Obama’s search for ‘balance’ defines his decision-making

WASHINGTON — It was just a few days after the Obama administration announced its groundbreaking decision to require employers providing health insurance to cover contraception, and a controversy was flaring.

Roman Catholic bishops were vowing to fight an “unconscionable” mandate. Catholic hospitals and even some Catholic Democrats were assailing President Obama, saying he was trampling on religious freedom.

Obama, as angry as his senior aides had ever seen him, summoned them to the Oval Office. The debate over the decision had roiled the administration, dividing top staff members along religious, gender and political lines. The policy was backed by trusted advisors, but the president never seemed comfortable with it.

On the day it was announced, he had caught his advisors by surprise when he told New York’s archbishop, Timothy Dolan, the policy was not final and there was still time to find a compromise. Now, the president was telling his aides that he had read the legal opinions and policy papers on the issue, and he saw no reason why a more accommodating solution had been ruled out.

“Fix this,” he said testily.

“He didn’t have the balance he wanted, and he wasn’t happy with us about it,” said a senior administration official, who, like others interviewed, declined to be identified talking about internal discussions.

Obama’s search for “balance” — deemed insufficient by critics and infuriating by allies — is the defining principle of this president’s decision-making. Part personal inclination and part political calculation, the president’s sometimes awkward attempts to accommodate both sides of the political spectrum have driven nearly every major policy move in his first term: his overhaul of the healthcare system, attempts to cut the national debt, and his plans to withdraw troops from Iraq and Afghanistan.

The contraceptives decision, although a smaller-scale one, offers a window into this process. In the weeks before the president’s decision, he juggled liberal inclinations within his administration with conservative views held by prominent Catholics, inside and outside the White House. He crafted a policy that largely sided with liberal supporters but attempted to be sensitive to religious concerns. And, as was true with many decisions in his first term, the president seemed startled to find that his policy did not mollify his opponents.

The tussle over the birth control mandate began in the summer of last year, after the Department of Health and Human Services laid out interim rules for the Affordable Care Act, often known as “Obamacare.”

The law required all employers to provide coverage for contraceptives to their employees at no additional cost, with an exception for “religious employers.” The interim rules defined religious employers as houses of worship, but not religious universities, hospitals and social service agencies, which serve and employ people of all religions and cultural backgrounds.

Within the White House, many top staffers wanted to make the interim rules permanent. But a subset — led by Catholics — saw the rules as a major blowup in the making. They thought it was possible to head off a controversy and important to try.

Vice President Joe Biden and Bill Daley, who was then chief of staff, set up a meeting between Obama and Dolan.

The two men had a rocky relationship. While both made public, personal overtures, they were far apart on policy. Dolan, the president of the U.S. Conference of Catholic Bishops who has since been elevated to cardinal, is the voice of the conservative wing of the Catholic Church.

When Dolan arrived at the White House, his organization was already in a battle with the Obama administration over a decision to pull grant money from Catholic groups working to combat sex trafficking.

In the Oval Office that day, according to one participant, Obama appeared conciliatory when it came to the grant dispute. And he asked questions about Dolan’s contention that the birth control policy would violate religious freedom.

Dolan, who declined to be interviewed, has said he left encouraged.

The Dolan meeting sent nervous jitters through pro-choice and women’s groups who were pushing to keep the interim rule. They intensified their lobbying, relying on White House senior advisor Valerie Jarrett and Kathleen Sebelius, secretary of Health and Human Services, as their main allies.

They also had a supporter in political advisor David Plouffe, who argued that the bishops were a lost cause and suggested the White House focus on moderate Catholics such as Sister Carol Keehan, head of the Catholic Health Assn. of the United States, who had backed the administration in the healthcare fight.

Plouffe also thought the bishops’ complaints could bolster a useful campaign narrative: that supporters of their view, including Republican Mitt Romney, held anachronistic views about women and family planning.

White House lawyer Kathy Ruemmler, meanwhile, concluded the federal government lacked the authority to implement a hybrid solution used in some states because it would place an obligation on insurers. In Hawaii, for example, employers who object to contraceptives on moral grounds can simply let female employees know where they can get coverage. By state law, those women can’t be charged more for contraceptives than they would pay if they got the coverage through their employers.

On Jan. 20, the president got on the phone. He was planning to inform Dolan and Keehan that they had lost this fight. They would have a year to comply. He was prepared for some tough calls. He had talking points from his staff to explain the legal hurdles to such compromises as Hawaii’s. But on the call with Dolan, the president indicated he was open to a Hawaii-style modification.

Within hours, Jarrett was on the phone with religious leaders. The president, she said, was interested in something along the lines of the “Hawaii model,” according to several people who were on the call.

Keehan was somewhat hopeful. “I was profoundly disappointed that we didn’t get the exemption but I was glad that it wasn’t the door slammed in our face,” she said.

A few days later, Obama ordered his aides to fix the problem. The president, a constitutional lawyer by training, challenged Ruemmler’s conclusions and pressed his aides to look again at implementing a hybrid solution. Over the next two weeks, the firestorm would intensify. Republicans on the Hill and on the campaign trail seized on the issue.

Staffers came up with a new hybrid idea with elements borrowed from New York, California and Hawaii.

Under the compromise plan, religious institutions would not be involved at all. The insurers, rather than the religious institutions, would tell employees about the availability of contraceptives. Insurers would also be required to cover the cost. Staffers, pressed by Obama, had revisited whether this would impose a burden on insurers. They concluded it would save them money. Contraceptives are much less expensive to provide than services that come with pregnancy, birth and early childhood.

When the proposal was presented to the president, he nodded in agreement. He had the approach he wanted.

On Feb. 10, Obama announced the revised policy. “Religious liberty will be protected, and a law that requires free preventive care will not discriminate against women,” he said.

The bishops still weren’t satisfied. Keehan, although she offered guidance in crafting of the solution and described it as a good first step, announced in June that she could not support it. A coalition of groups led by the bishops is suing the government.

But the accommodation did provide an appearance of moderation and quiet a controversy that endangered the president just before high campaign season. Polls suggest Obama’s standing with religious voters did not suffer because of the decision.

He “believes very strongly,” said White House spokesman Jay Carney, “in finding the balance that he believes he found.”

christi.parsons@latimes.com

kathleen.hennessey@latimes.com