The California Supreme Court in a March 1 ruling "bowed to political pressures" by requiring Catholic Charities and other church entities to pay for contraceptives in employee health insurance, according to a spokeswoman for the California Catholic Conference.

The 6-1 ruling said Catholic Charities of Sacramento may not be exempted from a 1999 state law that requires all employers to include contraceptives when they provide insurance coverage for prescriptions. The ruling could affect hospitals, colleges and universities and social service agencies run by the Catholic Church and other faith groups.

A decision on whether to appeal the ruling may not be made until a similar case pending in New York's state appeals court is resolved. About 20 states have similar laws.

Mark Chopko, general counsel for the U.S. Conference of Catholic Bishops, told Catholic News Service that aside from the practical implications for the church institutions affected, the ruling's "more dangerous doctrine is that a state can decide what is and isn't a religious institution."

"That sets a very dangerous precedent for religion in general," he said.

Carol Hogan, associate director for pastoral projects and communications for the California Catholic Conference, said the ruling "appears to cynically expect Catholic organizations to continue offering their employees prescription drug coverage even though the inclusion of contraceptives violates church teaching."

Catholic Charities challenged the law on the grounds that it unconstitutionally imposes a mandate that is contrary to the teachings of the church, which opposes all artificial means of contraception. The law does not require employers to provide coverage for prescriptions in general, but Catholic Charities argued that the church's social justice teachings call for it to provide prescription insurance as a moral duty.

The Women's Contraceptive Equality Act includes an exemption for "religious employers" but defines those as nonprofit institutions directly involved in inculcating religious beliefs, and whose employees and beneficiaries of services are primarily members of the faith group.

The Supreme Court said Catholic Charities does not qualify as a religious employer because it offers secular services to the public without regard for the recipients' beliefs and without preaching about Catholic values. Catholics do not make up either a majority of its employees or a majority of the recipients of its services.

A previous ruling said the church institutions could not be exempted from the requirement while the Catholic Charities case worked its way through the courts, so Hogan said many of the state's church-run institutions already have begun including coverage for contraceptives as insurance contracts have come up for renewal.

Some church-affiliated entities, such as hospitals that might have had to honor existing union contracts when they acquired other medical organizations, have included contraceptives in their insurance for a variety of reasons, Chopko and Hogan said.

Catholic Charities of San Jose has offered such coverage largely as a result of "partnerships with public entities (such as federal, state and municipal contracts) and nondiscrimination agreements," explained Diane Pelosi Saign, CEO of San Jose Catholic Charities.

The provision had been under study already, Saign said, but while the court case was pending and prevailing state law required offering contraceptive coverage, no change was on the table, she added.

In fact, the way the law was written, insurance companies are forbidden from offering prescription coverage plans that do not include contraceptives unless the employer fits the law's exemption, Hogan told CNS.

She said she recently learned that a few companies "as a matter of civil disobedience" have continued to provide coverage that excluded contraceptives, but that with the new ruling those exceptions will probably end.

Ned Dolejsi, director of the California Catholic Conference, said in a statement that "the case was never about contraceptives. It was never about insurance. It was about our ability to practice our religion --- providing food, clothing and shelter to the neediest among us --- as a religious organization which is part of the Catholic Church."

Chopko said the ruling "reads like the state's brief," which might mean the court was simply deferring to the Legislature in interpreting the law. "Maybe they didn't want to second-guess the Legislature," he added.

Hogan said the law itself was written to cover a very small percentage of workers statewide, many employed by Catholic institutions, for whom the cost of contraceptive prescriptions is equivalent to a year's worth of trips to Starbucks for coffee.

The ruling explains that the law was drafted to address the finding that 10 percent of those who had prescription drug coverage through their employers could not use the benefit to pay for contraceptives.

Said Hogan: "By any measure, 90 percent compliance represents full compliance."

She said the law and its exemption wording was "shopped around" to different states by the American Civil Liberties Union's Reproductive Freedom Project. The ACLU's press release about the ruling says the organization "crafted the statutory exemption, which reflects a sensitive balance among fundamental rights: gender equality, reproductive freedom and religious liberty."

In a dissenting opinion in the case, Justice Janice Rogers Brown said that gap "is not large and Catholic Church employers can constitute only a small percentage of that small percentage." She said the majority opinion did not make a persuasive case that the interests of the law "which focuses on a modest 10 percent gap in coverage --- cannot be achieved by less restrictive means."

Brown also said the law goes to great lengths to exclude religious institutions.

"This is such a crabbed and constricted view of religion that it would define the ministry of Jesus Christ as a secular activity," she wrote. Catholic Charities can avoid the mandate by dropping prescription coverage for employees, Brown noted, which fails to accomplish the law's goal of reducing the inequitable financial burden of health care for women.

However, if employers such as Catholic Charities are serious about opposing the mandate and drop all prescription coverage, "women who work for those employers could actually be worse off," she wrote.

---CNS