The St. Louis-based Catholic Health Association, the network of more than 2,000 U.S. Catholic hospitals and health care facilities, has refined and redefined its corporate “mind” on religious exemption for mandated health care.

Friday it called on the Obama administration to widen religious exemptions from mandated coverage for sterilization and contraception to all Catholic ministries. If the administration wants all large employee health plans to include sterilization and contraceptive coverage, it could pay for it, the CHA president suggested. CHA represents the largest religious association of medical centers in the country.

Long a backer of universal health care, the CHA sent the White House and the Department of Health and Human Services a letter that called current provisions to exempt only churches from providing sterilization and contraceptive coverage “unacceptable.”

In the letter CHA president, Sister Carol Keehan, asked for the federal department to expand its exemptions on religious grounds to "not only churches, but also Catholic hospitals, health care organizations and other ministries of the church.

"The exemption in the final rule is narrower than any conscience clause ever enacted in federal law and reflects an unacceptable change in federal policy regarding religious beliefs," Keehan, a member of the Daughters of Charity, wrote.

The federal mandate was revised in early February so that the insurance company, not the objecting employer would pay for such coverage. That February revision narrowly allows “conscience ” exemptions for churches themselves.

Over the past five months many leaders of Catholic universities, schools and social agencies such as Catholic Charities, the largest nonprofit welfare provider in Missouri, have called for the exemption to include them, too. The health care mandate is to go into effect in August; however, religious groups have been given a one-year extension to work it out.

The Lutheran Church-Missouri Synod and some Orthodox Jewish rabbis have also raised First Amendment objection to the coverage requirement.

While publicly this is often referred to by the shorthand “contraceptive” exemption that term leaves the sterilization insurance coverage below the radar. Specifically providing sterilization coverage is objectionable to a far wider group of religious leaders beyond Catholics.

Many who object to providing the coverage call it a freedom of religion issue. Last month the St. Louis archdiocese and Catholic Charities of St. Louis were among 43 Catholic organizations that filed federal law suits to overturn that portion of the Health and Human Services mandate. Those similar law suits contend that the mandate violates the First Amendment.

In January Keehan and her network of Catholic hospitals objected that there were no religious freedom exemptions in the federal bill for providing sterilization and contraception. Then, when Secretary of Heath and Human Services Katherine Sibelius announced a clause allowing churches an exemption, Keehan quickly welcomed it. But many Catholic hospital administrators have been saying that Keehan's statement came much too quickly.

Explaining what seems to be a reversal of opinion, she said that in February the exemption seemed to be “a good first step.”

“The final rule released on Feb. 10, 2012, implemented the narrow religious exemption as proposed, but also indicated the Administration’s intent to propose additional rules to implement the contraceptive coverage requirement in a way that would accommodate the concerns of nonexempt religious employers with objections to providing, paying for or referring for contraceptive coverage,” the letter says.

 “Our examination and study of the proposal as outlined has not relieved our initial concerns,” she wrote.

The CHA remains “deeply concerned” with the administration’s action over contraceptive services.

“The more we learn, the more it appears that the [mandate's] approaches for both insured and self-insured plans would be unduly cumbersome and would be unlikely to adequately meet the religious liberty concerns of all of our members and other church ministries," the letter says

Keehan suggests that the government itself might directly cover these services.

“If the government continues to pursue the policy that all employees should have access to contraceptive services, then it should find a way to provide and pay for these services directly without requiring any direct or indirect involvement of religious employers, as broadly defined,’ the CHA president wrote.