By Darryl Campagna
Friday, March 23, 2001
So-called "conscience clauses" are proliferating among the states, spurred by religious organizations that ban the use of contraceptives by their adherents. New York's proposed law would permit employers to refuse to offer contraceptive coverage.
ALBANY, N.Y. (WOMENSENEWS)--A dispute in the New York legislature over state-mandated insurance coverage for contraception is the latest chapter in a national debate that pits religious beliefs and, some argue, religious freedom, against a woman's access to affordable reproductive health care.
In New York, a women's health insurance bill that would mandate coverage for contraception and other health care has triggered a bitter debate.
Both the Senate and Assembly versions include contraception coverage, but the Senate version, championed by Cardinal Edward Egan of the Archdiocese of New York, would allow employers and insurers to exclude that coverage if it violates their "religious tenets."
The bill is the only one in the country with a conscience clause that covers employers as well as insurers. Other laws cover insurers only.
The Assembly version does not permit that "conscience" exemption. Both versions would provide for mammograms, bone density testing and cervical cancer screenings.
Egan lobbied for the Senate version during a mid-March visit to Albany. He opened the Senate session with a prayer in the cathedral-like gilt-and-marble Senate chamber.
"I think the case is being made," Egan said later. "I think the more the citizenry thinks about the case, the more we'll be able to say we'll have the best protection for women without any limitation on religious freedom."
New York is the most recent state to consider contraception coverage requirements. Since 1998, 14 states have passed laws mandating health insurance for contraception and 10 of those states include a religious exemption--the so-called "conscience clause" that allows employers or insurers to exclude contraception coverage because of religious beliefs or affiliations, according to the Alan Guttmacher Institute in Washington, D.C.
A number of state regulations and a handful of laws mandated contraception coverage prior to 1998. But then came a public outcry about insurance coverage for Viagra, the prescription treatment for impotence.
"One year later, a tremendous number of states had adopted contraceptive coverage," said Susan Tew, a spokeswoman for the Guttmacher Institute. With those laws, however, came the conscience clauses--the first in 1998, another six in 1999, two last year, and one this year, in New Mexico, where Gov. Gary E. Johnson has signed a bill with a conscience clause that will become effective June 15.
"Conscience clauses have been with us in the reproductive health arena for many years. The problem is, they are proliferating," said Marjorie Signer, a spokeswoman for the Religious Coalition for Reproductive Choice in Washington, D.C.
The organization convened in Washington this week to discuss challenges to reproductive freedom. While the group does not oppose conscience clauses across the board, it does object to exemptions that go beyond specific religious groups, Signer said.
"A Catholic hospital is not a religious institution," Signer said. "An institution that serves the public, that has some public funding, that does not have a religious purpose, and is servicing the public need, is not a religious institution. Individual doctors may say, 'I choose not to do this,' but the institution's responsibility is to provide the service."
The reproductive choice coalition's meeting came as Congress prepared to once again consider a bill that would require employment-related insurance plans to cover contraceptive services if they cover outpatient medical services in general. Originally introduced in 1997, the Equity in Prescription and Contraceptive Coverage Act was reintroduced to the Senate in January and the House this week. It does not include a conscience clause.
Catholic doctrine, and that of some other religions, says that all artificial contraception is unnatural, immoral and that it thwarts the will of God. These belief systems advocate abstinence and the "rhythm" method--timing intercourse to coincide with a woman's infertile days in her monthly cycle--as the only acceptable and natural contraception.
Critics say the Senate version of the New York bill is alarming because of its broad language, which allows insurers as well as employers to exclude contraception.
"If you allow the definition to stand as it is, institutions which are associated with the Catholic Church, but get all or most of their funding from state contracts, and all or most of their employees are non-Catholics, they would be able to deny coverage for contraceptives," said JoAnn M. Smith, president and chief executive officer of Family Planning Advocates of New York State Inc., a lobbying group and lead supporter of the Assembly bill.
Of all the conscience clauses enacted so far, "none of them include both the employer and the insurer. New York would," said Adam Sonfield, an Alan Guttmacher Institute public policy associate. "The other thing that makes it broader is the definition of a religious group that is broader than any of the existing ones."
The New York Legislature commonly delays action on such major bills until the session's final hours. It could be well into the summer before the women's health insurance bill comes to a vote, but Senate Majority Leader Joseph Bruno, a Republican, predicts the Senate version is the one that will become law.
"We're optimistic that in the Assembly, they'll truly understand that this is about religious expression and religious freedom," he said.
Proponents of the Assembly version are more cautious.
Last year, 19 Republican senators supported a version without a conscience clause, notes JoAnn Smith of Family Planning Advocates. However, the issue was tabled for further study. The Senate did pass a bill that mandated insurance coverage of prostate screenings.
"We support the prostate screening bill, but it just pointed out to us--one more time--men's health care coverage was okay; women's needed study," Smith said. "So we came back determined this year that would not be repeated. ... I don't think anyone can afford to walk away from this bill. I think women would be outraged, and I hope men would be, too."
Outrage was evident in a recent conference committee discussion of the bill. Assembly members made it clear they will not accept a conscience clause.
"Women of this state do not think it is appropriate or in any way acceptable to carve out some women for discrimination, based on their gender," said Assemblywoman Deborah J. Glick, a New York City Democrat and chief sponsor of the Assembly version. "They would rather come back next year with this bill intact, rather than have it eviscerated."
A conference committee meeting ended last week in a bitter impasse, and members decided this week not to meet again because they cannot resolve their differences.
Conscience clauses are also drawing strong reactions nationally.
The National Conference of Catholic Bishops opposes mandates for contraceptive coverage in general, but supports broad-based conscience clauses when mandates exist.
In a July 2000 letter to members of Congress, the Rev. Msgr. Dennis M. Schnurr, general secretary of the National Conference of Bishops, wrote, "If some form of mandate is adopted, effective protection for conscientious objection on both moral and religious grounds should be ensured."
The insurance industry has had little to say publicly about the bill.
Insurers generally focus more on the costs of mandated coverage than moral questions they raise, said Don Ingalls, vice president of government affairs at HealthNow New York, the parent company of Blue Shield of Northeastern New York and Blue Cross and Blue Shield of Western New York. The companies represent 750,000 people.
"Every 1 percent increase in premium costs leads to 300,000 more people losing health insurance," Ingalls said.
Opponents say conscience clauses foist rigid religious beliefs on women by denying coverage without alternatives.
An often-cited 1995 study by the Centers for Disease Control and Prevention determined that 96 percent of all surveyed Catholic women who have ever had sex have used modern contraceptive methods at some point in their lives. Opponents of conscience clauses also note that contraceptives have other medical uses: The birth control pill, for example, can treat acne.
"Exemptions because of bona fide religious beliefs are part of our democratic government," Signer of the Religious Coalition said. "We're not taking exception to that, as long as the patient's rights are respected. What's happening now is something different."
Most of the states that have included conscience clauses in their contraception coverage laws have not included any alternative coverage for women affected by the exemption, according to the Alan Guttmacher Institute. Alternative coverage might allow the employee to pay a separate fee for contraception, while paying a lower premium for the group coverage. But such plans are awkward to administer.
"There's a very, very wide spectrum of these things," said Sonfield, the institute's policy associate. "And that in essence is what they're fighting over in New York--how wide should this be? It's a matter of rights on both sides of it, and I don't think most people talk about the enrollee's rights as much."
Darryl Campagna is a free-lance writer based in Albany, N.Y.
Read other Women's Enews articles about the New York State women's health care bill and about Catholic hospital mergers:
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