ANTI-CHOICE LAWS
Refusal to Provide Medical Services
ABORTION REFUSAL CLAUSE
Connecticut allows certain individuals or entities to refuse to provide abortion services.
To whom does the refusal clause apply? Individuals.
What does the refusal clause allow? No person may be required to participate in any phase of an abortion against his or her judgment or philosophical, moral, or religious beliefs.
Does the law require the refusing individual or entity to notify the persons affected? No.
Are there circumstances under which a refusal clause may not be exercised? No.
Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services? No.
Does the law provide a mechanism for women to otherwise obtain specific reproductive health services, information, or referrals if an individual and/or entity exercises a refusal clause? No.
Conn. Agencies Regs § 19-13-D54 (Enacted 1974; Last Amended 2005).
INSURANCE COVERAGE FOR CONTRACEPTION REFUSAL CLAUSE
Although Connecticut law requires health insurance plans that cover prescription drugs to provide equitable coverage for contraception, certain employers and/or insurers may require that their plans exclude coverage for contraception.
To whom does the refusal clause apply? Religious employers for whom prescription contraceptive methods are contrary to their bona fide religious tenets, as well as insurance providers owned, operated, or substantially controlled by a religious organization that has religious or moral tenets that conflict with contraceptive coverage.
What does the refusal clause allow? Upon a religious employer's request, an insurance provider may issue to a religious employer a plan that excludes coverage for contraception. In addition, insurance providers owned, operated, or substantially controlled by a religious organization that has religious or moral tenets that conflict with contraceptive coverage may provide for coverage of prescription contraceptive methods through another entity offering a limited benefit plan, provided that the coverage has the same cost, terms, and availability as other prescription coverage offered to the insured.
Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? Yes. The law broadly defines the term "religious employer" as a church-controlled or church-affiliated organization. This broad definition inappropriately includes entities that operate in the public sphere.
Does the law require that the persons affected by the refusal be notified? Yes. A health insurance policy that excludes coverage for prescription contraceptive methods due to an employer's religious refusal must provide the insured or prospective insured with written notice of the exclusion.
Are there circumstances under which a refusal clause may not be exercised? Yes. A refusal clause may not be used to exclude coverage for prescription contraceptive methods ordered for reasons other than contraceptive purposes.
Does the law provide a mechanism for women to obtain contraceptive coverage if their employer and/or insurer exercises a refusal clause? No.
May an individual obtain a health insurance policy that excludes contraceptive coverage? Yes. An individual who states in writing that prescription contraceptive methods are contrary to the individual's religious or moral beliefs may obtain a health insurance policy from their insurer that excludes coverage for contraception.
Conn. Gen. Stat. Ann. §§ 38a-503e, -530e (Enacted 1999).
Targeted Regulation of Abortion Providers (TRAP)
Connecticut imposes a variety of requirements on abortion providers that are not imposed on other health care providers, including:
Restrictions on Where Abortions May Be Performed
Connecticut places medically unnecessary restrictions on where abortions may be performed.
The state, without reference to medical necessity, requires outpatient clinics that are operated by corporations or municipalities and that provide abortions (at any stage of pregnancy) to have a standard operating room. Conn. Agencies Regs. §19-13-D54(d)(9).
Clinics must hire counselors who have or who are supervised by a person with a graduate degree or training in social work, psychology, counseling, nursing, or ministry. Conn. Gen. Stat. Ann. § 19a-116 (Enacted 1979; Last Amended 1995); Conn. Agencies Regs. § 19a-116-1(d).
Among the most common TRAP regulations are those restricting the performance of abortions to hospitals or other specialized facilities, which require doctors to obtain medically unnecessary additional licenses, needlessly convert their practices to mini-hospitals at great expense, or perform abortions only in hospitals, an impossibility in many parts of the country.
Connecticut requires that all abortions after the second trimester be performed in a hospital. Conn. Agencies Regs. § 19-13-D54(c).
Restrictions on Who May Perform Abortions
Connecticut prohibits certain qualified health care professionals from performing abortions.
A regulation provides that only a person licensed to practice medicine and surgery in the state may perform an abortion. Conn. Agencies Regs. § 19-13-D54(a) (Enacted 1974; Last Amended 2005). The Connecticut Attorney General has issued an opinion concluding that this regulation applies only to surgical abortions and that advanced practice registered nurses, licensed nurse-midwives, and physician's assistants who are licensed in Connecticut may, in accordance with the statutory requirements and conditions governing their practices, dispense mifepristone in a licensed clinic as long as they are acting under the supervision of a physician who is a "qualified physician," as defined by the U.S. Food and Drug Administration (FDA). Conn. Op. Att'y Gen. No. 2001-003 (Feb. 7, 2001). The Connecticut Attorney General has also issued an opinion stating that, under Connecticut law, such clinicians may prescribe mifepristone. Conn. Op. Att'y Gen. No. 2001-015 (July 2, 2001).
PRO-CHOICE LAWS
Contraceptive Equity
Connecticut law requires health insurance plans that cover prescription drugs to provide equitable coverage for contraception.
What is required? If a health insurance plan provides coverage for outpatient prescription drugs, it must provide coverage for Food and Drug Administration-approved prescription contraceptive methods.
To which insurance plans does the law apply? Individual and group health insurance policies issued or renewed on or after October 1, 1999 that provide coverage for outpatient prescription drugs.
Does the law contain a refusal clause, allowing certain employers and/or insurers to refuse to provide or pay for contraceptive coverage? Yes.
To whom does the refusal clause apply? Religious employers for whom prescription contraceptive methods are contrary to their bona fide religious tenets, as well as insurance providers owned, operated, or substantially controlled by a religious organization that has religious or moral tenets that conflict with contraceptive coverage.
What does the refusal clause allow? Upon a religious employer's request, an insurance provider may issue to a religious employer a plan that excludes coverage for contraception. In addition, insurance providers owned, operated, or substantially controlled by a religious organization that has religious or moral tenets that conflict with contraceptive coverage may provide for coverage of prescription contraceptive methods through another entity offering a limited benefit plan, provided that the coverage has the same cost, terms, and availability as other prescription coverage offered to the insured.
Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? Yes. The law defines the term "religious employer" as a church-controlled or church-affiliated organization. This definition inappropriately includes entities that operate in the public sphere.
Does the law require that the persons affected by the refusal be notified? Yes. A health insurance policy that excludes coverage for prescription contraceptive methods due to an employer's religious refusal must provide the insured or prospective insured with written notice of the exclusion.
Are there circumstances under which a refusal clause may not be exercised? Yes. A refusal clause may not be used to exclude coverage for prescription contraceptive methods ordered for reasons other than contraceptive purposes.
Does the law provide a mechanism for women to obtain contraceptive coverage if their employer and/or insurer exercises a refusal clause? No.
May an individual obtain a health insurance policy that excludes contraceptive coverage? Yes. An individual who states in writing that prescription contraceptive methods are contrary to the individual's religious or moral beliefs may obtain a health insurance policy from their insurer that excludes coverage for contraception.
Conn. Gen. Stat. Ann. §§ 38a-503e, -530e (Enacted 1999).
Emergency Contraception
EMERGENCY CONTRACEPTION (EC) FOR SEXUAL ASSAULT VICTIMS
Connecticut law ensures that sexual assault victims receive access to emergency contraception (EC) in hospital emergency rooms. As part of the minimum standards for the examination and treatment of a sexual assault victim, a physician or other health care provider must provide a sexual assault victim with medically and factually accurate information about EC, offer her EC, and dispense EC to her upon request. Hospitals are allowed to administer pregnancy tests and if the test is positive, the hospital does not have to provide the victim with EC.
Hospitals are also allowed to contract with an "independent provider" defined as a physician, physician assistant, advanced practice registered nurse or registered nurse, or a nurse-midwife to ensure compliance with the law. Conn. Gen. Stat. Ann § 19a-112e (Enacted 2007).
Freedom of Choice Act
Connecticut has created additional protections for reproductive rights by adding an affirmative right to choose into its state law. This law ensures women's access to pre-viability abortions and would remain in effect even if Roe v. Wade were overturned.
"The decision to terminate a pregnancy prior to the viability of the fetus shall be solely that of the pregnant woman in consultation with her physician." Conn. Gen. Stat. Ann. § 19a-602(a) (Enacted 1990).
Low-Income Women's Access to Abortion
Connecticut allows women eligible for state medical assistance for general health care to obtain public funds for abortion. Conn. Dep't of Soc. Servs., Health Care Fin. Div., Managed Care Organizations, Policy Transmittal No. MS 96-07 (1996); Conn. Dep't of Soc. Servs., Conn. Medical Assistance Program, Physician Servs. Regulation/Policy, Ch. 7 § 173.IV (Oct. 1, 1999) at http://www.ctmedicalprogram.com/prmanuals/ch7physician.pdf.
A court held that a policy restricting the state medical assistance program from covering medically necessary abortions except in cases of life endangerment, rape, or incest violates the Connecticut Constitution by providing coverage for other medically necessary services, but not abortion. Doe v. Maher, 515 A.2d 134 (Conn. Super. Ct. 1986).
Protection Against Clinic Violence
Any person who engages in the use of force or threat for the purpose of depriving a person of equal protection of Connecticut or federal laws, or of equal privileges and immunities under Connecticut or federal laws, is guilty of a misdemeanor. If bodily injury or death results, the person is guilty of a felony. Any aggrieved person may seek injunctive relief, damages, and other equitable and just relief. Conn. Gen. Stat. Ann. §§ 52-571a, 53-37b (Enacted 1993).
This law's legislative history demonstrates that it was designed to protect clinic access. As the law's sponsor, Senator George Jepsen, testified, "Twenty years after Roe vs. Wade was handed down by the Supreme Court, . . . . abortion remains a fundamental right under the law of our land . . . . Unfortunately, as opponents of choice have grown more desperate in the last few years, some, not all, some in the minority have resorted to clearly illegal tactics, systematic, even para-military attempts to shut down on a regular basis abortion clinics across our country. . . . [This law] protects the legitimate constitutional rights of women who seek nothing more than to exercise their right to choose." Statements on Senate Floor Concerning S.B. 1046 (June 2, 1993), at http://search.cga.state.ct.us (last visited Sept. 25, 2007).
State Constitutional Protection
The Connecticut Constitution protects the right to reproductive choice as a fundamental right and to a greater extent than the federal Constitution. A court struck down under the state constitution a regulation limiting state medical assistance for abortion to cases of life endangerment without extending coverage to medically necessary abortion services. Doe v. Maher, 515 A.2d 134 (Conn. Super. Ct. 1986). A similar restriction has been upheld by the U.S. Supreme Court under the federal Constitution. Williams v. Zbaraz, 448 U.S. 358 (1980).
OTHER LAWS
Informed Consent
Connecticut has an abortion-specific informed consent law.
Prior to an abortion, a woman must receive information, including an oral explanation of the procedure and a description of the discomforts and risks, from a qualified counselor. The woman must sign a consent form that describes the "nature and consequences of the procedure which shall be used." Conn. Gen. Stat. Ann. §§ 19a-116, 19a-116-1(c) (Enacted 1983; Last Amended 1996).
Post-Viability Abortion Restriction
Connecticut's post-viability restriction states that no abortion may be provided after viability unless necessary to preserve the woman's life or health. Conn. Gen. Stat. Ann. § 19a-602(b) (Enacted 1990).
NARAL Pro-Choice America supports the legal framework established in Roe v. Wade and does not oppose restrictions on post-viability abortion, such as Connecticut's, that contain adequate exceptions to protect the woman's life and health.
Young Women's Access to Abortion
A young woman under 16 may not obtain an abortion without receiving counseling from a physician, nurse, physician's assistant, clergy member, or qualified counselor who must: (1) explain the alternative choices for managing the pregnancy, including adoption and abortion; (2) explain that public and private agencies are available to assist the minor with whichever alternative she chooses and offer a list of such agencies and services; and (3) discuss the possibility of involving the young woman's parents or an adult family member in her decision-making. Conn. Gen. Stat. Ann. §§ 19a-600 (Enacted 1990; Last Amended 1996); 19a-601 (Enacted 1990).
