In August, the Department of Health and Human Services accepted the recommendations of the Institute of Medicine and issued an interim final rule requiring health insurers to cover contraception and other women’s preventive services without additional cost sharing. The rule included a caveat that allowed religious institutions that offer health insurance to their employees to opt out of the coverage requirement, but now as HHS prepares to deliver the final regulation, conservative groups are pressuring the administration to significantly expand the exemption to include all religiously affiliated entities.

Organizations like the United States Conference of Catholic Bishops and Catholic Health Association insist that contraception encourages promiscuous behavior and that mandating coverage violates religious freedoms. As Sen. Pat Toomey (R-PA) wrote in a letter to HHS Secretary Kathleen Sebelius, “this regulation requires that a Catholic institution either violate its fundamental beliefs by providing coverage that includes contraception and sterilization or, per the new requirements of PPACA, potentially pay a heavy financial penalty for failing to provide what PPACA deems adequate health coverage to their employees.”

But broadening the exemption would place religious beliefs ahead of women’s health and significantly restrict access to the birth control that most women rely on. More than 99 percent of all women ages 15 to 44 who have ever had sexual intercourse have used at least one contraceptive method and most people support expanding access to them. A national poll conducted in May, for instance, found that 88 percent of voters, including four in five Republicans, support women’s access to contraception. Most Americans even think that improving women’s access to contraception is a more effective way of reducing the number of abortions than enacting restrictive abortion laws.

In fact, it’s not even clear that broadening the exemption is constitutional. Catholic Charities, for instance, has previously attempted to challenge state contraceptive equity laws in both New York and California, but lost “on the basis of a 1990 Supreme Court decision, Employment Division v. Smith.” The ruling found that the First Amendment’s exercise of religion clause did not trump a “neutral law of general applicability.” To permit permit religious entities and persons to pick and choose which laws they could follow “would be to make the professed doctrines of religious belief superior to the law of the land, and in effect to permit every citizen to become a law unto himself,” the court found.

The Affordable Care Act does not require religious organizations to specifically approve birth control any more than they would have to sign off on any other medication or treatment used by their employees — it simply states that insurance companies must offer a package of women’s health care benefits without additional charge. Allowing religious beliefs to override this provision would not only restrict access, but also represent a significant setback to the administration’s goal of coverage expansion.

Kate Nocera has an interesting report about something Mitt Romney has tried to claim for some time — that is, the health care reform he envisioned is actually quite different than the legislation he ultimately signed into law as governor of Massachusetts. In other words, pure Romneycare is far more market driven than the Massachusetts law and, by extension, the Affordable Care Act:

Romney wanted a lighter mandate, with a way to get out of it if people were willing to pay something upfront to cover them in catastrophic events. He didn’t want to cover as many benefits. And he didn’t want to expand Medicaid at all.

His vision was never going to fly in the liberal state — so he signed a much different version into law, often described as a framework for what was to come. But his original plan shows that his own ideas were more market-driven, with fewer required benefits for health plans and no mandate for small businesses to offer health insurance.

So when Romney says he wants health care to work more like a market, there’s actually more of a record behind his rhetoric than the final Massachusetts law suggests.

That argument would carry more weight if Romney hadn’t embarked on a national media tour following the passage of the law to highlight his success in reaching across the aisle and working with Democrats to produce a compromise measure both sides could agree on. As he put it in 2006, “I must admit that I’m pleased with the fact that here in a state that’s overwhelmingly Democratic, a Republican governor can introduce a plan to get everybody insured, work collaboratively with the Democratic legislature, combined with the administration in Washington and our delegation there to come up with a plan to get the job done.”

Still, Romney is correct on the details. Both he and the Heritage Foundation advocated a “personal responsibility” requirement in which families and individuals who did not purchase coverage would be required to spend $10,000 in the form of a bond that could be used to pay for hospital care down the road. To Romney, this idea ensured funds were directed back into health care rather to the government revenue. But charging a flat fee regardless of income means different things to different economic demographics and would have significantly disadvantaged middle class families — who would have had to set a side a huge amount of money for a rainy day. The mandate penalty in the Affordable Care Act takes some of these affordability concerns into account and requires those without coverage to pay a tax penalty of the greater of $695 per year or 2.5 percent of household income.

The ongoing budget and deficit reduction negotiations carry far-reaching consequences for every American. But further capping or cutting funding for vital health programs such as Medicare, community health centers, and Medicaid place communities that already face disparities in health and access to health care, including gay and transgender Americans, under even greater threat.

Heavy cuts to health care entitlement programs and health programs funded by nondefense discretionary spending would put these communities at serious risk of losing assistance essential to their well-being. Many gay and transgender people, like other Americans, rely on entitlement programs such as Medicare and stand to benefit substantially from the expansion of Medicaid and other promising provisions of the Affordable Care Act. Most importantly, further cuts to discretionary spending threaten to undermine the national health infrastructure that protects the health of all Americans and that is critical to closing the disparities that affect the lesbian, gay, bisexual, and transgender population.

Programs and initiatives at risk include:

– Data collection by HHS on sexual orientation and gender identity that would allow gay and transgender disparities to be identified and effectively targeted

– Biomedical and behavioral research on HIV prevention and treatment at the Centers for Disease Control and Prevention and the National Institutes of Health

– Primary, preventive, and other direct health care services through community health centers, which will serve an estimated 40 million Americans by 2015, including many gay and transgender people and their families

– Mental health services that help gay and transgender youth and adults cope with depression and other consequences of bullying and discrimination

– Substance abuse prevention and treatment programs, including tobacco cessation programs that work to reduce high rates of smoking among LGBT people

– Programs that support out-of-home gay and transgender youth, who comprise up to 40 percent of the homeless youth population in the United States

– Efforts by the Office of Minority Health to address the staggering disparities that affect gay and transgender communities of color

Though the funding for these programs may be discretionary, the programs themselves should not be.

The Center for American Progress recommends that cuts to both nondefense discretionary spending and entitlement programs be minimal and balanced by the kinds of revenue increases that will truly help eliminate the deficit and responsibly balance the budget. The committee must resist the urge to take a cuts-only approach without raising any significant additional revenue. Otherwise, it threatens to sacrifice our nation’s future health for short-term political gain.

Florida Gov. Rick Scott (R-FL) has rejected millions in grants from the Affordable Care Act, arguing that the law is unconstitutional and unsustainable. But during an editorial meeting with the Palm Beach Post yesterday, Scott went even further, claiming that the ACA won’t become the law of the land until — and unless — the Supreme Court upholds its constitutionality:

“It’s not the law of the land,” Scott said. “I don’t believe it will ever be the law of the land.” And if the Supreme Court upholds the law next year? Scott said Florida will be ready. “If it’s the law of the land, of course” Florida will implement it, he said. “If it’s the law of the land we will be ready.”

Where will the money come from? The budget, he said. But he won’t like it. “Obamacare overpromises, it overpays providers, and it rations care,” he said. “This act is going to cause the cost of health care to go up; it’s going to ration care, and the state obligations for Medicaid will kill jobs.”

It’s a convenient new standard that meets Scott’s ideological needs, but severely disadvantages the state of Florida — which has the third highest uninsurance rate in the country and a $3.7 billion budget gap. Floridians will face an uphill climb in establishing a health care infrastructure and building an operational exchange by 2014. Fortunately, in 2008 the state approved an exchange marketplace that could be converted to meet federal requirements, even though it is not yet operational. Scott has turned down millions in grants for programs that aid in cancer prevention, expand community health centers, counsel patients on long term care options, and disease management, but did accept over $2.5 million in ACA money to fund abstinence-only initiatives.