Two prominent Catholic groups are finding themselves, once again, on opposite sides of a key issue regarding the Affordable Care Act.
Three years ago, the Catholic Health Association, whose members run hospitals and nursing homes across the country, backed passage of the health law. The U.S. Conference of Catholic Bishops, which represents the hierarchy of the church, opposed it.
Now the groups are divided over the law's requirement for most employer-based health insurance plans to provide women with birth control.
Both groups say things are different this time around.
Sister Carol Keehan, president and CEO of the Catholic Health Association, said that the administration's final birth control rule wasn't what her organization would have preferred. "But it was a solution that we could make work, because it allows our members not to have to buy, contract for, refer or arrange for contraceptive services," she says.
Under the rule, churches and other houses of worship are exempt. Women who work for Catholic or other religious hospitals, universities and social service agencies will still get the no-cost birth control. But the religious entity won't have to be involved in providing it. An insurance company or insurance administrator will instead.
But while that's good enough for Keehan, it's not cutting it with the U.S. Conference of Catholic Bishops. Last week it hosted what it called a "religious liberty press conference" with representatives of several other faith groups to decry the rules.
Archbishop William Lori of Baltimore read from the letter the groups sent to Congress and the administration urging the rules be overturned. "We stand united in protest to this mandate, recognizing the encroachment on the conscience of our fellow citizens," he said.
Lori said later in the news conference that if women want to have birth control as part of their health insurance plans, they shouldn't go to work for religious employers.
"And I think those employers are pretty upfront about that right at the beginning," he said. "So it's always a person's choice, whether he or she wants to sign on to such a thing."
That outrages people like James Salt, executive director of Catholics United, a liberal Catholic group. "The bishops have staked out a fairly extreme position which we refer to as the Taco Bell exemption," Salt said. "They want every Taco Bell to be exempted from this mandate."
Salt doesn't mean Taco Bell, literally. He means any for-profit company headed by someone with a religious objection to the mandate. "They want those for-profit entities to have the right to exempt themselves," he says.
But unlike the fight over passage of the health law in 2010, when Keehan said it didn't provide new federal funding for abortion and the bishops said it did, both sides are trying to play down this split. The bishops noted that the Catholic Health Association had informed them of its decision before going public, and Keehan says she understands that the bishops have a larger agenda to pursue than she does.
"The whole religious freedom questions they are focused on now, that is a much bigger question," she says.
And the Catholic Health Association's endorsement of the rules wasn't really much of a surprise, particularly given its long-standing support of the law. "The CHA thinks it's OK and God bless 'em it's a free country, they're allowed to do that," says Mark Rienzi, senior counsel with the Becket Fund for Religious Liberty, which is representing many of those suing over the rules. "Other people don't think it's OK and that's why there are 60-some lawsuits that are out there and will continue."
In fact, one of the few things just about everyone agrees on is that this is an issue likely to be resolved only when it gets to the Supreme Court.
"Maybe the administration will back down, but they've shown no signs of it yet," says Rienzi. "So I think the bottom line is the relief will have to be through the courts, where it's been for all the businesses. And the fact of the matter is the businesses have been doing outstandingly well."
By that he means that many of the for-profit firms that have sued have at least had the birth control mandate put on hold while their cases are heard. But like the health law itself, this issue still has a long way to play out.