Refusal to Provide Medical Services

47 states and the District of Columbia allow certain individuals or entities to refuse to provide women specific reproductive-health services, information, or referrals: AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, WA, WV, WI, WY.

Several federal laws allow health-care employees and companies to refuse to provide, pay for, provide coverage of, counsel for, or even refer for abortion services – and in some cases contraceptives. The key laws include the Church amendment (1973, 1974), the Coats amendment to the Public Health Service Act (1996), and the Federal Refusal Clause (also known as the Weldon amendment, 2004). The furthest-reaching refusal law was implemented in 2009 through a Department of Health and Human Services regulation enacted in the last days of the Bush administration. The regulation, known as the Federal Refusal Rule, expanded the ability of health-care companies and providers to refuse to provide, cover, or refer for medical services. The Obama administration repealed the most overreaching elements of the Federal Refusal Rule in February 2011.

As part of the ACA, all newly issued health plans must cover the full range of FDA-approved methods of contraception. The policy explicitly exempts religious houses of worship. Moreover, the policy allows religiously affiliated employers that presently refuse to offer their employees contraceptive coverage a one-year grace period to come into compliance. These organizations will be allowed to opt out of the policy permanently if they oppose it – but in those cases, insurance companies will be responsible for covering birth control directly for the consumer.

3 states enacted 3 measures modifying existing laws that allow certain individuals or entities to refuse to provide women specific reproductive-health services, information, or referrals: AZ, KS, MO.

Arizona’s new law expands the state’s contraception-equity refusal law and now allows a broader range of employers to refuse to cover contraceptives in their health plans. Kansas’ new law expands the state’s abortion refusal law to allow additional health-care facilities to refuse to provide or refer for abortion care, and could be interpreted to allow refusal to provide birth control. The Missouri legislature overrode the governor’s veto and enacted a law that allows employers to refuse to cover birth control, abortion care, and sterilization.

Anti-choice members of Congress introduced a flurry of bills in opposition to the ACA’s new birth-control policy. Additionally, anti-choice committee chairs held numerous hearings to counter the policy. While the anti-contraception reaction in Congress resulted in only one floor vote – in the Senate – the lawsuits challenging the policy continue to move through the courts, threatening to restrict this new benefit. In March, the Senate tabled a measure sponsored by Sen. Roy Blunt (R-MO), which would have allowed any employer or insurance plan to refuse to cover any preventive-health service or essential health benefit required under the ACA for virtually any reason.

Although explicitly religious organizations (churches and other houses of worship) will be exempt from the new contraceptive-coverage requirement, and religiously affiliated employers will be allowed to refuse to pay or refer for birth-control coverage, more than 40 lawsuits have been filed challenging the policy. Courts have dismissed several of the lawsuits, explaining that without immediate harm, the cases were not ripe for trial.

2 states defeated 2 ballot measures attacking choice under the guise of religious freedom. Residents of North Dakota and Florida voted down vague constitutional amendments that could have led to discriminatory practices endangering women’s reproductive-health care.