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Religious Exemption To HHS Preventive Services Rule Draws Fire

Religious Exemption To HHS Preventive Services Rule Draws Fire

August 2, 2011 — HHS' proposed amendment to health care regulations that would allow religious employers to opt out of requirements for covering contraceptive services with no additional copayments is attracting criticism from women's health advocates, as well as conservative and religious groups, CQ HealthBeat reports. HHS proposed the amendment while announcing that it would adopt an Institute of Medicine panel's recommendations regarding a slate of women's preventive health services that health plans must cover under the federal health reform law (PL 111-148) (Adams, CQ HealthBeat, 8/1).

The health reform law requires health plans that start on or after Aug. 1, 2012, to cover certain preventive health services without copayments, co-insurance or deductibles. HHS on Monday said the covered services for women will include contraception -- as the IOM panel recommended -- but it proposed an amendment to previously issued regulations that permit religious entities offering their own health plans to choose whether to cover contraceptive services. Besides contraception, the covered preventive services for women will include domestic violence screening and counseling services, advanced screenings for cervical cancer and human papillomavirus for women ages 30 and older, counseling for sexually transmitted infections and HIV, screening for gestational diabetes for pregnant women, comprehensive coverage of breastfeeding equipment and support, and at least one annual preventive health exam.

The religious exemption applies to not-for-profit groups that have the inculcation of religious values as their purpose, primarily employ individuals who hold certain religious beliefs and primarily serve a population with those religious tenets, according to HHS. The agency said the "regulation is modeled on the most common accommodation for churches available in the majority of the 28 states that already require insurance companies to cover contraception." HHS is accepting comments on the proposed amendment (Women's Health Policy Report, 8/1).

Reaction From Women's Advocates

While women's health advocates praised the overall regulations on preventive services, they criticized HHS for allowing religious employers to not offer contraceptive coverage. Rep. Lois Capps (D-Calif.), who praised the overall requirements, said, "Science should apply to all women, regardless of where she works." The Center for Reproductive Rights and Catholics for Choice also expressed opposition to the exemption and likely will submit comments to HHS criticizing it (Ethridge, CQ Today, 8/1).

Debra Ness, president of the National Partnership for Women & Families, said the amendment "was not recommended by the IOM committee." She added, "Every employer should be required to provide coverage for this basic preventive care, which is essential to women's health. Allowing some employers to refuse to do so would create barriers that, for some women, may prove insurmountable" (Adams, CQ HealthBeat, 8/1).

Judy Waxman, vice president for health and reproductive rights at the National Women's Law Center, said the federal health reform law did not allow the administration to include an exemption. "We don't think there's any authority in the law to have a conscience clause," she said, adding, "It's unfortunate that the administration is considering this proposal to allow some employers to deny this coverage to women."

Conservative Opposition

Meanwhile, right-wing groups criticized the proposed exemption as too narrow. American United for Life staff counsel Anna Franzonello said it "leaves many pro-life Americans high and dry" and would require some employers who do not qualify under the definition of "religious employer" to provide benefits for services they oppose (Feder, Politico, 8/1).

Sister Mary Ann Walsh of the U.S. Conference of Catholic Bishops said "most Catholic social service agencies and health care providers" would not qualify for the exemption (Aizenman, Washington Post, 8/1).

Jeanne Monahan, director of the Family Research Council's Center for Human Dignity, said the exemption "offered a fig leaf of conscience protection for certain churches that fulfill very specific criteria. However, religious groups that provide social services, engage in missions work to people of different religious faiths, religious health insurance companies, let alone religious health care providers and individuals in such health plans are not protected from any discrimination whatsoever."

Janice Shaw Crouse, senior fellow at Concerned Women for America, said she does not support the rule overall, but has "guarded praise" for the conscience clause exemption. However, she asked, "Why not have others opt in?" adding, "It's always people with deeply held religious or philosophical beliefs who have to opt out. ... It's an inconvenience and burden that should not be there" (Adams, CQ HealthBeat, 8/1).