Kathleen Sebelius

Jose Luis Magana

WASHINGTON - Nonprofit religious groups won't have to pay for their employees' birth control under the 2010 health-care law, the Obama administration said Friday, attempting to quash a conflict that has triggered dozens of protests and lawsuits.

New rules the U.S. government issued require insurers who administer health coverage for religious nonprofits to cover birth control for employees of the groups without charging the nonprofit or the workers.

The issue has inspired at least 44 lawsuits against the government, according to The Becket Fund for Religious Liberty, a legal group fighting the mandate.

The health law, the Affordable Care Act, requires insurers and employers who provide health coverage to their workers to pay for government-recommended preventive services without copayments. In August 2011, the Obama administration said those services would include contraception such as birth control pills, implants and sterilization procedures.

Religious organizations opposed to birth control demanded an exception to the requirement. The Obama administration initially provided a one-year delay until this August to allow the groups to comply, while promising further compromise.

"The administration is taking the next step in providing women across the nation with coverage of recommended preventive care at no cost, while respecting religious concerns," Health and Human Services Secretary Kathleen Sebelius said in a statement.

The issue has drawn enormous scrutiny. About 200,000 people and organizations sent formal comments on preliminary rules outlining a compromise the administration issued in March 2012.

The government said it would broaden the types of organizations eligible for an exemption from the birth-control mandate and make it easier for them to escape it. Nonprofits that object to the requirement need only lodge a protest with the health insurer that covers their workers, or the company that administers their health benefits if they are self-insured, the administration said.

The rule "would limit any accommodation to nonprofit organizations that hold themselves out as religious," the administration said, a definition that may include church-affiliated hospitals and universities that weren't previously exempt.

It's unclear how Friday's proposal affects the lawsuits filed by nonprofits, said Kyle Duncan, general counsel for the Becket Fund.

Fourteen of the 44 lawsuits were filed by for-profit companies whose owners object to covering certain types of birth control such as Teva Pharmaceutical Industries Ltd.'s morning-after pill, Plan B One-Step. Ten of the companies have received injunctions against the requirement. The government's rule doesn't relieve for-profit companies from the birth-control mandate.

"Today's proposed rule does nothing to protect the religious liberty of millions of Americans," Duncan said.

Groups that advocate for civil liberties and abortion rights applauded the government's proposal.

"Over the last year, we've seen a disturbing number of instances where employers are trying to impose their religious beliefs on a diverse workforce that does not share them, and opponents of the law have made it clear that they won't rest until no insurance plan, whatever the source, is required to cover contraception," Sarah Lipton-Lubet, policy counsel for the American Civil Liberties Union, said in a statement.

For nonprofits that are self-insured, birth-control coverage for their workers will be more complicated.

The responsibility will fall to companies that manage benefits for the nonprofits, called third-party administrators. While many insurers act as third-party administrators, other companies that aren't insurers also perform the service.

If there is a cost to third-party administrators for the coverage, the government will reimburse them by reducing the fees their insurers pay to offer plans in new health insurance marketplaces, called exchanges, which are being established under the health law.