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Analysis: 10% of Large Not-For-Profits Requested Federal Contraceptive Coverage Rules' Accommodation

About 10% of large not-for-profits have asked HHS for an accommodation to the federal contraceptive coverage rules, according to a new analysis from Kaiser Family Foundation, the Washington Times reports (Howell, Washington Times, 12/1).


The contraceptive coverage rules, which are being implemented under the Affordable Care Act (PL 111-148), require most employers to offer contraceptive coverage to their workers. Houses of worship are exempt from the requirement, and not-for-profits that hold themselves out as religious, as well as certain closely held corporations, are eligible for an accommodation that ensures they do not have to pay for or directly provide the coverage for their employees. Instead, employees will be able to receive coverage directly from their insurers.

To request the accommodation, the not-for-profits may either complete a form to send to the insurers or third-party administrators or send a letter to HHS stating that they object to offering contraceptive coverage in their health plans.

Not-for-profits that hold themselves out as religious and oppose contraception have challenged the rules in federal courts throughout the U.S. Most appeals courts have dismissed the challenges, finding that the federal rules do not impose a substantial burden on the religious beliefs of the not-for-profits.

In November, the Supreme Court announced that it will hear a consolidated challenge against the accommodation that includes seven lawsuits filed by not-for-profits that hold themselves out as religious and oppose contraception. In hearing the appeal, the high court will consider whether the rules, with the accommodation, violate the federal Religious Freedom Restoration Act (PL 103-141), which requires the government to provide a "compelling reason" for measures that "substantially burden" religious beliefs. Further, under RFRA, the government must also demonstrate that the measure in question is the least burdensome method of reaching the underlying goal (Women's Health Policy Report, 11/9).

Analysis Details

The analysis used data from the Kaiser/Health Research & Educational Trust 2015 Annual Employer Health Benefits Survey.

It found that one in 10 not-for-profits with at least 1,000 employees and 3% of not-for-profits with at least 10 employees have sought out the accommodation (Kaiser Family Foundation release, 12/1). The Kaiser Family Foundation noted that as of 2013, roughly 1.4 million not-for-profits had registered with the IRS (Livingston, Business Insurance, 12/1).

According to the analysis, many of the not-for-profits that requested the accommodation likely are educational institutions or health care systems that are associated with the Catholic Church, which opposes contraception (Kaiser Family Foundation release, 12/1).