Mitt Romney faulted President Barack Obama's original push to require church-affiliated employers to pay for birth control as an "assault on religion," but as Massachusetts governor, Romney was largely silent about a state law that required virtually the same contraceptive coverage.
The Massachusetts law, which essentially mirrored Obama's proposal, was signed by Romney's predecessor in 2002, the year before he took office. Romney did not seek its repeal.
Despite his silence on the state law, as a presidential candidate Romney attacked Obama's initial proposal, which would have required Catholic-affiliated employers to pay for a service that violates the church's teachings.
"This kind of assault on religion will end if I'm president of the United States," Romney said, calling it "a real blow ... to our friends in the Catholic faith."
On Friday, Obama backed off the requirement, instead saying that workers at religious institutions would be able to get free contraception directly from health insurers.
As governor, Romney made no similar effort to amend or repeal the state law, which required employers that purchase insurance plans in Massachusetts to pay for contraceptives. He did clash with lawmakers about whether Catholic hospitals should be required to dispense emergency contraception to rape victims.
The 2002 law applies to employers who purchase insurance plans in Massachusetts. Larger employers that have private agreements with insurers and are considered self-insured are subject to federal laws.
Following on Romney's struggles to differentiate his state's health-insurance law from the nearly identical national version championed by Obama, the contraception episode is another example of how hard it is for Romney to contrast himself on some key issues with the president he seeks to defeat.
By choosing to engage Obama on such issues, he also adds to the perception that he shifts positions with the political winds.
The closest Romney came to addressing the question of mandated health care coverage was during the debate over what would become Massachusetts' landmark 2006 health care law.
Romney's version of the law would have lifted all mandated insurance benefit requirements for individuals and small businesses insured through what would become the state's health connector. It also would have lifted benefit requirements from subsidized insurance plans.
The goal was mandate-free insurance. But the version of the bill approved by the Democrat-controlled Legislature rejected Romney's proposal and the mandates remained.
Backers of the 2006 law signed by Romney say it actually expanded contraceptive coverage.
"The uninsured individuals who got access to health insurance because of the health law ... all got access to contraceptive coverage because of that law," said John McDonough, former head of the advocacy group Health Care For All.
While Romney was largely silent on the contraceptive coverage mandate, he fought a much more public battle over whether to require hospitals in Massachusetts to dispense emergency contraception to rape victims.
For Romney, the episode pitted his pledge to expand access to emergency contraception against another campaign promise not to change the state's abortion laws.
In the end Romney vetoed the bill, but declined to press any legal challenge to the new law once his veto was overturned by state lawmakers.
The issue surfaced in 2005, three years into his single term as governor.
The Legislature had just handed Romney a bill requiring that all public and private hospitals offer emergency contraception pills to victims of rape. The measure included the state's Catholic hospitals, whose opposition was based on religious grounds.
Romney said he could accept the measure if the pills simply prevented conception. But because the "morning after" pills can prevent a fertilized egg from developing, Romney said they could also be "abortion pills."
Romney had said he personally could accept abortion in cases of rape, incest and to save the life of the mother, but he nonetheless vetoed the bill.
"If it only dealt with contraception, I wouldn't have a problem with it. But it also in some cases terminates a life after conception, and therefore it ceases in that case to be a contraceptive provision," Romney said at the time.
"I indicated I wouldn't change abortion laws and I won't violate that promise," he added.
The debate stretches back to 2002, when Romney, then a Republican candidate for governor, answered "yes" on a candidate questionnaire distributed by NARAL Pro-Choice Massachusetts that asked whether he would support increased access to emergency contraception.
During the same campaign, Romney also promised not to alter the state's abortion laws.
Those two promises clashed when the Massachusetts House and Senate approved the emergency contraception bill.
"He went back on what he supported on the questionnaire by returning from vacation to veto a piece of legislation that would ensure broader access for emergency contraception," said Rose MacKenzie, director of policy for NARAL Pro-Choice Massachusetts. "Emergency contraception is not the same thing as abortion."
The bill required hospital emergency room doctors to offer the medication to rape victims, and made the pills available without prescription from pharmacies. A provision that exempted Catholic hospitals wasn't included in the final bill.
The medication is a hormone in pill form which, when taken after unprotected sex, prevents ovulation, stops the egg from being fertilized by sperm or stops a fertilized egg from attaching itself to the uterus wall.
It is most effective when taken within 72 hours of intercourse.
The debate was so contentious that Romney's hand-picked running mate, then-Lt. Gov. Kerry Healey, publicly broke with him and urged him to sign the bill.
Romney instead vetoed the bill at the end of July, 2005. Less than two months later the Massachusetts House and Senate easily overrode the veto.
Romney would try one more time to carve out an exemption for the state's Catholic hospitals, a move that would briefly throw the future of the law into chaos.
In December, 2005, just a week before the new law was to take effect, Romney's public health commissioner announced that Catholic and other privately run hospitals could be exempted from the emergency contraception law, pointing to an older law that barred the state from forcing private hospitals to dispense contraceptive devices or information.
Romney initially agreed, saying that while he personally believed hospitals should be required, at the least, to provide information about emergency contraception to rape victims, the new law couldn't supersede the old law.
"We have to follow the law," he said.
The new policy didn't last long.
Less than 24 hours after defending the proposed change, Romney scrapped the push to exempt private hospitals. He had come under intense pressure from women's groups, Democrats, the state attorney general and Healey.
Romney said that a fresh analysis by his legal counsel concluded that the new law in fact superseded the old law, and that all hospitals would now be required to offer the "morning after pill."
"On that basis I have instructed the Department of Public Health to follow the conclusion of my own legal counsel and to adopt that sounder view," Romney said. "In my personal view, it's the right thing for hospitals to provide information and access to emergency contraception to anyone who is a victim of rape."
The veto of the emergency contraception bill came at the time when Romney was contemplating his first run for president in 2008 and was staking out more conservative public positions.
A day after his veto, Romney explained it in an opinion piece in the Boston Globe, saying his anti-abortion views had "evolved and deepened."
"I believe that abortion is the wrong choice except in cases of incest, rape, and to save the life of the mother. I wish the people of America agreed, and that the laws of our nation could reflect that view," he wrote.