The Senate on Thursday killed a Republican effort to let employers and health insurance companies deny coverage for contraceptives and other items they object to on religious or moral grounds.
The vote was 51-48.
In effect, the Senate upheld President Barack Obama’s birth control policy, which guarantees that women have access to insurance coverage for contraceptives at no charge, through an employer’s health plan or directly from an insurance company.
Sen. Patty Murray, D-Wash., said the vote showed that “the Senate will not allow women’s health care choices to be taken away from them.”
The vote followed four days of impassioned debate in which senators weighed the competing claims of religious freedom and the reproductive rights of women.
Republicans said the administration was forcing religious institutions to violate tenets of their faith by providing access to contraceptives.
“The president is trampling on religious freedom,” said Sen. Mike Johanns, R-Neb.
Democrats, defending the new health care law, said the Republican proposal went far beyond contraception and would allow employers to deny coverage for other items and services to which they objected.
Sen. Barbara A. Mikulski, D-Md., said Republicans were attacking women’s health care as part of “a systematic war against women.”
Sen. Roy Blunt, R-Mo., offered the proposal as an amendment to a highway bill. Under the proposal, health insurance plans and employers could refuse to provide or pay for coverage of “specific items or services” if the coverage would be “contrary to the religious beliefs or moral convictions of the sponsor, issuer or other entity offering the plan.”
Kathleen Sebelius, the secretary of health and human services, urged the Senate to reject the proposal.
“The Obama administration believes that decisions about medical care should be made by a woman and her doctor, not a woman and her boss,” Sebelius said.
Speaker John A. Boehner said Thursday that House Republicans also wanted to protect religious employers that object to the requirement for contraceptive coverage.
“It’s important for us to win this issue,” he said.
Boehner did not offer any details about a legislative path forward but hinted that it would differ from the one tried by Senate Republicans.
The vote Thursday generally followed party lines. Sen. Olympia J. Snowe of Maine, who said this week that she would not run for re-election, was the only Republican voting with Democrats to uphold the president’s birth control policy.
The challenge to the president’s policy was supported by 45 Republicans and three Democrats: Sens. Bob Casey of Pennsylvania, Joe Manchin III of West Virginia and Ben Nelson of Nebraska; Casey and Manchin are up for re-election this year, while Nelson is retiring.
Republicans had hoped that the Senate debate would highlight what they see as the coercive nature of Obama’s health care overhaul, approved by Congress in 2010 without any Republican votes.
The Senate Republican leader, Mitch McConnell of Kentucky, said: “The president’s health care law empowers bureaucrats here in Washington to decide which tenets religious institutions can and cannot adhere to. If they don’t get in line, they’ll be penalized.”
Democrats argued that Republicans were trying to turn back the clock on women’s rights and pursuing an extreme right-wing social agenda that should scare voters in this election year.
The Senate majority leader, Harry Reid, D-Nev., said Republicans were “reviving the culture wars.”
“The Blunt amendment would allow any employer or insurer to deny coverage for virtually any treatment for virtually any reason,” Reid said.
Sen. Jeanne Shaheen, D-N.H., said the proposal could affect all Americans, not just women.
“The Blunt amendment would allow employers to deny virtually any preventive or essential health service based on a religious or moral objection,” Shaheen said. “An employer could deny coverage of HIV/AIDS screenings, prenatal care for single mothers, mammograms, vaccinations for children, or even screenings for diabetes based on a moral objection to a perceived unhealthy lifestyle.”
Blunt, a former president of Southwest Baptist University in Bolivar, Mo., said: “This amendment does not mention any procedure of any kind. The word ‘contraception’ is not in there because it’s not about a specific procedure. It’s about a faith principle that the First Amendment guarantees.”
The 2010 health care law requires most insurers to cover preventive services without co-payments or deductibles. Under the administration policy, these services include all contraceptive drugs and devices approved by the Food and Drug Administration, as well as sterilization procedures.
Churches and other houses of worship would be exempt. In February, after protests from the Roman Catholic Church and others, Obama announced what he described as “an accommodation” for church-affiliated schools, universities, hospitals and charities. They would not have to provide or pay for contraceptive coverage, but their female employees could obtain such coverage directly from the employers’ insurance companies at no cost.
Republicans called this an accounting gimmick and said that religious employers would eventually bear the cost, in higher premiums.
Sen. Barbara Boxer, D-Calif., disagreed.
“When insurers provide birth control, they save money,” she said. “It’s not only life-saving; it is cost-saving.”
Dr. Hal C. Lawrence III, executive vice president of the American Congress of Obstetricians and Gynecologists, opposed the Blunt amendment and affirmed the value of contraception, saying it “improves and saves babies’ lives, improves maternal health and can be life-saving for women with serious medical problems.”
The lobbying arm of the American Cancer Society also opposed the Blunt amendment, saying it would allow employers to deny coverage of life-saving preventive services like mammograms and smoking cessation programs, based on “undefined religious beliefs or moral convictions.”
Some Republicans acknowledged that Democrats were scoring political points on an issue that Republicans had expected would work to their advantage.
“Unfortunately, many have tried to characterize this amendment as denying women access to contraception,” said Sen. Kelly Ayotte, R-N.H. “That’s false. This measure simply allows health care providers and companies to have the same conscience rights they had before the president’s health care bill took effect.”