Halt Contraceptive Coverage Exemptions, Say Medical Groups

'Conscience Protections' Rules Would Harm Women, Physician Organizations Warn

November 14, 2018 11:25 am News Staff

Two final rules designed to give "conscience protections" to employers with religious or moral objections to contraceptive coverage unconscionably interfere with the physician-patient relationship and unfairly strip Americans of care, five major physician organizations said last week.

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"Efforts to decrease access to contraceptive services will have damaging effects on public health," the organizations said in a forceful statement that called on the administration to withdraw the rules.

The Nov. 8 statement was issued by the AAFP, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians and the American Psychiatric Association.

It came in response to final rules(www.hhs.gov) that were announced jointly Nov. 7 by HHS, the Internal Revenue Service and the Employee Benefits Security Administration. The rules, scheduled to be published in the Federal Register on Nov. 15, are largely the same as 2017 interim rules that two judges have blocked.

Last year, the administration moved to expand exemptions from the contraceptive coverage mandate(www.healthcare.gov) in the Patient Protection and Affordable Care Act (ACA). Employers could, under the interim rules, deny coverage for contraception by citing religious or moral objections.

A federal judge in Philadelphia blocked these interim rules(www.nytimes.com) last December, ruling that the exemptions proposed were too sweeping.

In California, another federal judge also blocked the interim rules,(www.nytimes.com) saying they would "transform contraceptive coverage from a legal entitlement to an essentially gratuitous benefit wholly subject" to the discretion of employers.

The administration's appeals of those decisions are ongoing.(www.washingtonpost.com)

The administration describes the newest exemptions, which do not require employers to notify the government of their actions, as "conscience protections to Americans who have a religious or moral objection to health insurance that covers contraceptive methods, including certain contraceptives that many view as abortifacients, and/or sterilization procedures."

But they would leave countless women and families vulnerable, said AAFP President John Cullen, M.D., of Valdez, Alaska.

"The rules will be harmful to millions of women of reproductive age who may be denied contraception coverage by their employers," Cullen told AAFP News. "Not only do they inappropriately insert a patient's employer into the physician-patient relationship, but they also interfere in women's personal health care decisions.

"These interim final rules will harm women's access to preventive care," he added. "Access to contraceptive care at no out-of-pocket cost is critical to ensuring American women and their families can get the care they need."

The AAFP and the other signatories underscored this point in their statement by reminding the administration what data have overwhelmingly proved: that no-cost preventive coverage benefits patients, as well as the country's economic health.

In 2010, before the ACA was fully enacted, unintended pregnancies cost about $21 billion(www.cdc.gov) in government expenditures, according to HHS. Since then, the rate of unplanned pregnancies has fallen to a 30-year low.(www.guttmacher.org)

Whereas before the ACA's mandate for contraception coverage, between 30 percent and 44 percent(www.kff.org) of women's total out-of-pocket health costs went to birth control alone, women have saved about $1.4 billion a year in out-of-pocket costs for contraception since the coverage became law.

The administration's upending of the mandate threatens to erode these gains and imperil public health.

"We know that when women have unintended pregnancies, they are more likely to delay prenatal care, resulting in a greater risk of complications during and following pregnancy for both the woman and her child," the joint statement said. "The final rules reject these facts and the corresponding recommendations of the medical community, jeopardizing many women's ability to maintain a vital component of their health care."

The organizations said the final rules "create a dangerous new standard for employers to deny their employees coverage based on their own moral objections" that could extend even further.

"These rules open the door to moral exemptions for other essential physician-recommended preventive services, such as immunizations," the organizations said. "We urge the administration to immediately withdraw these rules and instead focus on policies to expand access to evidence-based health care for all Americans.”

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AAFP Addresses Contraceptive Access and Coverage With FDA, CMS
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