By John M. Haas
In July 2010 the Department of Health and Human Services invited the public to submit commentary on its interim final rule on mandated coverage for preventive services for group health plans and health insurance issuers to be found in the new health care law: the Patient Protection and Affordable Care Act (PPACA). The National Catholic Bioethics Center submitted its comments on September 17 urging the department not to include and of the following in the category of preventive services: contraceptives, drugs or devices causing abortions, surgical sterilizations, or abortions.
Preventive services for women’s health care would certainly include such procedures as screening for cervical cancer or mammograms for breast cancer. Senator Barbara Mikulski had amended the bill to make sure these kinds of services were provided for women.
Her office issued a press release on her position: “Services that would be covered under the Mikulski Amendment are likely to include cervical cancer screenings for a broad group of women; annual mammograms for women under 50; pregnancy and postpartum depression screenings; screenings for domestic violence; and annual women’s health screenings, which would include testing for diseases that are leading causes of death for women such as heart disease and diabetes.” All these interventions are clearly directed toward the prevention of disease, and they are not necessarily covered in all current health plans. PPACA wanted to make sure they would be covered under the new law.
However, many people became concerned when voices began to be raised advocating contraception availability as preventative measures for women’s health. Our center submitted its comments to make it clear that contraception does not achieve the prevention of disease but rather disrupts an otherwise healthy reproductive system of the woman and therefore ought not to be viewed as preventative medicine and mandated by PPACA. Fertility is not an illness but a sign of health, and pregnancy is not a disease. This is not simply a position of the Catholic Church. Traditionally health insurance plans did not cover contraception because the insurance companies themselves did not think that contraception addressed health issues. Whether or not to have a child is a decision that married couples legitimately make between themselves for the sake of the family. Indeed, in 2007 the Eighth Circuit Court ruled in Stanbridge v. Union Pacific Railroad Company that the largest railroad company in the country did not discriminate against its female employees by not providing contraceptives in its employee health care plan.
In rare cases a pregnancy could make a pre-existing illness worse and that a child should be avoided for that reason. But fertility or a possible pregnancy ought not to be confused with the illness or otherwise viewed as a pathology. Health insurance provisions should be directed toward the diseases themselves.
It has sometimes been argued that oral contraceptives should be mandated in drug prescription plans since medications for males for erectile dysfunction, such as Viagra, are covered. However, erectile dysfunction is a disorder that can be medically treated. Fertility is not a disorder. On the other hand, however, contraception actually engenders a disorder, that of infertility, rather than cures one.
Confusion sometimes arises when legitimate hormonal treatments for a disorder are referred to as “birth control pills”. Hormones can be given to regulate a woman’s cycle or to treat excessive bleeding or a skin condition which are indeed health problems. The hormones sometimes come in the same dosage and have to be administered on a regular basis like oral contraceptives. But the truth of the matter is that they are not contraceptives but legitimate hormonal therapies for various disorders. Obviously there would be no objection for such medically legitimate therapies.
Employers and health plan issuers need to have the assurance that the new health care law will not force them to provide drugs or interventions that do not in fact directly address an illness or health problem. Employers and health insurance companies must also, under the provisions of the new law, be protected from being required to provide drugs that indeed do, or in some circumstances may, bring about an abortion, either by preventing an embryo from attaching itself in the womb or by attacking the developing child. This is often the case with some oral “contraceptives” and especially with the “Morning after Pills” such as Plan B or ellaOne.
Legitimate concerns about the woman’s health can indeed lead one to postpone having a child. However, new methods of determining precisely when a woman is fertile, by observing certain bodily signs, allows a couple to avoid relations at a time when she might become pregnant. These methods have an efficacy rate as high as any contraceptives but they respect the fertility of the woman as a true sign of health and avoid her risking her health by ingesting sometimes dangerous chemicals or submitting herself to a surgical intervention. It is an approach which is truly most respectful of the health of the woman.
John M. Haas, Ph.D., President, The National Catholic Bioethics Center, Philadelphia.