0910 SB 749

Insurance bill triggers contraception debate

Earlier this year, Gov. Jay Nixon vetoed a bill that would modify state laws regarding abortion, contraception and sterilization. On Wednesday, members of the Missouri General Assembly will meet for their annual veto session and are expected to try to override Nixon. There’s a good chance they’ll succeed.

1465 words with explanatory info graphic table and supplemental information box 

JEFFERSON CITY — A debate mixing the issues of access to birth control and abortion with those of religious freedom and states’ rights would be an emotional undertaking any time. But it becomes all the more tense when it happens in the middle of a political campaign season.

Earlier this year, Gov. Jay Nixon vetoed a bill that would modify state laws regarding abortion, contraception and sterilization. On Wednesday, members of the Missouri General Assembly will meet for their annual veto session and are expected to try to override Nixon. There’s a good chance they’ll succeed.

The core of Senate Bill 749, sponsored by Sen. John Lamping, R-St. Louis, is that insurance companies would not have to cover contraception, abortion or sterilization if they object to those services on religious or moral grounds.

The bill also would allow any employer to prevent such coverage from being added to group insurance plans when it conflicts with its moral, ethical or religious beliefs. State law now allows only religious organizations to prevent that addition to their coverage. The bill contains a retroactive clause that would make it effective Aug. 1 if the General Assembly overrides Nixon’s veto.

“It’s basically giving the insurance companies (the right) to not cover additional things, even if the employer and employee want them,” Sen. Kurt Schaefer, R-Columbia, said.

Schaefer said he objects to SB 749 on that principle and on the legal grounds that it contradicts federal law.

State Rep. Mary Still, D-Columbia, who is campaigning to replace Schaefer as the 19th District senator, also opposes the bill.

“We’re talking access to birth control,” Still said. “I believe that access to contraception is important to a woman’s health and economic well being” because it allows a woman to plan for a pregnancy.

“To deny that portion (of health insurance) that is uniquely important to women is discrimination,” she said.

While the bill’s description implies that it’s written to protect religious freedoms, Lamping said he sponsored it as a matter of states’ rights. He denied that the bill restricts a woman’s access to health care.

“This bill does no such thing,” Lamping said.

The price of access

The legislation’s impact on “access” depends largely on how that term is defined.

“You have access under SB 749 just like current employees do now who work for religious organizations,” Lamping said.

If those organizations prevent contraceptive services from being added to their coverage, employees can purchase contraception privately or opt out of their employer-based group plan, Lamping said.

In that case, they can access insurance for contraception elsewhere, such as through a spouse’s plan or by purchasing private, individual coverage that includes those services, Calvin Call, executive director of the Missouri Insurance Coalition, said.

“That’s an expensive proposition for women,” Still said.

Access: a federal mandate

An estimated 10.7 million American women use oral contraceptives and 10.3 million opt for sterilization, according to a 2010 report from the Centers for Disease Control.

Yet, almost half of all pregnancies in the United States are unintended — a rate that doubles or triples for women who are 18 to 24, poor, or unmarried and living with their partners.

Partially because unintended pregnancies are associated with increased risk of birth complications, the U.S. Department of Health and Human Services recently changed a policy, under President Barack Obama’s direction. Effective Aug. 1 of this year, all insurance policies are to provide contraceptive services, education and counseling directly to women and free of charge.

This rendered moot religious organizations’ exemption from the requirement to provide access to contraception. Yet, while they would not be forced to subsidize contraception directly, religious employers argued, those services still would flow through their group health plans.

Lawsuits challenging the federal mandate are pending. In the meantime, legislators such as Lamping are doing what they can to contest it.

“What’s extraordinary … is that it’s the first federal government mandate for state health insurance,” Lamping said. “That’s where 749 became a bill.”

Employees who want coverage for birth control but can’t get it through their employers may feel forced into a take-it-or-leave-it decision: Should they take what they can get through work? In that case, they could go without contraceptive insurance and just buy their contraception privately. Or, should they find an entirely different plan that covers it?

Lamping recognizes this, and he maintains that providing access to those services through group plans forces a parallel all-or-nothing decision for employers with strong objections to contraception: Should they offer health insurance, knowing that it may ultimately be a vehicle for contraception, or should they not offer health insurance at all?

Two colleges in Florida, Ave Maria University and Florida Catholic University, reportedly have cited the mandate as part of their reasons for choosing to discontinue health insurance coverage for their employees.

Lamping listed Catholic hospitals, high schools and adoption agencies as the types of religious organizations that may choose that path as well.

In that case, like anyone who chooses to find their own insurance rather than settle for a plan that doesn’t meet their contraceptive needs, those employees could access — and pay for — health plans on the open market.

States’ rights

Lamping isn’t alone in his belief that Obama’s policy overstepped the federal government’s jurisdiction. Rep. Chris Kelly, D-Columbia, said he understands why Lamping would say that.

“It’s a politically popular thing to say, and I actually agree with him,” Kelly said. “But state law cannot abrogate federal law.”

Kelly said he also believes the law is unnecessary because Missouri statutes already protect employers from having to pay for contraception or abortion coverage.

“So what they’re actually doing is denying the employee their moral or religious discretion,” Kelly said. He is urging his colleagues to sustain Nixon’s veto of SB 749 when it comes up for an override vote.

Schaefer takes a similar stance.

“This law is not needed to tee-up a fight with the federal government,” Schaefer said. If Missouri wants to fight the federal mandate, he said, the place to do it is through the courts.

Religious freedom

Senate Majority Floor Leader Tom Dempsey, R-St. Charles, said that, from a business standpoint, he thinks most companies will continue to include contraceptive coverage in their group plans.

“Insurance companies will provide a plan that meets the purchaser’s requirements,” he clarified by email.

Dempsey is one of four co-sponsors of SB 749, along with 32nd District Sen. Ron Richard, 6th District Sen. Mike Kehoe and 2nd District Sen. Scott Rupp.

“It’s a religious freedom issue,” Dempsey said. “Obama made a ruling related to employers that have a religious mission. He took an option away from them. And we are trying to put that option back in place.”

Still couldn’t disagree more.

“If you’re in the business of providing insurance, I think it’s important to consider the needs of the person you’re insuring, and that’s also a religious issue,” she said. “To be fair and open-minded about the needs of a woman is an important tenet of my religion.”

Still also is concerned about the very premise of SB 749: that a business regulation could be based on “religious beliefs or moral convictions.”

“It’s a slippery slope of how you define moral convictions,” she said. “What if you are a Christian Scientist? And I think Jehovah’s Witnesses don’t believe in blood transfusions. It’s moving in that direction. The state doesn’t need to be making laws about it,” Still said. (Her impression of Jehovah’s Witnesses’ policy on blood transfusions is partially true.)

Women’s health

Above all, SB 749 is a women’s health issue to Still, she said. She doesn’t buy the argument that it has anything to do with states’ rights.

“We have addressed that issue with the Civil War,” she said. “This bill deals with contraception.” Still said she ties that directly to a woman’s health and economic well-being.

“Your insurance is a benefit of your employment,” she said. “To say that an employer can deny birth control (as a women’s health service) is discrimination.”

She also challenged Schaefer to filibuster SB 749 when it comes up for a vote.

“I voted against it previously, and I see no reason I would change my position on that,” Schaefer responded.

“A filibuster in a special session … Even the Democrats won’t likely do that,” he said, arguing that all filibustering would do is make the session longer and more expensive.

Schaefer said he hasn’t decided whether he will speak in opposition to the bill or just vote against it.

“I don’t know. We’ll have to see what the debate is,” he said.

When it passed the General Assembly, representative in the House voted 105-33 to approve SB 749, while the Senate voted 28-6. To override a veto, votes of 109 in the House and 23 in the Senate are required.

Comparing Insurance Costs

Health insurance costs vary widely depending on the age, health and habits of the insured and the trade-off between premiums, co-pays and deductibles, among other considerations. There is also a difference in cost between individual and group plans, in no small part because employers typically pay for at least a portion of group plans.

In Missouri, the statewide average cost of individual health insurance is $2,364 annually, according to the Henry J. Kaiser Family Foundation. Employer-based premiums average $5,019 per year per employee, of which $1,155, or 23 percent, is paid by the employee while the remainder, $3,864, is picked up by the employer.

But those figures don’t account for the potential cost of deductibles.

To get a better sense of how much health insurance might cost on the individual market, the Missourian sought online quotes for preventive care for a 37-year-old woman who doesn’t smoke. The lowest monthly premium quoted was $135 and included a $10,000 deductible. The highest monthly premium quoted was $229.74 with a $2,500 deductible.

Drafts

Draft 3

COLUMBIA — Contraception, religious freedom and states’ rights are in the wings, awaiting debate during this fall’s veto session at the statehouse.

Earlier this year, Gov. Nixon vetoed a bill that would modify state laws regarding abortion, contraception and sterilization. On Sept. 12, the Missouri General Assembly will likely try to override his veto. The prospects for success are good, but not certain.

The upshot of Senate Bill 749, sponsored by Sen. John Lamping, R-St. Louis, is that insurance companies would no longer have to cover contraception, abortion or sterilization.

Another change is that, while only religious organizations currently are exempt from having to let employees add coverage for contraception to their personal health insurance, any employer could prevent contraception, abortion or sterilization from being added to a plan through his or her group coverage in the future.

Actually, that would happen in the past. The bill contains an emergency clause that would make the first provision effective last month, as of Aug. 1, if the General Assembly overrides Nixon’s veto.

[To learn more about what the bill would change in current law, see the table HERE (need link).]

“It’s basically giving the insurance companies (the right) to not cover additional things, even if the employer and employee want them,” Sen. Kurt Schaefer, R-Columbia, said.

Schaefer said he objects to SB 749 on that principle and on legal grounds: The bill contradicts federal law.

“We’re talking access to birth control,” Rep. Mary Still, D-Columbia, said. She is currently campaigning to replace Schaefer in the 19th District Missouri Senate seat. “I believe that access to contraception is important to a woman’s health and economic well being” because it allows a woman to plan for a pregnancy, Still said.

“To deny that portion (of health insurance) that is uniquely important to women is discrimination,” she said.

Lamping said that, while the bill’s description implies it’s written to protect religious freedoms, he is most passionate about it as a matter of states’ rights. He denied that the bill restricts a woman’s access to healthcare.

“This bill does no such thing,” Lamping said.

The price of access

The legislation’s impact on “access” depends largely on how that term is defined.

“You have access under SB 749 just like current employees do now who work for religious organizations,” Lamping said.

If those organizations exclude the contraception OR ABORTION? rider from their coverage, employees can opt out of their employer-based group plan. In that case, they can access health insurance elsewhere, such as through a spouse or by purchasing private, individual coverage that includes those services, according to Calvin Call, executive director of the Missouri Insurance Coalition.

“That’s an expensive proposition for women,” Still said.

Access: a federal mandate

An estimated 10.7 million American women use oral contraceptives and 10.3 million opt for sterilization, according to a 2010 report from the Centers for Disease Control.

Yet, almost half of all pregnancies in the United States are unintended — a rate that doubles or triples for women who are 18-24 years old, poor, or unmarried and living with their partners.

Partially because unintended pregnancies are associated with increased risk of birth complications, the U.S. Dept. of Health and Human Services recently changed a policy, under President Obama’s direction. Effective Aug. 1 of this year, all insurance policies are to include contraceptive services, education and counseling directly to women and free of charge.

This made a moot point out of religious organizations’ exemption from providing access to contraception. Yet, while they would not be forced to subsidize contraception directly, religious employers argued, those services still would flow through their group health plans.

Lawsuits challenging the federal mandate are pending. In the meantime, state legislators across the country, such as Lamping here in Missouri, are doing what they can to challenge it.

“What’s extraordinary … is that it’s the first federal government mandate for state health insurance,” Lamping said. “That’s where 749 became a bill.”

If it goes through, women who want coverage for birth control but can’t get it through their employers may feel forced into a take-it-or-leave-it decision: Should they take what they can get through work and go without contraceptive coverage, or find an entirely different plan on their own?

Lamping recognizes this, and maintains that providing access to those services forces a parallel all-or-nothing decision for employers with strong objections to contraception: Should they offer health insurance, knowing that it may ultimately be a vehicle for contraception or abortion, or should they not offer health insurance at all?

Two colleges in Florida, Ave Maria University and Florida Catholic University, reportedly have cited the mandate as part of their reasons for choosing to discontinue health insurance coverage for their employees.

Lamping listed Catholic hospitals, high schools and adoption agencies as the types of religious organizations that may choose that path, as well.

In that case, like the women who opt to find their own insurance rather than settle for coverage that doesn’t meet their contraceptive needs, those employees could access — and pay for — health plans on the open market.

States’ rights

Lamping isn’t alone in his belief that Obama’s policy overstepped the federal government’s jurisdiction. Rep. Chris Kelly, D-Columbia, said he understands why Lamping would say that.

“It’s a politically popular thing to say. And I actually agree with him,” Kelly said. “But state law cannot abrogate federal law,” Kelly said.

Kelly said he also believes the law is superfluous, because current Missouri statutes already protect employers from paying for the contraceptive services.

“So what they’re actually doing is denying the employee their moral or religious discretion,” Kelly said. He is urging his colleagues to sustain Nixon’s veto of SB 749 when it comes up for an override vote Sept. 12.

Schaefer takes a similar stance.

“This law is not needed to tee-up a fight with the federal government,” Schaefer said. If Missouri wants to fight the federal mandate, he said, the place to do it is through the courts.

Religious freedom

Senate Majority Floor Leader Tom Dempsey, R-St. Charles, said that, from a business standpoint, he thinks most companies will continue to include contraceptive coverage in their group plans.

“Insurance companies will provide a plan that meets the purchaser’s requirements,” he clarified by email.

Dempsey is one of four co-sponsors of SB 749, along with 32nd District Sen. Ron Richard, 6th District Sen. Mike Kehoe and 2nd District Sen. Scott Rupp.

“It’s a religious freedom issue,” Dempsey said. “Obama made a ruling related to employers that have a religious mission. He took an option away from them. And we are trying to put that option back in place,” he said.

Rep. Still could not disagree more.

“If you’re in the business of providing insurance, I think it’s important to consider the needs of the person you’re insuring, and that’s also a religious issue. To be fair and open-minded about the needs of a woman is an important tenet of my religion,” she said.

Still is also concerned about the very premise of SB 749: that a business regulation could be based on “religious beliefs or moral convictions.”

“It’s a slippery slope of how you define moral convictions,” she said. “What if you are a Christian Scientist? And I think Jehovah’s Witnesses don’t believe in blood transfusions. It’s moving in that direction. The state doesn’t need to be making laws about it,” Still said. (Her impression of Jehovah’s Witnesses’ policy on blood transfusions is partially true.)

Women’s health

Above all, SB 749 is a women’s health issue to Still, she said. She doesn’t buy the argument that it’s got anything to do with states’ rights.

“We have addressed that issue with the Civil War,” she said. “This bill deals with contraception.” Still said she ties that directly to a woman’s health and economic well being.

“Your insurance is a benefit of your employment. To say that an employer can deny birth control (as a women’s health service) is discrimination,” she said.

She also challenged Schaefer to filibuster SB 749 when it comes to an override vote Sept. 12.

“I voted against it previously and I see no reason I would change my position on that,” Schaefer responded.

“A filibuster in a special session … Even the Democrats won’t likely do that,” he said, because all filibustering would do is make the session more expensive by making it longer.

Schaefer said he’s undecided whether he will speak in opposition to the bill when it comes up, or just vote against it.

“I don’t know. We’ll have to see what the debate is,” he said.

When it passed the General Assembly, SB 749 won 105-33 in the House and 28-6 in the Senate. To override a veto, votes of 109 in the House and 23 in the Senate are required.

ISSUE CURRENT PROPOSED
Contraception* is included in health insurance plans as part of prescription coverage: Yes, with exceptions:

  • Not if the employer doesn’t want to offer it. The option to exclude contraception from a group plan exists for all employers, not just official religious organizations.
  • Not if the employee doesn’t want it. (Employees can have it taken out of their plans.)
Employees can still get contraception coverage added to their individual coverage, even if it’s not included in their group plans: Yes, but:

  • Not if the employer is exempt from the requirements due to religious objections to contraception. In that case, the employee would only be able to access contraception on the private market, not through a rider attached to the group plan.
  • The employee bears the cost of that extended coverage.
Depends:

  • Not if the employer chooses a plan that doesn’t allow it. This option would exist for all employers, regardless of official religious standing.
  • Yes, if the employer chooses to allow it.
Employees can get contraception taken out of their coverage if it’s included in their employer’s group plans: Yes. Current law allows health insurance companies to offer an alternate plan that doesn’t include contraception to employees who don’t want it. Yes. SB 749 requires health insurance companies to offer an alternate plan without contraception to employees who don’t want coverage for it.
Health insurance companies can eliminate contraception entirely from their portfolio of offerings. No. All exemptions from contraception coverage currently refer to employers and employees, but not to health insurance companies. Yes. Health insurance companies are added to the list of entities exempt from providing access to contraception.
Sterilization is included with contraception and abortion as services that anyone can exclude from their health insurance plans. No. Sterilization is not mentioned in current law. All exemptions from coverage refer only to contraception and abortion. Yes. Sterilization** is added to the list of services that anyone can exclude from their plans.
Elective abortions can only be covered by an optional rider attached to a health insurance plan.

 

* Contraception, in both the current statute and proposed legislation, only refers to medical services carried out for the sole purpose of preventing pregnancy. Other medical indications for the use of contraception are excluded.

** Sterilization, in this case, only refers to procedures carried out for the sole purpose of rendering someone incapable of reproduction. Other medical indications for sterilization are excluded.

 

INFO BOX: (Already uploaded)

* Contraception, in both the current statute and proposed legislation, only refers to medical services carried out for the sole purpose of preventing pregnancy. Other medical indications for the use of contraception are excluded.

** Sterilization, in this case, only refers to procedures carried out for the sole purpose of rendering someone incapable of reproduction. Other medical indications for sterilization are excluded.

 

INFO BOX: (Already uploaded)

Health insurance costs vary widely depending on the age, health and habits of the insured and the trade-off between premiums, co-pays and deductibles, among other considerations. There is also a difference in cost between individual and group plans, in no small part because employers typically pay for at least a portion of group plans.

In Missouri, the statewide average cost of individual health insurance is $2364 annually, according to the Henry J. Kaiser Family Foundation.

Employer-based premiums average $5019 per year per employee. Of that total, an average of $1155, or 23 percent, is paid by the employee while the remainder of the tab, $3864, is picked up by the employer.

But those costs don’t account for deductibles, which is only a potential cost.

To get a better sense of how much health insurance might cost on the individual market, I got three online quotes to compare. Based on my age, gender and non-smoking status, the lowest bid was $5256, which costs $229.74 monthly with a $2500 deductible. The highest was $11,620 for a $135 monthly premium and a $10,000 deductible.

In Missouri, about half the population is insured through employer plans, while 14 percent are uninsured, according to Kaiser. 

Draft 2

COLUMBIA — Access to birth control and abortion mixed with religious freedoms and bundled in states’ rights makes for an emotional debate anytime. Schedule a vote on the brew in the middle of campaign season, and that debate becomes all the more freighted.

Earlier this year, Gov. Nixon vetoed a bill that would modify state laws regarding abortion, contraception and sterilization. On Sept. 12, the Missouri General Assembly will likely try to override his veto. The prospects for success are good, but not certain.

And what it all means depends on whom you ask.

The upshot of Senate Bill 749, sponsored by Sen. John Lamping, R-St. Louis, is a change to state health insurance mandates. Currently, health insurance plans with that include coverage for prescriptions also have to cover contraception. [DOES THE OB/GYN CARE ALSO COVER ABORTION?] The one exception is for religious organizations, which are exempted.

Employees whose group plans do not include contraception coverage have the option of purchasing a rider, a sort of a la carte addition to their group plan. In that case, the employee does not have to pay for the contraception rider; employees bear its cost entirely.

This would change if the General Assembly successfully overrides Nixon’s veto of the SB 749. Under the proposed legislation, employers would be able to purchase group plans that do not include the optional rider for abortion or contraception. Sterilization is also added as coverage that employers could wash their hands of due to their own “religious beliefs or moral convictions.”

Part and parcel of this new arrangement: Insurance companies would be required to offer plans for which the optional rider is, well, not an option.

“We’re talking access to birth control,” Rep. Mary Still, D-Columbia, said. “I believe that access to contraception is important to a woman’s health and economic well being. To deny that portion (of health insurance) that is uniquely important to women is discrimination,” she said.

Lamping denied that the bill restricts a woman’s access to healthcare. “This bill does no such thing,” he said.

The price of access

The legislation’s impact on “access” depends largely on how that term is defined.

“You have access under SB 749 just like current employees do now who work for religious organizations,” Lamping said.

If those organizations exclude the contraception or abortion rider from their coverage, employees can opt out of their employer-based group plan and purchase individual coverage with the contraceptive rider attached, according to Calvin Call, executive director of the Missouri Insurance Coalition.

“But you can’t insure the rider with a vendor or 3rd party outside of your group plan coverage,” Call said.

“That’s an expensive proposition for women,” Still said.

Access: a federal mandate  

An estimated 10.7 million American women use oral contraceptives and 10.3 million opt for sterilization, according to the Centers for Disease Control.

Yet almost half of all pregnancies in the United States are unintended — a rate that doubles or triples for women who are 18-24 years old, poor or unmarried and living with their partners.

Partially because unintended pregnancies are associated with increased risk of birth complications,[3]the U.S. Dept. of Health and Human Services recently changed a policy, under President Obama’s direction. Effective Aug. 1 of this year, all insurance policies are to include contraceptive services, education and counseling directly to women and free of charge.[4]

This made a moot point out of religious organizations’ exemption from providing access to contraception. Yet, while they would not be forced to subsidize contraception directly, those services still would flow through the religious employers’ health plans.

Dozens of federal lawsuits challenging that mandate are pending. In the meantime, state legislators across the country, such as Lamping here in Missouri, are doing what they can to challenge it.

“What’s extraordinary … is that it’s the first federal government mandate for state health insurance,” Lamping said. “That’s where 749 became a bill.”

If it goes through, women who want coverage for birth control but can’t get it through their employers may feel forced into a take-it-or-leave-it decision: Should they take what they can get from work and go without contraceptive coverage, or find an entirely different plan on their own?

Lamping recognizes this, and maintains that providing access to those services forces a parallel all-or-nothing decision for employers with strong objections to contraception: Should they offer health insurance, knowing that it may ultimately be a vehicle for contraceptive or abortion services, or should they not offer health insurance at all?

Two colleges in Florida, Ave Maria University and Florida Catholic University, reportedly have cited the mandate as part of their reasons for choosing to discontinue health insurance coverage for their employees.[5]

Lamping lists Catholic hospitals, high schools and adoption agencies as the types of religious organizations that may choose that path, as well. “Up to 30,000 employees could lose their insurance,” he said.

In that case, like the women who opt to find their own insurance rather than settle for coverage that doesn’t meet their contraceptive needs, those employees could access — and pay for — health plans on the open market.

States’ rights

Lamping isn’t alone in his belief that Obama’s policy overstepped the federal government’s jurisdiction. Rep. Chris Kelly, D-Columbia, said he understands why Lamping would say that.

“It’s a politically popular thing to say. And I actually agree with him,” Kelly said. “But state law cannot abrogate federal law,” Kelly said.

Kelly said he also believes the law is superfluous, because current Missouri statutes already protect employers from paying for the contraceptive services.

“So what they’re actually doing is denying the employee their moral or religious discretion,” Kelly said. He is urging his colleagues to sustain Nixon’s veto of SB 749 when it comes up for an override vote Sept. 12.

Sen. Kurt Schaefer, D-Columbia, also opposes SB 749.

“This law is not needed to tee-up a fight with the federal government,” Schaefer said. If Missouri wants to fight the federal mandate, he said, the place to do it is through the courts.

But that is not his only objection to the bill.

“It’s basically giving the insurance companies (the right) to not cover additional things, even if the employer and employee want them,” he said.

Religious freedom

Sen. Tom Dempsey, R-St. Charles, said he thinks “in most cases, from a business standpoint,” it’s unlikely that an insurance company would choose to exclude the contraception rider entirely from its portfolio. Dempsey is one of four co-sponsors of SB 749, along with 32nd District Sen. Ron Richard, 6th District Sen. Mike Kehoe and 2nd District Sen. Scott Rupp.

“Obama made a ruling related to employers that have a religious mission. He took an option away from them. And we are trying to put that option back in place,” Dempsey said. “It’s a religious freedom issue.”

Rep. Still could not disagree more.

“If you’re in the business of providing insurance, I think it’s important to consider the needs of the person you’re insuring, and that’s also a religious issue. To be fair and open-minded about the needs of a woman is an important tenet of my religion,” she said. For the record, Still said she is a Methodist.

Still is also concerned about the very premise of SB 749: that a business regulation could be based on “religious beliefs or moral convictions.”

“It’s a slippery slope of how you define moral convictions,” she said. “What if you are a Christian Scientist? And I think Jehovah’s Witnesses don’t believe in blood transfusions. It’s moving in that direction. The state doesn’t need to be making laws about it,” Still said. [1]

Women’s health

Above all, SB 749 is a women’s health issue to Still, she said. She doesn’t buy the argument that it’s got anything to do with state’s rights.

“We have addressed that issue with the Civil War,” she said. “This bill deals with contraception.” Still ties that directly to a woman’s health and economic well being.

“Your insurance is a benefit of your employment. To say that an employer can deny birth control (as a women’s health service) is discrimination,” she said.

She also challenged Schaefer to filibuster SB 749 when it comes to an override vote Sept. 12. (Still is campaigning to replace Schaefer as the 19th District Senator serving the Columbia area.)

“I voted against it previously and I see no reason I would change my position on that,” Schaefer said.

“A filibuster in a special session … Even the Democrats won’t likely do that,” he said, because all filibustering would do is make the session more expensive by making it longer.

Schaefer said he’s undecided whether he will speak in opposition to the bill when it comes up, or just vote against it.

“I don’t know. We’ll have to see what the debate is,” he said.

Suspense is already building about what that debate will bring.

House Minority Floor Leader Mike Talboy, D-Kansas City, anticipates it will be the most difficult of the governor’s vetoes to sustain.

“It’s probably the most fueled and emotional type of bill that we’re going to see in veto session,” Talboy said.

Draft 1

Access to birth control and abortion mixed with religious freedoms and bundled in states’ rights is an emotional debate anytime. Schedule a vote on it in the middle of campaign season, and that debate becomes all the more freighted.

Earlier this year, Gov. Nixon vetoed a bill that would change state laws regarding abortion, contraception and sterilization. On Sept. 12, the Missouri General Assembly will likely try to override his veto. The prospects for success are good, but not certain.

And what it all means depends on whom you ask.

The upshot of Senate Bill 749 is a change to state insurance mandates. Currently, Missouri employers who provide health insurance coverage have to offer employees a “rider,” a sort of a la carte addition to an insurance plan, to cover abortion and contraception.

Employers do not, however, have to pay for it. If employees want that optional rider, they bear the cost for it entirely. The employer, meanwhile, will offer the rest of the group insurance plan and subsidize it to whatever extent they desire.

Sen. John Lamping, R-St. Louis, sponsored SB 749 and intends to bring it forward Sept. 12 to override Nixon’s veto.

“Employers can offer good plans, bad plans, or no plans at all,” Sen. John Lamping, R-St. Louis, said. But under current law, if they do offer health insurance, that coverage has to include an optional rider for birth control or abortion. The one exception is for religious organizations, which are exempted.

This would change if the General Assembly successfully overrides Nixon’s veto of the bill. Under SB 749, employers would be able to purchase group plans that do not include the optional rider for abortion or contraception. Sterilization is also added as coverage that employers could wash their hands of due to their own “religious beliefs or moral convictions.”

Part and parcel of this new arrangement: Insurance companies would be required to offer plans for which the optional rider is, well, not an option.

“We’re talking access to birth control,” Rep. Mary Still, D-Columbia, said. “I believe that access to contraception is important to a woman’s health and economic well being. To deny that portion (of health insurance) that is uniquely important to women is discrimination,” she said.

Sen. Lamping denied that the bill restricts a woman’s access to healthcare. “This bill does no such thing,” he said.

The price of access

The legislation’s impact on “access” depends largely on how that is defined.

“You have access under SB 749 just like current employees do now who work for religious organizations,” Lamping said. If those organizations exclude the contraception or abortion rider from their coverage, the employees are free to go elsewhere for that coverage.

“You can opt out of the group plan and go purchase your own individual coverage with that contraceptive rider attached,” according to Calvin Call, executive director of the Missouri Insurance Coalition. “But you can’t insure the rider with a vendor or 3rd party outside of your group plan coverage.”

To get the contraception, abortion, or sterilization coverage if your employer doesn’t make it available, in other words, an employee would have to forego the employer’s plan altogether and find health insurance another way.

If the desired coverage is not available through a spouse’s employer, an individual health insurance plan could be purchased.

“That’s an expensive proposition for women,” Rep. Still said.

{Get figures that show on average how much more expensive, or at least how much individual plans generally cost.}

Access: a federal mandate  

More than 10.5 million American women use oral contraceptives, according to the National Conference of State Legislatures. The Centers for Disease Control state that “The Pill,” as it’s known, is by far the most popular form of contraception, followed by female sterilization, condoms, male sterilization, and other methods[1].

Despite the preponderance of contraception, almost half of all pregnancies in the United States are unintended, according to a 2006 report cited by the CDC[2]. That rate doubles or triples for women who are 18-24 years old, poor or “cohabiting,” the researchers found.

Partially because unintended pregnancies are associated with increased risk for birth complications,[3] the U.S. Dept. of Health and Human Services made a change. Effective Aug. 1 of this year, all insurance policies are to include contraceptive services, education and counseling with no cost sharing. WTF does “cost sharing mean”?

The traditional exemption from providing access to contraception for religious organizations was made moot. Instead of exempting religious organizations from the requirement, President Obama’s policy requires insurance companies to provide contraception to women directly and free of charge.[4]

This means that, while religious organizations would not be forced to directly subsidize contraception, those services would still flow through the religious employers’ health plans.

Dozens of federal lawsuits challenging that mandate are pending. In the meantime, state legislators across the country, such as Lamping here in Missouri, are doing what they can to challenge it.

“What’s extraordinary … is that it’s the first federal government mandate for state health insurance,” Lamping said. “What’s where 749 became a bill.” He wrote the bill, in part, as a challenge to the federal law.

If it goes through, women who want coverage for birth control but can’t get it through their employers may feel forced into a take-it-or-leave-it decision: Should they take what they can get from work and go without contraceptive coverage, or find an entirely different plan on their own?

Lamping recognizes this, and maintains that providing access to those services forces a parallel all-or-nothing decision for employers with strong objections to contraception: Should they offer health insurance, knowing that it may ultimately be a vehicle for contraceptive or abortion services, or should they not offer health insurance at all?

Two colleges in Florida, Ave Maria University and Florida Catholic University, reportedly have cited the mandate as part of their reasons for choosing to discontinue health insurance coverage for their employees.[5]

Lamping lists Catholic hospitals, high schools and adoption agencies as the types of religious organizations that may choose that path, as well. “Up to 30,000 employees could lose their insurance,” he said.

In that case, like the women who opt to find their own insurance rather than settle for coverage that doesn’t meet their contraceptive needs, they could access — and pay for — health plans on the open market.

Are there any examples of places in MO that have cut insurance for this reason? Can I get some numbers of employees who work for religious organizations?

States’ rights

Lamping isn’t alone in his belief that Obama’s policy overstepped the jurisdiction of the federal government.

Rep. Chris Kelly, D-Columbia, agrees. But he comes out in a very different place.

“I understand why he would say that because it’s a politically popular thing to so. And I actually agree with him,” Kelly said. “But state law cannot abrogate federal law,” Kelly said. He is urging his colleagues to sustain Nixon’s veto of SB 749 when it comes up for an override vote Sept. 12.

Kelly also believes the law is superfluous, because current Missouri statutes already protect employers from paying for the contraceptive services.

“So what they’re actually doing is denying the employee their moral or religious discretion,” Kelly said.

Sen. Kurt Schaefer, D-Columbia, also opposes SB 749.

“The fact that we pass a law is not going to preempt or undo a federal law. This law is not needed to tee-up a fight with the federal government,” Schaefer said. He said if Missouri wants to fight the federal mandate, the place to do it is through the courts.

That’s not his only objection.

“The other thing too, is it’s basically giving the insurance companies (the right) to not cover additional things, even if the employer and employee want them.”

Religious freedom

Sen. Tom Dempsey, R-St. Charles, said he thinks “in most cases, from a business standpoint,” it’s unlikely that an insurance company would choose to offer no plans at all that include the optional rider for contraception. Dempsey is one of four co-sponsors of SB 749, along with 32nd District Sen. Ron Richard, 6th District Sen. Mike Kehoe and 2nd District Sen. Scott Rupp.

“Obama made a ruling related to those employers that have a religious mission. He took that option away from them. And we are trying to put that option back in place,” Dempsey said. “It’s a religious freedom issue.”

Rep. Still couldn’t disagree more.

“If you’re in the business of providing insurance, I think it’s important to consider the needs of the person you’re insuring, and that’s also a religious issue. To be fair and open-minded about the needs of a woman is an important tenet of my religion,” she said. For the record, Still said she is a Methodist.

But Still is also concerned about the very premise of SB 749: that a business regulation could be based on “religious beliefs or moral convictions.”

“It’s a slippery slope of how you define moral convictions,” she said. “What if you are a Christian Scientist? And I think Jehovah’s Witnesses don’t believe in blood transfusions. It’s moving in that direction. The state doesn’t need to be making laws about it,” Still said. [I need to verify if JWs allow transfusions.}

Women’s health

Above all, SB 749 is a women’s health issue to Still, she said. She doesn’t buy the argument that it’s got anything to do with state’s rights.

“We have addressed that issue with the Civil War,” she said. “This bill deals with contraception.”

Still ties that directly to a woman’s health and economic well being.

“Your insurance is a benefit of your employment. To say that an employer can deny birth control (as a women’s health service) is discrimination,” she said.

She also challenged Schaefer to filibuster SB 749 when it comes to an override vote Sept. 12. (Still is campaigning to replace Schaefer as the 19th District Senator serving the Columbia area.)

“I voted against it previously and I see no reason I would change my position on that,” Schaefer said.

A filibuster, however, is not likely.

“A filibuster in a special session … Even the Democrats won’t likely do that,” he said, because all filibustering would do is make the session more expensive by making it longer.

Schaefer said he’s undecided whether he will speak in opposition to the bill when it comes up, or just vote against it.

“I don’t know. We’ll have to see what the debate is,” he said.

 

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