Commentary Contraception

One Down and 23 to Go: Judge Tosses Baseless Challenge to Birth Control Coverage

ACLU

Real religious freedom gives everyone the right to make personal decisions – including whether and when to use birth control – based on our own beliefs. It doesn't give one group the right to impose its beliefs on others by denying employees access to critical health services.

By Sarah Lipton-Lubet, ACLU Washington Legislative Office & Brigitte Amiri, ACLU Reproductive Freedom Project

Tuesday, a Nebraska federal court rejected a lawsuit challenging the Obama administration’s rule requiring insurance plans to cover contraception. This was the first of two dozen challenges to be decided. We applaud the court’s decision and hope that the judges in the other cases follow the Nebraska federal judge’s lead.

As we’ve explained before, these lawsuits don’t have much of a leg to stand on: Insurance covers a broad range of benefits, some of which any given individual will never use. The rule simply requires that employers and insurers treat coverage for contraception the same as other preventive medical care. It’s up to the employee – as it should be – to decide whether to access that coverage in her private life. 

The Nebraska lawsuit was always especially out there. Or, as the court put it,“based on layers of conjecture.” Basically, a few attorneys general – from Nebraska, Texas, Michigan, South Carolina, Florida, Ohio, and Oklahoma – tried to elbow their way to the table. They spun an elaborate story alleging that employers in their states would drop all health care coverage if these rules go into effect (although we know that in the 28 states with contraceptive equity rules, no such thing has happened), forcing droves of new citizens on to the Medicaid rolls, thereby burdening the state government. The court properly rejected this ridiculous argument as “conjecture,” and because individuals with jobs generally don’t financially qualify for Medicaid.  

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You might be asking yourself, “when did these states became so concerned about their uninsured citizens – didn’t most of these states try to take down health care reform?” Yes, ironically they did. Furthermore, three of these states – Texas, South Carolina, and Florida – are also refusing to participate in the Affordable Care Act’s Medicaid expansion, which would allow the federal government to pay the full cost of insuring their states’ uninsured. So much for consistency. 

The court also ruled that the attorneys general did not have the right to raise religious liberty claims – those are individual, not state, rights. Indeed, it seemed odd that the attorneys general could side with a few entities that objected to providing contraception coverage, and throw all of the women in their state under the bus. But these baseless lawsuits were never about religious liberty anyway. They are part of a long series of attacks on birth control by those who want to roll back women’s rights.

Real religious freedom gives everyone the right to make personal decisions – including whether and when to use birth control – based on our own beliefs. It doesn’t give one group the right to impose its beliefs on others by denying employees access to critical health services. The courts in these cases should continue to affirm that basic principal.

News Family Planning

Lawsuit Challenges Arizona’s Attempt to Defund Planned Parenthood

Nicole Knight Shine

The Republican-backed law specifically targets abortion providers, excluding any facility from Medicaid that fails "to segregate taxpayer dollars from abortions, including the use of taxpayer dollars for any overhead expenses attributable to abortions.”

Planned Parenthood and the American Civil Liberties Union (ACLU) asked a federal court to block an Arizona law defunding Planned Parenthood, arguing in a legal challenge filed Thursday that the Arizona measure is “illegal.”

The GOP-backed law, signed by Republican Gov. Doug Ducey in May, specifically targets abortion providers, excluding any facility from Medicaid that fails “to segregate taxpayer dollars from abortions, including the use of taxpayer dollars for any overhead expenses attributable to abortions.”

Federal law already bars health-care providers from using Medicaid dollars for abortion care, except in cases of rape, incest, or life endangerment.

In an 18-page complaint, the plaintiffs argue that the restriction is impermissible under Medicaid statutes, and they ask for an injunction on the law, which goes into effect August 6. Planned Parenthood said in an emailed statement that the law could slash funding for birth control, cancer screenings, and preventive care, affecting more than 2,500 Medicaid patients in the state.

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The Arizona Health Care Cost Containment System, the state Medicaid agency, did not respond to a request for comment.

Jennifer Lee, staff attorney at the ACLU, called the Arizona law “another attempt to intimidate doctors who provide abortion and to punish low-income women in particular,” in a statement announcing the lawsuit. Planned Parenthood operates 11 medical centers in the state, including three in underserved and impoverished communities with high rates of infant mortality, according to the court filing.

At least ten states, including Arizona, have attempted to strip Planned Parenthood of funding—the fallout from a string of deceptive smear videos masterminded by David Daleiden, the head of the anti-choice front group the Center for Medical Progress, who now faces a felony record-tampering charge.

“This case is about the people who rely on us for basic care every day,” said Cecile Richards, president of Planned Parenthood Federation of America, in an announcement of the Arizona suit. “We’ll continue fighting in Arizona, and anywhere else there are efforts to block our patients from the care they need.”

The Arizona law represents the state’s second attempt to defund Planned Parenthood. In 2014, the Ninth Circuit Court of Appeals affirmed a lower court decision finding a similar defunding measure, HB 2800, violated federal Medicaid law.

In April, the federal Centers for Medicare & Medicaid Services sent a letter to all 50 states saying that cutting funding to qualified providers solely because they provide abortion care violates federal law.

Independent analysis suggests gutting Planned Parenthood funding exacts a toll on health care.

2015 report from the Congressional Budget Office indicated that health-care access would suffer under Planned Parenthood funding cuts, with the potential for $650 million in additional Medicaid spending over a decade and thousands of more births.

In Texas, births surged 27 percent among low-income women who were using injectable birth control but lost access to the service when the state cut Medicaid funding to Planned Parenthood, according to a study published in the New England Journal of Medicine.

News Human Rights

Lawsuit: Religious Groups Are Denying Abortion Care to Teen Refugees

Nicole Knight Shine

The suit accuses the federal government of paying millions to religious grantees that refuse to provide unaccompanied minors with legally required reproductive health services.

Two years ago, 17-year-old Rosa was raped as she fled north from her home country in Central America to the United States. Placed in a Catholic shelter in Florida, the teen learned she was pregnant, and told shelter officials that if she couldn’t end the pregnancy, she’d kill herself. She was hospitalized for suicidal thoughts. Upon her release, the facility in which she’d been originally placed rejected her because of her desire for an abortion, according to a federal lawsuit filed Friday. So did another. Both, reads the lawsuit, were federal contractors paid to care for unaccompanied minors like Rosa.

Rosa’s story is one in a series sketched out in a 16-page complaint brought by the American Civil Liberties Union (ACLU) against the U.S. Department of Health and Human Services (HHS). The suit accuses the federal government of paying millions to religious grantees—including nearly $20 million over two years to the U.S. Conference of Catholic Bishops (USCCB)—that refuse to provide unaccompanied minors with legally required reproductive health services, including contraception and abortion. The grantees are paid by the federal Office of Refugee Resettlement (ORR) to house and care for young refugees.

The lawsuit, brought in U.S. District Court in San Francisco, amounts to a fresh test of the degree to which Catholic organizations and other faith-based groups can claim exemptions from federal laws and regulations on religious grounds.

“Religious liberties do not include the ability to impose your beliefs on a vulnerable population and deny them legal health care,” said Jennifer Chou, attorney with the ACLU of Northern California, in a phone interview with Rewire. “The government is delegating responsibility … to these religiously affiliated organizations who are then not acting in the best interest of these young people.”

Mark Weber, a spokesperson for the HHS, which includes the ORR, told Rewire via email that the agency cannot comment on pending litigation.

Escaping turmoil and abuse in their home countries, young refugees—predominantly from Central America—are fleeing to the United States, with 33,726 arriving in 2015, down from 57,496 the year before. About one-third are girls. As many as eight in ten girls and women who cross the border are sexually assaulted; it is unknown how many arrive in need of abortion care.

The federal ORR places unaccompanied minors with organizations that are paid to offer temporary shelter and a range of services, including reproductive health care, while the youths’ applications for asylum are pending. But documents the ACLU obtained indicate that some groups are withholding that health care on religious grounds and rejecting youths who request abortion care.

The 1997 “Flores agreement” and ORR’s contracts with grantees, which the ACLU cites in its lawsuit, require referrals to “medical care providers who offer pregnant [unaccompanied immigrant minors] the opportunity to be provided information and counseling regarding prenatal care and delivery; infant care, foster care, or adoption; and pregnancy termination.”

In 2016, the federal government awarded 56 grants to 30 organizations to provide care to unaccompanied minors, including 11 that the ACLU claims impose religious restrictions on reproductive health care.

In one case, ORR officials struggled to find accommodations for 14-year-old Maria, who wanted to end her pregnancy, according to the complaint. An ORR official wrote, according to a document the ACLU obtained, that the agency would have liked to transfer Maria to Florida to be near family, but “both of the shelters in Florida are faith-based and will not take the child to have this procedure,” meaning an abortion.

In another, the complaint reads, 16-year-old Zoe was placed with Youth for Tomorrow, a faith-based shelter in Virginia, where she learned she was pregnant. She asked for abortion counseling, which was delayed nearly two weeks, the complaint says. Learning of her decision to end the pregnancy, Youth for Tomorrow asked to transfer Zoe elsewhere because of its abortion prohibition, even though Zoe said she was happy at the shelter.

For vulnerable youths, such transfers represent a form of “secondary trauma,” according to the ACLU’s Chou.

“These women have already endured so much,” she told Rewire. “The process of transferring these youths from shelter to shelter tears them away from their only existing support system in the U.S.”

Federal officials, according to the complaint, were aware that the religious grantees would withhold abortion referrals. In one case, the Archdiocese of Galveston-Houston was awarded more than $8 million between 2013 and 2016, although it stated in its grant application that rape survivors wouldn’t be offered abortion care, but instead permitted to “process the trauma of the rape while also exploring the decision of whether to keep the baby or plan an adoption.”

The lawsuit also claims that a contract with the U.S. Conference of Catholic Bishops included language requiring unaccompanied minors who were pregnant to be given information and counseling about pregnancy termination, but the ORR removed that language after the USCCB complained.

The USCCB did not respond to Rewire‘s request for comment. But in a letter last year to the ORR, the USCCB and five religious groups, including some ORR grantees, wrote they could not facilitate health-care services for unaccompanied minors that run contrary to their beliefs.

The lawsuit is the second the ACLU has filed recently against the federal government over religious privileges.

Last month, the ACLU filed a Freedom of Information Act suit demanding that the federal Centers for Medicare & Medicaid Services release complaints against federally funded Catholic hospitals, where patients have reported being denied emergency medical care in violation of federal law.

In 2009, the ACLU also sued the federal government for allowing USCCB to impose religious restrictions on a taxpayer-funded reproductive health program for trafficking survivors. In 2012, a district court ruled in the ACLU’s favor, and the government appealed. The First Circuit Court of Appeal later dismissed the case as “moot” because the government did not renew USCCB’s contract.