U.S. House of Representatives Energy and Commerce Sub-Committee on Health
Do New Health Care Mandates Threaten Conscience Rights and Access to
Care?
2 November, 2011
Testimony of David L. Stevens, MD, MA (Ethics)
CEO, Christian Medical Association
Sub-Committee Hearing
Summary of arguments
1. The potential "religious exemption" in the
contraception mandate--exempting only a nano-sector of "religious employers"
from the guidelines--is meaningless to conscientiously objecting health care
professionals, insurers and patients.
2. The contraception mandate can potentially trigger a decrease
in access to health care by patients in medically underserved
regions and populations.
3. The contraception mandate further contributes to an
increasingly hostile environment in which medical students,
residents and graduate physicians face discrimination, job loss and
ostracism for holding pro-life views on abortion, controversial
contraceptives and other ethical issues.
4. The contraception mandate creates a climate of coercion
that can prompt pro-life health care professionals to limit the scope of
their medical practice and can discourage pro-life medical students and
residents from choosing careers in Family Medicine, Obstetrics and
Gynecology and other specialties likely to involve conflicts of conscience.
5. The contraception mandate can potentially cause a decrease in
the provision of health insurance for employees of pro-life health
care employers who want to avoid conflicts of conscience regarding the
subsidy and implied endorsement of controversial contraceptives.
David Stevens, MD Christian Medical Association Page 2 of 8
Testimony
Mr. Chairman, I am testifying on behalf of the over 16,000 members of the
Christian Medical Association, a professional membership organization that
helps healthcare professionals to integrate their faith and profession and
to care for patients according to longstanding ethical and moral principles.
I am a Diplomate of the American Board of Family Medicine and hold a
master's degree in bioethics.
Our members include physicians who hold a range of conscience convictions
on controversial ethical and moral issues including contraception, health
care reform, participation in the death penalty, and other conscience issues
that span the left-right political spectrum.
- Virtually all medical professionals and student members we recently
surveyedi say it is "important to
personally have the freedom to practice health care in accordance with
the dictates of [his or her] conscience."
- Even more specific to our topic today, over nine of ten say they
"would not prescribe FDA-approved contraceptives that might cause the
death of a developing human embryo."
The principle of physicians practicing professional judgment regarding
both medical options and ethical standards is neither novel nor new; in
fact, it has guided the practice of medicine for millennia.
Many physicians today conscientiously profess allegiance to
life-affirming ethical standards such as the Hippocratic oath, which was
first adopted over two millennia ago to protect the interests of patients
and establish objective professional standards. It is especially important
today for pro-life patients to retain the freedom to choose physicians whose
professional judgments reflect the patient's own life-affirming values.
[Page 3 of 8] The HHS interim final
regulations would force insurance plans nationwide to cover "all Food and
Drug Administration approved contraceptive methods, sterilization
procedures, and patient education and counseling for all women with
reproductive capacity."
The contraception mandate does not exempt controversial drugs such as
Ella and the "morning-after pill," which according to the FDA have
post-fertilization effects that "may inhibit implantation" of a living human
embryo. That is an issue of weighty moral concern for many pro-life and
faith-based health care professionals, individuals and groups.
The potential "religious exemption" in the contraception
mandate--exempting only a nano-sector of "religious employers" from the
guidelines--is meaningless to conscientiously objecting health care
professionals, insurers and patients.
The HHS rule implementing provisions of the Patient Protection and
Affordable Care Act fits a pattern of this administration's extremely narrow
and limiting view of conscience rights. The HHS rule has the potential to
negatively impact patients and health care professionals in the following
ways:
- 1. The contraception mandate can potentially
trigger a decrease in access to health care by patients in
medically underserved regions and populations.
- The New York Timesii
reports that "Health policy experts have long expressed concern about a
shortage of primary care doctors, including family physicians and
internists. The shortage, they say, could become more serious if, as
President Obama hopes, more than 30 million people gain insurance coverage
under the health care law passed last year."
- [Page 4 of 8] Ironically, the administration's own policies on the exercise of conscience in
health care, including the gutting of the only federal conscience-protecting
regulation, actually threaten to worsen the physician shortage.
- A national surveyiii of over 2,100 faith-based physicians
revealed that over nine of ten are prepared to leave medicine if pressured to
compromise their ethical and moral commitments.
- The recent survey of our members revealed that 85 percent of medical
professionals and students said that "policies that restrict the exercise of
conscience in health care" make it less likely that they will "practice health
care in the future."
2. The contraception mandate further
contributes to an increasingly hostile environment in which
medical students, residents and graduate physicians face discrimination, job
loss and ostracism for holding pro-life views on abortion, controversial
contraceptives and other ethical issues. This administration's gutting of
the only conscience-protecting federal regulation only serves to reinforce
such intolerance.
3. The contraception mandate creates a
climate of coercion that can prompt pro-life health care
professionals to limit the scope of their medical practice and can
discourage pro-life medical students and residents from choosing careers in
Family Medicine, Obstetrics and Gynecology and other specialties likely to
involve conflicts of conscience.
-
[Page 5 of 8]Over half
of the medical professionals and students we surveyed said the "new
contraception mandate might cause [them] to restrict [their] practice of
medicine."
-
One out of five faith-based medical students
surveyed say they will not go into an Ob-Gyn specialty because of
abortion-related pressures.
4. The contraception mandate can potentially
cause a decrease in the provision of health insurance for employees
of pro-life health care employers who want to avoid conflicts of conscience
regarding the subsidy and implied endorsement of controversial
contraceptives.
The contraceptive mandate rule sweepingly tramples conscience rights,
which have not only provided a foundation for American civil liberties but
also a foundation for the ethical and professional practice of medicine.
The administration should rescind this mandate entirely, for the ethical
and practical reasons I have noted that especially impact faith-based and
pro-life health care professionals and patients. The rule should also be
rescinded for the constitutional and statutory reasons outlined in our
official comment letter of September 29 to HHS, which I am submitting
separately and ask to be included in the record.
We encourage Members of Congress to uphold conscience rights by passing
the Respect for Rights of Conscience Act, which will ensure that
"health care stakeholders retain the right to provide,
purchase, or enroll in health coverage that is consistent with their
religious beliefs and moral convictions, without fear of being penalized or
[Page 6 of 8] discriminated against … and to
ensure that no requirement in [the new health care law] creates new
pressures to exclude those exercising such conscientious objection from
health plans or other programs…."
Upholding a respect for conscience and our First Amendment freedoms
protects all Americans: conservatives and liberals, capitalists and
socialists, atheists and people of faith.
Thank you for your consideration of these views.
David Stevens, MD
Christian Medical Association
Addendum
[Page 7 of 8]
September 29, 2011 - Submitted Electronically
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attn: CMS-9992-IFC2
PO Box 8010
Baltimore, Maryland 21244-8010
Re: Interim Final Rule on Preventive Services. File Code CMS-9992-IFC2.
Dear Sir or Madam:
I am writing on behalf of the 16,000 members of the Christian Medical
Association, a professional membership organization that helps healthcare
professionals to integrate their faith and profession and to care for
patients according to longstanding ethical and moral principles.
We offer comments on the amendments to the interim final regulations (76
Fed. Reg. 46621 (Aug. 3, 2011)) regarding mandatory coverage nationwide of
certain preventive health services under provisions of the Patient
Protection and Affordable Care Act.
Key components of the mandate that especially impact faith-based health
care include the following:
- The new rule would force insurance plans to cover "all Food and Drug
Administration approved contraceptive methods, sterilization procedures,
and patient education and counseling for all women with reproductive
capacity."
- The Amended Regulations only consider for potential exemption a
"religious employer" to be one that "(1) Has the inculcation of
religious values as its purpose; (2) primarily employs persons who share
its religious tenets; (3) primarily serves persons who share its
religious tenets; and (4) is a non-profit organization under section
6033(a)(1) and section 6033(a)(3)(A)(i) or (iii) of the [Internal
Revenue Code]." Conscientiously objecting individuals and
religiously affiliated health insurers are not exempted.
- The new rule does not exempt drugs that according to the FDA have
post-fertilization effects that "may inhibit implantation" of a living
human embryo--an issue of weighty moral concern for many faith-based
health care professionals, individuals and groups.
The administration should rescind this mandate entirely, for the
following reasons:
1. Pregnancy is not a disease to be prevented;
therefore, mandating contraceptives has no place in preventive disease
policies.
2. The federal mandate imposes a radical ideological
stance--unprecedented in and inconsistent with federal law--regarding
conscience, contraception and abortion, on the vast majority of states that
have taken a far less coercive and far more balanced approach.
3. [Page 8 of 8]The
mandate violates the Constitution, federal law and the administration's
stated policies:
a. The mandate violates the religion and free speech
clauses of the First Amendment of the Constitution, by coercing faith-based
health care ministries to not only violate the very faith-based tenets that
have motivated patient care for millennia, but also to pay for that
violation.
b. The mandate violates the Weldon amendment, passed
every year by Congress since 2004.
c. The mandate violates the abortion and
non-preemption provisions of the Patient Protection and Affordable Care Act
(PPACA).
d. The mandate violates the Administration's own
public assurances that PPACA would not be construed to require coverage of
abortion; it also violates the related presidential Executive Order to
secure passage of the Act.
4. The potential "religious exemption" is
meaningless:
a. The preamble to the Amended Regulations offers no
actual exemption but merely allows "additional discretion" to exempt a
nano-sector of "religious employers" from the guidelines regarding
contraception.
b. The potential exemption provides no protection to
conscientiously objecting individuals or insurers.
c. The narrow potential exemption is far more
restrictive than any other genuine religious exemption in federal health
care law.
d. HHS is not constitutionally empowered--especially
absent a compelling state interest--to simply make up its own definition of
religious ministry.
5. Such conscience-violating mandates will ultimately
reduce patients' access to faith-based medical care, especially depriving
the poor and medically underserved populations of such care. A national
survey (available at www.Freedom2Care.org) of over 2,100 faith-based
physicians revealed that over nine of ten are prepared to leave medicine if
pressured to compromise their ethical and moral commitments.
Thank you for your consideration of these views.
Sincerely,
David Stevens, MD, MA (Ethics)
CEO
Notes
i. Christian Medical Association online
survey of membership conducted Oct. 24-29, 2011, N=1,177.
ii. New York Times, "Administration Halts
Survey of Making Doctor Visits, June 28, 2011.
iii. Available online at
https://www.freedom2care.org/learn/page/polls-april-2009.