Tag Archives: Contraception

Doctors Aren’t Dummies: Support the Patient Trust Act

By Kate Michelman, WomenVote PA and Susan Frietsche, WLP Senior Staff Attorney

Doctors aren’t dummies.

They don’t need politicians to tell them what they can and can’t say to patients, or how to administer tests and treatments.

On September 8, the House Democratic Policy Committee convened to explore the need to pass the Patient Trust Act in Pennsylvania. Physicians, medical ethics experts, and patient advocates met in Pittsburgh to discuss the dangers patients face when medical care becomes politicized.

Introduced by Rep. Dan Frankel (D-Allegheny) and Senator Mike Stack (D-Phila) in July, the Patient Trust Act is part of the Pennsylvania Agenda for Women’s Health, a pro-active, pro-choice package of bills developed by the bipartisan Women’s Health Caucus in the Pennsylvania Legislature.

The Patient Trust Act protects patients. It says that politicians have no business putting words that are “not medically accurate and appropriate for the patient” into the mouths of doctors.

Since antiquity, physicians have taken an oath to treat patients to the best of their ability, with knowledge rooted in clinical experience and scientific consensus. But in recent years, politicians have made it difficult — and in some cases even illegal — for doctors to keep that sacred obligation.

These government-intrusion laws run the gamut from prohibitions on discussing gun storage safety with patients to gag orders preventing doctors from naming the toxic chemicals that are poisoning a patient’s body. A significant number of these government-intrusion laws are proposed by lawmakers trying to disguise their opposition to contraception and abortion by disingenuously claiming that these laws promote women’s health and safety.

Recently, the National Partnership for Women and Families released a report that explored the nationwide spike in laws that command doctors what to say and coerce them to administer — and bill patients for — medically unnecessary procedures.

Bad Medicine: How a Political Agenda is Undermining Women’s Health found that the majority of states — 35 in all — have passed such laws. In many cases, the information doctors are forced to give patients is not even medically and scientifically accurate.

The report’s authors concluded that “anti-choice laws are requiring health care providers to choose between following their medical training and their ethical obligations to their patients — and following the law.”

From the Bad Medicine report:

*Five states force doctors to tell patients of a false link between abortion and breast cancer.

*Five states force doctors to falsely advise a patient that an abortion will affect her future fertility.

*Eight states force doctors to provide misinformation that falsely indicates the only possible emotional response to abortion is negative.

*Twelve states force doctors to provide unfounded information that fetuses can feel pain, despite lack of scientific evidence.

In 2012, anti-choice Pennsylvania lawmakers proposed mandating that doctors perform medically unnecessary ultrasounds on women seeking an abortion. The bill, one of the most severe of its kind in the country, was quietly abandoned after a similar bill led to a backlash in Virginia.

But that doesn’t mean the mandatory ultrasound bill, or legislation like it, won’t be proposed in Pennsylvania again.

Laws like these enable politicians to act like ventriloquists, throwing their words into the mouths of doctors. It’s time for politicians to stop masquerading as ideological ventriloquists.

Doctors aren’t dummies. Patients deserve better. Women need to be able to trust that the voice they’re hearing is from their physician, not from Harrisburg’s political puppeteers.

Kate Michelman is co-chair of WomenVote PA, an organization that educates, engages, and mobilizes Pennsylvanians to make equality a reality for women. She is also president emerita of NARAL Pro-Choice America and author of “With Liberty and Justice for All: A Life Spent Protecting the Right to Choose.”

Sue Frietsche is a senior staff attorney in the Western Pennsylvania office of the Women’s Law Project.

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Filed under Contraception, Health Care, Health insurance, PA Legislature, Pennsylvania, Reproductive Rights, Women's health

Women’s rights fight has moved to state level

Op-Ed  by Kate Michelman and Carol Tracy, appeared in the Philadelphia Inquirer, Sunday, December 9, 2012

That Mitt Romney was stunned by his defeat says much about his and others’ blindness to the divergent forces that carried Barack Obama to victory.

Imagine the bitter truths they must confront as the nature of the electorate becomes clear. The demographic realities that shaped the victory gave joy to those of us who have been ignored, belittled, and targeted by the conservative right. The very women, youth, people of color, gays and lesbians they assumed to be at the margins of national politics had their revenge. And, yes, we voted for “liberal” causes, obvious rights that have been denied for too long by the people who saw the country through out- of- date lenses.

Women, in particular, claimed our rights in bold print. More women turned out to vote than men. We were the largest deciding block in Obama’s victory (11 points over Romney). We left absolutely no doubt that we demand and deserve equal rights: equal pay, an end to pregnancy discrimination and sexual harassment, better family health care, paid leave, and broad access to contraception. At t he t op of t he list: Government should have no part in a woman’s reproductive decisions. Choice. It’s what most women demand for all women. An exit poll revealed that Americans believe abortion should be legal, 59 percent to 36 percent.

We had a great day. We won a solid and lasting protection against discrimination and political harassment. The national vote said it all.

Wrong.

The national vote, while worthy of high-fives all round, is hardly the end of our struggle for women’s rights. When conservatives lose a decisive battle at the federal level, they redouble their efforts at the state and local levels. And they’ve already made that clear in Ohio. A few days after the election the legislature defunded Planned Parenthood.

Facing vetoes from the White House and having no hope of stacking the Supreme Court, pro-life advocates will become much more aggressive at the state levels. Their targets: governors (30 Republicans), Republican-controlled legislatures, and local governments and institutions, including hospital boards, PTAs, even library boards. They are particularly focused on judicial appointments.

Women showed our force in checking the war on women. But don’t be deceived; the war goes on. Only the battlefields change.

Consider some of their recent legislative gains across the nation. Parental disclosure. Ultrasound tests. Showing a woman the X-rays of her unborn. Preprocedure lectures. Shutting down clinics by needlessly raising architectural standards. Forcing women farther afield to find a clinic. The list goes on.

Extreme conservatives can’t roll back Roe v. Wade, but they can and will try to crawl beneath the radar of broad publicity with seemingly innocuous ways to shame us, to deny our rights and our equality. They will count on our satisfaction in winning the White House to soon give way to apathy. To ignore their zeal is to risk forfeiting our hard-fought gains.

To exercise their power in ways that affect their lives and health, women must educate themselves about the values and policy views of decision-makers at every level. In many cases, the decisions that have the biggest impact are made by officials who often don’t attract much attention.

The country is served well by national organizations, but today the greater need is at the state and local levels — to make effective use of traditional and social media and grassroots efforts to profile candidates and encourage women to be aware, to choose, and to vote.

The best of these information groups include both Republicans and Democrats. They may or may not endorse candidates. Their objective is to keep vigilance over all manner of issues affecting women in that state, to share solid information, and to demand accountability from those who threaten our rights.

The only way women will continue our advance toward equality and privacy is to be aware — to take the time not just to understand the forces trying to take back our recent gains, but to make the time to fight back.

Kate Michelman is co-chair of WomenVote PA, president emerita of NARAL Pro-Choice America, and author of “With Liberty and Justice for All: A Life Spent Protecting the Right to Choose.”

Carol E. Tracy is co-chair of WomenVote PA, an initiative of the Women’s Law Project, and Executive Director of the Women’s Law Project.

 

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Filed under 2012 Election, Abortion Access, Contraception, Equality, Reproductive Rights, Women's health, WomenVote PA

Court Ruling: Hobby Lobby Cannot Deny Contraceptive Coverage to its Employees

By Amal Bass, WLP Staff Attorney

On November 19, 2012, an Oklahoma federal court denied Hobby Lobby’s motion for a preliminary injunction, telling the business and its co-plaintiff (Mardel, another business owned by the same family trust) that they would be unlikely to succeed in their legal challenge to the contraceptive coverage rule under the Affordable Care Act (ACA).  This rule makes contraception more affordable for women by requiring new or renewed insurance to cover the cost without co-pays or deductibles as of August 1, 2012.

Religious organizations, like houses of worships, are exempt from providing such coverage, and the Obama Administration has proposed an “accommodation” for other religious organizations under certain circumstances.  Just yesterday, November 27, 2012, a Pennsylvania federal court dismissed a lawsuit by the Catholic Diocese of Pittsburgh, Catholic Charities, and Catholic Cemeteries Association as premature because, unlike Hobby Lobby, several exceptions to the contraceptive coverage rule apply to them at the present time either because they are religious organizations or have grandfathered plans.  Most v. Sebelius, No. 12-cv-00676, 2012 U.S. Dist. LEXIS 167737 (W.D. Pa. 2012).  Hobby Lobby, as a private, for-profit business, is in a different situation; it does not fit within the accommodation or exemptions.

In its lawsuit, Hobby Lobby and Mardel claimed that requiring contraceptive coverage in the health plans they offer to their employees violates their rights under the First Amendment of the U.S. Constitution and the Religious Freedom Restoration Act of 1993 (RFRA).  In particular, Hobby Lobby protested coverage for contraceptive methods that it wrongly believed to be abortifacients, such as Emergency Contraception (EC), which does not cause abortions because it works by preventing the ovary from releasing an egg, not by disturbing a fertilized egg implanted in the uterus.

The United States District Court for the Western District of Oklahoma ruled against Hobby Lobby and Mardel, concluding that the companies were not entitled to a preliminary injunction because:

Hobby Lobby and Mardel, [being] secular, for- profit corporations, do not have free exercise rights. The [owners] do have such rights, but are unlikely to prevail as to their constitutional claims because the preventive care coverage regulations they challenge are neutral laws of general applicability which are rationally related to a legitimate governmental objective.

Plaintiffs also have failed to demonstrate a probability of success on their Religious Freedom Restoration Act claims. Hobby Lobby and Mardel are not ‘persons’ for purposes of the RFRA and the Greens have not established that compliance with the preventive care coverage regulations would ‘substantially burden’ their religious exercise[.]

Essentially, the court concluded that, for the purposes of free exercise of religion, corporations are not people and do not have such rights.  Their owners have religious freedom rights, but broadly applicable, neutral laws like the ACA do not infringe on these constitutional or statutory rights.  Legal challenges waged by secular, for-profit businesses against the contraceptive coverage rule in other lower federal courts, however, have resulted in mixed results.

It is important that our federal courts protect the contraceptive coverage rule from attacks like the one at the heart of Hobby Lobby v. Sebelius.  Business owners should not be able to impose their personal religious beliefs on their employees, who come from a wide range of backgrounds.  Depending on the method used, contraception can cost between $15 and $1,000 up front, and the contraceptive coverage rule ensures that fewer women will pay out-of-pocket for birth control, which is not only important for family planning but also to address other health concerns, such as polycystic ovarian syndrome.

To learn more about the Affordable Care Act and reproductive health care, see our report, Through the Lens of EQUALITY: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women.

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Filed under Contraception, Emergency Contraception, Health Care, Health insurance, Reproductive Rights, Uncategorized, Women's health

The Affordable Care Act Extends No-Cost Preventive Care to Women

Nikki Ditto, WLP Intern

Wednesday, August 1st  is an important day for women’s health. After this date, all new insurance plans must cover certain women’s preventive health services, including contraceptives, without co-pays or deductibles. This represents an essential change in access to health care for women. Women, who have long been subjected to denial of access to insurance coverage for essential health services are more likely than men to forgo needed health care due to cost.  The number of women who can access these benefits will continue to expand as older plans lose their “grandfathered” status and become subject to the ACA’s preventive health services requirements.  For now, many college and university students will benefit if they receive health insurance through their schools, as those plans usually begin their health plan years around the start of the school year.  Other insurance policies that are renewed with substantially different content (usually on January 1st) will also comply with the new law.

Women whose insurance plans fall under the new guidelines will now have access to a number of services that will “keep them healthier and…catch potentially serious conditions at an earlier, more treatable stage,” according to Secretary of Health and Human Services, Kathleen Sebelius. This includes annual well-woman visits, as well as screening and counseling for HPV, HIV, and STIs. Insurance policies will also have to cover testing for gestational diabetes, breastfeeding support, and domestic violence screening and counseling. Perhaps most significantly, women will also have access to birth control and other forms of contraception without a co-pay, though exceptions have been made for religious institutions and self-funded plans. These services add to the no-cost coverage that has already been implemented for pap smears and mammograms.

The Department of Health and Human Services reports that 20.4 million women have been and will be affected by this expansion in coverage. A startling 52% of women “report delaying needed medical care because of cost,” a number that will be decreased under the ACA. The Women’s Law Project (WLP) explained in its report Through the Lens of EQUALITY: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women that “lack of access to the full range of women’s health care has many adverse health consequences.”  Many women are unable to afford contraceptives, which range from $15 to more than $1,000 up front depending on the methodThe contraceptive coverage rule will increase women’s access to these methods of contraception, which will help them plan pregnancies and address other health concerns, such as polycystic ovarian syndrome, for which birth control pills are a common treatment.

Controversy continues over the provision requiring employer-provided insurance plans to cover birth control and other forms of contraception, including sterilization. As WLP blogged about today, twenty-four legal challenges are still pending in courts. The ACA already provides exceptions for religious institutions, and allows religiously affiliated businesses to push cost and administration on to the insurance companies. These accommodations, however, have not stopped the debate. WLP has blogged before about lawsuits that challenge the constitutionality of the provision on the basis of the First Amendment. As Terry Fromson, WLP’s Managing Attorney, explained, “the First Amendment does not give church leaders any right to impose their beliefs about contraception on women.”

Overall, the implementation of this provision of the ACA represents an important and necessary change to the way we view women and women’s health. Reproductive and sexual health must be seen as central to ensuring the health and well-being of all women, and not as a secondary concern. America will be healthier if women are given better access to the services necessary to care for themselves and their families, and increasing access to contraception is a step in the right direction.

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Filed under Contraception, First Amendment, Government, Health Care, Health insurance, Maternity Coverage, Pregnancy, Reproductive Rights, Sexually Transmitted Infections, Women's health

Courts Come to Different Decisions on the ACA’s Provision Requiring Some Employers to Cover Contraception

Mary Pat Dwyer, WLP Law Intern

Two federal district court judges ruled recently on claims regarding the Affordable Care Act (ACA) provision which requires that employers providing health insurance to their employees cover reproductive health services, including birth control, emergency contraception, and other procedures.

On Tuesday, July 17, Judge Warren Urbom of the District of Nebraska dismissed a suit brought by several states, Catholic groups, and individual plaintiffs challenging the constitutionality of the provision.  The groups argued that the First Amendment’s protection of freedom of association gave them the right to deny their employees coverage for these essential services.  The states claimed that the groups and others like them would cease to provide insurance for their employees rather than comply with the law, which in turn would increase the number of Medicaid applicants and adversely affect state budgets.

Judge Urbom found that the plaintiffs did not have standing to pursue their claim that the mandate violated the first amendment for two reasons.  First, the federal government has delayed enforcement of the provision until August 2013.  Because of this, the groups are not facing any imminent requirement to comply with the law, and thus cannot show the “direct and immediate harm” that plaintiffs must show in order to have the courts consider their claims. Second, the states claims that they would face increases in Medicaid costs were based purely on “layers of conjecture,” and had no factual grounding. Furthermore, Judge Urbom pointed out that the Department of Health and Human Services is currently considering revising the definition of religious employers under the ACA. Because of the potential for revision, none of the plaintiffs could show that they would ever be impacted by the provision.

On Friday, July 27, Judge John Kane of the District of Colorado reached a drastically different conclusion when he granted an injunction prohibiting the federal government from enforcing the provision against Hercules Industries Inc., a private corporation. Judge Kane found that for the Catholic plaintiffs, who serve as co-owners and board of directors of a company that manufactures HVAC equipment, the obligation to comply with the law threatened their right to exercise their religious beliefs under the Religious Freedom Restoration Act (RFRA). Katherine Sebelius, Secretary of the Department of Health and Human Services, expressed disappointment with Judge Kane’s decision, but also stated that she is “confident that as this case moves through the courts, the policy that most health insurance plans cover contraception will be upheld.” Sebelius also reaffirmed the administration’s position that “health decisions should be between women and their doctors, not their employers.”

Twenty-four similar lawsuits claiming that the requirement violates the First Amendment are still pending in courts across the country. These suits undermine the security of women’s health care, and it is crucial that the courts recognize the grave importance of comprehensive health care access. As WLP highlighted in Through the Lens of Equality: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women, women who face restricted access to contraceptive care suffer serious health risks as a result. Women who are unable to effectively and safely plan their pregnancies are more likely to experience pregnancy complications. For women who have preexisting conditions, such as diabetes, coronary artery disease, or arthritis, unintended pregnancies can be life threatening. Additionally, children born of unplanned pregnancies, face increased risks of premature birth, low birth, poor nutrition, and infant mortality.

Neither judge ruled on the constitutionality of the provision. However, as we have previously explained, the federal contraceptive coverage rule does not violate the First Amendment because it is a neutral law that does not target a particular faith and applies to everyone equally.  It is constitutional.

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Filed under Contraception, Emergency Contraception, Family Planning, Federal Court, First Amendment, Health Care, Health insurance, Reproductive Rights, Women's health

First Amendment Does Not Give Church Leaders Right to Impose Beliefs on Women

Terry L. Fromson, Women’s Law Project Managing Attorney

Advancing the church’s unrelenting pursuit of control over women’s reproductive lives, Joe Watkins’ op-ed published in The Philadelphia Inquirer on June 3 (Mandate for health services touches full religious spectrum) incorrectly labels the federal contraceptive coverage rule unconstitutional.  The First Amendment does not give church leaders any right to impose their beliefs about contraception on women.

Nor do women want the church to interfere in their personal decisions about use of contraception.  Most women, including active churchgoers, use contraception at some time in their lives.  They do so because contraceptive coverage is essential to their health care, both for achieving healthy pregnancies and for combatting medical conditions unrelated to pregnancy. The cost and lack of insurance coverage for contraception have remained barriers to access for many.

The federal contraceptive coverage rule, which ensures access to contraceptive services, prescriptions, and devices for millions of women, is constitutional.  Neutral laws that do not target a particular faith and apply to everyone equally do not violate the First Amendment.  The contraceptive coverage rule is such a law.

Contrary to the op-ed’s assertion, the challenged federal rule does not require religious institutions to pay for contraceptive coverage.  It exempts churches themselves and then goes beyond and provides that religiously affiliated institutions that perform non-religious functions do not even have to pay for coverage.  Religiously affiliated schools, hospitals and charitable institutions employ individuals of all faiths and accept public dollars to provide their services.  Individuals who work for them should not have to give up their Constitutional rights.

For more information, see our blog from February, “Obama Administration Ensures a Wide Range of Contraceptive Insurance Coverage, Even at Religiously-Affiliated Institutions

Also see WLP work on Health Care Reform.

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Filed under Contraception, Family Planning, First Amendment, Health Care, Health insurance, Philadelphia Inquirer, Reproductive Rights, Women's health

Welcome, Gentlemen, to the World of Chemical Contraception

Samantha Yakas, WLP Intern

Over the last year, birth control has become a frequent topic of debate in legislatures across the country. Issues regarding access to reproductive health care have received widespread media coverage. However, these debates make women and their bodies the central focus, an emphasis which may soon come to an end.

 In the past, the options for male birth control have been very limited, which has caused men to have essentially a third-party stake in the birth control argument. Legislative regulations for birth control have focused mainly on the pill and emergency contraception, which are largely considered “women’s issues.. However, birth control may soon be considered a “people’s issue” because of new developments in the realm of reproductive health. A promising male contraceptive is being tested that can be up to 100% effective. The injection is currently going through clinical trials and has not yet been FDA approved.

 The new contraceptive is a gel that is injected into the male vas deferens, and it prevents the sperm from being fertile. The procedure is effective for up to ten years, and it can be reversed with another shot if a couple later decides to have a baby. Long-term, the contraceptive works due to the effect it has on the Katnal1 gene. Scientists are currently testing the future contraceptive on infertile mice in an attempt to fix mutated Katnal1 genes and correct infertility. Though it is a long way from correcting human male infertility, it is a promising start.  

In addition to the injection, other ongoing research is looking at different methods through which male fertility can be controlled, including sperm mobility, sperm maturation, and the ways in which sperm is triggered. Currently, development is in progress of a male contraceptive that controls these mechanisms through a pill. The pill is still being tested and is not yet FDA approved. Earlier research examined a possible male contraceptive based on the body’s immune system response, but this option was not found to be effective. However, with hormone pills and the injection still being tested, the chances of success are on the rise for a new way for men to proactively prevent unwanted conception.

Contraception has always been treated as a women’s issue, which has influenced the way that legislation is perceived and discussed. With the development of chemical options for men these issues could begin to affect men’s lives far more directly, and thus radically change the debate on birth control.

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Filed under Contraception, Sex