News Contraception

Obama Administration Does the Right Thing, Finally, on Contraceptive Coverage

Jodi Jacobson

The Obama Administration has made a final decision on contraceptive coverage under health reform, ensuring that virtually all women with health insurance will now have access to the full range of preventive services originally recommended by the Institute of Medicine (IOM), including all FDA-approved forms of contraception.

Today, the Obama Administration took a long-overdue stand on women’s rights to basic reproductive and sexual health care by making a final ruling on contraceptive coverage under health reform. The decision requires that the vast majority of employer-based health insurance plans must cover preventive services for women including contraception without charging a co-pay, co-insurance or a deductible. This means all women with health insurance coverage will have access to the full range of preventive services originally recommended by the Institute of Medicine (IOM), including all FDA-approved forms of contraception.

“All women should have access to contraceptive coverage, regardless of where they work,” said Nancy Keenan, president of NARAL Pro-Choice America. “The administration stood firm against intensive lobbying efforts from anti-birth-control organizations trying to expand the refusal option even further to allow organizations and corporations to deny their employees contraceptive coverage. As a result, millions will get access to contraception—and they will not have to ask their bosses for permission.”

“I applaud the Administration for making a decision based on science that greatly expands women’s access to affordable contraceptive coverage,” said Congresswoman Lois Capps (D-CA).

Especially in tough economic times like we are experiencing now, women and their partners often have to choose between high contraceptive costs and paying the bills. Today’s announcement will go a long way in making sure that cost does not prohibit women from planning their pregnancies.

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Last August, the Department of Health and Human Services (HHS) issued the initial or “interim” ruling on contraceptive coverage. But the fate of contraceptive care without a co-pay was called into question when the United States Conference of Catholic Bishops (USCCB) and other religious right groups–who are opposed to virtually all forms of reproductive and sexual health services–began a strenuous campaign to over-turn the original interim ruling.  

The stakes were raised when then-Archbishop and now Cardinal Timothy Dolan paid a visit to the White House and held a private meeting with President Obama, during which he apparently pressed hard for an exception for religious organizations so broad it would have left millions of women and couples without insurance coverage for contraceptive care. The original interim ruling exempted all organizations with a specific religious mission from having to cover contraception (e.g. churches) but did not exempt religiously-affiliated businesses and organizations without a specifically religious mission, such as Catholic hospitals, from offering contraceptive coverage. The USSCB wanted an exemption for all religious organizations that oppose contraception, regardless of their mission.

Concern about the Obama Administration’s final decision on contraceptive coverage was heightened when Dolan, in an interview with the New York Times, indicated that the President had expressed sympathy for the “Catholic point of view,” otherwise known as the USCCB point of view, since 98 percent of Catholic women use contraception at some point in their lives. Anxiety rose further after the administration, in a rejection of considerable medical, public health and scientific consensus, over-rode for political reasons the Food and Drug Administration’s recommendation that Plan B One Step emergency contraception be made available over the counter for all females at risk of unintended pregnancy, including those ages 17 and under.

“The bishops pulled out all the stops in their campaign against women’s access to contraception,” said Jon O’Brien, president of Catholics for Choice. “While the refusal clause that is contained in the legislation is still too expansive, denying many women, as it does, affordable access to contraception, we are relieved by this announcement. Catholics for Choice and our colleagues in the reproductive rights movement expended a huge amount of energy and resources mobilizing the public to take action on this pivotal issue. In the final analysis, this was a victory for common sense and scientific advice in the interests of the common good.”

With the final rule on contraceptive coverage, however, women, as noted by the statement from HHS Secretary Kathleen Sebelius, “will not have to fore-go these services because of expensive co-pays or deductibles, or because an insurance plan doesn’t include contraceptive services.”

Moreover, as she noted:

This rule is consistent with the laws in a majority of states which already require contraception coverage in health plans, and includes the exemption in the interim final rule allowing certain religious organizations not to provide contraception coverage. Beginning August 1, 2012, most new and renewed health plans will be required to cover these services without cost sharing for women across the country.  

According to the Guttmacher Institute, 50 percent of women ages 18 to 34, including Latinas, say there has been a time when cost of prescription birth control interfered with their ability to use it consistently.

HHS did make a concession to the religious right, by giving religious organizations that do not currently provide contraceptive coverage an extra year–until August 1, 2013– to comply with the final rule. HHS stated that employers wishing to take advantage of the additional year “must certify that they qualify for the delayed implementation.”

According to research conducted by the National Latina Institute of Reproductive Health (NLIRH),  Latinas want the full range of birth control options available to them. And, noted NLIRH in a statement, “birth control use is nearly universal in the United States: 99 percent of sexually experienced women will have used birth control at some point in their lives, including 98 percent of sexually experienced Catholic women.”

This additional year will allow these organizations more time and flexibility to adapt to this new rule.  We intend to require employers that do not offer coverage of contraceptive services to provide notice to employees, which will also state that contraceptive services are available at sites such as community health centers, public clinics, and hospitals with income-based support.  We will continue to work closely with religious groups during this transitional period to discuss their concerns.

More than any other factor, it was the anger of women during a presidential election cycle that drove the administration to do the right thing. Scientific and public health evidence are unequivocal on the health benefits of access to contraception. The availablity of birth control enables women to exercise their rights to decide whether and when to bear a child, and by extension, as extensive social science data show, enables women to pursue their educational and economic goals, and to be full members of society.

For these and other reasons, “it is crucial that women have access to affordable birth control to prevent unintended pregnancies, plan the timing and size of their families, and protect their health,” said Judy Waxman, Vice President for Health and Reproductive Rights of the National Women’s Law Center. “The reality is that nearly all sexually active women in the U.S., regardless of their religious beliefs, use contraception at some point in their lives.”

But the evidence and ubiquity of contraceptive use notwithstanding, it took a grassroots movement to override the outsized influence the 270-odd bishops and the religious right have on the White House and Congress when it comes to abortion, contraception, sexual health education and related issues.

“This decision was never a sure thing,” said Cecile Richards, president of Planned Parenthood Federation of America. “For months, anti-women’s health groups and their congressional allies lobbied hard to undermine this important benefit. But after over 100,000 Planned Parenthood supporters spoke out, President Obama stood strong… to protect women’s health.”

The massive outpouring of support for access to birth control we saw over the past few weeks was powerful, it was passionate, and it drowned out the opposition. You and I know that birth control is essential preventive health care. We know that expanding access is one of the most effective ways to reduce the number of unintended pregnancies in America and keep women and their families healthy. We know this is the right thing to do.”

Likewise, NARAL Pro-Choice America sent 135,543 grassroots messages to the Obama administration “calling on the White House to stand strong in support of no-cost coverage of contraception.”

To those concerned about women’s health and rights, and relying on science and evidence as the basis of public policy, this constitutes a huge victory, albeit in a battle that should never have been necessary to wage. For millions of low- and middle-income women seeking to manage the competing demands of family, job, and health care, contraceptive coverage will bring considerable relief, either because they will not lose something they already have, or they will gain coverage for an expense that can run over $600.00 per year and which is unique to them as women.

Nonetheless, at a time when a record number of anti-choice provisions are being introduced in legislatures across the nation, when neither the Administration nor Congress show evidence of consistent strong support for–nevermind understanding of–women’s health and rights, and when numerous presidential candidates are making vilification of reproductive and sexual health care a centerpiece of their campaigns, this is but one victory in a long and ongoing war on women’s lives.

“The battle over this issue is a warning about what is to come,” said O’Brien, “especially as the bishops are playing the victim card in their pleas for special treatment and their false assertions about alleged attacks on religious freedom. The president and Congress will need to get real about what is going on, and remember that this coming November the electorate will not be listening to the bishops, so neither should they.”

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Law and Policy

Federal Judge Guts Florida GOP’s Omnibus Anti-Choice Law

Teddy Wilson

"For many people, Planned Parenthood is the only place they can turn to,” said Barbara Zdravecky, president and CEO of the Planned Parenthood of Southwest and Central Florida. “We may be the only place they can go in their community, or the only place that offers the screening or birth control method they need. No one should have their basic health care taken away."

A federal judge on Thursday permanently blocked two provisions of a Florida omnibus anti-choice law that banned Planned Parenthood from receiving state funds and required annual inspections of all clinics that provide abortion services, reported the Associated Press.

U.S. District Judge Robert Hinkle issued an order in June to delay implementation of the law.

“The Supreme Court has repeatedly said that a government cannot prohibit indirectly—by withholding otherwise-available public funds—conduct that the government could not constitutionally prohibit directly,” Hinkle wrote in the 25-page ruling.  

Thursday’s decision came after Republican Gov. Rick Scott’s administration decided not to pursue further legal action to defend the law, and filed a joint motion to end the litigation.

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Hinkle issued a three page decision making the injunction permanent.

HB 1411, sponsored by Rep. Colleen Burton (R-Lakeland), was passed by the Republican-controlled state legislature in March.

The judge’s ruling nixed provisions in the law that banned state funding of abortion care and required yearly clinic inspections. Other provisions of the law that remain in effect include additional reporting requirements for abortion providers, redefining “third trimester,” and revising the care of fetal remains.

The GOP-backed anti-choice law has already had a damaging effect in Palm Beach County, where Planned Parenthood was forced to end a program that focused on teen dropout prevention.

Barbara Zdravecky, president and CEO of the Planned Parenthood of Southwest and Central Florida, said in a statement that the ruling was a “victory for thousands of Floridians” who rely on the organization for reproductive health care.

“For many people, Planned Parenthood is the only place they can turn to,” Zdravecky said. “We may be the only place they can go in their community, or the only place that offers the screening or birth control method they need. No one should have their basic health care taken away.”

A spokesperson for Scott told Reuters that the administration is “reviewing” the decision.

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