A Catholic-affiliated health care system in Sioux Falls is drawing criticism from Catholic bishops for its decision to offer contraceptive services coverage in some of its medical insurance plans in violation of church teaching.
Avera Health Plans recently chose to comply with a Department of Health and Human Services mandate that requires insurance plans to offer contraceptive services under the Affordable Care Act without cost sharing. Avera Health Plans is a wholly-owned but separate civil corporation within the Avera system.
The decision to comply with the HHS mandate, made earlier this year by Avera chief executive officer and president John Porter, affects only commercial plans offered to private businesses and individuals that do not qualify for any "safe harbor" exemptions given to religious organizations under HHS rules.
Those exemptions mean that Avera employees, as workers at a Catholic health facility, do not have access to free contraceptive coverage in their health plans.
"This change only affects commercial customers," said Daryl Thuringer, vice president of marketing and public relations for Avera. "This is not part of the plan that is offered to our employees."
Avera's ACA compliance drew sharp criticism from Bishop Paul Swain of the Catholic Diocese of Sioux Falls, who called the development "troubling in a number of ways" in a March 1 letter sent to diocesan clergy.
"Most importantly, as an organization, Avera will now be materially cooperative in the termination of life," Swain wrote.
The HHS mandate requires coverage for emergency contraception, which includes abortifacient drugs, as well as birth control pills and sterilizations, all of which violate Catholic teaching on the sanctity of life.
The Sioux Falls diocese is a customer of Avera Health, but none of its policies covering clergy or other diocesan employees, such as Catholic school teachers, are affected by the compliance.
Porter, who is not Catholic, was not available for comment Friday. Thuringer said that Avera, in its role as a Catholic health ministry, still abides by the religious teachings of the Catholic Church. The health plan division's legal separation from the parent organization as a licensed insurance corporation is a distinction without a difference to Swain.
"Avera's decision, as I explained to Mr. Porter in a subsequent meeting, creates public scandal; as a Catholic institution, its practice is of course inconsistent with Church teaching."
Thuringer said Avera continues its efforts to have the mandate reversed.
"Together with a lot of other Catholic health-affiliated organizations, we have protested this regulation and we are going to continue to push to have it reversed," he said.
In the Black Hills area, about 3,000 people are insured through an Avera Health Plan, but only about 300 of those have a plan that now covers contraception without a co-pay, Thuringer estimated.
The Diocese of Rapid City does not purchase health insurance from Avera, said Matt Doyle, communication director for the diocese, but Bishop Robert Gruss expressed his "disappointment" with the providers' decision Friday.
Thuringer said he is not aware of any customers who have dropped their Avera insurance coverage over its compliance with the HHS contraception mandate and that includes the Sioux Falls diocese.
Chancellor Matt Althoff said the Sioux Falls diocese has no plans to stop administering its self-funded health plans through Avera or to encourage other customers to drop their Avera plans.
Bishop Swain did ask two diocesan employees to resign from Avera advisory board roles in protest of the decision, which Althoff said confuses customers who don't make the distinction between the hospital's medical services and its insurance division when they see the Avera logo.
"I think people see the same font and the Avera green logo and ... think, here's something that has that logo on it that is sin," he said.
"The church's role is always to help form consciences," said Althoff, noting that "there's certainly been a reaction" by Catholics who don't want their insurance premiums to fund abortifacient drugs. "That's a pastoral moment, when people realize that 'I'm complicit in sin.' That's precisely why the bishop offered (the letter) at this time."
Avera and the diocese agree that the mandate, and what they see as its attack on religious liberty, is the root of the problem, Althoff said.