Self-insurance is popular among large employers, who often hire an insurance company to administer the fund. So a range of religiously affiliated employers are likely to fall into this category.
“We don’t really see how this new accommodation would satisfy our concerns,” said Michael Warsaw, president and chief executive of EWTN, a nonprofit nationwide network of Catholic television and radio stations that self-insures its roughly 350 employees. The organization has filed a lawsuit challenging the birth control rule.
An administration official, who requested anonymity to discuss what the White House is considering, said the White House will be looking at how to address such cases.
“This policy will be developed collaboratively,” the official said.
Other organizations expressed concern that employers with moral objections to contraception will not be eligible for the accommodation if they are for-profit enterprises.
Meanwhile, female staff members at churches, which are completely exempt from the rule, will not be able to obtain the additional coverage from their insurer.
Administration officials cited studies indicating that the impact of the accommodation on insurers would be cost-neutral. But industry representatives said they were troubled by the precedent the administration was setting in requiring them to provide a service without allowing them to adjust their premiums.
In addition to the escalating attacks from the GOP, the White House over the past week has faced intensifying pressure from friends on both sides of the issue.
Representatives of women’s groups and Democratic members of Congress, who were worried that the White House would go wobbly and weaken the rule, repeatedly called key Obama advisers to press their case.
Several leading Catholic Democrats and outside religious leaders who are otherwise supportive of the administration offered a competing perspective. They argued that the White House had needlessly put at risk the goodwill that Obama had built over years of courting religious leaders and voters.
By late last week, faith leaders close to the administration were pushing hard for a resolution.
“This thing was going south real fast,” said Joel C. Hunter, a Florida mega-church pastor who has advised the White House on faith issues and become a spiritual adviser to Obama. “I just can’t picture how they could fumble this kind of very important announcement.”
The fumble was months in the making and generated considerable internal strife within the White House.
The controversy first erupted in August, when Health and Human Services Secretary Kathleen Sebelius unveiled a proposed regulation fleshing out a provision of the 2010 health-care law. The law requires insurers to cover preventive care for women with no out-of-pocket charges, but it was left to Sebelius to draft the list of covered services.