The HHS Rule & The States

A lot of people are saying that the HHS ruling is not a big deal because 28 states are already doing this. Then I saw someone say that actually, that number is closer to 8 because a bunch of those 28 states have the religious exemption that the HHS is denying here. So I decided to do a little legwork and look it up. It looks to me like the latter argument is closer to correct. Here is the breakdown:

States that appear to require contraception coverage for religious institutions (10):
Colorado
Georgia
Illinois
Iowa
New Hampshire
Ohio
Vermont
Virginia
Washington
Wisconsin

States that require contraception coverage but do have an exemption process (19):
Arizona
Arkansas
California
Connecticut*
Delaware
Hawaii
Maine
Maryland
Massachusetts
Missouri
Nevada
New Jersey
New Mexico
New York
North Carolina
Oregon
Rhode Island
Texas**
West Virginia***

States that have no contraception requirement at all(21):
Alabama
Alaska
Florida
Idaho
Indiana
Kansas
Kentucky
Louisiana
Michigan
Minnesota
Mississippi
Montana
Nebraska
North Dakota
Oklahoma
Pennsylvania
South Carolina
South Dakota
Tennessee
Utah
Wyoming

(Note: I am assuming that if no exemption is mentioned in the description, that none exists. It could be the case that there is something.)

* – Connecticut was moved from the first category to the second.

** – Contraceptive coverage is necessary to preserve the life or health of the insured individual is required.

*** – Religious organizations that require an exemption must make alternate arrangements so that their employees can have group-rate coverage, but they are not required to extend this coverage themselves.

Will Truman

Will Truman is the Editor-in-Chief of Ordinary Times. He is also on Twitter.

11 Comments

  1. Fess up, you really did this for use in a future trivia question, right?

    I looked up CT — from what I can tell based on this text, it should be in the second category:

    (b) (1) Notwithstanding any other provision of this section, any insurance company, hospital or medical service corporation, or health care center may issue to a religious employer a group health insurance policy that excludes coverage for prescription contraceptive methods which are contrary to the religious employer’s bona fide religious tenets.

    • (because although it’s a pretty liberal state, there’s a whole mess o’ Catholics here, so I was surprised to see it in the non-exemption list.)

  2. My only question is whether “religious employer” includes hospitals owned by religious organizations or just the current HHS rule which is just ya’ know, actual churches.

    • In some of the cases. In some of the laws from what I’ve read it’s very clear (for example, Missouri). In others, it’s far more nebulous what religious employer means.

    • Jesse,

      Agreed. The information is interesting, but that little detail is necessary to really begin to know what it all means.

    • As far as I know, none of the states make the distinction that the HHS does. The straightforward interpretation of the wording, religious employer, is “employer that is a religious organization.”

      If there is a distinction based on what capacity you work for, I think that would need to be delineated.

      Are you familiar with any states that make this distinction? It’s not something I have heard before. If you are aware of one, and they do use the generic term “religious employer”, then I think that would call what is (to me) the most straightforward interpretation into question.

      • Okay, I found one. California does define religious entity rather clearly and narrowly. That does throw into question how narrowly or broadly “religious employers” are defined in other states.

        Apparently, I could have saved myself a lot of time if I had simply read the link that Ryan provided. Here is what it says:
        8 states provide no religious exemptions at all.
        4 states provide narrow exemptions, like the HHS
        7 states cover schools, universities, charities, associations, and just about everything short of hospitals
        8 states exempt all of the above and hospitals

        I’m not sure why there are only 27 states above, but 28 states that have a contraception requirement.

  3. Note that if the religious employer is self-insured, ERISA probably preempts the state contraceptive coverage mandate.

    • I should expand and clarify that:

      If an employer is self-insured, ERISA preempts state benefit mandates.

    • But not the HHS mandate?

      If so, that suggests that the number of states that have a real HHS-mandate is likely less than ten.

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