Catholics from across the American political spectrum have opposed the move, calling it an infringement of the U.S. Constitution’s First Amendment’s religious freedom clause.  

Obama has since offered a compromise by putting the onus on insurance providers to offer contraception to individual employees of Catholic institutions free of charge. Catholic groups such as the Catholic Health Association of the United States have accepted the compromise, but most bishops have not.  

In the Feb. 10 Philadelphia Inquirer, Archbishop Charles Chaput called the compromise “belligerent, unnecessary and deeply offensive to the content of Catholic belief.”

“Any such mandate would make it morally compromising for us to provide health-care benefits to the staffs of our public-service ministries,” Chaput said. “Moreover, we cannot afford to be fooled — yet again — by evasive and misleading allusions to the administration’s alleged ‘flexibility’ on such issues.”

So far 175 bishops, representing every Catholic diocese in the United States, have publicly spoken against the HHS mandate.

The Canadian health care system is much different, with health care provincially administered, said Catholic Health Alliance of Canada executive director James Roche. Catholic hospitals and other health care institutions have entered into agreements with the provincial government so that they are not forced to perform abortions, sterilizations, in vitro fertilization or other procedures that are contrary to Catholic teachings, he said, stressing that in Canada no Catholic institution can be compelled to do things contrary to its mission and values.

But as hospitals specialize and amalgamate, Catholic institutions might end up sending someone to another institution for care the Catholic facility does not provide, he said.

While American bishops oppose the imposition of mandates to provide insurance for contraception, Canada’s single-payer medicare system already makes taxpayers — Catholic and non-Catholic alike —  fund abortion on demand, even if Catholic hospitals are not forced to perform them. 

Canadian taxpayers do not pay for all contraception, though family physician Dr. Barbara Powell said birth control pills and other contraceptive services are provided to women on social assistance, and are available free through many municipal clinics. Many doctors hand out free samples.  

“Any resourceful woman in Ontario can obtain free contraception,” she said.  

Roche said that when Canada began to create its medicare system in the 1940s, health care was not nearly as complex. Then the ethical guidelines for Catholic hospitals fit into a six-page booklet. Now they are 1,000 pages, he said.  

What framed the ultimate embrace of medicare by the Catholic health care institutions was the “notion of ensuring every Canadian would have access to medical care and hospital services.”  

“Abortion was not legal,” he said. “That too changed as the decades went on.”