Testimony Before Committee on Oversight & Government Reform Regarding Refusal Cl

The National Health Law Program (?NHeLP?) submits this testimony to the Committee on Oversight & Government Reform. NHeLP is a public interest law firm working to advance access to quality health care and protect the legal rights of low-income and underserved people. NHeLP provides technical support to direct legal services programs, community-based organizations, the private bar, providers, and individuals who work to preserve a health care safety net for the millions of uninsured or underinsured low-income people.  Consistent with this mission, NHeLP works to ensure that all people in the United States?including women?have access to preventive health services. The Patient Protection and Affordable Care Act (?the ACA?) similarly recognizes that preventive health services are critical to individual and community health, and that cost is often a barrier to accessing needed preventive services.  The ACA also acknowledges the critical role that a woman?s health plays in the health and well- being of her family and her community, as well as women?s disproportionately lower earnings, by explicitly requiring that women?s preventive health services be covered without cost-sharing.
Healthcare coverage decisions should be based on accepted standards of medical care recognized by the various professional medical academies.  ?Standards of care? are practices that are medically appropriate, and the services that any practitioner under the circumstances should be expected to render. Every person who enters a doctor?s office or hospital expects that the care he or she receives will be based on medical evidence and meet accepted medical guidelines ? in other words, that care will comport with medical standards of care.  Refusal clauses and denials of care, however, violate these standards.  They undermine standards of care by allowing or requiring health care professionals and institutions to abrogate their responsibility to deliver services and information that would otherwise be required by generally accepted practice guidelines. Ultimately, refusal clauses and institutional denials of care conflict with professionally developed and accepted medical standards of care and have adverse health consequences for patients.  NHeLP?s publication, Health Care Refusals: Undermining Quality Care for Women (Appendix A), is an extensive analysis of medical standards of care for women's health and the impact of refusal clauses and institutional denials of care on health access and quality.1
NHeLP?s testimony addresses issues raised by the question presented by the Committee on Oversight & Government Reform.  NHeLP strongly supports the Department of Health and Human Services? (HHS) requirement that most new health insurance plans cover women's preventive health services, including contraception, without cost-sharing.  The decision significantly benefits millions of women who are currently insured or who will obtain health insurance through the ACA?and one that will ensure that most women have access to contraception without expensive co-pays, saving some women up to $600 per year.  The Administration recently adopted a religious employer exemption that would allow certain religious employers to refuse to cover contraception, as they would otherwise be required to do. The Administration has also announced that it will develop rules that will ensure that women can obtain contraceptive coverage at no additional cost while also allowing non-profit religiously- affiliated employers, such as hospitals or universities, to refuse to provide contraceptive coverage.  Despite these accommodations, the drive to deprive women of the right to obtain affordable birth control continues.  NHeLP strongly opposes efforts to undermine the health and autonomy of women.  Every woman should be able to make her own decisions about whether or when to have children based on her own beliefs and needs.  Employers and insurance companies should not be able to override the health care decisions of individual women.
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