Perhaps the determining element in the question whether institutional cooperation with the HHS Mandate is formal or material consists in the answer to the question whether an institutional choice to provide a basket of services including a malum, implies an institutional choice of that malum.  From the vantage of the individual opposed to contraception the answer can be simple:  no, because the individual is simply trying to obtain a licit service and being extorted.  But there is no prima facie legal or moral obligation for an institution to provide health insurance.  Thus, to choose to provide health insurance with malum, is not only materially to include the malum, but to choose to obtain it and to make it obtainable by others.  The malum is like an integer added to a sum:  it is included in the object of choice as something one is contracting to provide; it is as formal as the presence of a musical note in a musical composition, which would indeed be a different composition without that note, even though as merely a “part” of the composition that note is “material”.  Hence, while “material” in relation to the whole ensemble—as is every “part” qua “part”—it is formal with respect to the choice to provide it.  I.e., contracting to provide an evil is not merely material inasmuch as the evil is every bit as essential to the basket of items contracted for as all the other constituents, even though the institution might prefer not to choose it.  If one views goodness as from total causes, then the addition of one element that is wrong destroys the action.  Of course, one might say that it is evil to comply, but only because it is a more proximate material cooperation that is still material.  However (assuming a Catholic institution), the end for the sake of which the institute acts is health care; but it does this by formally choosing something that is not choiceworthy.  That the malum is only materially included does not change the datum that it is essentially included (and this is the heart of the difficulty:  to be merely material in the object does not keep something from being essential to the object).  Now, it could be merely material cooperation if the purchase of the evil “service” were per se ordained to a good.  But there is nothing about provision of access to abortifacient contraception that is of itself per se ordered to the provision of health care.  Thus, the relation between providing contraceptive “services” and providing health care is per accidens, and so one is doing two things, not one, with two species, not one:  one is providing access to vice, and one is providing access to health care.  These two acts have different species.  Acts are specified by their objects.  So, one is faced with buying an evil service.  How bad is that?  Well, how bad is the service?  It is a service to help people contracept, often killing conceived children.  It might be argued from the vantage of the institutional intention to provide health care, that the malum of providing access to evil is treated as a means although it isn’t one:  i.e., “if we are to provide health care, we can only do it by also consenting to provide access to abortifacient contraception; so we must provide access to the latter in order to do the former.”  It is not that the abortifacient contraception or its provision is naturally of itself the means for health care (if it were, the species from the intention of providing health care would be most formal and containing) but rather that only by consenting to the provision of contraceptives may one provide what one wants to provide, so that this consent to provide abortifacient contraception is in this way a chosen condition of pursuing one’s intention.  But, to reiterate, here too one sees that there is a per accidens order, with two species:  providing health care, and providing access to vice.  But the act of choosing to provide access to vice, i.e., contraceptive “services,” is not choiceworthy.  Of course, it is true that those who consider the cooperation to be proximate material cooperation concur in this judgment.  But it is important to realize that what is only materially present in the object may still be essential and therefore constitute formal cooperation.  Granted that what is most formal in the hypothetic cooperative action of the Catholic institution is its effort to provide access to health care, it must still choose something that is not choiceworthy in order to proceed, and ought not to do this. Would it be “even more formal” cooperation did the institution positively seek to provide the malum?  Yes.  But insofar as the institution chooses a package with a gravely evil constituent, irrespective the intention, it is formally in choice embracing that constituent which is deliberately chosen along with the rest, and that includes its nature and per se effects.  Of course, when one considers that formally and juridically Catholic institutions are being commanded to give scandal as a condition for obtaining health care—and that the analogously sacred missio the pursuit of which defines such institutions would thus be sacrilegiously perverted by a unilateral act of the state—it is all the clearer that cooperation is absolutely impossible.