutions like Santa Clara University, Loyola Marymount University, along with other California employers and citizens."
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"It is a flagrant violation of their civil rights and deepest moral convictions, and is government coercion of the worst kind," McElroy said Oct. 1, 2014.
In June 2016, the Obama Administration rejected the California Catholic Conference's federal complaint against the mandate. The HHS Office for Civil Rights said it "found no violation of the Weldon Amendment and is closing this matter without further action."
At that time, leaders with the U.S. Conference of Catholic Bishops said it was "shocking" that the federal government allowed California to force all employers, including churches, to fund and facilitate elective abortions.
"Even those who disagree on the issue of life should be able to respect the conscience rights of those who wish not to be involved in supporting abortion," Cardinal Timothy Dolan of New York and Archbishop William Lori of Baltimore said in June 2016. They objected that the ruling was "contrary to the plain meaning of the law" and called for Congress to pass the Conscience Protection Act.
Marjorie Dannenfelser, president of the pro-life Susan B. Anthony List, praised the Trump administration's move against the California policy.
"Abortion is not health care and no American should ever be forced to participate in the destruction of innocent human life," said Dannenfelser, who also co-chairs the Pro-Life Voices for Trump National Advisory Board ahead of the 2020 election.