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Irish Law, “Conscience Clauses,” and Needless Death: Three Questions About Savita Halappanavar’s Death

1:36 pm in Uncategorized by RH Reality Check

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See all our coverage of the tragic case of Savita Halappanavar here.

An Irish flag hangs against a blue sky

Could the tragic death of an Irish woman happen in the United States?

Last night, we reported on the unnecessary and tragic death of Savita Halappanavar, who entered an Irish hospital undergoing what turned out to be a miscarriage of a wanted pregnancy at 17 weeks, and was denied a life-saving abortion because, as she and her husband were told, Ireland is “a Catholic country.” Translation? Even a non-viable fetus, perhaps already dead but in any case absolutely certain not to survive, is more important than a woman’s life.

Numerous questions have arisen in the wake of this case.

One: Why did this happen? Doesn’t Ireland, a country with otherwise draconian abortion laws, allow abortion to save the life of the mother?

Two: Was there any doubt an abortion was necessary to save Savita’s life?

Three: Can this happen in the United States?

I’ll take these in turn.

The reason this happened is at once very simple and highly complex. It starts with Irish abortion law, and ends with the imposition of a misogynistic ideology on a woman literally begging for mercy from pain and for her own life as she pleaded with her doctors numerous times to perform an abortion on a fetus it was clear would not live.

Current Irish law on abortion is somewhat murky. The country’s laws, like those of most others, have shifted dramatically over the past two centuries, until in the mid-fifties abortion was made illegal in virtually all circumstances. The legal landscape changed again over 20 years ago when the Irish Supreme Court decided that women had a constitutional right to an abortion where there was “real and substantial risk” to the life of the mother. The Supreme Court decision came in response to the case of “X,” who, as a February 2012 article in the New York Times pointed out, was a 14-year-old girl prevented from leaving the country to have an abortion after she became pregnant from rape. After that decision, according to a Human Rights Watch (HRW) report:

 abortion [in Ireland remained] legally restricted in almost all circumstances, with potential penalties of penal servitude for life for both patients and service providers, except where the pregnant woman’s life is in danger.

In its 1992 decision, the Irish Supreme Court also required the government to clarify the conditions under which a legal abortion might take place.

Nonetheless, as we reported in December 2011, Human Rights Watch found that 20 years later:

Read the rest of this entry →

We Are All Savita Halappanavar: Catholic Hospital in Ireland Denies Woman Life-Saving Abortion

3:27 pm in Uncategorized by RH Reality Check

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See our further analysis of this case.

Galway University Hospital, the scene of the crime.

Last month, a woman was admitted to a hospital in Galway, Ireland. She was 17 weeks pregnant with a wanted child. She was experiencing severe back pain. She was found to be miscarrying the pregnancy.

Within days, she was dead.

Why? Because she ended up in a Catholic hospital, governed by an ethic that even a non-viable fetus doomed to die is more important than a living, breathing 31-year-old woman.

It really is that simple.

IrishTimes.com reports that Savita Halappanavar, a dentist, arrived at the hospital on October 21st. According to the story:

Her husband, Praveen Halappanavar (34), an engineer at Boston Scientific in Galway, says she asked several times over a three-day period that the pregnancy be terminated. He says that, having been told she was miscarrying, and after one day in severe pain, Ms Halappanavar asked for a medical termination.

This was refused, he says, because the fetal heartbeat was still present and they were told, “this is a Catholic country.”

Indeed.

So, the story continues, “She spent a further 2½ days “in agony” until the fetal heartbeat stopped.

According to IrishTimes.com, Mr Halappanavar, speaking from Belgaum in the state of Karnataka, India, said an internal examination was performed when she first presented.

Read the rest of this entry →

Health, Freedom, and the Birth Control Mandate: The Testimony Chairman Issa Didn’t Want You to Hear

6:39 am in Uncategorized by RH Reality Check

Written by Sandra Fluke for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

This testimony was prepared by the author appearing at the February 16th hearing of the House Committee on Oversight and Government Reform Hearing on Contraceptive Coverage. However, the Committee Chair, Congressman Darrell Issa (R-CA) did not allow her to speak.  Instead a panel composed of male panel, and one anti-choice female participant

For all our coverage of the 2012 Contraceptive Mandate, click here.

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Members of Congress, good morning, and thank you for allowing me to testify. My name is Sandra Fluke, and I’m a third-year student at Georgetown Law, a Jesuit school. I’m also a past president of Georgetown Law Students for Reproductive Justice or LSRJ. I’d like to acknowledge my fellow LSRJ members and allies and thank them for being here today.

Georgetown LSRJ is here today because we’re so grateful that this regulation implements the nonpartisan, medical advice of the Institutes of Medicine. I attend a Jesuit law school that does not provide contraception coverage in student health plans. Just as we students have faced financial, emotional, and medical burdens as a result, employees at religiously-affiliated hospitals and universities across the country have suffered similar burdens. We are all grateful for the new regulation that will meet the critical health care needs of so many women. Simultaneously, the recently announced adjustment addresses any potential conflict with the religious identity of Catholic and Jesuit institutions.

As I have watched national media coverage of this debate, it has been heartbreaking, frankly, to see women’s health treated as a political football. When I turn off the TV and look around my campus, I instead see the faces of the women affected, and I have heard more and more of their stories. You see, Georgetown does not cover contraceptives in its student insurance, although it does cover contraceptives for faculty and staff. On a daily basis, I hear from yet another woman who has suffered financial, emotional, and medical burdens because of this lack of contraceptive coverage. And so, I am here to share their voices and ask that you hear them. Read the rest of this entry →

The Cost of Contraception in Insurance Plans: What the Data Say

11:08 am in Uncategorized by RH Reality Check

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

In 2011, the Department of Health and Human Services examined the issue of just how much it costs insurance companies to cover contraception. Based on data from a wide range of peer-reviewed medical and public health data, evidence-based research and actuarial studies as well as prior experience with insurance policies in which contraception is covered without a co-pay, the HHS analysis found that it costs more not to provide contraception than it does to provide it.  HHS concluded:

While the costs of contraceptives for individual women can be substantial and can influence choice of contraceptive methods, available data indicate that providing contraceptive coverage as part of a health insurance benefit does not add to the cost of providing insurance coverage.

HHS guidelines for including contraceptive care and supplies as part of the essential package of primary health care for women were based on this analysis as well as on recommendations to HHS from the Institute of Medicine, which conducted an extensive study, relying on independent physicians, nurses, scientists, and other experts as well as evidence-based research to draw conclusions and formulate its recommendations.

Here, in brief, is what the cost analysis said.

The Evidence

“Evidence from well-documented prior expansions of contraceptive coverage,” states the HHS issue brief, “indicates that the cost to issuers of including coverage for all FDA-approved contraceptive methods in insurance offered to an employed population is zero.”

In 1999, when Congress required the health plans in the Federal Employees Health Benefits (FEHB) program to cover the full range of FDA-approved contraceptive methods, premiums for 1999 had already been set when the legislation passed. The Office of Personnel Management (OPM), which administers the FEHB program, provided for a reconciliation process for insurers who found this requirement burdensome. But, HHS notes:

[T]here was no need to adjust premium levels because there was no cost increase as a result of providing coverage of contraceptive services.

In other words, no insurance company complained because they found it was to their advantage to provide the service.

This is critical because it is perhaps the best model for the nation in terms of what to expect. The FEHB program is the largest employer-sponsored health benefits program in the United States, and at the time, notes HHS, “it covered approximately 9 million Federal Employees, retirees and their family members and included approximately 300 health plans.”

Likewise a review of a similar mandate in Hawaii found no increase in insurance costs.  In 1999, Hawaii prohibited employer group health plans from excluding contraceptive services or supplies from coverage, requiring them to include FDA-approved contraceptive drugs or devices to prevent unintended pregnancy.

A report on this experience by the Insurance Commissioner of Hawaii concludes that the mandate did not appear to increase insurance costs in any of the four surveyed health plans in Hawaii servicing employer groups.

What do reviews of actuarial data show?

The direct costs of providing contraception as part of a health insurance plan are very low and do not add more than approximately 0.5 percent to the premium costs per adult enrollee, as per studies from three actuarial firms–Buck Consultants, PriceWaterhouseCoopers (PwC), and the Actuarial Research Corporation (ARC)–which estimated the direct costs of providing contraception coverage. 

More recent analysis of actuarial data conducted in July 2011 by the Actuarial Research Corporation and using data from 2010 estimated that contraceptive coverage without a co-pay costs roughly $26 per year per enrolled female.

However, notes HHS, “as indicated by the empirical evidence described above, these direct estimated costs overstate the total premium cost of providing contraceptive coverage.”

When medical costs associated with unintended pregnancies are taken into account, including costs of prenatal care, pregnancy complications, and deliveries, the net effect on premiums is close to zero. One study author concluded, “The message is simple: regardless of payment mechanism or contraceptive method, contraception saves money.

Counting indirect costs–such as time away from work and productivity losses–further reduces the total cost to an employer. 

A model developed by Global Health Outcomes that incorporates costs of contraception, costs of unintended pregnancy, and indirect costs found that covering contraception saves employers $97 per year per employee. Similarly, the PwC actuaries state that after all effects are taken into account, providing contraceptive services is “cost-saving.”

Does providing contraception through public programs also save costs?

Yes.

As HHS notes:

Each year, public funding for family planning prevents about 1.94 million unintended pregnancies, including almost 400,000 teen pregnancies.  Preventing these pregnancies results in 860,000 fewer unintended births, 810,000 fewer abortions and 270,000 fewer miscarriages.  More than nine in 10 women receiving publicly-funded family planning services would be eligible for Medicaid-funded prenatal, delivery, and postpartum care services upon pregnancy.  Avoiding the significant costs associated with these unintended births saves taxpayers $4 for every $1 spent on family planning.

Evidence that expanding access to contraception through Medicaid is unequivocal: Increased access saves taxpayer money.

During the 1990s, HHS states:

…many states implemented Medicaid Section 1115 Family Planning Demonstrations.  An independent evaluation of the experience of six of these states found that all six Demonstrations yielded savings, with annual state savings ranging between $1.3 million in New Mexico and nearly $30 million in Arkansas.

As of August 1, 2010, 27 states, including States like Pennsylvania, Texas, Florida, and Virginia had expanded Medicaid eligibility for family planning services under waivers that stipulated that these expansions be budget neutral.  Based on this experience, the Congressional Budget Office has estimated that expanding family planning to all States would save $400 million over 10 years.

Why would insurance companies provide contraception without a co-pay to their female employees?  The answers are clear.

 

Why I Skipped Mass Today: A Practicing Catholic Objects to the Bishops’ Arguments Over Birth Control

10:47 am in Uncategorized by RH Reality Check

(image: ee382, photobucket)

(image: ee382, photobucket)

Written by Anonymous for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Reproductive health politics are controversial enough, but they are even more so for a family of practicing Catholics. My spouse begged me not to put my name on this, concerned about our son, who is scheduled to receive First Holy Communion in a few months. Certainly, neither of us want him to be hassled, or to have his standing jeopardized because of his parents’ dissent toward an increasingly politicized Church. So please excuse the anonymity of this editorial.

There is a really cool website called Bible Gateway that serves as a Google-style search engine for the Christian Bible. Any visitor can search for key words in 46 languages, and the English options includes 31 different versions representing a wide variety of religious traditions, from the 21st Century King James Version to Young’s Literal Translation. What kind of words can you look up? Anything, really. As a Catholic, my Bible Gateway is set to the New American Standard Bible, the same that is listed on the Vatican’s website. It’s interesting to note that, excluding articles, conjunctions, prepositions and other small words, the most common word in the Bible is Lord (6,726 times) and God is second (4,188 times). I have to admit that I was surprised that Jesus comes up only 990 times, but I am sure it’s a contextual thing.

The word love will get you 484 hits, and the results will direct you to excerpts from Genesis to Revelation. Some are passages you might expect to find, such as Jesus’ repeated instruction to “LOVE your neighbor as yourself” and there are some surprises, such as the rather chilling, “Outside are the dogs and the sorcerers and the immoral persons and the murderers and the idolaters, and everyone who LOVES and practices lying.” (Revelations 22:15). Yikes! Read the rest of this entry →

Kansas in 2012? A Prediction of More Legal Battles, Higher Tax Bills, and Declining Access to Services

1:43 pm in Uncategorized by RH Reality Check

Photobucket

Written by Kari Ann Rinker for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

I work for Kansas NOW.  Our mission encompasses a broad expanse of issues linked to equality and justice.  In Kansas, equality of opportunity and social supports are currently being eliminated through a multitude of administrative and legislative maneuverings and measures via the leadership of Governor Brownback.  The vast array and sheer volume of the changes that are being attempted and implemented in this state could make it difficult to prioritize where time, energy and resources of a small nonprofit should be spent.

However, as my organization looks ahead to 2012, we don’t need a crystal ball to tell us where a great deal of our time, energy and resources will be spent.  My organization stands in support of women’s reproductive rights, which means much of our prioritizing will be done for us.  The 2012 Kansas Legislature will be introducing another slew of abortion restrictions.

These may include expansion of the already existing religious “conscience clause”.  Like the failed Personhood Ballot measure in Mississippi (which was voted down) an expansion to the Kansas Right of Conscience could reach far beyond the medical procedure of abortion.  Such legislation could affect access to many common medications and medical procedures.  The medications range from oral contraception and IUD’s to Viagra and procedures such as vasectomies, surrogate motherhood and in vitro fertilization.  It could also be interpreted to deny lifesaving abortions, which is currently part of Federal Medicaid requirements.  This opens up possibilities for further litigation at taxpayer expense.

We also expect the pursuit of “tax code legislation” aimed at nonprofit organizations that advocate for or even present abortion as an option.  We believe it will be similar to what has recently been blocked in an Arizona court.

As I mentioned, a piece of our organizational mission is advancing reproductive freedom.  These days, it’s not so much advancing, as it is defending.  Right now, we are defending something that barely exists within our state.  There are no abortion clinics in Wichita and just three in the Kansas City area.  Kansas is a state of 82,282 square miles.  Why is the Kansas legislature focused upon three small medical clinics within these 82,282 miles?  Why will legislative time, energy and resources be spent on this during difficult economic times?

Last session, six different reproductive health restrictions were introduced, including the de-funding of Planned Parenthood of Kansas and Mid-Missouri’s family planning services.  Five of the measures passed and three of the five are currently in the midst of litigation.  It is estimated that current court proceedings have cost Kansas taxpayers $476,000.  This should be considered just the tip of the monetary iceberg.   In these cases, witnesses have not yet been deposed, motions are being filed, the system is in motion and court cases take time.

In 2012, abortion legislation will continue to be sponsored by legislators. Committees will hear these bills and votes will be cast.  The large anti-choice majority will act as a rubber stamp for this entire process.  These unconstitutional bills will be presented to Governor Brownback and he will sign them.  In doing so, he will also be signing his name on the check to the lawyers that will be needed to defend these laws in court.

Our history with former Kansas Attorney General Phill Kline shows us the longevity in these abortion wars.  He is still costing Kansas taxpayers money a decade later.  As of April, taxpayers had spent $400,000 for his defense surrounding his alleged misconduct in his pursuit of abortion doctors in Kansas.  Not to mention the $350,000 settlement paid to settle a sex discrimination suit, but that’s another matter.

How much the citizens of Kansas are willing to shell out remains to be seen.  The extent of their support for ideological candidates has had its limits in the past.  While I remain ever-hopeful that sanity will eventually prevail within the state, I’m just not quite sure how much damage will be done before Kansans demand a change of course.  Until then, our elected oppressors will no doubt continue to spend state time, energy and resources toward the never-ending pursuit of being the first state in the union to eliminate abortion through the eradication of access.  Meanwhile, during the course of this process, they are ensuring that the taxpayers of Kansas will be saddled with a substantial ideological debt.

Contraception: Expand Access, Not Exemptions

10:55 am in Uncategorized by RH Reality Check

Open Access - Don't Limit It! (Image: wakingtiger, flickr)

Open Access - Don't Limit It! (Image: wakingtiger, flickr)

Written by Jessica Arons for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

This article is cross-posted with permission from ThinkProgress Health.

As the Obama Administration debates whether to expand an exemption to a new health insurance requirement to cover all FDA-approved methods of contraception, there are some important facts to keep in mind:

– The average woman spends five years pregnant, postpartum, or trying to get pregnant, and at least 30 years trying to avoid pregnancy.

More than 99 percent of women of reproductive age who have had sexual intercourse have used at least one method of family planning.

– Contraception is the most commonly prescribed medication for women ages 18 to 44

Eighty-eight percent of voters support access to birth control

– Approximately three-quarters of Americans agree that insurance should cover contraception

Fifty-eight percent of pill users rely on oral contraception at least in part for non-contraceptive reasons

Eighteen percent of women on the pill reported inconsistent use, such as skipping doses, as a cost-cutting measure

Under the Affordable Care Act, or the ACA, women will benefit from greatly expanded access to contraception—which has been shown to improve health. But this important consumer protection is at risk of being undermined by an unreasonably expansive religious exemption. Read the rest of this entry →

Do New Health Law Mandates Threaten Conscience Rights and Access to Care?

1:31 pm in Uncategorized by RH Reality Check

Written by Jon O’Brien for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

This testimony was submitted to the US House of Representatives Committee on Energy and Commerce’s Subcommittee on Health on November 2, 2011. It is written testimony for the hearing record on “Do New Health Law Mandates Threaten Conscience Rights and Access to Care?”

The article was amended at 12:38 p.m., Thursday, November 3rd to correct links in one paragraph.

Mr. Chairman, Ranking Member Pallone and Members of the Subcommittee, thank you for this opportunity to present testimony on behalf of Catholics for Choice on this important question of conscience rights and access to comprehensive healthcare.

For nearly 40 years, Catholics for Choice has served as a voice for Catholics who believe that the Catholic tradition supports a woman’s moral and legal right to follow her conscience on matters of sexuality and reproductive health. Throughout the world, we strive to be an expression of Catholicism as it is lived by ordinary people. We are part of the great majority of the faithful in the Catholic church who disagrees with the dictates of the Vatican on matters related to sex, marriage, family life and motherhood. We represent those who believe that Catholic teachings on conscience mean that every individual must follow his or her own conscience — and respect others’ right to do the same.

Certainly, at Catholics for Choice, we are no strangers to the intersection of religion, sex and politics. While religious voices and traditions are a vital part of public discourse, religious views should not be given disproportionate weight in public policy discussions. When this happens the lives of men and women can suffer greatly. We believe in a world where all voices, the voices of the religious and of the secular, of Catholics and non-Catholics alike, are heard in public policy discussions.

This hearing seeks to answer the question: Do new health law mandates threaten conscience rights and access to care? I firmly believe the requirements under the Affordable Care Act, and the slate of regulations being created to implement it, infringe on no one’s conscience, demand no one change her or his religious beliefs, discriminate against no man or woman, put no additional economic burden on the poor, interfere with no one’s medical decisions, compromise no one’s health — that is, if you consider the law without refusal clauses. When the question is asked in light of these unbalanced and ever-expanding clauses, the answer becomes yes, it would do all these things. When burdened by such refusal clauses, the new health law absolutely threatens the conscience rights of every patient seeking care for these restricted services and of every provider who wishes to provide comprehensive care to their patients. These restrictions go far beyond their intent of protecting conscience rights for all by eliminating access to essential healthcare for many, if not most patients, especially in the area of reproductive healthcare services. This will make it harder for many working Americans to get the healthcare they need at a cost they can afford.

The Affordable Care Act 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 healthcare 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 healthcare 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. Almost everyone, including most Catholics, agrees that it is reasonable to allow healthcare professionals, including doctors, nurses and pharmacists, to opt out of providing essential reproductive healthcare services and medications to which they conscientiously object. There is no doubt that there are times when the conscience of an individual doctor, nurse or pharmacist may conflict with the wishes orneeds of a patient. This often happens in cases related to abortion. 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 healthcare providers interfering with the provision of the best possible care. Therefore, it is in the best interests of all that only medical professionals committed to providing such services do so. Women need support and compassionate care when they access reproductive healthcare services, not judgment and disdain.

When this is not possible, a reasonable ethical fallback is for the institution to guarantee timely referrals to ensure that patients receive continuity of care without facing an undue burden, such as traveling long distances or encountering additional barriers to obtaining the desired services. Moreover, good practice should also compel a religious institution to make sure that the consciences of both the healthcare (or social services) provider and the patient (or client) are accommodated by having policies in place that enable individuals to receive whatever medications they are prescribed, procedures they require or services they seek.

Like many Catholics, I accept that conscience has a role to play in providing healthcare services, but recent moves to expand conscience protections beyond the simple right for individual healthcare providers to refuse to provide services to which they personally object go too far. Increasingly, demands and regulatory proposals attempt to grant that option to an institution or any individual along the spectrum of care, funding and coverage. It is incredible to suggest that a hospital or an insurance plan has a conscience. Granting institutions, or entities like these, legal protection for the rights of conscience that properly belongs to individuals is an affront to our ideals of conscience and religious freedom.

Allowing religious institutions to dictate the medical care available to their employees or religiouslyaffiliated organizations to dictate what services their beneficiaries are allowed to access would encroach on the individual consciences of those seeking care and assistance. Refusal clauses such as these fly in the face of true religious freedom by promoting the interests of certain elements of particular religions over the consciences and beliefs of individuals. They ignore the moral agency of the many who do not share the beliefs of a particular religious ideology. If allowed to stand, these refusal clauses do nothing but endanger many women’s access to the healthcare they need. When codified into law at the federal or state level, these “protections” actually constitute state-sponsored discrimination against women based on where they are employed, where and how they buy health insurance and where they seek to receive care.

Today, the 98 percent of sexually active Catholic women in the US who have used a form of contraception banned by the Vatican have exercised their religious freedom and followed their consciences in making the decision to use contraception. Thus, they are in line with the totality of Catholic teachings, if not with the views of the hierarchy. The problem is very clearly with the Catholic hierarchy and not the Catholic church, which includes the vast majority of the 68 million Catholics in the United States who use and support the availability of comprehensive reproductive healthcare services for all those who choose to utilize them.

Having failed to convince Catholics in the pews, the United States Conference of Catholic Bishops (USCCB) and other conservative Catholic organizations are now attempting to impose their personal beliefs on all people by seeking special protection for their “conscience rights.“ They claim to represent all Catholics when, in truth, theirs is the minority view. The bishops have identified several sympathetic high-profile allies in healthcare, education and social service provision to assist them in promoting their demands, but these allies are heavily reliant on the bishops for funding and prestige. Hospitals and colleges can lose their Catholic designation at the bishop’s whim, as happened recently in Phoenix, Arizona.

At a Catholic hospital in Phoenix, medical professionals acted to save the life of a pregnant woman by performing a life-saving abortion on a mother of four. The local bishop decided that his authority over the hospital allowed him to second-guess the medical decisions they made and he stripped the hospital of its Catholic designation. This is antithetical to the Catholic social justice tradition, which would not leave a woman’s life out of any healthcare equation.

What occurred in Phoenix helps to illustrate the problem with the bishops’ intrusion into medical decisions. The personal and professional freedom to make healthcare decisions is being threatened by expansive refusal clauses. The exemptions that the USCCB and other conservative Catholic organizations are demanding do not offer any more protection for religious freedom, but rather impede the religious freedom of millions of Americans, taking reproductive healthcare options away from everybody.

The USCCB and some Catholic organizations, many that receive taxpayer money, are asking to be allowed to:

  • deny condoms as part of HIV outreach;
  • ban employees and their dependents from getting the benefit of no-cost contraceptive coverage that other insured Americans enjoy;
  • opt out of providing emergency contraception to victims of sexual violence who come to Catholic hospitals for help; and
  • deny abortion care to everybody — even those women whose lives are threatened by their pregnancy.

They claim that they are representing all Catholics, but this is not true. The majority of Catholics support equal access to contraceptive services and oppose policies that impede upon that access. 

Two-thirds of Catholics (65 percent) believe that clinics and hospitals that take taxpayer money should not be allowed to refuse to provide procedures or medications based on religious beliefs. A similar number, 63 percent, also believes that health insurance, whether private or government-run, should cover contraception. A strong majority (78 percent) of Catholic women prefer that their hospital offer emergency contraception for rape victims, while more than half (55 percent) want their hospital to provide it in broader circumstances. This support for the full range of contraceptive services is unsurprising, as restrictions such as refusal clauses or prohibitive costs affect Catholics just as often as non-Catholics — 98 percent of sexually active Catholic women have used a modern method of birth control,mirroring the rate of the population at large (99 percent).

Advocating for expansive refusal clauses in healthcare delivery regulations would affect all patients — whether those patients are Catholic or not. Seeking exemptions for religious organizations to cover essential health benefits, such as full coverage of recommended preventive services including contraception, under the Affordable Care Act will only serve to endanger many women’s access to the healthcare they need — whether those employees share those religious beliefs or not. In reality, these exemptions would deny the right of everyone seeking comprehensive healthcare.

When religious voices are allowed to direct policymaking, the best interests of those seeking healthcare services can be ignored. This is clear in the case of the Catholic healthcare industry which, despite providing much valuable service, persists in refusing to provide a full range of reproductive healthcare services, even to those who are in desperate need of them.

Respect for individual conscience is at the core of Catholic teaching. Catholicism also requires deference to the conscience of others in making one’s own decisions. Our faith compels us to listen to our own consciences in matters of moral decision-making and to respect the rights of others to do the same. Our intellectual tradition emphasizes that conscience can be guided, but not forced, in any direction. This deference for the primacy of conscience extends to all men and women and to their personal decisions about moral issues.

Our faith also compels us to respect religious pluralism and religious freedom. Religious freedom is an expansive rather than restrictive idea. It has two sides: freedom of religion and freedom from religion. It is not about telling people what they can and cannot believe or practice, but rather about respecting an individual’s right to follow his or her own conscience in religious beliefs and practices, as well as in moral decision making. The protections we put in place to preserve religious freedom do not permit religious institutions or individuals to obstruct or coerce the exercise of another’s conscience.

Sweeping refusal clauses and exemptions allow a few to dictate what services many others may access. They disrespect the individual capacities of women to act upon their individual conscience-based decision. They impede the rights of women and men to make their own decisions about what is best for their own health, and that of their families, as well as restricting their right to act upon those decisions without undue and unjust burdens.

One woman who saw these burdens placed on her conscience rights is “Sandra,” a science teacher at a Catholic school in the Midwest. Her story is an example of the many Americans who fall under these types of expansive refusal clauses being pushed by the bishops and their allied organizations. What is a reality for Sandra today is what many women can look forward to in their future.

As with almost all Catholic schools, Sandra’s employers follow diocesan rules regarding employees’ insurance — meaning no contraceptive coverage, regardless of medical necessity. When she first learned of the refusal clause proposed in the recent regulation to implement the preventive health services under the Affordable Care Act, she was outraged. As she explained to us, they added “insult to injury” by ignoring the healthcare needs of women like her and allowing her employers to continue to deny her coverage.

“I just never assumed that in 2011 I would be denied birth control,” she said. “I’m in my mid-twenties. I have no intention of having kids at the moment. I like teaching kids, but it’s a whole other thing having them.”

Sandra lost coverage when she began working under the jurisdiction of her local diocese. “I went to fill my birth control prescription like I always do. I say ‘Here’s my new insurance card,’ and they say I’m not covered,” she related. “They thought that it was weird and asked where I worked. As soon as I said I worked in a Catholic school, they said, ‘Oh, 99 percent of Catholic schools will not cover it. We’ve never had it covered before.’ I had no clue.”

For Sandra, this posed a significant hardship. She had taken a salary reduction in order “to go to work every day saying that it’s what I love.” She and her husband had carefully considered their insurance plans and determined that it was more economical for them to remain on separate policies, but once she had to pay out of pocket for the birth control that was best for her, a non-generic prescription, their careful financial planning was all for naught.

“Birth control is a lot of extra money on top of the salary reduction, but the principle of it is really what gets me,” she told us. “I don’t like being told by some guy that I’ve never met that I can’t use it. The bishops are not even having sex in the first place. How are they supposed to know how to tell me what to do in that situation?”

Her story, as she recognized, is all too common and reflects the repeated marginalization of many women by the Catholic hierarchy—the same women whose voices have been deemed unimportant by those on both sides of the recent debates. Sandra is just one of the many individuals whose conscience is not being protected by refusal clauses exempting entire institutions from covering their employees for services guaranteed to everyone else by the new law.

Catholic teachings on conscience require due deference to the conscience of others in making decisions — that the employer should not be allowed to dismiss the conscience of the employee seeking coverage for the healthcare services guaranteed to any other. In light of this precept, the public policy efforts of the hierarchy should take into account the experiences of individual Catholics as well as the beliefs of patients and clients, workers in social services and healthcare providers of other faiths and no faith, so that patients will not be refused any legal and medically appropriate treatment or be denied services they seek.

You have heard from some conservative Catholics on this issue, but it would be a grave mistake to confuse the individual positions of a few powerful interest groups with the majority view of the more than 68 million Catholics in the United States. For Catholic employers to claim to be the arbiter of any person’s good conscience is clearly disingenuous. When medical professionals refuse to provide legal reproductive health services, or provide timely referrals to other providers, they violate the right to conscience of the person seeking those services. This does not fall under anybody’s definition of a good conscience. Catholics for Choice and the majority of Catholics respect everybody’s individual conscience and their ability to act in accordance with their personal beliefs. However, we expect the hierarchy and their allied organizations, in keeping with the teachings of our shared Catholic faith and our American tradition, to respect our consciences and the consciences of the patients and clients who seek the services they need. We hope that those who serve to represent all of us in public service and in government will respect our consciences, too.

Protecting the freedom of conscience for all Americans no matter what their beliefs may be — for the atheist, for the employee of a Catholic institution, for the sexual assault victim who seeks care at a Catholic hospital — is indeed the job of the government. Expanding individual refusal clauses to include institutions and exemptions for religious institutions to deny the rights of all would sacrifice these people’s rights. Public policy should be implemented to further the common good and to enable people to exercise their conscience-based healthcare decisions.

Lawmakers of all political hues can come together to support a balanced approach to individual conscience rights and access to comprehensive healthcare. It makes sense for all those who want to provide more options to women seeking to decide when and whether to have a child. It makes sense for those who want to keep the government’s involvement in healthcare to a minimum. And it makes sense for those who think that it is the government’s role to facilitate the healthcare decisions that people want to make. Above all, it makes sense for a society that believes in freedom of religion — a right one can’t claim for oneself without extending it to one’s neighbor. The bottom line is that protecting conscience rights and preserving access to care shouldn’t just be about protecting those who seek to dictate what care is and is not available to all. Nor should it be for those who would dismiss the conscience of others by imposing their view of which consciences are worth protecting.

Protecting individual conscience and ensuring access to affordable, quality care is not just an ideal, it is a basic tenet of our society and it is the right thing to do. I thank the Subcommittee for inviting me today and for your attention. I look forward to any questions Members may have.

Religious Exemptions and Contraceptive Coverage: How Far Can Denial Go and Still Be Constitutional?

9:09 am in Uncategorized by RH Reality Check

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Written by Annamarya Scaccia for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

A change was made to this article at 11:48 am, Friday September 30th to include a missing piece of the following sentence: “The points raised in the United States Conference of Catholic Bishops’ letter may be flawed at best. In its attempt to underscore the narrowness of the religious exemption, the group cites the Church Amendment to the “Health Programs Extension Act of 1973,” as evidence of long-standing federal conscience protections.”

New guidelines applied August 1 by the Department of Health and Human Services (HHS) to the Affordable Care Act, requiring that employers include coverage of women’s preventive care, including birth control have drawn fierce opposition from the religious.

The new guidelines require all new private insurance plans to cover preventive services—including, for example, breast exams and pap smears, maternity care, HPV testing, gestational diabetes screening and breastfeeding support—sans co-payment, co-insurance or a deductible and without cost-sharing. The guidelines, which go into effect as of August 1, 2012, also require coverage without a co-pay of FDA-approved contraception and contraceptive counseling. And there’s the rub. The Guttmacher Institute recently reported that 98 percent of sexually active Catholic women have used modern forms of birth control banned by the Catholic Church hierarchy, yet some Catholic organizations are crying foul over the birth control mandate.

Based on language from conscience clauses found in 28 states, non-profit religious institutions that exist for religious purposes, and primarily employ and serve those who share their religious values can opt out of offering contraceptive coverage in their group health plans. The HHS opened the interim policy for public comment for 60 days since the announcement, which closes on Friday, September 30. Read the rest of this entry →

What Pharmacy Denials in Missouri Would Mean for Me

8:24 am in Uncategorized by RH Reality Check

Written by Pamela Merritt for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Going to the pharmacy and picking up prescriptions is a part of most people’s regular routine.  Consumers go online or place a phone call, schedule a time to pick up their meds and then go get them.  But, as more states debate legislation designed to protect pharmacists who refuse to fill prescriptions on moral grounds, many consumers may be faced with a debate, forced public disclosures or delay at the pharmacy counter.  Missouri legislators have made filing legislation protecting pharmacists who refuse to fill prescriptions on moral grounds an annual event.  That trend has resulted in an annual reflection on what a refusal at the pharmacy would mean in my life and the lives of my fellow Missourians.

State Representative David Sater (R) has filed legislation that “specifies that no licensed pharmacy can be required to perform, assist, recommend, refer to, or participate in any act or service in connection with any drug or device that causes a pregnancy to end prematurely resulting in an abortion.”  Since individuals cannot purchase the pill approved for abortion (mifepristone) over the counter, that leaves us with a bill that would protect pharmacists should they refuse to dispense any other medication that they feel may have an adverse affect on a pregnancy.

The intent of this legislation is to mislead Missourians into thinking that emergency contraception, which is available over the counter, is an abortifacient.  It’s not, but that hasn’t stopped anti-choice advocates from saying otherwise. Read more