As President Obama deals with issues surrounding religious freedom and women's demand for contraceptive coverage, it's worth noting that such battles have already been waged in Washington state.

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In Washington state, the Battle of the Pill has already been waged in many venues over the past two decades as judges, lawmakers and state regulators attempted to balance religious freedom with women’s demands for contraceptive coverage.

President Obama on Friday changed his earlier stand that religious organizations be required to pay for birth control for their workers. Instead, he said, insurance companies would be required to provide the coverage for free.

By most accounts, Obama’s compromise policy, which could force commercial-insurance companies to bear some new costs, likely will bring little change to Catholic institutions in the state.

For example, at Seattle University, a Jesuit Catholic university, two employee plans and student plans already include oral-contraceptive coverage “consistent with state law,” said Gerald Huffman, vice president for human resources and university services.

Wait and see

Providence Health & Services, a multistate health system that recently entered into an affiliation with Swedish Medical Center, wouldn’t say whether its plans cover contraceptives.

Spokeswoman Colleen Wadden would say only that plans vary and Providence won’t talk publicly about the details of any benefits except with employees.

“When we get actual regulatory language we will review it to better understand the implications for Providence,” she said.

Swedish, on the other hand, which remains a secular institution, according to the affiliation agreement, will continue to provide employees access to prescription contraceptives, said spokesman Ed Boyle.

The Archdiocese of Seattle didn’t respond Friday for comment.

Insurers here say they can’t yet predict how the policy will affect them.

In a statement, Regence BlueShield said it was “evaluating how the contraceptive-coverage mandate will impact our members.” But, the company said, “expanded coverage and benefits have a direct impact on the total cost of coverage.”

Eric Earling at Premera Blue Cross said it was too early to say how the president’s policy would work in practice. “We’d have to look at how the exact rules are laid out … the actual details,” Earling said.

Group Health Cooperative said it was not prepared to comment.

The issue’s history here

The balancing act between freedom of religion and women’s health-care rights is not new in Washington state.

Over nearly two decades, the issues have been debated and ruled on in the Legislature, in court and through insurance regulation.

Some arose during the crafting of Washington’s own comprehensive health-care legislation, which passed in the early 1990s. Many of the heated debates then had to do with abortion, but birth control went along for the ride.

A 1995 law guaranteed that “no individual or organization” would be required to buy coverage for a health service it considered religiously or morally objectionable.

But in 2000, in response to a lawsuit against Bartell Drugs, a federal judge said the self-insured company must treat contraception just like other drugs or devices in its health coverage, because not doing so violated the Civil Rights Act of 1964 by discriminating against female employees.

That prompted a state regulation requiring all insurance plans that cover prescription drugs to also cover contraceptives.

However, the state’s insurance commissioner doesn’t control self-insured companies, which include Swedish, Providence and other large employers. For the most part, though, those employers recognized they could run the risk of violating civil-rights laws if they covered prescription drugs but not oral contraceptives.

Just how the state insurance regulation interacts with the 1995 law exempting religious institutions isn’t clear; a 2006 opinion from the state’s attorney general said it couldn’t address that issue because doing so would require a comment on the constitutionality of Washington’s existing statutes.

The new federal health-care law has a specific definition of religious organizations (see www.healthcare.gov/law/resources/regulations/womensprevention.html).

Assuming the Obama compromise is agreeable to all sides, there is at least one remaining question: cost.

Although the President maintained access to contraception saves health-care costs overall, whether that would prove true for individual insurers remains to be seen — particularly if the insurance company would not otherwise have been on the hook for pregnancy or birth-related costs.

At this point, said Regence spokeswoman Rachelle Cunningham, “there are too many unknowns” to calculate how the policy might impact costs.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com.

On Twitter @costrom. Includes material from The Associated Press.