Most Nebraska employers that offer birth control at no cost to employees are unlikely to stop doing so in the wake of exemptions the federal government has carved out for employers on moral or religious grounds.

But employees of any organization with “sincerely held religious beliefs,” or of nonprofit organizations and some types of businesses that object to contraception on moral grounds, are at risk for losing their coverage.

How many will actually see a change is disputed. And employees won’t necessarily know if their employer is considering making a change. As before, employers that qualify for an exemption are not required to file notice with the government that they are claiming an exemption.

The Trump administration estimates that the rules will affect only about 200 employers nationwide, those who filed lawsuits or have claimed religious exemptions. It estimates that it will affect no more than 120,000 women. But some observers worry that the impact will be broader than that.

“It’s really difficult to determine which way they (employers) are going to go or how many will take advantage of this rule,” said Rachel Lopez, spokeswoman for Planned Parenthood of the Heartland. So far, officials with the Des Moines-based organization, which operates in Iowa and Nebraska, have not heard of any employers that plan to seek the new exceptions.

Under the rules published Oct. 6, any for-profit or nonprofit employer or insurer can stop following the birth control mandate on religious grounds. Right now, under the Affordable Care Act, many employers have had to offer birth control as a covered item under their health insurance plans.

Other employers including businesses, colleges and nonprofit organizations — but not publicly traded companies or government employers — can obtain an exemption based on moral convictions. The rules take effect immediately.

Chuck Olson, chief executive of OCi Insurance and Financial Services in Omaha, said he doesn’t see the change affecting many employers. Small group plans available to smaller employers typically have a set plan design that already includes such benefits, meaning they’re unlikely to have a plan without the coverage readily available.

Large corporate businesses are unlikely to eliminate the coverage. They would have to claim a moral objection; and publicly traded companies would have to claim a religious objection. Many of these firms see contraception as an important benefit, one employees and prospective employees have come to expect.

Olson said of companies’ thinking: “Unless I have some strong moral conviction, I’m going to err on the side of giving people what they want.”

In general, women without insurance coverage pay up to $50 a month for birth control pills, according to Planned Parenthood; one also needs to see a doctor to get a prescription for the pills — an additional cost. Other forms of birth control, such as an intrauterine device, can cost much more without coverage, up to $1,300.

Before the ACA, nearly 21 percent of women ages 15 to 44 with health coverage from a large employer had out-of-pocket expenses for oral contraceptives, according to an analysis by the Kaiser Family Foundation. By 2014, only 3.6 percent of such women had those expenses.

Omaha-based TD Ameritrade, the publicly traded Fortune 1000 brokerage firm, said it won’t opt out of providing no-cost contraception as preventive care.

“We have a diverse employee base of more than 10,000 nationwide and believe it’s important that we continue to offer as much choice as possible in our various health care offerings,” spokeswoman Kim Hillyer said. “It’s an important part of our employee compensation philosophy.”

First Data, the Fortune 500 payments processing firm that employs around 5,000 people in Omaha, also will keep the coverage.

“We currently cover birth control at 100 percent and have no plans to change that coverage,” spokeswoman Liidia Liuksila said.

Mutual of Omaha, the Fortune 500 insurance provider with 4,000 employees in Nebraska, said the same.

Some employers didn’t want to talk about whether their plans cover contraception, or whether that might change.

Employers that declined to comment on the topic included Kiewit, the employee-owned Fortune 500 construction and mining firm based in Omaha, which on its website touts a “top-tier” health benefits plan; regional grocers Hy-Vee and Fareway Stores, both based in Iowa; and the YMCA of Greater Omaha.

Practically speaking, the most likely employers to curtail contraceptive coverage are hospitals, universities and nonprofits with a religious affiliation or mission, said Dania Palanker, assistant research professor at Georgetown University’s Center on Health Insurance Reforms. She disputed the Trump administration’s estimates, saying there are many more than 120,000 women who get their health care plans through Catholic hospitals and religiously affiliated universities.

Creighton University, which as a Catholic institution could opt out on religious grounds, declined to discuss its benefits. “University officials are still reviewing the directive,” spokeswoman Cindy Workman said in an email.

Creighton employees currently have access to no-cost contraception, according to information provided on the university’s website for prospective employees, but the university does not provide or pay for those services.

The university uses a work-around accommodation for nonprofit religious organizations allowed under a 2013 exemption to the ACA. Contraception is available directly through the employer’s health plan — in Creighton’s case, United Healthcare, according to Creighton’s website. Creighton employees can enroll in a “contraceptive services only” plan, with contraceptives available at no cost.

Under the new rules, Creighton could continue to voluntarily use the same process. Or, it could completely opt out of this arrangement, so its employees would no longer have access to no-cost contraception through their insurance provider.

Catholic Health Initiatives, the Denver-area parent of CHI Health in Nebraska and Iowa, already has the accommodation. Nothing is expected to change, a spokesman said.

Some employers have not been offering no-cost contraception, even through an accommodation. Several Omaha employers are among those that have “grandfathered” plans. Those are plans that were in place before the ACA took effect March 23, 2010, and haven’t substantially changed.

Those plans don’t have to offer all the same benefits the ACA requires. About a quarter of U.S. employers that offer health benefits offer at least one “grandfathered” plan, according to a Kaiser Family Foundation survey, and about 17 percent of covered employees are in a grandfathered plan.

Employees at the Salvation Army, which has a grandfathered plan, can get coverage for contraceptives with a copay, said Patti Sherwin, director of human resources for the nonprofit’s western division, headquartered in Omaha. It has more than 400 employees in Nebraska.

The Salvation Army describes itself as an evangelical part of the Christian church. Sherwin said it doesn’t take a stance on whether people should use contraception. Under the new rules, she said, “there has been no conversation whatsoever about excluding it.”

Lincoln paralegal Kate Dwyer, whose contraception is covered by her employer, is concerned that the new rules mean many more employers can object and be exempt.

“It really makes the requirement meaningless,” she said.

While she doesn’t worry that her own employer, a law firm, will stop covering the services, she worries for her friends who work at hospitals and universities with religious affiliations.

“That’s a really scary position to be in,” Dwyer said.

Palanker, at Georgetown, said that legally the door is open wide for other employers to stop offering contraceptive coverage, with the rules greatly expanding the number of employers that can take an exemption. She’s concerned that rules like these could one day extend to other aspects of the health care law or even to nondiscrimination laws.

“It’s really unprecedented to allow an employer out of a federal legal requirement because they are morally opposed to it,” she said.

But Andrew Bath, executive vice president and general counsel for the Chicago-based St. Thomas More Society, said the exemption will affect very few.

The legal society, whose clients include religious groups, welcomes the rule changes but would have preferred that the mandate had been rescinded altogether, he said.

Meanwhile, the American Civil Liberties Union has filed a lawsuit challenging the new rules.

barbara.soderlin@owh.com

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