Justification by the Obama Administration for "contraceptive mandate"[Full
text]
Introduction:
The Obama administration has decided that, as a matter of public
policy, individual women should not have to pay for
"FDA approved
contraceptive services," which include surgical sterilization,
contraceptives and embryocides.
The reasons offered
for this policy are mainly economic and socio-political.
Note:
Contrary to an administration statement
on 10 February, 2012, the
regulation has not
been changed to accommodate objecting religious believers. The
wording and legal effect of the regulation remains exactly as it was
when it was
announced on 20 January, 2012.
Since sterilization and birth control have to be paid for by
someone, the administration intends to force others to pay for them
through insurance plans, even if they object to doing so for reasons
of conscience or religion. The
U.S. Department of Health and
Human Services enacted a
regulation for this purpose.
This is an annotated version of
the administration's justification for the regulation. Key terms are highlighted, links have been added for the convenience
of readers, and annotations are provided in text boxes to the right.
- Administrator
DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Part 54
TD 9578
RIN 1545-BJ60
DEPARTMENT OF LABOR
Employee Benefits Security Administration
29 CFR Part 2590
RIN 1210-AB44
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CMS-9992-F
45 CFR Part 147
RIN 0938-AQ74
Group Health Plans and Health Insurance Issuers Relating to Coverage
of Preventive Services Under the Patient Protection and Affordable Care
Act
AGENCIES:
Internal Revenue Service, Department of the Treasury;
Employee Benefits Security Administration, Department of Labor; Centers
for Medicare & Medicaid Services, Department of Health and Human
Services.
ACTION:
Final rules.
SUMMARY:
These regulations finalize, without change,
interim final regulations authorizing the exemption of group
health plans and group health insurance coverage sponsored by certain
religious employers from having to cover certain preventive health
services under provisions of the Patient Protection and Affordable Care
Act.
****
SUPPLEMENTARY INFORMATION:
I. Background
The Patient Protection and Affordable Care Act, Pub. L. 111-148, was enacted
on March
23, 2010; the Health Care and Education Reconciliation Act of 2010, Pub. L.
111-152, was
enacted on March 30, 2010 (collectively, the Affordable Care Act). The
Affordable Care Act
reorganizes, amends, and adds to the provisions of part A of title XXVII of the
Public Health
Service Act (PHS Act) relating to group health plans and health insurance
issuers in the group
and individual markets. The Affordable Care Act adds section 715(a)(1) to the
Employee
Retirement Income Security Act (ERISA) and section 9815(a)(1) to the Internal
Revenue Code
(Code) to incorporate the provisions of part A of title XXVII of the PHS Act
into ERISA and the
Code, and make them applicable to group health plans.
Section 2713 of the PHS Act, as added by the Affordable Care Act and
incorporated into
ERISA and the Code, requires that non-grandfathered group health plans and
health insurance
issuers offering group or individual health insurance coverage provide benefits
for certain
preventive health services without the imposition of cost sharing. 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 (HRSA Guidelines).1 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. Except as
discussed below, non-grandfathered group health plans and health insurance
issuers are required
to provide coverage consistent with the HRSA Guidelines, without cost sharing,
in plan years
(or, in the individual market, policy years) beginning on or after August 1,
2012.2 These
guidelines were based on recommendations of the independent Institute of
Medicine, which
undertook a review of the evidence on women's preventive services.
The Departments of Health and Human Services, Labor, and the Treasury (the
Departments) published interim final regulations implementing PHS Act section
2713 on July
19, 2010 (75 FR 41726). In the preamble to the interim final regulations, the
Departments
explained that HRSA was developing guidelines related to preventive care and
screening for
women that would be covered without cost sharing pursuant to PHS Act section
2713(a)(4), and
that these guidelines were expected to be issued no later than August 1, 2011.
Although
comments on the anticipated guidelines were not requested in the interim final
regulations, the
Departments received considerable feedback regarding which preventive services
for women
should be covered without cost sharing. Some commenters, including some
religiously-affiliated
employers, recommended that these guidelines include contraceptive services
among the
recommended women's preventive services and that the attendant coverage
requirement apply to
all group health plans and health insurance issuers. Other commenters, however,
recommended
that group health plans sponsored by religiously-affiliated employers be allowed
to exclude
contraceptive services from coverage under their plans if the employers deem
such services
contrary to their religious tenets, noting that some group health plans
sponsored by organizations
with a religious objection to contraceptives currently contain such exclusions
for that reason.
In response to these comments, the Departments amended the interim final
regulations to
provide HRSA with discretion to establish an exemption for group health plans
established or
maintained by certain religious employers (and any group health insurance
coverage provided in
connection with such plans) with respect to any requirement to cover
contraceptive services that
they would otherwise be required to cover without cost sharing consistent with
the HRSA
Guidelines. The amended interim final regulations were issued and effective on
August 1,2011.3
Many religious denominations consider this 'exemption'
to be worthless.
Confirmation
by Secretary Sebelius on 20 January, 2012, that the exemption would not
be revised resulted in a widespread revolt by religious leaders across the
United States. In response, on 10 February,the Obama administration
announced that the concerns of the religious
groups would be accommodated. However, the text of the
regulation was promulgated five days later
without change. The administration has promised not to enforce it for a
year while it attempts to find a compromise.
The amended interim final regulations specified that, for purposes of this
exemption, a
religious employer is 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 described in section
6033(a)(1) and
section 6033(a)(3)(A)(i) or (iii) of the Code. Section 6033(a)(3)(A)(i) and
(iii) of the Code refers
to churches, their integrated auxiliaries, and conventions or associations of
churches, as well as
to the exclusively religious activities of any religious order.
In the HRSA
Guidelines, HRSA
exercised its discretion under the amended interim final regulations such that
group health plans
established and maintained by these religious employers (and any group health
insurance
coverage provided in connection with such plans) are not required to cover
contraceptive
services.
In the preamble to the amended interim final regulations, the Departments
explained that
it was appropriate that HRSA take into account the religious beliefs of certain
religious
employers where coverage of contraceptive services is concerned. The Departments
noted that a
religious exemption is consistent with the policies in some States that
currently both require
contraceptive services coverage under State law and provide for some type of
religious
exemption from their contraceptive services coverage requirement. Comments were
requested
on the amended interim final regulations, specifically with respect to the
definition of religious
employer, as well as alternative definitions.
II. Overview of the Public Comments on the Amended Interim Final Regulations
The Departments received over 200,000 responses to the request for comments
on the
amended interim final regulations. Commenters included concerned citizens, civil
rights
organizations, consumer groups, health care providers, health insurance issuers,
sponsors of
group health plans, religiously-affiliated charities, religiously-affiliated
educational institutions,
religiously-affiliated health care organizations, other religiously-affiliated
organizations, secular
organizations, sponsors of group health plans, women's religious orders, and
women's rights
organizations.
Some commenters recommended that the exemption for the group health plans of
a
limited group of religious organizations as formulated in the amended interim
final regulations
be maintained. Other commenters urged that the definition of religious employer
be broadened
so that more sponsors of group health plans would qualify for the exemption.
Others urged that
the exemption be rescinded in its entirety. The Departments summarize below the
major issues
raised in the comments that were received.
Some commenters supported the inclusion of contraceptive services in the HRSA
Guidelines and urged that the religious employer exemption be rescinded in its
entirety due to
the importance of extending these benefits to as many women as possible. For
example, one
provider association commented that all group health plans and group health
insurance issuers
should offer the same benefits to plan participants, without a religious
exemption for some plans,
and that religious beliefs are more appropriately taken into account by
individuals when making
personal health care decisions. Others urged that the exemption be eliminated
because making
contraceptive services available to all women would satisfy a basic health care
need and would
significantly reduce long-term health care costs associated with unplanned
pregnancies.
Some of the commenters supporting the elimination of the exemption argued that
section
2713 of the PHS Act does not provide any explicit basis for exempting a subset
of group health
plans. One commenter asserted that Congress's incorporation of section 2713 of
the PHS Act
into ERISA and the Code indicates its intent to require coverage of recommended
preventive
services under section 2713 of the PHS Act in the broadest spectrum of group
health plans
possible.
Many commenters that opposed the exemption asked that, at a minimum, the
Departments not expand the definition of religious employer. Alternatively, they
asked that, if
the Departments decided to base the relevant portion of the definition of
religious employer on a
Code section other than section 6033, the other portions of the definition of
religious employer
be retained to limit the exemption largely to houses of worship.
Some commenters urged the Departments not to modify the definition of
religious
employer. For example, some commenters asserted that the exemption is
appropriately targeted
at houses of worship, rather than a larger set of religiously-affiliated
organizations. Others
argued that, while the exemption addresses legitimate religious concerns, its
scope is already
broader than necessary and should not be expanded.
Commenters opposing any exemption stated that, if the exemption were to be
retained,
clear notice should be provided to the affected plan participants that their
group health plans do
not include benefits for contraceptive services. In addition, they urged the
Departments to
monitor plans to ensure that the exemption is not claimed more broadly than
permitted.
On the other hand, a number of comments asserted that the religious employer
exemption
is too narrow. These commenters included some religiously-affiliated educational
institutions,
health care organizations, and charities. Some of these commenters expressed
concern that the
exemption for religious employers will not allow them to continue their current
exclusion of
contraceptive services from coverage under their group health plans. Others
expressed concerns
about paying for such services and stated that doing so would be contrary to
their religious
beliefs.
Commenters also claimed that Federal laws, including the Affordable Care Act,
have
provided for conscience clauses and religious exemptions broader than that
provided for in the
amended interim final regulations. Some commenters asserted that the narrower
scope of the
exemption raises concerns under the First Amendment and the Religious Freedom
Restoration
Act.
Other commenters, however, disputed claims that the contraceptive coverage
requirement
infringes on rights protected by the First Amendment or the Religious Freedom
Restoration Act.
These commenters noted that the requirement is neutral and generally applicable.
They also
explained that the requirement does not substantially burden religious exercise
and, in any event,
serves compelling governmental interests and is the least restrictive means to
achieve those
interests.
Some religiously-affiliated employers warned that, if the definition of
religious employer
is not broadened, they could cease to offer health coverage to their employees
in order to avoid
having to offer coverage to which they object on religious grounds.
Commenters supporting a broadening of the definition of religious employer
proposed a
number of options, generally intended to expand the scope of the exemption to
include
religiously-affiliated educational institutions, health care organizations, and
charities. In some
instances, in place of the definition that was adopted in the amended interim
final regulations,
commenters suggested other State insurance law definitions of religious
employer. In other
instances, commenters referenced alternative standards, such as tying the
exemption to the
definition of "church plan" under section 414(e) of the Code or to status as a
nonprofit
organization under section 501(c)(3) of the Code.
III. Overview of the Final Regulations
In response to these comments, the Departments carefully considered whether
to
eliminate the religious employer exemption or to adopt an alternative definition
of religious
employer, including whether the exemption should be extended to a broader set of
religiouslyaffiliated
sponsors of group health plans and group health insurance
This is the one year period
announced by Secretary Sebelius on 20
January, 2012, to give religious employers time to adjust to the new
rules. The law is in effect, but will not be enforced during that
time.
coverage.
For the
reasons
discussed below, the Departments are adopting the definition in the amended
interim final
regulations for purposes of these final regulations while also creating a
temporary enforcement
safe harbor, discussed below. During the temporary enforcement safe harbor, the
Departments
plan to develop and propose changes to these final regulations that would meet
two goals -
providing contraceptive coverage without cost-sharing to individuals who want it
and
accommodating non-exempted, non-profit organizations' religious objections to
covering
contraceptive services as also discussed below.PHS Act section 2713 reflects a determination by Congress that coverage of
recommended preventive services by non-grandfathered group health plans and
health insurance
issuers without cost sharing is necessary to achieve basic health care coverage
for more
Americans. Individuals are more likely to use preventive services if they do not
have to satisfy
cost sharing requirements (such as a copayment, coinsurance, or a deductible).
Use of
preventive services results in a healthier population and reduces health care
costs by helping
individuals avoid preventable conditions and receive treatment earlier.4
Further, Congress, by
amending the Affordable Care Act during the Senate debate to ensure that
recommended
preventive services for women are covered adequately by non-grandfathered group
health plans and group health insurance coverage, recognized that women have
unique health care needs and
burdens. Such needs include contraceptive services.5
As documented in a report of the Institute of Medicine, "Clinical Preventive
Services for
Women, Closing the Gaps," women experiencing an unintended pregnancy may not
immediately
be aware that they are pregnant, and thus delay prenatal care. They also may not
be as motivated
to discontinue behaviors that pose pregnancy-related risks (e.g., smoking,
consumption of
alcohol). Studies show a greater risk of preterm birth and low birth weight
among unintended
pregnancies compared with pregnancies that were planned.6 Contraceptives also
have medical
benefits for women who are contraindicated for pregnancy, and there are
demonstrated
preventive health benefits from contraceptives relating to conditions other than
pregnancy (e.g.,
treatment of menstrual disorders, acne, and pelvic pain).7
Reasons offered to support regulation
Health Benefits:
1) Preventing pregnancy when it is contraindictated.
2) Treating disorders using hormonal contraceptives.a
Economic Benefits
1) Savings to employers due to pregnancy-related absence and reduced
productivity.
2) Women become healthy and productive workers.
3) Eliminating economic disparity between men and women.
In addition, there are significant cost savings to employers from the
coverage of
contraceptives. A 2000 study estimated that it would cost employers 15 to17
percent more not to
provide contraceptive coverage in employee health plans than to provide such
coverage, after
accounting for both the direct medical costs of pregnancy and the indirect costs
such as
employee absence and reduced productivity.
8 In fact, when contraceptive coverage
was added to the Federal Employees Health Benefits Program, premiums did not
increase because there was
no resulting health care cost increase.
9 Further, the cost savings of covering
contraceptive
services have already been recognized by States and also within the health
insurance industry.
Twenty-eight States now have laws requiring health insurance issuers to cover
contraceptives. A
2002 study found that more than 89 percent of insured plans cover
contraceptives.
10 A 2010
survey of employers revealed that 85 percent of large employers and 62 percent
of small
employers offered coverage of FDA-approved contraceptives.
11Furthermore, in directing non-grandfathered group health plans and health
insurance
issuers to cover preventive services and screenings for women described in
HRSA-supported
guidelines without cost sharing, Congress determined that both existing health
coverage and
existing preventive services recommendations often did not adequately serve the
unique health
needs of women. This disparity places women in the workforce at a disadvantage
compared to
their male co-workers. Researchers have shown that access to contraception
improves the social
and economic status of women.12 Contraceptive coverage, by reducing the number
of
unintended and potentially unhealthy pregnancies, furthers the goal of
eliminating this disparity
by allowing women to achieve equal status as healthy and productive members of
the job force.
Research also shows that cost sharing can be a significant barrier to
effective contraception.13 As
the Institute of Medicine noted, owing to reproductive and sex-specific
conditions, women use
preventive services more than men, generating significant out-of-pocket expenses
for women.14
The Departments aim to reduce these disparities by providing women broad access
to preventive
services, including contraceptive services.
The religious employer exemption in the final regulations does not undermine
the overall
benefits described above. A group health plan (and health insurance coverage
provided in
connection with such a plan) qualifies for the exemption if, among other
qualifications, the plan
is established and maintained by an employer that primarily employs persons who
share the
religious tenets of the organization. As such, the employees of employers
availing themselves of
the exemption would be less likely to use contraceptives even if contraceptives
were covered
under their health plans.
A broader exemption, as urged by some commenters, would lead to more
employees
having to pay out of pocket for contraceptive services, thus making it less
likely that they would
use contraceptives, which would undermine the benefits described above.
Employers that do not
primarily employ employees who share the religious tenets of the organization
are more likely to
employ individuals who have no religious objection to the use of contraceptive
services and
therefore are more likely to use contraceptives.
This is
like saying that employers who refuse to pay for or subsidize employee
political party memberships are subjecting their employees to their
political views and inhibiting their involvement in political activity
and the benefits that flow from that.
Including these employers
within the scope of
the exemption would subject their employees to the religious views of the
employer,limiting
access to contraceptives,and thereby inhibiting the use of contraceptive
services and the benefits of preventive care.
"Contraceptive services"
as defined include surgical
sterilization, contraceptives, and drugs and devices that may cause the death of
an embryo before implantation (embryocides).
The Departments note that this religious exemption is intended solely for
purposes of the
contraceptive services coverage requirement pursuant to PHS Act section 2713 and
the
companion provisions of ERISA and the Code.
Many routine changes that are made
annually to insurance plans will result in the loss
of grandfathered status.
The Departments also note that some group health plans sponsored by employers
that do
not satisfy the definition of religious employer in these final regulations may
be grandfathered
health plans15 and thus are not subject to any of the preventive services
coverage requirements of
section 2713 of the PHS Act, including the contraceptive coverage requirement.
With respect to certain non-exempted, non-profit organizations with religious
objections
to covering contraceptive services whose group health plans are not
grandfathered health plans,
guidance is being issued contemporaneous with these final regulations that
provides a one-year
safe harbor from enforcement by the Departments.
These are promises that will
not result in final rules until after the November, 2012 presidential
election. However, the promises are considered suspect by those
opposed to the "contraceptive mandate" because President Obama rescinded a protection of
conscience
regulation passed by the previous administration.b His
administration also ignored
warnings that
the "contraceptive mandate" was not the "sensible" conscience clause he
promised to enact. This is now seen by many
as evidence that his administration cannot be trusted on this issue.
Before the end of the temporary enforcement safe harbor, the Departments
will
work with
stakeholders to develop alternative ways of providing contraceptive coverage
without cost
sharing with respect to non-exempted, non-profit religious organizations with
religious
objections to such coverage. Specifically, the Departments
plan to initiate a
rulemaking to
require issuers to offer insurance without contraception coverage to such an
employer (or plan
sponsor) and simultaneously to offer contraceptive coverage directly to the
employer's plan
participants (and their beneficiaries) who desire it, with no cost-sharing. Under this approach,
the Departments
will also require that, in this circumstance, there be no charge
for the
contraceptive coverage. Actuaries and experts have found that coverage of
contraceptives is at
least cost neutral when taking into account all costs and benefits in the health
plan.
16
The Departments intend to develop policies to achieve the same goals for
self-insured group health
plans sponsored by non-exempted, non-profit religious organizations with
religious objections to
contraceptive coverage.
A future rulemaking
would be informed by the existing practices of some
issuers and
religious organizations in the 28 States where contraception coverage
requirements already exist,
including Hawaii. There, State health insurance law requires issuers to offer
plan participants in
group health plans sponsored by religious employers that are exempt from the
State
contraception coverage requirement the option to purchase this coverage in a way
that religious
employers are not obligated to fund it. It is our understanding that, in
practice, rather than
charging employees a separate fee, some issuers in Hawaii offer this coverage to
plan
participants at no charge.
The
end of the temporary enforcement safe harbor is after the presidential
election in November, 2012.
The Departments
will work with stakeholders
to
propose and finalize
this policy before the end of the temporary enforcement safe harbor.
Nothing in these final regulations precludes employers or others from
expressing their
opposition, if any, to the use of contraceptives, requires anyone to use
contraceptives, or requires
health care providers to prescribe contraceptives if doing so is against their
religious beliefs.
These final regulations do not undermine the important protections that exist
under conscience
clauses and other religious exemptions in other areas of Federal law. Conscience
protections
will continue to be respected and strongly enforced.
But see
Colorado Christian University v.
Kathleen Sebelius et al;
Bemont Abbey College v. Kathleen
Sebelius et al;
EWTN v.Kathleen Sebelius et al.
This approach is consistent with the First Amendment
and Religious Freedom
Restoration Act. The Supreme Court has held that the First Amendment right to
free exercise of
religion is not violated by a law that is not specifically targeted at
religiously motivated conduct
and that applies equally to conduct without regard to whether it is
religiously motivated - a socalled neutral law of general applicability. The
contraceptive coverage requirement is generally
applicable and designed to serve
The only public health goal
identified
is the prevention of pregnancy in women for whom it is contra-indicated.
the
compelling public health and gender equity
goals described
above, and is in no way specially targeted at religion or religious practices.
Likewise, this
approach complies with the Religious Freedom Restoration Act, which generally
requires a
federal law to not substantially burden religious exercise, or, if it does
substantially burden
religious exercise, to be the least restrictive means to further a compelling
government interest.
Notes
1. The HRSA Guidelines can be found at:
https://www.hrsa.gov/womensguidelines.
2. The interim final regulations published by the Departments on July 19,
2010, generally provide that plans
and issuers must cover a newly recommended preventive service starting with the
first plan year (or, in the
individual market, policy year) that begins on or after the date that is one
year after the date on which the new
recommendation or guideline is issued. 26 CFR 54.9815-2713T(b)(1); 29 CFR
2590.715-2713(b)(1); 45 CFR
147.130(b)(1).
3. The amendment to the interim final regulations was published on August 3,
2011, at 76 FR 46621.
4. Inst. of Med., Clinical Preventive Services for Women: Closing the Gaps,
Wash., D.C.: Nat'l Acad. Press,
2011, at p.16.
5. Inst. of Med., Clinical Preventive Services for Women: Closing the Gaps,
Wash. D.C.: Nat'l Acad. Press,
2011, at p. 9; see also Sonfield, A.,
The Case for Insurance Coverage of
Contraceptive Services and Supplies
Without Cost Sharing, 14 Guttmacher Pol'y Rev. 10 (2011), available at
h
6. Gipson, J.D., et al., The Effects of Unintended Pregnancy on Infant, Child
and Parental Health: A Review
of the Literature, Studies on Family Planning, 2008, 39(1):18-38.
7. Inst. of Med., Clinical Preventive Services for Women: Closing the Gaps,
Wash., D.C.: Nat'l Acad. Press,
2011, at p.107.
8. Testimony of Guttmacher Inst., submitted to the Comm. on Preventive Servs.
for Women, Inst. of Med.,
Jan. 12, 2012, p.11citing Bonoan, R + Gonen, JS, "Promoting Healthy Pregnancies:
Counseling and Contraception
as the First Step", Washington Business Group on Health, Family Health in Brief,
Issue No. 3. August 2000; see
also Sonfield, A., The Case for Insurance Coverage of Contraceptive Services and
Supplies without Cost Sharing,
14 Guttmacher Pol'y Rev. 10 (2011); Mavranezouli, I., Health Economics of
Contraception, 23Best Practice & Res.
Clinical Obstetrics & Gynaecology 187-198 (2009); Trussell, J., et al., Cost
Effectiveness of Contraceptives in the
United States, 79 Contraception 5-14 (2009); Trussell, J., The Cost of
Unintended Pregnancy in the United States,
75 Contraception 168- 170 (2007).
9. Dailard, C., Special Analysis: The Cost of Contraceptive Insurance
Coverage, Guttmacher Rep. on Public
Pol'y (March 2003).
10. Sonfield, A., et al., U.S. Insurance Coverage of Contraceptives and the
Impact of Contraceptive Coverage
Mandates, Perspectives on Sexual and Reproductive Health 36(2):72-79, 2002.
11. Claxton, G., et al., Employer Health Benefits: 2010 Annual Survey, Menlo
Park, Cal.: Kaiser Family
Found. and Chi., Ill.: Health Research & Educ. Trust, 2010.
12. Testimony of Guttmacher Inst., submitted to the Comm. on Preventive Servs.
for Women, Inst. of Med.,
Jan. 12, 2012, p.6, citing Goldin C and Katz L, Career and marriage in the age
of the pill, American Economic
Review, 2000, 90(2):461-465; Goldin C and Katz LF, The power of the pill: oral
contraceptives and women's
career and marriage decisions, Journal of Political Economy, 2002,
110(4):730-770; and Bailey MJ, More power to
the pill: the impact of contraceptive freedom on women's life cycle labor
supply, Quarterly Journal of Economics,
2006, 121(1):289-320.
13. Postlethwaite, D., et al., A Comparison of Contraceptive Procurement Pre-
and Post-Benefit Change, 76
Contraception 360 (2007).
14. Inst. of Med., Clinical Preventive Services for Women: Closing the Gaps,
Wash., D.C.: Nat'l Acad. Press,
2011, p.19.
15. See section 1251 of the Affordable Care Act and its implementing
regulations at 26 CFR 54.9815-1251T;
29 CFR 2590.715-1251; 45 CFR 147.140.
16. Bertko, John, F.S.A., M.A.A.A., Director of Special Initiatives and
Pricing in the Center for Consumer
Information and Insurance Oversight at the Centers for Medicare and Medicaid
Services, Glied, Sherry, Ph.D.,Assistant Secretary for Planning and Evaluation,
U.S. Department of Health & Human Services (ASPE/HHS),
Miller, Erin, MPH, (ASPE/HHS), Wilson, Lee, (ASPE/HHS), Simmons, Adelle,
(ASPE/HHS),
"The Cost of
Covering Contraceptives through Health Insurance," (9 February 2012), available
at:
Annotation Notes
Provided by the Protection of Conscience Project
a. Note that sterilization, barrier
methods of contraception and intra uterine devices are not used to treat
disorders of the type identified in the commentary, so this benefit
pertains only to drugs typically marketed as hormonal contraceptives.
b. Senator Obama criticized the regulation when
it was proposed in August, 2008, saying that he was "committed to
ensuring that the health and reproductive rights of women are
protected." (Savage, David G.,
"'Conscience' medical rule to take effect." LA Times,
19 December, 2008.) Accessed 2012-0214
When the final regulation was announced in December, 2008, the response
from his transition team "did not specifically address the rule
yesterday, but spokesman Nick Shapiro issued a statement that said Obama
"will review all eleventh-hour regulations and will address them once he
is president." Obama criticized the regulation when it was proposed last
summer. . ." Stein, Rob,
"Rule Shields Health Workers Who Withhold Care Based on Beliefs." Washington
Post, 19 December, 2008. Accessed 2012-02-14