A group of men with no real background in law or medicine, but blessed with a strong personal interest in women’s bodies, have quietly influenced all of the major anti-abortion legislation over the past several years. The U.S. Conference of Catholic Bishops may be one of the quietest, yet most powerful lobbies on Capitol Hill, with political allies that have enabled them to roll back decades of law and precedent.

Over the past two years the GOP-controlled House of Representatives has launched one of the most extreme assaults on women's choice the U.S. has seen in decades. Republicans voted twice to slash federal family planning funds for low-income women, moved to prevent women from using their own money to buy insurance plans that cover abortion, introduced legislation that would force women to have ultrasounds before receiving an abortion and, most recently, passed a bill that will allow hospitals to refuse to perform emergency abortions for women with life-threatening pregnancy complications.

But the erosion of women's rights didn't begin with the GOP takeover. President Barack Obama's health care reform law contained some of the most restrictive abortion language seen in decades.

Lift the curtain, and behind the assault was the conference of bishops.

"It is a very effective lobby, unfortunately, and now they have an ally in the Republican majority because both groups find this a means by which to fight women's health issues in general," said Rep. Lois Capps (D-Calif.), a member of the House Pro-Choice Caucus. "The bishops carry a lot of clout."

"We consider the two biggest opponents on the other side the Catholic bishops and National Right to Life," said Donna Crane, policy director of NARAL Pro-Choice America. "They are extremely heavy-handed on this issue."

While the bishops have always been vocal on the issue of choice, they have emerged since the 2009 health care reform debate as one of the most powerful anti-abortion advocates on Capitol Hill.

Now, they are stepping up their attack on women's choice with a new, high-intensity campaign aimed at the latest front in the national anti-abortion battle: birth control. And the opposition is worried that they might have just enough sway over lawmakers to succeed.

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On November 6, 2009, one day before the Democrat-controlled House was scheduled to vote on the Affordable Care Act, House Speaker Nancy Pelosi (D-Calif.) reconvened with the Pro-Choice Caucus after a contentious meeting with the bishops.

The sticking point was abortion funding. Pelosi and the Democrats desperately wanted to pass health care reform. The bishops dug their heels in and refused to support a bill that didn't include the notorious "Stupak Amendment," which would block insurance companies from covering abortion under the plan, and the 39 pro-life Democrats in the House couldn't politically afford to oppose the bishops.

"The Catholic bishops were willing to bring down the health care bill over the issue of abortion -- even though the bill did not expand access to abortion," Rep. Rosa DeLauro (D-Conn.) said. "This was very troubling."

Emotions ran high as Pelosi, DeLauro and other staunch abortion rights advocates realized they were going to have to choose between passing sweeping health care reform and standing up for women's choice.

"Some of these women had been working to pass the health care bill for decades, and it had all these other great things for women, like immunizations and maternal health provisions and preventative care," one Democratic staffer involved in the negotiations recalled. "You could see them having this internal struggle with, do we sink the whole thing over this one issue?"

In addition to having the support of the pro-life Democrats in the House, the bishops claimed to have the support of Catholic congregations around the country. They instructed all Catholic priests to talk about the Stupak Amendment during Mass, issued church bulletins and strongly urged Catholics and the clergy to oppose the entire health care bill if the abortion provision didn't pass.

"The bishops came out of nowhere," said another staffer who worked on health care reform for a member of the pro-choice caucus. "They made their appearance during the health care debate, and all of a sudden were this hugely important group, like the NRA."

The Conference of Catholic Bishops is not technically a lobbying organization -- churches are tax-exempt, and they don't have to disclose publicly how much money they put toward lobbying. According to the IRS, a 501(c)(3) organization like the Conference can speak out on moral issues as much as it wants, but "may not attempt to influence legislation as a substantial part of its activities."

The Catholic clergy's secret weapon is a man named Richard Doerflinger, who dropped out of a doctoral program in theology 31 years ago to work on abortion policy for the USCCB as Deputy Director of the Secretariat for Pro-Life Activities. As the point person on pro-life issues for the bishops, Doerflinger says he has been helping lawmakers write anti-abortion bills behind the scenes for decades, including the Stupak Amendment. In 2008 he was recognized by the Gerald Health Foundation as one of the "greatest heroes of the pro-life movement."

And the bishops were not only influential in swaying votes during health care reform debate; Doerflinger said they actually helped Reps. Bart Stupak (D-Mich.) and Joe Pitts (R-Pa.) write the controversial anti-abortion amendment, which the House approved by a vote of 290 to 194.

"Those bishops were literally sitting in Bart Stupak's office and, from what we could tell, instructing him all about the laws he should be supporting, and the text of the laws, and the strategy of getting them through," said Terry O'Neill, the president of the National Organization for Women. "It was absolutely appalling."

The National Organization for Women has called for the bishops conference to lose its tax-exempt status over its lobbying activities.



Doerflinger says that the bishops derived most of their power in the health care debate from the influx of conservative Democrats after the 2008 elections.

"I think there was a special circumstance in the consideration of health care reform, because everybody knew that virtually all of the Republicans were going to vote against it anyway," Doerflinger said. "So the key role in determining what could pass the House was held by a group of a couple dozen pro-life Democrats who worked more comfortably with us than any the other groups working on the abortion issue, because we also wanted universal health care coverage."

The fact that nearly a third of Congress -- 156 members -- are Catholic also likely helps the bishops' cause.

"[The bishops] have the most sway in offices that are either sympathetic to that perspective on abortion, or where that faith has sway -- either the member is Catholic, or there is a strong constituency of Roman Catholics in the district," said Crane. "We've seen all three."

Ultimately, the bishops lost the health care reform battle when the pro-life Democrats agreed to a compromise that excluded the Stupak language from the bill. In exchange for their support, President Barack Obama promised the lawmakers he would issue an executive order against using the health care funds for abortion.

The bishops were not satisfied. "Only a change in the law enacted by Congress, not an executive order, can begin to address this very serious problem in the legislation," Doerflinger wrote in a statement.

Still, the bishops had established themselves as a superpower in the crusade against reproductive choice.

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While Doerflinger and the bishops have largely operated in the shadows over the past couple of years, quietly advising lawmakers on legislation, recent developments on the contraception front have led them to step up their advocacy actions.

The Obama administration has been particularly supportive of efforts to provide contraception and family planning services to underserved communities in the U.S. and abroad, which violates the Vatican's teachings on abstinence and runs counter to the programs the bishops offer to their congregations.

The Department of Health and Human Services (HHS) is currently considering a list of insurance coverage guidelines that would mandate that all health plans under the Affordable Care Act cover birth control at no cost for women. The rules have a religious exemption for churches, but many Catholic-affiliated organizations such as charities, schools and hospitals would still have to offer plans that cover birth control for their employees.

The bishops argue that the exemption is too narrow.

"You have to hire and serve primarily people of your own faith [to qualify for the exemption]," Doerflinger said. "Jesus himself would not be exempt, because he treated Samaritans and Roman soldiers. It's absurd."

HHS held an open comment period in September during which various advocacy groups could express their opinions on the interim guidelines before the final version is released, but the bishops went further. The day the comment period ended, the USCCB established a major new political arm -- the Ad Hoc Committee on Religious Liberty -- to continue flexing their political muscles on the issue and convince the Obama administration either to entirely remove the coverage of birth control from the guidelines, or to give all Catholic-related organizations a free pass.

"The bishops are the loudest voice when it comes to removing contraception from the guidelines, so that no woman would have access to that benefit," said Sarah Lipton-Lubet, policy counsel at the American Civil Liberties Union. "In lieu of that, they're asking for sweeping exception that would completely swallow the rule and make the guidelines meaningless for women."

The bishops' new initiative is multi-pronged. In addition to submitting official comments to HHS and urging parishes around the country to do the same, the bishops are pushing their agenda in Congress.

"Religious freedom is a fundamental freedom," Bishop William Lori, the chair of the ad hoc committee, told HuffPost in an interview. "It should not become a second class right to other so-called rights that have been discovered farther down the road."

"No one would ever dispute the ready availability of so-called reproductive services in our society for anyone who wants it," he continued.

Lori testified before the House Judiciary Subcommittee last week about what he said were recent government assaults on the freedom of religion.

"I am here today to call your attention to grave threats to religious liberty that have emerged since June -- grim validations of the bishops' recognition of the need for urgent and concerted action in this area," Lori said. "I focus on these because most of them arise under federal law and so may well be the subject of corrective action by Congress."

Lori urged subcommittee members to support three bills currently in Congress that would help to codify their agenda: the Protect Life Act (H.R. 358), the Abortion Non-Discrimination Act (H.R. 361) and the Respect for Rights of Conscience Act (H.R. 1179) -- all anti-abortion and anti-contraception bills that Doerflinger says he directly influenced.

Doerflinger told HuffPost he had "some input" into the Protect Life Act, which was sponsored by Rep. Joe Pitts (R-Pa.) and passed by the House in October. Nicknamed the "Let Women Die Act" by opponents, the bill would prevent women from using their own money to pay for private insurance plans that cover abortion under the new health care exchanges, and it would also allow religious hospitals to refuse emergency care to pregnant women in need of life-saving abortions.

Doerflinger worked with Rep. Jeffrey Fortenberry (R-Neb.) on the Respect for Rights of Conscience Act, which would impose a giant religious exemption onto the new HHS recommendations, preempting the Obama administration. The bill would allow insurance companies to "decline coverage of specific items and services that are contrary to the religious beliefs of the sponsor, issuer, or other entity offering the plan," meaning that thousands of women who work for Catholic organizations, even if the women are not personally Catholic, would be denied the preventative health coverage options available to most other women in America.

"These new mandates are ideologically driven by Obama and [HHS Secretary] Kathleen Sebelius," Fortenberry said. "The religious exemption is very narrow, and frankly, it's insulting and discriminatory. It would allow an institution to opt out only if it serves people of its faith tradition, so you can envision a situation in which a Catholic hospital has to hang a sign in the window: No Baptists allowed.'"

"Even Jesus wouldn't qualify," he added, echoing Doerflinger.

Doerflinger said the bishops "were probably more involved than any other group in Washington I can think of" on Fortenberry's bill. And their message is resonating in Congress: In addition to last week's Judiciary Subcommittee hearing, the bishops are appearing at a House Energy and Commerce subcommittee forum on Wednesday to testify about the narrow scope of the religious exemption.

"That's their slim basis for having the hearing, that they say it violates provider conscience rights," said Rep. Capps, a member of the Health Subcommittee of the Committee on Energy and Commerce. "The real purpose of the hearing is to prevent women from getting access to preventative health care. It isn't a rational hearing, but it's not the first hearing we've had that's not rational."

What the bishops haven't mentioned during their highly public anti-contraception campaign is the large amount of money at stake.

The USCCB established the ad hoc committee just days before the story broke that HHS was dropping the bishops from a massive $19 million, five-year contract to help victims of sexual trafficking. The bishops believe they lost the contract because they refuse to provide trafficking victims the full range of contraceptive and gynecological services that other agencies provide, such as abortion referrals, birth control pills and condoms.

"The efforts of the Church in the field of human trafficking and also in serving the poorest of the poor has been hampered, not by a legislature, but by the HHS, because we refuse to compromise our conscience," Lori told HuffPost. "We are being forced to choose between our mission and our beliefs, and we believe that is a violation of religious liberty."

President of Catholics for Choice Jon O'Brien, however, believes the establishment of the ad hoc committee was more about money and political power than religious liberty.

"This is really a political committee designed to lobby to get the results bishops want for their charities," he told HuffPost. "International aid is a big business, and the bishops are investing the staff, time and resources to make an issue around this so they don't lose more contracts going into the future."

If the bishops can sway Congress and the Obama administration over to their side on the issue of contraception, it could restrict access to birth control for millions of U.S. women and sexual trafficking victims worldwide.

"What they're attempting to do is use the legislative process to legislate us and others into their sense of morality," O'Brien said. "If you can't reach them at the pulpit, you go to Congress! And sometimes they win."

* * * * *

The assumption that the bishops represent Catholic voters and have some sway over how those constituents will vote is not necessarily true. The Catholic vote is huge: 68.5 million Americans, about a quarter of the U.S. population, are Catholic. But polls suggest the bishops' views on abortion and contraception do not at all reflect the views of most Catholics.

"The bishops are entirely out of sync with the people they purport to represent," said Donna Crane, NARAL's policy director. "All the polling and public opinion research is very clear: Catholics are majority pro-choice. They hold that belief, they use the services and they just aren't in agreement with the hierarchy on these issues."

The Catholic clergy opposes abortion even in cases of rape and incest, stem cell research and all artificial contraception and sterilization methods, including birth control pills and condoms.

But according the 2008 National Survey of Family Growth, 98 percent of sexually active Catholic women over the age of 18 have used some form of contraception banned by the Vatican. Even among more religious Catholic women, who attend Mass on a weekly basis, 83 percent use some form of contraception.

In 2009, 63 percent of Catholic voters said they support health insurance coverage for contraception, including birth control pills, according to a Belden Russonello Strategists poll. A 2008 Pew Research poll found that only 21 percent of Catholic respondents believe abortion should be illegal, and a new study released Oct. 24 shows that Catholics have become increasingly likely to say that issues of sexual morality and abortion should be left up to individuals -- not the church.

There are even some disagreements among Catholic leadership over abortion and sexual morality issues. A coalition of religious orders representing about 59,000 nuns sent a letter to Congress in early 2010 urging them to pass health care reform, despite the bishops' objections that the bill would allow federally subsidized abortions.

"Despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions. It will uphold long-standing conscience protections and it will make historic new investments -- $250 million -- in support of pregnant women," wrote the nuns. "This is the REAL pro-life stance, and we as Catholics are all for it."

Capps said the nuns are some of the Democrats' biggest allies in the choice debate.

"The bishops don't represent all the Catholic voices. We have an ally in several Catholic organizations, mostly comprised of nuns," she said. "And they're at the front lines. That's where health care is delivered, by them, in the hospitals. They provide the services."

When asked about the dissonance among Catholics and the leadership on abortion and contraception issues, Bishop Lori said that divisions were beside the point.

"It's not for a government to exploit fault lines within religious institutions," he said. "We recognize that not everybody shares that teaching; nevertheless, it is a fundamental right for the church to stand by their convictions."

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The ultimate victory for the bishops would be to reverse Roe vs. Wade, the 1973 Supreme Court decision that prevents states from banning abortion before the fetus is viable. But even without that prize, women's choice advocates said the effect the bishops have had on reproductive choice in the U.S. has already been noticeable.

"Women have fewer abortion rights today than we had three or four years ago," O'Neill said. "We are so grateful for our friends in Congress who stopped the Stupak amendment, but ultimately we did see an anti-abortion provision go into health care law, and in 2011 alone we had more than 100 anti-abortion laws signed into law at a state level, which is unprecedented."

O'Neill finds it troubling that a group of men that has historically denied women the opportunity to participate in leadership positions is exercising so much power over such a broad range of women's reproductive health legislation.

"Clearly there's a problem when men take such an interest in the sexual function of women," she said. "There's something deeply off about it."

The Democrat-controlled Senate is likely to reject any anti-abortion bills the House passes under influence of the bishops. But as HHS considers the final ruling on preventative health coverage guidelines, a key question is whether the Obama administration will end up caving to pressure from the bishops on the issue of birth control.

Capps says she believes it "surely could."

"It makes me very nervous," she said. "The administration and the secretary have been beleaguered on all sides throughout this health care debate, and I don't want this to be the straw that breaks the camel's back."

"Is this the one they have to cave on, because they have to cave somewhere?"

