The question of how to reconcile "self-insured" religious institutions with the contraception coverage mandate has been something of an adjunct to the entire brouhaha, but it is a difficult problem and may emerge as a real stumbling block.A New York Times business story today explores and explains the issue very well:

Employers that self-insure provide health insurance directly to employees, paying the health care claims of their workers. Large employers often choose to self-insure because they can spread the risk across hundreds or thousands of workers. The option is often more economical and can allow an organization to tailor its plan to the specific needs of its employees. Many such employers contract with an insurance company to administer the plan.Nationwide, 60 percent of workers with health insurance were covered by a self-funded plan in 2011, according to the Kaiser Family Foundations annual survey of employer health benefits. Among large employers, the number is even higher. Eighty-two percent of covered workers at companies of more than 200 employees had self-funded plans.Insurance industry experts and Catholic groups said they did not know how many religiously affiliated organizations self-insure, but they said the number was likely to mirror the national trend. Many of the organizations are large employers, including hospital systems and universities.

One proposal I've heard would be to grandfather in self-insured religious organizations. That doesn't sound very satisfying, or just, if you are a granddaughter organization. Exempting self-insured religious institutions entirely might work, and actually be a back door into the kind of de facto religious exemption the bishops wanted.Those with actual knowledge of these topics are invited to comment...