Roundup: Catholic Bishops Coming For Your Birth Control

Robin Marty

Not content to have elminated abortion coverage from healthcare reform, now the United States Conference of Catholic Bishops wants birth control out, too.

The United States Conference of Catholic Bishops is once more trying to flex its muscles.  Not happy to have simply pushed to remove all abortion coverage from health care reform, they now have a new target: making sure birth control isn’t covered, either.

Via BusinessInsurance.com:

An organization representing U.S. Catholic bishops is asking federal regulators not to classify contraceptives and sterilization as preventive services, thus entitling them to full coverage under the health care reform law, in final rules.

The United States Conference of Catholic Bishops, in a letter sent Friday to the Department of Health and Human Services, said that preventing pregnancy is not preventing a disease.

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Over at Lifenews, the group goes into great detail, promoting falsehoods about the dangers of hormonal contraceptives as a reason not to cover them as the plan does all other preventative medications.

Normally preventive services mean vaccines, tests, screenings, etc. that are given with minimal risk to patients to prevent—or at least detect and provide an early warning of—serious illness and life-threatening conditions. Common examples: blood pressure and cholesterol screening for hypertension, mammograms for breast cancer, Pap tests for cervical cancer, and vaccines to prevent transmission of communicable diseases.

But prescription contraceptives don’t prevent or screen for disease. Their purpose is to block the normal functioning of a healthy reproductive system. They prevent a person from being conceived or born.

Moreover, far from preventing diseases, contraceptive use is associated with many harmful side effects and actually increases the risk of acquiring certain diseases.

The World Health Organization lists estrogen as a carcinogen. Estrogen is used in combined oral contraceptives (e.g., the pill, the patch, the vaginal ring) and in hormone replacement therapy (HRT) for menopause. U.S. breast cancer rates soared as the number of women on HRT increased from the early 1980s to 2002, when the Women’s Health Initiative trial was halted after finding elevated risks of breast cancer and stroke. Between 2003 and 2006, when HRT use dropped significantly, breast cancer rates in the U.S. plummeted 18 percent!

Cancer is not the only problem. Contraceptive Technology cites numerous studies in which estrogen in contraceptives has been associated with increased risk of heart attacks, strokes, blood clots, and hypertension.

Progestin-only contraceptives—mini pills, injections, and implants—have been associated with menstrual cycle disturbance, “excessive weight gain,” hair loss, and depression. The injectable contraceptive Depo-Provera has been found to significantly decrease bone mineral density.

Aside from being immoral to use and involving the above-mentioned health risks, contraceptives don’t work very well. Fifty-four percent of U.S. women seeking abortion were using contraception the month they became pregnant. The presumed efficacy of condom use in preventing STD transmission has been shown in studies to be completely offset by complacency and “risk compensation” (more casual partners, less care in use).

Planned Parenthood is fully aware of these increased risks, yet it wants mandated contraceptive coverage for all, perhaps so women will end up having to use their other services—emergency “contraception,” STD screening and treatment, mammograms and Pap tests, pregnancy testing, and abortions. That is no reason for the federal government to force all of us to buy such coverage. Is it not wiser and healthier to avoid these risks by respecting one’s own dignity and the dignity of marriage?

But advocates are reminding the public that preventative care is just that — preventing a medical condition.  Especially in the case of pregnancy, which can be both risky and expensive.  Via The Hill:

Montana’s commissioner of securities and insurance, however, wrote to urge mandatory coverage of “the full range of women’s preventive health care needs, including family planning.”

“Pregnancy is an expensive proposition and prevention of unplanned pregnancy is highly cost effective,” writes Commissioner Monica Lindeen. “For every public dollar invested in contraception, nearly $3.75 is saved in Medicaid expenditures that would have been needed for prenatal care, labor and delivery, postpartum care, and the infant’s first year of medical care.

“In addition, the costs of complications can be very high. Women with unplanned pregnancies have more complicated pregnancies and deliveries on average due to increased likelihood of inadequate prenatal care, exposure of the fetus to harmful substances, and low birth weight.”

Can the Conference of Bishops once more outmaneuver and strong arm politicians into abandoning any promises to help women through health care reform?  It looks like we’ll have another showdown to watch.

Mini Roundup: In a very public and morbid reminder of the fragile state of maternal mortality, Times Square’s National Debt Clock has a new counterpart.  Introducing the Maternal Death Clock, which will run for three days, marking the number of women who die every day due to childbirth and complications.

September 21, 2010

September 20, 2010

News Abortion

Anti-Choice Legislator Confirms Vote on House Conscience Protections (Updated)

Christine Grimaldi

The Conscience Protection Act would give health-care providers a private right of action to seek civil damages in court, should they face supposed coercion to provide abortion care or discrimination stemming from their refusal to assist in abortion care. The Act allows providers to sue not only for threats, but also for perceived threats.

UPDATE: July 14, 10 a.m.: The House passed the Conscience Protection Act Wednesday night in a largely party line 245-182 vote. Prior to floor consideration, House Republicans stripped the text of an unrelated Senate-passed bill (S. 304) and replaced it with the Conscience Protection Act. They likely did so to skip the Senate committee referral process, House Democratic aides told Rewire, expediting consideration across the capitol and, in theory, ushering a final bill to the president’s desk. President Barack Obama, however, would veto the Conscience Protection Act, according to a statement of administration policy.

The U.S. House of Representatives will vote next Wednesday on legislation that would allow a broadened swath of health-care providers to sue if they’re supposedly coerced into providing abortion care, or if they face discrimination for refusing to provide such care, according to a prominent anti-choice lawmaker.

Rep. Joe Pitts (R-PA) told Rewire in a Friday morning interview that House leadership confirmed a vote on the Conscience Protection Act (H.R. 4828) for July 13, days before the chamber adjourns for the presidential nominating conventions and the August recess. Pitts said he expects the bill to be brought up as a standalone measure, rather than as an amendment to any of the spending bills that have seen Republican amendments attacking a range of reproductive health care and LGBTQ protections.

The office of U.S. House Speaker Paul Ryan (R-WI) had no immediate comment.

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Pitts’ remarks came during and after he hosted a “Forum on Conscience Protections” in the House Energy and Commerce Committee room to garner support for the bill.

Energy and Commerce Democrats boycotted the forum, a House Democratic aide told Rewire in a subsequent interview.

Legislation Builds on Precedent

Conscience protections are nothing new, the aide said. The latest iteration is a successor to the Health Care Conscience Rights Act (S. 1919/H.R. 940), which remains pending in the House and U.S. Senate. There’s also the Abortion Non-Discrimination Act (S. 50) and similarly named bills in both chambers. The fiscal year 2017 Labor, Health, and Human Services funding bill, which guts Title X and Teen Pregnancy Prevention grants, includes the Health Care Conscience Rights Act.

At the leadership level, Ryan’s recently released health-care plan mimics key provisions in the Conscience Protection Act. Both would give health-care providers a private right of action to seek civil damages in court, should they face alleged coercion or discrimination stemming from their refusal to assist in abortion care. The Conscience Protection Act goes a step further, allowing providers to sue not only for threats, but also for perceived threats.

The proposals would also codify and expand the Weldon Amendment, named for former Rep. Dave Weldon (R-FL), who participated in Pitts’ conscience forum. The Weldon Amendment prohibits states that receive federal family planning funding from discriminating against health-care plans based on whether they cover abortion care. Currently, Congress must pass Weldon every year as an amendment to annual appropriations bills.

Administration Action Provides Impetus

There hadn’t been much public dialogue around conscience protections with the exception of some anti-choice groups that “have really been all over it,” the aide said. The National Right to Life issued an action alert, as did the Susan B. Anthony List, to galvanize support for the Conscience Protection Act.

The relative silence on the issue began to break after the Obama administration took a stand on abortion care in June.

The U.S. Department of Health and Human Services’ Office for Civil Rights rejected anti-choice groups’ “right of conscience” complaint against California’s requirement that insurance plans must cover elective abortions under the definition of “basic health-care services.” Anti-choice groups had argued the California law violates the Weldon Amendment, but the administration found otherwise.

The California decision reinvigorated support for the Conscience Protection Act, the aide said. Ryan’s earlier health-care plan also specifically references the decision.

“We think this is going to be a big issue for us throughout the rest of this Congress,” the aide said.

Aide Outlines Additional Consequences

Beyond creating a private right of action and codifying Weldon, the Conscience Protection Act contains additional consequences for abortion care, the aide said.

The legislation would expand the definition of health-care providers to employers, social service organizations, and any other entity that offers insurance coverage, allowing them to raise objections under Weldon, the aide said. The aide characterized the change as a direct response to the California decision.

The legislation also broadens the list of objectionable services to include facilitating or making arrangements for abortion care, according to the aide.

The Republican-dominated House is likely to pass the Conscience Protection Act. But the aide did not expect it to advance in the Senate, which would all but certainly require a 60-vote threshold for such a controversial measure. More than anything, the aide said, the bill seems to be catering to anti-choice groups and long-time proponents of conscience clauses.

“The House oftentimes will pass these kinds of anti-choice proposals, and then they just go nowhere in the Senate,” the aide said.

Commentary Law and Policy

Here’s What You Need to Know About Your Birth Control Access Post-Supreme Court Ruling

Bridgette Dunlap

Yes, the Zubik v. Burwell case challenged the Affordable Care Act's contraceptive coverage mandate. But that shouldn't stop you from getting your reproductive health needs met—without a co-payment.

In May, the Supreme Court issued a sort of non-decision in Zubik v. Burwell, the consolidated case challenging the Affordable Care Act’s mandate that employers provide contraceptive coverage. The ruling leaves some very important legal questions unanswered, but it is imperative that criticism of the Court for “punting” or leaving women in “limbo” not obscure the practical reality: that the vast majority of people with insurance are currently entitled to contraception without a co-payment—that includes people, for the most part, who work for religiously affiliated organizations.

Two years ago, hyperbole in response to the Court’s decision in Burwell v. Hobby Lobby—that, for example, the Court had ruled your boss can block your birth control—led too many people to believe the contraceptive coverage requirement was struck down. It wasn’t. The Zubik decision provides a good opportunity to make sure that is understood.

If people think they don’t have birth control coverage, they won’t use it. And if they don’t know what coverage is legally required, they won’t know when their plans are not in compliance with the law and overcharging them for contraceptives or other covered services, perhaps unintentionally. The point of the contraceptive coverage rule is to make it as easy as possible to access contraceptives—studies show seemingly small obstacles prevent consistent use of the most effective contraceptives. Eliminating financial barriers isn’t enough if informational ones undermine the goal.

The most important thing to know is that most health plans are currently required to cover reproductive health services without a co-payment, including:

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  • One version of every kind of FDA-approved contraception—that is, only the generic or the brand-name version of the contraceptive could be covered, but at least one must be. So you shouldn’t be paying a co-payment whether you use the pill, the patch, the shot, or want long-acting reversible contraception (LARC) like an IUD, which is more expensive, but most effective.
  • Screening for HIV and high-risk strains of HPV
  • An annual well-woman visit
  • Breastfeeding counseling and supplies like pumps

There are exceptions, but most plans should be covering these services without a co-payment. Don’t assume that because you work for Hobby Lobby or Notre Dame—or any other religiously affiliated employer—that you don’t currently have coverage.

The original contraceptive coverage rule had an “exemption” for church-type groups (on the somewhat dubious theory that such groups primarily employ individuals who would share their employers’ objection to contraception). When other kinds of organizations, which had religious affiliations but didn’t primarily employ individuals of that same religion, objected to providing contraceptive coverage, the Obama administration came up with a plan to accommodate them while still making sure women get contraceptive coverage.

This “accommodation” is a workaround that transfers the responsibility to provide contraceptive coverage from the employer to the insurance company. After the employer fills out a form noting it objects to providing contraception, the insurance company must reach out to the employee and provide separate coverage that the objecting organization doesn’t pay for or arrange.

This accommodation was originally available only to nonprofit organizations. But dozens of for-profits, like Hobby Lobby, sued under the Religious Freedom Restoration Act (RFRA)—arguing that their owners were religious people whose beliefs were also burdened by the company having to provide coverage.

The Hobby Lobby decision did not say your boss’s religious belief trumps your right to a quality health plan. What the Court did was point to the existence of the accommodation for nonprofits as proof that the government could achieve its goals of ensuring coverage of contraception through a workaround already in place to give greater protection to objectors. Basically, the Court told the government to give the for-profits the same treatment as the nonprofits.

The Hobby Lobby decision states explicitly that the effect of this on women should be “precisely zero.” The Obama administration subsequently amended the contraceptive regulations, making coverage available to employees of companies like Hobby Lobby available through the accommodation. Hobby Lobby added some headaches for administrators and patients, but it did not eliminate the contraceptive coverage rule.

Next, however, the nonprofits went on to argue to the Supreme Court and the public that the accommodation the Court had seemed to bless in Hobby Lobby also violated RFRA—because having to fill out a form, which notified the government that they objected to contraceptive coverage and identifying their insurers, would substantially burden their religious beliefs.

Following oral arguments in Zubik, the eight-member Supreme Court issued a highly unusual order: It asked the parties to respond to its proposed modification of the accommodation, in which the government would not require objecting nonprofits to self-certify that they oppose contraception nor to identify their insurers. The government would take an organization’s decision to contract for a health plan that does not cover contraception to be notice of a religious objection and go ahead with requiring the insurer to provide it instead.

The petitioners’ response to the Court’s proposed solution was “Yes, but…” They said the Court’s plan would be fine so long as the employee had to opt into the coverage, use a separate insurance card, and jump through various other hoops—defeating the goal of providing “seamless” contraceptive coverage through the accommodation.

When the Court issued its decision in Zubik, it ignored the “but.” It characterized the parties as being in agreement and sent the cases back to the lower courts to work out the compromise.

The Court told the government it could consider itself on notice of the petitioners’ objections and move forward with getting separate contraceptive coverage to the petitioners’ employees, through the accommodation process, but without the self-certification form. How the government will change the accommodation process, and whether it will satisfy the petitioners, are open questions. The case could end up back at the Supreme Court if the petitioners won’t compromise and one of the lower courts rules for them again. But for prospective patients, the main takeaway is that the Court ruled the government can move forward now with requiring petitioners’ insurers to provide the coverage that the petitioners won’t.

So—if your plan isn’t grandfathered, and you don’t work for a church or an organization that has sued the government, your insurance should be covering birth control without a co-payment. (If your plan is grandfathered and your employer makes a change to that plan, then those formerly grandfathered plans would be subject to the same contraceptive coverage requirements.) If you do work for one of the nonprofit petitioners, the government should be making contraceptive coverage available even before the litigation is resolved. And in some cases, employees of the petitioners already have coverage. Notre Dame, for example, initially accepted the accommodation before being pressured by off-campus contraception opponents to sue, so its insurer is currently providing Notre Dame students and employees coverage.

Don’t despair about the Supreme Court’s gutting access to contraception. Assume that you have coverage. The National Women’s Law Center has great resources here for finding out if your plan is required to cover contraception and how to address it with your insurance plan if it isn’t in compliance, and a hotline to call if you need help. The fact that equitable coverage of women’s health care is the new status quo is a very big deal that can be lost in the news about the unprecedented litigation campaign to block access to birth control and attacks on Obamacare more generally. Seriously, tell your friends.