On November 2, the House Energy and Commerce Subcommittee on Health held a hearing, “Do New Health Law Mandates Threaten Conscience Rights and Access to Care?”
Chair Joe Pitts (R-PA) said, “On August 3, 2011, the Department of Health and Human Services [HHS] issued an interim final rule that would require nearly all private health plans to cover contraception and sterilization as part of their preventive services for women. While the rule does include a religious exemption, many entities feel that it is inadequate and violates their conscience rights by forcing them to provide coverage for services for which they have a moral or ethical objection. The religious employer exemption allowed under the preventive services rule – at the discretion of the HRSA [Health Resources and Services Administration] – is very narrow. And the definition offers no conscience protection to individuals, schools, hospitals, or charities that hire or serve people of all faiths in their communities. It is ironic that the proponents of the health care law talked about the need to expand access to services, but the administration issues rules that could force providers to stop seeing patients because to do so could violate the core tenants of their religion.”
Full committee Ranking Member Henry Waxman (D-CA)countered, “[T]his is not a hearing about abortion. This is not a hearing about whether people can adhere to their religious beliefs, follow their own individual consciences. This is a hearing about whether the Republicans can have the government intrude to the point where people who buy health insurance can be denied insurance coverage for the preventive service of family planning. Preventing conception is what family planning is all about, and it is a legitimate medical service. In fact, the Institute of Medicine (IOM) made recommendations to the Department [of Health and Human Services] for what would be covered under preventive services, and they recommended that this be a covered preventive service. So the question is, if somebody does [not] want to provide contraception, because it violates their religion or their conscience, would they be required to? Absolutely not. The question, then, comes down to what is the scope of the exception that church-provided insurance need not cover family planning?”
David Stevens, MD, MA, chief executive officer of the Christian Medical Association, said “The HHS interim final regulations would force insurance plans nationwide to cover ‘all Food and Drug Administration [FDA] approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.’ The contraception mandate does not exempt controversial drugs such as Ella and the ‘morning-after pill,’ which according to the FDA have post-fertilization effects that ‘may inhibit implantation’ of a living human embryo. That is an issue of weighty moral concern for many pro-life and faith-based health care professionals, individuals, and groups. The potential ‘religious exemption’ in the contraception mandate – exempting only a nano-sector of ‘religious employers’ from the guidelines – is meaningless to conscientiously objecting health care professionals, insurers and patients. The HHS rule implementing provisions of the Patient Protection and Affordable Care Act [P.L. 111-148] fits a pattern of this administration’s extremely narrow and limiting view of conscience rights. The HHS rule has the potential to negatively impact patients and health care professionals in the following ways: The contraception mandate can potentially trigger a decrease in access to health care by patients in medically underserved regions and populations…The contraception mandate further contributes to an increasingly hostile environment in which medical students, residents, and graduate physicians face discrimination, job loss, and ostracism for holding pro-life views on abortion, controversial contraceptives, and other ethical issues…The contraception mandate creates a climate of coercion that can prompt pro-life health care professionals to limit the scope of their medical practice and can discourage pro-life medical students and residents from choosing careers in family medicine, obstetrics and gynecology, and other specialties likely to involve conflicts of conscience…The contraception mandate can potentially cause a decrease in the provision of health insurance for employees of pro-life health care employers who want to avoid conflicts of conscience regarding the subsidy and implied endorsement of controversial contraceptives…The contraceptive mandate rule sweepingly tramples conscience rights, which have not only provided a foundation for American civil liberties but also a foundation for the ethical and professional practice of medicine.”
Jon O’Brien, president of Catholics for Choice, said, “The Affordable Care Act [P.L. 111-148] has many positive elements to it. Millions will now be able to access insurance coverage for their health needs and, with the basic level of coverage required under the new law, these newly insured and the millions of those better insured will now have greater access to a wider range of services than ever before. However, the law includes a refusal clause which has been expanded in the past decades to threaten the consciences of both those who seek to receive and those who want to provide services. Advocates of these expansive refusal clauses claim these are necessary to protect conscience rights. Others believe that refusal clauses such as these are simply part of attempts to derail the Affordable Care Act and to curb access to reproductive health care services entirely. Moreover, proposals to expand existing refusal clauses increase threats to the conscience rights of patients and providers by including not just abortion but also family planning services and, should some get their way, any other service deemed ‘unacceptable’ by a tiny minority. In recent years, under the guise of protecting religious freedom and ‘conscience rights’ we have seen a dramatic upswing in attempts to expand the scope of refusal clauses, their application, and the entities able to utilize them. These new, ever-broader refusal clauses do far more than allow those health care professionals or social service providers with conscience objections to opt out. Instead, they are effectively being used as a means to refuse some treatments, medications, benefits, and services to all comers. These expansions have increased not only the services that may be refused – including reproductive health services as well as insurance coverage for those services and even training for medical professionals – but they have also the number of those who may claim these protections.” Mr. O’Brien added, “Almost everyone, including most Catholics, agrees that it is reasonable to allow health care professionals, including doctors, nurses and pharmacists, to opt out of providing essential reproductive health care services and medications to which they conscientiously object…Except in emergency situations, it is reasonable and indeed prudent to allow those who are opposed to abortion to opt out of providing the service. In these situations, women seeking these services should not have to worry about the religious and moral beliefs of their health care providers interfering with the provision of the best possible care.”
William Cox, president and chief executive officer of The Alliance of Catholic Health Care; Jane Belford, chancellor of the Roman Catholic Archdiocese of Washington; and Mark Hathaway, MD, MPH, director of Obstetrics and Gynecology Outreach Services for Women’s and Infants’ Services at the Washington Hospital Center, also testified.