Grassley, Harkin split as Senate tables repeal of birth-control mandate

The U.S. Senate voted today to table Republican Senator Roy Blunt's amendment to repeal a federal regulation on birth-control coverage in employer-provided health care insurance. Iowa's senators split on party lines.

UPDATE: Added a statement from Tom Harkin below. He argues that the Blunt amendment goes way beyond coverage of contraception and other preventive health services.

Since December 2000, the federal government has required employers that offer health insurance to cover contraception as part of preventive care. The 2010 health insurance reform law led to new rulemaking in this area, and the Obama administration announced plans to require employers to cover birth-control costs with no co-pays for the insurance holder.

Blunt's amendment would have allowed employers to opt out of covering the cost of contraception as a matter of conscience, religious belief or moral conviction. He sought to attach his amendment to the unrelated surface transportation bill now under consideration in the Senate. But after a lively floor debate, senators voted to table the Blunt amendment.

Tom Harkin was among the 50 Democrats and one Republican who supported the motion to table. Chuck Grassley was among the 45 Republicans and three Democrats who opposed the motion (roll call).

I am seeking comment on today's vote from Grassley and Harkin and will update this post later.

I enclose the full text of the Blunt amendment, followed by a White House statement on President Obama's "compromise" intended to address objections from religious employers that do not want to provide contraception coverage. Finally, I posted a statement Grassley released last month on why he believes the president's compromise "falls short."

(1) FINDINGS.--Congress finds the following:

   (A) As Thomas Jefferson declared to New London Methodists in 1809, ``[n]o provision in our Constitution ought to be dearer to man than that which protects the rights of conscience against the enterprises of the civil authority''.

   (B) Jefferson's statement expresses a conviction on respect for conscience that is deeply embedded in the history and traditions of our Nation and codified in numerous State and Federal laws, including laws on health care.

[Page: S539]  GPO's PDF

   (C) Until enactment of the Patient Protection and Affordable Care Act (Public Law 111-148, in this section referred to as ``PPACA''), the Federal Government has not sought to impose specific coverage or care requirements that infringe on the rights of conscience of insurers, purchasers of insurance, plan sponsors, beneficiaries, and other stakeholders, such as individual or institutional health care providers.

   (D) PPACA creates a new nationwide requirement for health plans to cover ``essential health benefits'' and ``preventive services'' (including a distinct set of ``preventive services for women''), delegating to the Department of Health and Human Services the authority to provide a list of detailed services under each category, and imposes other new requirements with respect to the provision of health care services.

   (E) While PPACA provides an exemption for some religious groups that object to participation in Government health programs generally, it does not allow purchasers, plan sponsors, and other stakeholders with religious or moral objections to specific items or services to decline providing or obtaining coverage of such items or services, or allow health care providers with such objections to decline to provide them.

   (F) By creating new barriers to health insurance and causing the loss of existing insurance arrangements, these inflexible mandates in PPACA jeopardize the ability of individuals to exercise their rights of conscience and their ability to freely participate in the health insurance and health care marketplace.

   (2) PURPOSES.--The purposes of this section are--

   (A) to ensure that health care stakeholders retain the right to provide, purchase, or enroll in health coverage that is consistent with their religious beliefs and moral convictions, without fear of being penalized or discriminated against under PPACA; and

   (B) to ensure that no requirement in PPACA creates new pressures to exclude those exercising such conscientious objection from health plans or other programs under PPACA.

   (b) Respect for Rights of Conscience.--

   (1) IN GENERAL.--Section 1302(b) of the Patient Protection and Affordable Care Act (Public Law 111-148; 42 U.S.C. 18022(b)) is amended by adding at the end the following new paragraph:


   ``(A) FOR HEALTH PLANS.--A health plan shall not be considered to have failed to provide the essential health benefits package described in subsection (a) (or preventive health services described in section 2713 of the Public Health Service Act), to fail to be a qualified health plan, or to fail to fulfill any other requirement under this title on the basis that it declines to provide coverage of specific items or services because--

   ``(i) providing coverage (or, in the case of a sponsor of a group health plan, paying for coverage) of such specific items or services is contrary to the religious beliefs or moral convictions of the sponsor, issuer, or other entity offering the plan; or

   ``(ii) such coverage (in the case of individual coverage) is contrary to the religious beliefs or moral convictions of the purchaser or beneficiary of the coverage.

   ``(B) FOR HEALTH CARE PROVIDERS.--Nothing in this title (or any amendment made by this title) shall be construed to require an individual or institutional health care provider, or authorize a health plan to require a provider, to provide, participate in, or refer for a specific item or service contrary to the provider's religious beliefs or moral convictions. Notwithstanding any other provision of this title, a health plan shall not be considered to have failed to provide timely or other access to items or services under this title (or any amendment made by this title) or to fulfill any other requirement under this title because it has respected the rights of conscience of such a provider pursuant to this paragraph.

   ``(C) NONDISCRIMINATION IN EXERCISING RIGHTS OF CONSCIENCE.--No Exchange or other official or entity acting in a governmental capacity in the course of implementing this title (or any amendment made by this title) shall discriminate against a health plan, plan sponsor, health care provider, or other person because of such plan's, sponsor's, provider's, or person's unwillingness to provide coverage of, participate in, or refer for, specific items or services pursuant to this paragraph.

   ``(D) CONSTRUCTION.--Nothing in subparagraph (A) or (B) shall be construed to permit a health plan or provider to discriminate in a manner inconsistent with subparagraphs (B) and (D) of paragraph (4).

   ``(E) PRIVATE RIGHTS OF ACTION.--The various protections of conscience in this paragraph constitute the protection of individual rights and create a private cause of action for those persons or entities protected. Any person or entity may assert a violation of this paragraph as a claim or defense in a judicial proceeding.

   ``(F) REMEDIES.--

   ``(i) FEDERAL JURISDICTION.--The Federal courts shall have jurisdiction to prevent and redress actual or threatened violations of this paragraph by granting all forms of legal or equitable relief, including, but not limited to, injunctive relief, declaratory relief, damages, costs, and attorney fees.

   ``(ii) INITIATING PARTY.--An action under this paragraph may be instituted by the Attorney General of the United States, or by any person or entity having standing to complain of a threatened or actual violation of this paragraph, including, but not limited to, any actual or prospective plan sponsor, issuer, or other entity offering a plan, any actual or prospective purchaser or beneficiary of a plan, and any individual or institutional health care provider.

   ``(iii) INTERIM RELIEF.--Pending final determination of any action under this paragraph, the court may at any time enter such restraining order or prohibitions, or take such other actions, as it deems necessary.

   ``(G) ADMINISTRATION.--The Office for Civil Rights of the Department of Health and Human Services is designated to receive complaints of discrimination based on this paragraph and coordinate the investigation of such complaints.

   ``(H) ACTUARIAL EQUIVALENCE.--Nothing in this paragraph shall prohibit the Secretary from issuing regulations or other guidance to ensure that health plans excluding specific items or services under this paragraph shall have an aggregate actuarial value at least equivalent to that of plans at the same level of coverage that do not exclude such items or services.''.

   (2) EFFECTIVE DATE.--The amendment made by paragraph (1) shall be effective as if included in the enactment of Public Law 111-148.



February 10, 2012

FACT SHEET: Women's Preventive Services and Religious Institutions

Thanks to the Affordable Care Act, most health insurance plans will cover women's preventive services, including contraception, without charging a co-pay or deductible beginning in August, 2012.  This new law will save money for millions of Americans and ensure Americans nationwide get the high-quality care they need to stay healthy.

Today, President Obama will announce that his Administration will implement a policy that accommodates religious liberty while protecting the health of women. Today, nearly 99 percent of all women have used contraception at some point in their lives, but more than half of all women between the ages of 18-34 struggle to afford it.

Under the new policy to be announced today, women will have free preventive care that includes contraceptive services no matter where she works.  The policy also ensures that if a woman works for religious employers with objections to providing contraceptive services as part of its health plan, the religious employer will not be required to provide contraception coverage, but her insurance company will be required to offer contraceptive care free of charge.

The new policy ensures women can get contraception without paying a co-pay and addresses important concerns raised by religious groups by ensuring that objecting religious employers will not have to provide contraceptive coverage or refer women to organizations that provide contraception.  Background on this policy is included below:

Section 2713 of the Affordable Care Act, the Administration adopted new guidelines that will require most private health plans to cover preventive services for women without charging a co-pay starting on August 1, 2012.  These preventive services include well women visits, domestic violence screening, and contraception, and all were recommended to the Secretary of Health and Human Services by the independent Institute of Medicine of the National Academy of Science.

Today, the Obama Administration will publish final rules in the Federal Register that:

Exempts churches, other houses of worship, and similar organizations from covering contraception on the basis of their religious objections.

Establishes a one year transition period for religious organizations while this policy is being implemented.

The President will also announce that his Administration will propose and finalize a new regulation during this transition year to address the religious objections of the non-exempted religious organizations. The new regulation will require insurance companies to cover contraception if the non-exempted religious organization chooses not to. Under the policy:

Religious organizations will not have to provide contraceptive coverage or refer their employees to organizations that provide contraception.

Religious organizations will not be required to subsidize the cost of contraception.

Contraception coverage will be offered to women by their employers' insurance companies directly, with no role for religious employers who oppose contraception.

Insurance companies will be required to provide contraception coverage to these women free of charge.

Covering contraception saves money for insurance companies by keeping women healthy and preventing spending on other health services. For example, there was no increase in premiums when contraception was added to the Federal Employees Health Benefit System and required of non-religious employers in Hawaii.  One study found that covering contraception lowered premiums by 10 percent or more.

For Immediate Release

Friday, February 10, 2012

Senator Chuck Grassley released the following statement after the President attempted to compromise on a rule issued by the Department of Health and Human Services, as part of the department's implementation of the sweeping Affordable Care Act of 2010, that mandated that religious-affiliated charities, schools and hospitals provide coverage for controversial contraceptive products.

           On Tuesday, Grassley called on the Secretary of Health and Human Services to rescind the Obama Administration's health care rule that will force religious affiliated organizations to either abandon their freedom of conscience or pay a fine of up to $2,000 per employee.

           Here is Grassley's statement following today's announcement.

           "Adhering to one of this country's most valued principles shouldn't be an afterthought.  Unfortunately, though, disregarding the Constitution has become an all too common pattern for this administration.  Its latest questionable move challenging religious freedom raised the ire of people across the country.  The administration's attempt to reverse this outright affront to religious freedom falls short and continues to highlight the concern of many of us that the health care law overreaches into personal freedoms and liberties."

UPDATE: Harkin's office released a radio actuality on this topic today. Here is my transcript:

In the presidential primaries and in state legislatures, conservative Republicans are reigniting the culture wars, including on issues that used to be beyond bipartisanship, for instance ensuring women's access to contraception. The same extremism is now rearing its ugly head in the United States Senate. Later this morning, the Senate will vote on a measure sponsored by Senator Blunt of Missouri that would allow any employer or any health plan to deny women access to contraception, mammograms, prenatal screenings, cervical cancer screenings, and much more. Indeed, the Blunt amendment is even broader in its scope. It would allow employers and health insurance companies to deny coverage of any health services they find "morally objectionable."

Clearly the immediate target of the Blunt amendment is women and their access to health care. If this amendment becomes law, an estimated 225,000 women in Iowa could lose access to preventive health services. Nationwide, an estimated 20 million women could lose access. Supporters of the amendment say that this is about respecting the rights of conscience. But this amendment goes way beyond respecting an individual's conscience. It would allow employers and insurance companies to refuse to cover not just any preventive services, but

any other health service required under the Affordable Care Act. In other words, this amendment would largely dismantle the health reform law and the protections that it provides to millions of Americans.

In health care reform I fought hard to ensure that all Americans have access at no cost to preventive services. Our aim is to transform our current "sick care system" into a genuine "health care system," one that emphasizes wellness, prevention, and public health. This amendment, really a blunt instrument, would wipe away these gains for women basically in one fell swoop.

Well, I've got a simple message for the culture warriors and these extremists. Women are not going to be dragged backward to the days when they were denied access to contraception and other essential services. The American people are not going to be dragged backward to the days when insurance companies called the shots with regard to our access to essential health care. Be assured that I am working hard to defeat this very dangerous amendment.

  • huh?

    Women are not going to be dragged backward to the days when they were denied access to contraception and other essential services.

    Does anybody really buy this talking point? If my employer doesn't directly pay for my food or my house, does that mean they're denying me access to food and shelter?

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