"I call this the parish housekeeper exemption - that's about all it covers," said Sister Carol Keehan, president of the 600-member umbrella group for Catholic hospitals. "What we are trying to do is make workable the conscience protection the administration says it is willing to give."
Most Catholic hospitals do not cover birth control for their employees, Keehan said, but in some cases they are required to by state law. Doctors caring for patients at the hospitals are not restricted from prescribing birth control.
The Health and Human Services Department is asking for public comment on its proposed conscience clause before making a final decision, expected later this year.
Polls show that Americans overwhelmingly support greater access to birth control, which medical experts say promotes well-being by allowing women to adequately space their pregnancies. For example, a survey earlier this year by the nonpartisan Public Religion Research Institute found that 89 percent of Catholic women favored expanding access to birth control for women who cannot afford it, with 8 percent opposed. Birth control use is virtually universal in the U.S., according to the government.
Women's rights groups are opposed to any conscience exemption, pointing out that it's not specifically authorized by the health care law.
"All women do use contraception at some point in their lives, and we think it should be available to them as a preventive health service," said Judy Waxman, vice president for health and reproductive rights at the National Women's Law Center. That includes women who work for Catholic hospitals and for the church itself, Waxman added.
Conscience exemptions are a common component of legislation that creates tension with religious mores. In this case, the Health and Human Services Department says the administration picked language used by states that require health insurers to cover contraception as a prescription benefit. Spokesman Richard Sorian said the administration is open to considering alternatives.
"We look forward to hearing from the public as we work to strike the balance between providing access to proven prevention and respecting religious beliefs," Sorian said. The coverage requirement doesn't take effect right away.
The administration's proposed exemption defines a religious employer as one whose purpose is to instill religious values, which primarily employs and serves people who share its religious tenets, and which is nonprofit.
Three of those four tests don't work for Catholic hospitals and their 640,000 employees, said Keehan. "Catholic hospitals have never discriminated about employment," she explained. Likewise, the 5.6 million patients they admit annually can be of any religious faith, or none. And while patients might see a crucifix, they're not going to get a sermon.
It's not just Catholic hospitals that would be ineligible for an exemption, said Jeanne Monahan, a policy expert at the conservative Family Research Council. "Any religious group that is not focused on proselytizing will not receive this exemption," she said.
"Educational institutions, groups that are focused on serving the homeless, feeding the hungry, they won't receive it."
Law professor Nicholas Cafardi of Duquesne University in Pittsburgh, an expert on tax exempt organizations, said he agrees the administration's current definition is too narrow. He suggested a more liberal standard employed in the federal tax code might be part of a compromise. Duquesne is a Catholic institution.
In the critical final stages of the congressional health care debate last year, Catholic hospitals broke with the bishops to support passage of the legislation. While the bishops contended the bill would open the way for taxpayer-supported abortions, Keehan said her analysis indicated it would not, a view recently seconded by a federal judge.
In an interview, Keehan indicated she still supports the expansion of health insurance coverage under Obama's law.
"I'm not a blast-out kind of person," she said. "I'm saying (to the administration) thank you very much for this exemption, but it's not broad enough. We'd like to talk to you, and we hope you'll listen."