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updated 6/15/2012 4:01:16 PM ET 2012-06-15T20:01:16

Sharpening an election-year confrontation over religious freedom and government health insurance rules, the nation's Catholic hospitals on Friday rejected President Barack Obama's compromise for providing birth control coverage to their women employees.

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The Catholic Health Association was a key ally in Obama's health care overhaul, defying opposition from church bishops to help the president win approval in Congress. But the group said Friday it does not believe church-affiliated employers should have to provide birth control as a free preventive service, as the law now requires.

The hospital group's decision calls into question a compromise offered by the president himself only months ago, under which the cost of providing birth control would be covered by insurance companies and not religious employers. While churches and other places of worship are exempt from the birth control mandate, nonprofits affiliated with a religion, such as hospitals, are not.

In a letter to the federal Health and Human Services department, the hospital group said the compromise initially seemed to be "a good first step" but that examination of the details proved disappointing. The plan would be "unduly cumbersome" to carry out and "unlikely to adequately meet the religious liberty concerns" of all its members, the group said.

While some liberal-leaning religious groups see no problem with the birth control rule, Roman Catholic bishops and conservative-leaning groups are treating it as an affront and calling it an attack on religious freedom. Institutions ranging from the University of Notre Dame to Catholic Charities in several states to the Archdiocese of Washington have sued to block the rule.

With the Catholic Health Association now voicing concerns, opponents gained a powerful endorsement. There was no immediate reaction from the Obama administration.

The association represents about 600 hospitals and hundreds of nursing homes and other health-related organizations, totaling 2,000 members around the country. One of every six patients is cared for in a Catholic hospital.

In its letter, the group said the government should either broaden the exemption for religious employers, or pay directly for the birth control coverage.

Starting next Jan, 1, in most cases, women will have access to birth control at no additional charge through their job-based coverage, as part of a package of preventive services that also includes HIV screening and support for breast-feeding mothers. Some employers, considered to be "grandfathered" in under the health care law, will not have to provide the coverage.

The requirement applies to all birth control approved by the Food and Drug Administration. That includes the pill, intrauterine devices, the so-called morning-after pill, and newer forms of long-acting implantable hormonal contraceptives that are becoming widely used in the rest of the industrialized world.

The morning-after pill is particularly controversial. It has no effect if a woman is already pregnant, but many religious conservatives consider it tantamount to an abortion drug.

As recently as the 1990s, many health insurance plans didn't cover birth control. Protests, court cases, and new state laws led to dramatic changes. Today, almost all plans cover prescription contraceptives — but usually impose copays.

The White House has struggled to find a solution that will satisfy women's rights advocates without offending people who object on grounds of religious freedom. While Catholic church teaching has long opposed artificial means of birth control, polls show the faithful use the pill nonetheless.

Obama in 2008 won the total Catholic vote, 54 percent to Sen. John McCain's 45 percent, but he lost the white Catholic vote, 52 percent to 47 percent, according to exit polls. Once reliably Democratic, Catholics are now swing voters, with white Catholics making up the majority of the group.

Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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