HHS Publishes Provider Conscience Expansion Rule

Emily Douglas

The Department of Health and Human Services today published a new regulation broadening protections for health care providers who refuse to provide health care services based on religious or moral grounds.

The Department of Health and Human Services today published a new
regulation broadening protections for health care providers who refuse
to provide health care services based on religious or moral grounds.
The new regulations, which have been widely denounced by women’s health
groups, physicians’ groups, members of Congress, President-Elect Obama, the Equal Employment Opportunity Commission, and by over 200,000 individual commenters filing opposition to the regulations,
expand the definition of health care providers protected by provider
conscience regulation and allow dissenting providers to refuse to refer
patients for treatment in addition to refusing treatment itself.

The administration made almost no substantive changes to the regulation following the period of public comment, says Adam Sonfield, senior public policy associate at the Guttmacher Institute. "The 200,000 comments in opposition to the rule they dismiss," says Sonfield. "They pretend to respond directly to them, but they actually don’t."  The only major substantive change the administration made to the rule is to expand the definition of the workforce the rule applies to — for instance, it now includes contractors.  

An early, leaked draft version of the regulation specifically
suggested that providers who consider hormonal birth control to be an
abortifacient should not have to prescribe it or refer patients for its
prescription.  The regulation relied on arcane, non-medical definitions
of pregnancy to suggest that the belief that pregnancy begins at
fertilization is valid and that, a hormonal contraceptive, which
anti-choicers claim block implantation of a fertilized egg, is
tantamount to abortion.  The second, released draft, now published,
does not conflate contraception with abortion, but in its broad scope
nonetheless provides protections for providers who would like to
do just that.  "The regulation confirms what we feared," says Marilyn Keefe of the National Partnership for Women & Families. "HHS
refused to allay any of the concerns raised in earlier iterations.  Contraception
clearly remains a target."

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One of the rule’s more disturbing provisions is the announcement that Title X family planning funding will now be open to grantees who refuse to counsel women on the availability of abortion.  Title X has always required that when a woman tests positive for pregnancy, she must be counseled on all of her options, including abortion, and given referrals based on what her expressed interest.  The regulations state that Title X funding will be granted "non-discriminatorily" to applicants, including those who refuse to provide counseling and referral for abortion.

Additionally, the rule fails to make clear whether health care centers that do intend to provide unbiased options counseling can even ask potential employees whether they are comfortable
participating in an abortion procedure or counseling a woman about her
options, Roger Evans, director of litigation at Planned Parenthood, acknowledged today. 

Moral objection, meanwhile, is not strictly limited to religious belief
— it can mean any personal moral commitment, which is a much broader
protection than "traditional conscience clauses," says Jessica Arons, of the Center for American Progress.  

The rule must now be submitted to both the Government Accountability
Office and both houses of Congress.  Congress has a period of time to
review the rule (and because of the timing of the rule’s publication,
this period will stretch into the 111th Congress), during which time a
motion to disprove can be introduced.  If the motion to disprove is
passed by both houses of Congress and signed by the President, the rule
cannot be enforced or defended in court. Using the Congressional Review Act in this way to invalidate the
regulation, however, would be "controversial," says Matt Madia, of OMB
Watch. A motion to disprove has to see an up-or-down vote; it can’t be
attached to appropriations bills or other must-pass legislation.
"Everyone has to go on record on the issue, and there’s no way to fudge
it," says Madia.

If this avenue fails, Congress
could refuse to appropriate funds for implementation of the rule, or
Congress could pass the legislation introduced by Sens. Hillary Clinton
and Patty Murray that would prohibit HHS from implementing the
regulation.
Finally, the new administration could begin a new round of rule-making, perhaps the most time-consuming option.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

News Law and Policy

GOP Pushes LGBTQ Discrimination on Pulse Shooting Anniversary

Christine Grimaldi

A business or other organization drawing on taxpayer money and acting on those views, for instance, could deny child care, health care, and retirement benefits to an employee with a same-sex spouse without penalty from the federal government.

On the one-month anniversary of the massacre at the Pulse nightclub in Orlando, Florida, congressional Republicans pushed legislation that would shield individuals and groups that receive federal funds from penalties for discriminating against LGBTQ people.

A U.S. House of Representatives committee Tuesday debated the First Amendment Defense Act (FADA). Republicans have proposed multiple official and unofficial versions of FADA. All of them share a common purpose: Protect recipients of federal dollars that act on their “religious belief or moral conviction” against same-sex marriage or sex outside of marriage. Conservative groups such as the Heritage Foundation have praised FADA for building on broader Religious Freedom Restoration Act (RFRA) and other so-called religious liberty bills. (The legal website Justia breaks down the similarities and differences between RFRA and FADA.)

A business or other organization drawing on taxpayer money and acting on those views, for instance, could deny child care, health care, and retirement benefits to an employee with a same-sex spouse without penalty from the federal government, Democratic lawmakers opposing the bill said at the House Oversight and Government Reform Committee hearing. Employers could even refuse to provide time off under the Family and Medical Leave Act to care for an ill same-sex spouse.

That possibility troubled Jim Obergefell, the plaintiff in the landmark U.S. Supreme Court ruling on marriage equality. “This is not the kind of dignity and respect that the Supreme Court spoke so eloquently of in the decision granting the freedom to marry nationwide last June,” Obergefell told lawmakers.

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If enacted into law, FADA would also empower those with religious objections to be able to turn away LGBTQ people seeking services such as housing or medical care, experts testified before the committee.

Rep. Elijah Cummings (D-MD), the committee’s ranking member, fellow Democrats, and 80 civil rights and other groups petitioned Republicans to reschedule the FADA hearing, to no avail. More than 3,000 faith and clergy last year leaders voiced their opposition to FADA, he said.

“To say that this hearing is ill-timed is the understatement of the year,” Cummings said as he opened the hearing. That evening, House Democrats and the Congressional LGBT Equality Caucus gathered on the capitol steps for a vigil honoring the 49 victims of the Pulse shooting.

Rep. Raúl Labrador (R-IN) introduced the House’s bill (H.R. 2802), and Sen. Mike Lee (R-UT), the identical Senate counterpart (S. 1598). FADA has little to no chance of becoming law this year given President Barack Obama’s increasingly outspoken support for the LGBTQ community, indicating that he would veto any such legislation that somehow managed to advance in the House and Senate. A Mississippi judge recently blocked a similar state law from taking effect.

House Democratic aides provided Rewire with a revised FADA draft that they said Labrador has been circulating since last Friday that goes even further.

Lawmakers and witnesses at the hearing discussed the revised draft, which they said would apply to all businesses—both for-profit and nonprofit. This draft permits discrimination against same-sex and opposite-sex couples except by federal employees acting in the scope of their employment and for-profit federal contractors acting in the scope of a government contract, they added.

David Stacy, the government affairs director for the Human Rights Campaign, the prominent LGBTQ civil rights group, described these exemptions, and others for hospital visitations and medical decisions, as concessions that don’t mask FADA’s underlying discrimination.

“That all being said, the bill has really significant problems that remain,” he said in an interview.

Columbia School of Law professor Katherine Franke underscored that FADA would go beyond permitting discrimination against LGBTQ individuals and include unmarried parents and heterosexual couples.

“A broad reading of this bill would create a safe harbor from penalties associated with an enormous range of behavior that is otherwise illegal or prohibited by federal law and regulation,” Franke said in her testimony before the committee.

Under FADA, she said, the federal government could not deny Title X funding to a health-care clinic that provides family planning services only to patients that can furnish a marriage license. Nor could the government deny a Violence Against Women Act grant to a domestic violence shelter that required residents to pledge their opposition to marriage equality or extramarital relations, she added.

Schools that accept federal funds could fire teachers suspected of having premarital sex, the Huffington Post reported. NARAL Pro-Choice America highlighted the “legislation that lets your boss fire you for having premarital sex (yes, really)” in a scathing memo sent to reporters.

“Are you a single mother whose landlord doesn’t believe in sex outside of marriage? Under this law, your landlord could refuse to house you,” the memo said. “Do you work at a company where your boss doesn’t believe in premarital sex? Under this law, if your boss found out about your private life, they could fire you.”