Who matters more to President Obama, 271 Catholic bishops or millions upon millions of sexually active Catholic women who have used (or—gasp!—are using right this minute) birth control methods those bishops disapprove of? Who does Obama think the church is—the people in the pews or the men with the money and power? We’re about to find out. Some day soon the president will decide whether to yield to the US Conference of Catholic Bishops (USCCB), which has lobbied fiercely for a broad religious exemption from new federal regulations requiring health insurance to cover birth control with no co-pays—one of the more popular elements of Obama’s healthcare reform package. Talk about the 1 percent and the 99 percent.

There’s already an exemption in the law for religious employers, defined as those whose primary purpose is the “inculcation of religious values,” who mostly serve and employ people of that faith, and qualify as churches or “integrated auxiliaries” under the tax code. That would be, say, a diocesan office or a convent or, for that matter, a synagogue, mosque or megachurch. Even this exemption seems unfair to me—why should a bishop be able to deprive his secretary and housekeeper of medical services? The exemption is based on the notion that people shouldn’t have to violate their religious consciences, but what makes his conscience more valuable than theirs? I would argue that it is less valuable—he’s not the one who risks getting pregnant.

The exemption becomes truly outrageous, though, if it is broadened, as the bishops want, to include Catholic hospitals, schools, colleges and social service organizations like Catholic Charities. These workplaces employ millions; and let’s not forget their dependents and the roughly 900,000 students enrolled at Catholic colleges. Now we’re talking about lots of people who aren’t Catholics, who serve non-Catholics and whose workplace may have only a tenuous connection to the institutional church. The Jewish social worker, the Baptist nurse, the security guard who hasn’t seen the inside of a church in decades—all these people, and their spouses and other dependents, will have to pay out of pocket, even as most Americans applaud the advent of vastly broadened access to essentially free contraception. It’s not a small amount of money at stake, either—the pill can cost $50 a month. The IUD, wider use of which would do much to help lower our high unintended pregnancy rate, lasts for many years but costs $800 to $1,000 up front. How is it fair to make millions of women live under old rules that the rest of society is abandoning precisely because they are injurious to health and pocketbook? Is there a social value in a woman’s having to skip her pills because she’s short $50? If it was any medication other than birth control—sorry, the Pope thinks you should control your cholesterol through prayer and fasting; no statins for you!—more people would be up in arms.

Why would Obama give in to the bishops? One theory is that it’s not the bishops he wants to please. “The Administration feels beholden to antiabortion people in the Catholic healthcare industry who supported Obama in the health insurance fight,” Jon O’Brien, head of Catholics for Choice, told me by phone. “People who said the antiabortion compromise was enough, like Sister Carol Keehan, to whom he gave one of the pens with which he signed the Affordable Care Act.” On November 28, Catholics for Choice paid for an ad on the New York Times op-ed page, urging President Obama, “Don’t turn your back on women.” But as O’Brien observes, “It’s pathetic that you have to put an ad in the newspaper to remind a president of his commitments to women.” Yes, you would think Obama had been elected thanks to the votes of antiabortion clergy and not those of single mothers, working women, young women and women for whom $600 a year is a major stretch.

In the bishops’ topsy-turvy world, religious liberty means the state must enable them to force their medieval views on others. Thus it was “anti-Catholic” for HHS not to renew a 2006 contract with the bishops’ refugee-services office to help victims of human trafficking—never mind that the office denied these women, often victims of rape and forced prostitution, birth control and emergency contraception. In what world do people have the right to be hired to not provide services? You might as well say it’s bigoted to deny the Jehovah’s Witnesses a contract to run a blood bank. You can expect more of this self-serving nonlogic from the USCCB’s newly beefed-up Committee on Religious Liberty, which plans to fight for broader religious exemptions in certain areas, such as the “right” to use federal funds to discriminate against gays in adoption and foster-care placements.

President Obama has done some good things for women—he signed the Lilly Ledbetter Fair Pay Act; he reversed the Mexico City Policy preventing NGOs receiving foreign aid from so much as mentioning abortion; he nominated Sonia Sotomayor and Elena Kagan to the Supreme Court. But the Affordable Care Act abortion compromise was a huge setback, not only in itself—unlike anyone else, fertile women stand to lose coverage many now possess—but because it set the stage for the wildly expanded reading of the Hyde Amendment in Congress. Universal birth control coverage with no co-pays is a way of righting the balance a bit. It will save women hundreds of millions of dollars, prevent much misery and anxiety, cure numerous medical problems unrelated to sex, lower rates of some diseases over the long run and, of course, prevent many unintended pregnancies. You would think the people who consider ending a pregnancy the moral equivalent of strangling a 10-year-old would rejoice about that.

When it comes to family planning, the bishops lost the battle among the faithful decades ago. Can it really be that President Obama will put state power at their disposal?