Free Sterilizations Must be Offered to All College Women

CNS News:

(CNSNews.com) – All student health care plans covering female college students in the United States must include coverage for free voluntary sterilization surgery, the Department of Health and Human Services announced late Friday afternoon.

Women of college age who do not attend school will also get free sterilization coverage whether they are insured through an employer, their parents, or some form of government-subsidized plan.

All student health plans, HHS said Friday as it finalized a new regulation under the Affordable Care Act (otherwise known as Obamacare) must cover the full set of cost-free women’s “preventive services” that HHS ordered last month must be covered by all U.S. health care plans.

These free “preventive services” include surgical sterilization procedures and all Food and Drug Administration-approved contraceptives, including those that cause abortions.

“These preventive health services include, with respect to women, preventive care and screening provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) that were issued on August 1, 2011,” HHS said in a request for comments about how the new regulation will be implemented.

“As relevant here, the HRSA Guidelines require coverage, without cost sharing, for ‘[a]ll Food and Drug Administration [(FDA)] approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity,’ as prescribed by a provider,” said the HHS description of the regulation, which will be published in the March 21 edition of the Federal Register.

In announcing the rule for college-based health plans, HHS said it would follow the same system for enforcing the rule on religious colleges and universities that object to purchasing sterilizations, contraceptives and abortifacients for its students that President Barack Obama has proposed for enforcing the regulation on religious non-profit organizations in the coverage for their employees: The insurer will be forced to provide the sterilizations, contraceptives and abortifacients to the students free of charge.

“Under the final rule, students will gain the same consumer protections other people with individual market insurance have, like a prohibition on lifetime limits and coverage of preventive services without cost sharing,” HHS said in a press release. “In the same way that religious colleges and universities will not have to pay, arrange or refer for contraceptive coverage for their employees, they will not have to do so for their students who will get such coverage directly and separately from their insurer.”

The U.S. Catholic Bishops have said that this mechanism does not satisfy their concerns about the regulation’s violation of the freedom of conscience and religion of those who have moral and religious objections to sterilization, artificial contraception and abortion. Institutions that object on moral and religious grounds would still have to provide insurance plans that covered these things, even if these particular services were theoretically paid for by the insurer rather than the institution securing the insurers services to cover its students and employees.

Also, just as the regulation requiring free coverage for sterilizations, contraceptives and abortifacients makes no accommodation at all for private-sector employers who object on religious or moral grounds, the rule requiring this coverage for students makes no accommodation for non-religious private schools that object on religious and moral grounds or for state colleges in states where local voters, taxpayers, legislators and governors may object to providing free sterilizations, contraceptives and abortifacients to college students.

The regulation in question was recommended by the Institute of Medicine, a government funded element of the National Academy of Sciences that HHS hired last year to come up with recommendations for “preventive services” to be mandated under Obamacare.

“The committee recommends for consideration as a preventive service for women: the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity,” the IOM said in its report on the matter issued last July.

HHS adopted verbatim the recommendation of the IOM committee it hired to develop the recommendation.

The committee said women of “reproductive capacity” included those as young as 15 years of age.

“A wide array of safe and highly effective FDA-approved methods of contraception is available, including barrier methods, hormonal methods, emergency contraception, and implanted devices; sterilization is also available for women and for men,” the IOM said in explaining its mandate recommendation.

“This range of methods provides options for women depending upon their life stage, sexual practices, and health status,” said the IOM report. “Some methods, such as condoms, spermicides, and emergency contraceptives, are available without a prescription, whereas the more effective hormonal and long-acting reversible methods, such as oral contraceptives and intrauterine devices, are available by prescription or require insertion by a medical professional.

“Sterilization,” the IOM report said, “is a surgical procedure.”

In explaining the prevalence of contraception and sterilization in the United States, the IOM’s report on its recommendations cited a government study entitled, “The Use of Contraception in the United States: 1982 to 2008,” that was published by HHS’s Centers for Disease Control and Prevention in 2010.

The study said that 16.7 percent of American women between the ages of 15 and 44 have been sterilized. This includes 4.5 percent of American women ages 15 to 44 who have never been married.

Although surgical sterilization is less common among college-age women than older women, it does occur—even in the pre-Obamacare era when the federal government did not guarantee college-age women they could be sterilized for free.

According to this CDC report, among women ages 20-24, who are using contraception, 2.4 percent have been sterilized. Among those aged 25-29, who are using contraception, 15.0 percent have been sterilized.

The IOM report that HHS relied on in developing its mandate noted that the “most cost-effective” methods of contraception “were longer-acting contraceptives that do not rely on user compliance.” However, one problem the committee noted with these methods is that they have “high up-front costs.”

By requiring employers, colleges and insurers to fully subsidize the cost of these “preventive services,” the new HHS mandate effectively gets rid of the “high up-front costs” for devices and drugs implanted in women to render them infertile over long periods of time as wells as for sterilization surgery that can make them permanently infertile.

“In a study of the cost-effectiveness of specific contraceptive methods, all contraceptive methods were found to be more cost-effective than no method, and the most cost-effective methods were long-acting contraceptives that do not rely on user compliance,” said the IOM report on its mandate recommendations.

“The most common contraceptive methods used in the United States are the oral contraceptive pill and female sterilization,” said the report. “It is thought that greater use of long-acting, reversible contraceptive methods—including intrauterine devices and contraceptive implants that require less action by the woman and therefore have lower use failure rates—might help further reduce unintended pregnancy rates. Cost barriers to use of the most effective contraceptive methods are important because long-acting, reversible contraceptive methods and sterilization have high up-front costs.”

Appearing before the House Energy and Commerce Committee earlier this month, HHS Secretary Kathleen Sebelius argued that forcing the insurers covering employees of religious institutions that object to the mandate to provide sterilizations and contraceptives for free would save money because the number of human beings born would decrease.

“The reduction in the number of pregnancies compensates for the cost of contraception,” she said.

In a press release put out late Friday, Sebelius said: “The president’s policy respects religious liberty and makes free preventive services available to women. Today’s announcement is the next step toward fulfilling that commitment.”

GOP senators fail to reverse birth control rule

WASHINGTON (AP) - In an election year battle mixing birth control, religion and politics, Democrats narrowly blocked an effort by Senate Republicans to overturn President Barack Obama's order that most employers or their insurers cover the cost of contraceptives.

The 51-48 vote on Thursday killed a measure that would have allowed employers and insurers to opt out of portions of the president's health care law they found morally objectionable. That would have included the law's requirement to cover the costs of birth control.

Sen. Olympia Snowe, who this week dropped her re-election bid and cited frustration with the polarized Congress, cast the lone Republican vote to block the measure. Two Democrats up for re-election and one who is retiring voted against Obama's requirement.

Majority Democrats said the legislation would have allowed employers and insurers to avoid virtually any medical treatment with the mere mention of a moral or religious objection.

"We have never had a conscience clause for insurance companies," said Sen. Barbara Boxer, D-Calif. Insurers, she said, don't need an invitation to deny coverage for medical treatment. "A lot of them don't have any consciences. They'll take it."

Republicans argued that the requirement under the health care overhaul violates the First Amendment's guarantee of religious freedom by forcing insurers and employers to pay for contraception for workers even if the employers' faith forbids its use. Roman Catholic leaders have strongly opposed the requirement.

The Senate vote aside, the debate "won't be over until the administration figures out how to accommodate people's religious views as it relates to these mandates," said the measure's sponsor, Sen. Roy Blunt, R-Mo. "This is a debate that might be settled at that building across the street," he said, referring to the Supreme Court.

Such cultural issues have been prominent in this presidential election year, with Republican presidential candidates casting Obama's health care law as government overreach into the most personal types of medical decisions. The contraception policy in particular touches on religious and women's rights important to the activists at the core of each party.

A majority of Americans support the use of contraceptives. The public is generally in favor of requiring birth control coverage for employees of religiously affiliated employers, according to a CBS News/New York Times poll Feb. 8-13. The survey found that 61 percent favor the mandate, while 31 percent oppose it. Catholics support the requirement at about the same rate as all Americans.

The legislative fight came after the controversy had already forced the White House to budge somewhat. The administration initially ruled that religious-affiliated institutions such as hospitals and universities must include free birth control coverage in their employee health plans. As protests mounted from Catholic leaders and many Republicans, Obama announced an adjustment: Religious employers could opt out, but insurance companies must then pay for the birth control coverage.

Defending the White House stand on Thursday, Vice President Joe Biden also gave voice to the way it came together.

Said Biden: "It got screwed up in the first iteration."

Republicans say it's still not fixed since many employers pay insurers to cover their workers and in effect underwrite the contraception coverage.

GOP senators insisted on attaching Blunt's amendment to an unrelated transportation bill. Democrats cast the move as just one of a number of attempts by the GOP to roll back long-established women's rights.

Both sides protested strenuously that an issue affecting millions of Americans was being used for political gain. But in reality, virtually the entire four-day discussion in the Senate was about election-year strategy. With the presidency and congressional majorities at stake, both sides used the issue to rally their bases of support.

Republicans sought to hold together conservatives and others in the midst of their party's unsettled battle for the presidential nomination. And for Obama, there is no constituency more crucial to his re-election chances than women.

In the end, the vote hung on a handful of centrists as Democrats chose a parliamentary maneuver that required only 50 votes to kill the amendment.

Snowe, R-Maine, had said the GOP amendment was written too broadly for her to support. Democrats voting in favor of the measure were Joe Manchin of West Virginia and Bob Casey of Pennsylvania, both up for re-election, and Ben Nelson of Nebraska, who is retiring.

Democrats saw broader symbolism in Snowe's decisions. "If Republicans keep this up, they're going to drive away independent voters, women and men, just as they are driving moderates out of their caucuses," said Sen. Chuck Schumer of New York.

But Republicans kept one such lawmaker in the fold on the vote, Snowe's fellow senator from Maine. Susan Collins kept all sides on edge until minutes before the vote, saying on the Senate floor that she was troubled that the administration could not assure her that faith-based self-insured organizations would be protected from the mandate to cover contraception.

"I feel that I have to vote for Senator Blunt's amendment," she said.

On the presidential campaign trail, GOP front-runner Mitt Romney apparently stumbled over a question of whether he supported the amendment, in the end saying that he did, "of course." His main challenger, former Pennsylvania Sen. Rick Santorum, has said that contraception conflicts with his Roman Catholic beliefs.

The Obama administration and congressional Democrats said Blunt's measure was so broad it could allow employers to opt out of virtually any kind of medical treatment.

"This proposal isn't limited to contraception, nor is it limited to any preventive service. Any employer could restrict access to any service they say they object to," said Secretary of Health and Human Resources Kathleen Sebelius. "The Obama administration believes that decisions about medical care should be made by a woman and her doctor, not a woman and her boss."