Many church-affiliated institutions will have to cover free birth control for employees, the Obama administration announced Friday in an election-year move that outraged religious groups, fueling a national debate about the reach of government.
In a concession, Health and Human Services Secretary Kathleen Sebelius said nonprofit institutions such as church-affiliated hospitals, colleges and social service agencies will have one additional year to comply with the requirement, issued in regulations under President Barack Obama's health care overhaul.
"I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services," Sebelius said in a statement.
Yet the concession was unlikely to stop a determined effort by opponents to block or overturn the rule. If they fail, some predicted that religious employers would simply drop coverage for their workers, opting instead to pay fines to the federal government under the health care law.
"Never before has the federal government forced individuals and organizations to go out into the marketplace and buy a product that violates their conscience," said New York Cardinal-designate Timothy Dolan, president of the U.S. Conference of Catholic Bishops. "This shouldn't happen in a land where free exercise of religion ranks first in the Bill of Rights."
Officials said the administration's ruling was carefully considered, after reviewing more than 200,000 comments from interested parties and the public. The one-year extension, they said, responds to concerns raised by religious employers about making adjustments. Administration officials stressed that individual decisions about whether or not to use birth control, and what kind, remain in the hands of women and their doctors.
Underscoring the sensitivity of the decision, Obama personally spoke with Dolan on Friday to inform him of the announcement, an administration official said.
The Becket Fund for Religious Liberty, a powerhouse law firm based in Washington that tackles religious freedom issues, predicted in a statement that religious groups "will never pay for abortion drugs in violation of their religious beliefs." Many religious conservatives consider the morning-after birth control pill to be an abortion drug.
Liberals and women's rights groups praised the decision, saying that women who work for religious employers should not have to accept a lower standard of health coverage.
"The administration stood firm," said Nancy Keenan, president of NARAL Pro-Choice America. "As a result millions will get access to contraception, and they will not have to ask their bosses for permission."
Democratic Sen. Patty Murray of Washington, a member of Senate leadership, said, "The president made the right decision by putting access and the reproductive rights of women first."
Birth control use is virtually universal in the United States, and most health insurance plans cover the pill, usually with copays. Still, about half of all pregnancies are unplanned.
At issue is a provision of the health care law that requires insurance plans to cover preventive care for women free of charge to the employee. Last year, an advisory panel from the respected Institute of Medicine recommended including birth control on the list, partly because it promotes maternal and child health by allowing women to space their pregnancies.
Sebelius agreed, issuing a new federal regulation last summer.
That rule, however, exempted houses of worship and their employees, as well as other institutions whose primary purpose is to promote religious belief. Churches, synagogues, mosques and other places would not be required to cover contraceptives, it specified.
It was a different story for religious-affiliated hospitals, colleges and social service agencies.
Although many of those employers had not traditionally covered birth control, the new regulation required them to do so. Catholic hospitals, which at a critical moment had defied the bishops to back Obama's health care law in Congress, immediately sought a broader exemption. On Friday they were denied.
Representing some 600 hospitals, the Catholic Health Association expressed disappointment.
"The challenge that these regulations posed for many groups remains unresolved," said Sister Carol Keehan, president of the group. "This indicates the need for an effective national conversation on the appropriate conscience protections in our pluralistic society, which has always respected the role of religions."
The administration says between 1 million and 2 million people work for religious-affiliated institutions, though it's not clear how many would be affected. Some states already require religious employers to cover the pill.
For religious-affiliated employers, the requirement will take effect August 1, 2013, and their workers in most cases will have access to coverage starting January 1, 2014.
Women working for secular enterprises from profit-making companies to government will have access to the new coverage starting January 1, 2013, in most cases.
Workplace health plans will have to cover all forms of contraception approved by the Food and Drug Administration, ranging from the pill to implantable devices to sterilization. Also covered is the morning-after pill, which can prevent pregnancy after unprotected sex and is considered as tantamount to an abortion drug by some religious conservatives.
However, the new regulation does not require coverage of abortions.
Associated Press writer Julie Pace contributed to this report.