Background on S. 2139, Mandating Contraceptive Insurance Coverage in Massachusetts
The following materials are included in this informational packet regarding the contraceptive insurance mandate in Massachusetts:
SUMMARY OF LEGAL IMPACT OF S. 2139, MANDATING CONTRACEPTIVE COVERAGE IN HEALTH CARE PLANS IN MASSACHUSETTS.
FEBRUARY 22, 2002
Senate Bill 2139 is directed towards the insurance industry but would impact any business that purchases health benefits from an insurance company or health maintenance organization (HMO) for its employees. The bill applies to policies in Massachusetts for accident and sickness insurance, hospital and medical services, and HMO care.
The bill mandates that such policies must cover "hormone replacement therapy services" and "all contraceptive methods to prevent pregnancy that have been approved by the United States Food and Drug Administration" (FDA). Both individual and group health care plans would be subject to the mandate.[1]
The bill exempts only those plans purchased by "a church" or "church-controlled organization" as defined by the Internal Revenue Service (IRS) code.[2]
However, the bill will force insurance companies to include contraceptive coverage in any plans they sell to a broad range of other religious institutions not directly under diocesan control, such as hospitals and nursing homes, social service agencies including Catholic Charities, and colleges, universities and non-diocesan high schools. The bill also prohibits the insurance companies from selling employee health plans without the contraceptive coverage to conscientiously opposed secular businesses.
The Massachusetts House of Representatives rejected by a vote of 49 to 107 an amendment intended to broaden the "church controlled" exemption. The amendment sought to exempt "any church affiliated or religiously based organization" opposed to contraceptive coverage on "moral or religious grounds". The amendment would have also allowed individual employees to purchase special riders if they did not want their premiums to support the contraceptive coverage included in the plans offered by their secular employers. In addition, the amendment clarified that coverage for contraceptives used for non-contraceptive purposes, such as hormone replacement, would still be mandatory in all cases.
Both branches have passed S. 2139 by overwhelming margins (and the bill is currently before the Senate on a question of accepting amendments by the House unrelated to the exemption issue). The Acting Governor is expected to sign the bill into law. The bill would take effect Jan. 1, 2003.
These events raise important questions about cooperation with programs contrary to our faith and teaching (represented by both the contraceptive purposes and the abortifacient effects of the drugs and services at issue). All religious and other organizations conscientiously opposed, not directly under church control, and that purchase health insurance for their members or employees must determine how they will respond to the mandate.
These institutions will need to explore their options in light of their moral obligation to avoid doing wrong, their right to freedom of religious exercise, and their just commitment to the welfare of those they employ and those they serve.
FOOTNOTES
[1] The bill amends M.G.L. chaps. 175 (governing corporations formed to provide accident and sickness insurance), 176A & B (governing non-profit corporations organized to provide hospital and physician (medical) service plans), and 176G (governing health maintenance organizations).
[2] See 26 U.S.C. §3121(w)(3)(A) & (B), incorporated by reference into S. 2139’s exemption clause.
MASSACHUSETTS CATHOLIC CONFERENCE PRESS RELEASE
For Immediate Release: January 31, 2002
Contact:
Statement of Maria Parker on Mass. House Vote to Force Catholic Institutions To Provide Contraceptive Insurance Coverage
Maria Parker, the Associate Director for Public Policy of the Massachusetts Catholic Conference, issued the following statement after the Massachusetts House of Representatives passed on Wednesday, January 30, a bill entitled "An Act Providing Equitable Coverage of Services Under Health Plans" (S. 2139), and defeated an amendment to exempt religiously affiliated organizations such as Catholic Charities and Catholic hospitals from the bill’s mandate to provide employee insurance coverage for contraception, including those methods that cause early abortions. The bill contained a narrow exemption that applied only to diocesan agencies, parishes, and parochial schools. The bill was passed unanimously by the Senate last year and must go to the Acting Governor to be signed into law.
Ms. Parker’s statement is as follows:
The House’s shameful vote to force Catholic hospitals, colleges, nursing homes, and social service agencies to cover contraceptive services in their employee insurance plans violates the religious freedom rights of these institutions. It is a very sad day when legislators, including Catholic ones, take the floor and accuse the Church of being behind the times and unfair to its employees by insisting on the right to exercise certain fundamental principles at the core of our faith. We are being punished for standing up for our religious values.
I cannot say enough about the courage of those legislators who rose to speak in defense of religious freedom and for all of the 49 who voted for a reasonable amendment to expand the exemption. I especially thank Reps. Gene O’Flaherty (Chelsea), Elizabeth Poirier (N. Attleboro), Stephen Tobin (Quincy), Fran Marini (Hanson), and Paul Frost (Auburn) for their eloquence and conviction.
LETTER TO HOUSE MEMBERSHIP
January 28, 2002
To Members of the Massachusetts House of Representatives
The Massachusetts Catholic Conference opposes S. 2139, a bill mandating private employee insurance coverage for drugs that are contraceptive and cause the death of human embryos.
Mischaracterized as strictly a contraceptive mandate, the bill would require religious-affiliated hospitals, schools, service agencies and other private employers to provide employee insurance coverage for birth control methods that, in reality and as documented below, take human lives. The bill’s narrow exemption extends only to church "controlled" employers serving members of their own faith.[1]
Thus, a vote for this bill is a vote to force contraception and abortion coverage on a broad range of Catholic institutions and other morally opposed private employers.
S. 2139 has passed the Senate and is up for engrossment in the House. The bill mandates private insurance coverage for "all contraceptive methods to prevent pregnancy which have been approved by the United States Food and Drug Administration" [FDA]. The key words are "to prevent pregnancy". So-called "reproductive rights" advocates argue that "pregnancy in a woman cannot begin until the fertilized ovum is implanted in her uterus."[2]
From this perspective, drugs that prevent the creation of new human life, and that allow new human lives to be fertilized but prevented from implanting in a woman’s womb—thereby causing early abortions--are classified as "contraceptive".
The federal government and abortion advocates acknowledge that chemical contraceptives such as the so-called "morning-after" pill will act as abortifacients. According to the FDA, emergency contraception pills either "act by delaying or inhibiting ovulation", by "inhibiting fertilization", or by "inhibiting implantation".[3] Likewise, a publication of the Guttmacher Institute, the research arm of Planned Parenthood (the largest abortion provider in the country and the Commonwealth) agrees that "[d]epending on the timing of intercourse in relation to a woman’s hormonal cycle, they [emergency contraceptive pills]—as is the case with all hormonal contraceptive methods—may prevent pregnancy either by preventing fertilization or by preventing implantation of a fertilized egg in the uterus."[4]
These and other public admissions by authoritative agencies lead the Pontifical Academy for Life at the Vatican to conclude in 2000 that "it is clear . . . that the proven ‘anti-implantation’ action of the morning-after pill is really nothing other than a chemically induced abortion. . . . Consequently, from the ethical standpoint the same absolute unlawfulness of abortifacient procedures also applies to distributing, prescribing and taking the morning-after pill. All who, whether sharing the intention or not, directly cooperate with this procedure are also morally responsible for it. . . . [W]e strongly urge everyone who works in this sector to make a firm objection of moral conscience".[5]
S. 2139 as presently written will force Catholic Charities, Caritas Christi, and other service networks morally opposed to contraception and abortion to either suspend employee insurance benefits altogether or to violate their moral conscience by covering contraceptives and abortifacients contrary to their religious beliefs. On the basis of moral conscience we object to S. 2139, and on behalf of religious freedom we urge the members of the House to oppose the bill.
Gerry D’Avolio, Esq., Executive Director, Massachusetts Catholic Conference
Maria Parker, M.B.A., Associate Director for Public Policy
FOOTNOTES
[1] See 26 U.S.C. 3121(w)(3), the federal IRS language incorporated by reference into S. 2139’s exemption clause.
[2] Phillip Stubblefield, Self-Administered Emergency Contraception—A Second Chance, 339 N. Eng. J. Med. 41 (1998).
[3] FDA Notice, 62 Fed. Reg. 861 (Feb. 25, 1997).
[4] S.A. Cohen, Objections, Confusion Among Pharmacists Threaten Access to Emergency Contraception, The Guttmacher Report on Public Health, June 1999, at 1 (emphasis added).
[5] Pontifical Academy for Life, Statement on the So-Called "Morning-After Pill" (Oct. 31, 2001).
MCC HANDOUT
CATHOLIC INSTITUTIONS IN MASSACHUSETTS SUBJECT TO THE CONTRACEPTIVE INSURANCE COVERAGE MANDATE IN S. 2139
Hospitals……………………….12
Nursing Homes……….………..28
Colleges & Universities…………9
Social Service Centers…………62
Residential & Other Centers for
Persons with Disabilities.………10
Non-Diocesan High Schools……26
Data obtained by the Massachusetts Catholic Conference from The Official Catholic Directory (Kenedy & Sons Pub. 2001).
SAMPLES OF CONTRACEPTIVE DRUGS OR DEVICES APPROVED BY THE FDA THAT MAY CAUSE EARLY ABORTION OF A HUMAN EMBRYO
Preven & Plan B: Two FDA-approved forms of oral "emergency contraceptives" that "work[] by either preventing an egg from being released from the ovary or [by] changing the lining of the uterus so that a fertilized egg could not implant in the uterus". Planned Parenthood League of Massachusetts website (pplm.org).
Mirena & Other IUDs (Intra-Uterine Devices): "Postcoital emergency contraceptive insertion of an IUD may involve the same mechanism [of inhibiting ovulation or preventing fertilization] in some cases, but it is more likely to interfere with implantation." Planned Parenthood Federation of America website (planned parenthood.org)
Progestin-Only Contraceptives: According to a 1999 report in a publication of Planned Parenthood’s Guttmacher Institute, "all hormonal contraceptive methods—may prevent pregnancy either by preventing fertilization or by preventing implantation of a fertilized egg in the uterus." S.A. Cohen, Objections, Confusion Among Pharmacists Threaten Access to Emergency Contraception, The Guttmacher Report on Public Health, June 1999, at 1 (emphasis added).
The risk of failed contraception and early abortion is greater with progestin-only contraception that lacks estrogen. Among the 34 different types of this contraceptive identified by the Physicians Desk Reference are included: Nor-QD, Micronor, Norplant, Lunelle, Lo/Ovral, Zovia, Levora, Mircette, Alesse, Mirena Intrauterine System, Ogestrel.
Information provided by the Massachusetts Catholic Conference, Jan. 30, 2002
AN ACT PROVIDING EQUITABLE COVERAGE OF SERVICES UNDER HEALTH PLANS [AS ENGROSSED BY THE HOUSE, 140-16].
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION 1. Chapter 175 of the General Laws, as appearing in the 2000 Official Edition, is hereby amended by inserting after section 47V the following section:--
Section 47W. (a) Any individual policy of accident and sickness insurance issued pursuant to section 108 and any group blanket policy of accident and sickness insurance issued pursuant to section 110 that is delivered, issued or renewed within or without the commonwealth and that provides benefits for outpatient services shall provide hormone replacement therapy services for peri- and post menopausal women and outpatient contraceptive services under the same terms and conditions as for other outpatient services. Outpatient contraceptive services shall mean consultations, examinations, procedures and medical services provided on an outpatient basis and related to the use of all contraceptive methods to prevent pregnancy that have been approved by the United States Food and Drug Administration.
(b) Any individual policy of accident and sickness insurance issued pursuant to section 108 and any group blanket policy of accident and sickness insurance issued pursuant to section 110 that is delivered, issued or renewed within or without the commonwealth and that provides benefits for outpatient prescription drugs and devices shall provide benefits for hormone replacement therapy services for peri- and post menopausal women and for outpatient prescription contraceptive drugs or devices which have been approved by the United States Food and Drug Administration under the same terms and conditions as for other prescription drugs or devices, provided that in covering all FDA approved prescription contraceptive methods, nothing herein precludes the use of closed or restricted formulary.
(c) The requirements of this section shall not apply to an individual policy of accident and sickness insurance delivered, issued or renewed pursuant to section 108 or any group blanket policy of accident and sickness insurance delivered, issued or renewed pursuant to section 110 of chapter 175 if that policy is purchased by an employer that is a church or qualified church-controlled organization, as those terms are defined in 26 U.S.C. section 3121 (w) (3) (A) and (B).
SECTION 2. Chapter 176A of the General Laws, as so appearing, is hereby amended by inserting after section 8V the following section:--
Section 8W. (a) Any contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within or without the commonwealth and that provides benefits for outpatient services shall provide to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth hormone replacement therapy services for peri- and post menopausal women and outpatient contraceptive services under the same terms and conditions as for other outpatient services. Outpatient contraceptive services shall mean consultations, examinations, procedures and medical services provided on an outpatient basis and related to the use of all contraceptive methods to prevent pregnancy that have been approved by the United States Food and Drug Administration.
(b) Any contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within or without the commonwealth and that provides benefits for outpatient prescription drugs or devices shall provide to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth benefits for hormone replacement therapy services for peri- and post menopausal women and for outpatient prescription contraceptive drugs or devices which have been approved by the United States Food and Drug Administration under the same terms and conditions as for other prescription drugs or devices, provided that in covering all FDA approved prescription contraceptive methods, nothing herein precludes the use of closed or restricted formulary.
(c) The requirements of this section shall not apply to a contract between a subscriber and the corporation delivered, issued or renewed pursuant to this chapter if that contract is purchased by a subscriber that is a church or qualified church-controlled organization, as those terms are defined in 26 U.S.C. section 3121 (w) (3) (A) and (B).
SECTION 3. Chapter 176B of the General Laws, as so appearing, is hereby amended by inserting after section 4V the following section:--
Section 4W. (a) Any subscription certificate under an individual or group medical service agreement that is delivered, issued or renewed within or without the commonwealth and that provides benefits for outpatient services shall provide to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth benefits for hormone replacement therapy services for peri- and post menopausal women and outpatient contraceptive services under the same terms and conditions as for other outpatient services. Outpatient contraceptive services shall mean consultations, examinations, procedures and medical services provided on an outpatient basis and related to the use of all contraceptive methods to prevent pregnancy that have been approved by the United States Food and Drug Administration.
(b) Any subscription certificate under an individual or group medical service agreement that is delivered, issued or renewed within or without the commonwealth, and that provides benefits for outpatient prescription drugs or devices, shall provide to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth benefits for hormone replacement therapy services for peri- and post menopausal women and for outpatient prescription contraceptive drugs or devices which have been approved by the United States Food and Drug Administration under the same terms and conditions as for other prescription drugs or devices, provided that in covering all FDA approved prescription contraceptive methods, nothing herein precludes the use of closed or restricted formulary.
(c) The requirements of this section shall not apply to a subscription certificate under an individual or group medical service agreement delivered, issued or renewed pursuant to this chapter if that subscription certificate is purchased by an employer that is a church or qualified church-controlled organization, as those terms are defined in 26 U.S.C. section 3121 (w) (3) (A) and (B).
SECTION 4. Chapter 176G of the General Laws is hereby amended by inserting after section 4N, added by section 6 of chapter 355 of the Acts of 2000,the following section:
Section 4O. (a) Any individual or group health maintenance contract that is issued, renewed or delivered within or without the commonwealth and that provides benefits for outpatient services shall provide to residents of the commonwealth and to persons having a principal place of employment within the commonwealth hormone replacement therapy services for peri- and post menopausal women and outpatient contraceptive services under the same terms and conditions as for other outpatient services. Outpatient contraceptive services shall mean consultations, examinations, procedures and medical services provided on an outpatient basis and related to the use of all contraceptive methods to prevent pregnancy that have been approved by the United States Food and Drug Administration.
(b) Any individual or group health maintenance contract that is issued, renewed or delivered within or without the commonwealth and that provides benefits for outpatient prescription drugs or devices shall provide to residents of the commonwealth and to persons having a principal place of employment within the commonwealth benefits for hormone replacement therapy services for peri- and post menopausal women and for outpatient prescription contraceptive drugs or devices that have been approved by the United States Food and Drug Administration under the same terms and conditions as for other prescription drugs or devices, provided that in covering all FDA approved prescription contraceptive methods, nothing herein precludes the use of closed or restricted formulary.
(c) The requirements of this section shall not apply to a health maintenance contract delivered, issued or renewed pursuant to this chapter if that contract is purchased by an employer that is a church or qualified church-controlled organization, as those terms are defined in 26 U.S.C. section 3121 (w) (3) (A) and (B).
SECTION 5. The provisions of this act shall apply to all policies, contract, plans and certificates of insurance issued or delivered within the commonwealth on or after January 1, 2003, and to all policies, contracts, agreements, plans and certificates of insurance in effect before that date upon renewal on or after January 1, 2003
AMENDMENT TO BROADEN RELIGIOUS EXEMPTION [DEFEATED 49-107]
Introduced by Reps. Elizabeth Poirer, Mark Carron, and others:
"(c) Notwithstanding paragraphs (a) and (b) of this section and any other provision of law to the contrary—
(i) Provision of contraceptive services and prescription contraceptive drugs and devices, and of benefits for such services, drugs and devices, shall not apply to any church affiliated or religiously based organization issuing, delivering, renewing or purchasing a policy when such organization objects to the provision thereof on moral or religious grounds.
(ii) A policy excluding contraceptive services and prescription contraceptive drugs and devices shall be issued to any person with such moral or religious objection.
(iii) Nothing in this section shall be construed to authorize the refusal to provide any services, prescription drugs and devices, or of benefits therefore, that are prescribed for purposes other than to prevent pregnancy."