(AP Photo/Jacquelyn Martin)

The federal government should avoid making Catholic hospitals choose between offering health coverage and violating their principles.

William Cox, president of the Alliance of Catholic Health Care, Sacramento, Calif., made that argument today during a hearing on Patient Protection and Affordable Care Act of 2010 (PPACA) mandates organized by the House Energy and Commerce Committee.

Witnesses talked about federal mandates that are set to require most employers other than churches, associations of churches and religious orders to include coverage for contraceptives and sterilization procedures in their basic preventive services packages starting in August 2012.

Witnesses also talked about federal rules that now let doctors, nurses, pharmacists and other health care professionals refrain from providing care – such as abortions, and access to drugs that lead to abortions – that they feel violate their principles.

Jon O’Brien, president of Catholics for Choice, said the PPACA “refusal clause” – the clause that lets providers refuse to provide services that they feel conflict with the dictates of their conscience – threatens access to basic family planning services as well as to abortion

“Except in emergency situations, it is reasonable and indeed prudent to allow those who are opposed to abortion to opt out of providing the service,” O’Brien said in written testimony posted on the committee website. “It is in the best interests of all that only medical professionals committed to providing such services do so.” Women need support and compassionate care when they access

But women should be able to get referrals for the care they need, and “it is incredible to suggest that a hospital or an insurance plan has a conscience,” O’Brien said. “Granting institutions, or entities like these, legal protections for the rights of conscience that properly belongs to individuals is an affront to our ideals of conscience and religious freedom.”

Some institutions are trying to use the refusal clause to keep Catholic hospitals from offering condoms through HIV outreach programs and to opt out of providing emergency contraception to victims of sexual violence, O’Brien said.

“They claim that they are representing all Catholics, but this is not true,” O’Brien said. “The majority of Catholics support equal access to contraceptive services and oppose policies that impede upon that access.”

Dr. Mark Hathaway, an obstetrician at Washington Hospital Center, contended that easy access to affordable contraception is critical to women’s health, and especially to the health of poor women.

He described an uninsured mother of two with diabetes who would have been in a medically high-risk category if she were pregnant. “She would have been devastated by a positive pregnancy test,” Hathaway said. “She was incredibly relieved to learn she was not pregnant.”

But Cox argued that the 54 hospitals and more than 40 other facilities that belong to his alliance ought to be able to stick to their principles and not offer contraceptive benefits through their health plans and not have to provide contraceptive services to patients.

When the U.S. Department of Health and Human Services (HHS) and other agencies decided in August to define contraceptive services as basic preventive services, that ruling “was deliberately designed to contravene the religious conduct of religious organizations, such as Catholic hospitals, universities and social services,” Cox said.

The PPACA amendment provides a religious exclusion only for churches, church auxiliaries and religious orders, and it does not provide the kind of exclusion for schools and hospitals affiliated with religious organizations that comparable state laws and regulations typically provide, Cox said.

“HHS’s definition of religious employer raises a fundamental question,” Cox said. “May the government determine what parts of a bona fide religious organization are religious and what parts are secular? And, in particular, may the government make such distinctions in order to infringe the religious freedom of that portion of the organization the government declares to be secular?”