The Joplin Globe, Joplin, MO

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September 22, 2012

New contraceptive coverage law creates controversy in Missouri

Supporters and detractors are worlds apart on what they say will be the effect of a controversial new Missouri law dealing with insurance coverage on contraceptives.

Disagreements also extend to the intent of the legislation, which says no employer will be required to provide contraception coverage in its workers’ insurance plans if it violates the employer’s religious beliefs.

The new law — Senate Bill 749 — went into effect after Missouri lawmakers earlier in the month voted to override Gov. Jay Nixon’s veto. The override challenges a mandate in the federal Affordable Care Act that all health care plans — with few exceptions — must provide contraceptives and related coverage.

The Legislature’s action is the subject of a court challenge filed by the Greater Kansas City Coalition of Labor Union Women. The lawsuit seeks a court injunction to block enforcement of the measure, arguing the state cannot trump federal law.

Members of Joplin’s area legislative delegation, all Republicans, voted for the override, and several offered comments defending the measure. Sen. Ron Richard, of Joplin, and State Reps. Tom Flanigan, of Carthage, and Mike Kelley, of Lamar, said the override supports the rights of employers and protects the religious freedoms of consumers in the health insurance market.

The legislation’s sponsor, Sen. Jim Lamping, R-Ladue, said he sees the bill as “not a contraception bill — it’s an anti-employer mandate bill.”

The lawmakers who favor the override insist it will have no significant impact on services currently being provided. They also argue it will not affect coverage for medications or procedures deemed medically necessary. The change, they said, will be for religious organizations that employ workers and do not want to offer contraception or related coverage as part of their employees’ health coverage. They will not be required to, they said, despite mandates in the federal Affordable Care Act.

“If there is a medical need for sterilization or contraception, it’s covered,” Lamping said. “And if it’s covered today, it’s still covered.”

Paula Gianino, president of Planned Parenthood of St. Louis and Southwest Missouri, disagreed, saying the Missouri law puts those decisions in the hands of employers.

“This law allows any employer in the state to stop providing coverage for birth control, and female and male sterilization services,” she said. ”All they have to do is say, ‘I morally object,’ and they can pick and choose what coverage they want to provide. This is unprecedented. It could impact millions of people, and Missouri is the only state doing it.”

Lamping bristles at representations that large numbers of Missouri residents will lose elements of insurance coverage because of the override.

“That whole argument is a fallacy,” he said. “If employers have a moral objection, that coverage isn’t in their plan now. So, nothing is being taken away.”

That “sounds like an empty promise,” said Katherine Mays, of Carl Junction.

“In the current state of the economy and employers looking to cut wherever they can, I just don’t think there’s any assurance out there that an employer might not drop that coverage,” she said.

The override limits women, said Mays, who has a master’s degree in health administration, “and not just the ability of you and your husband to plan for when you want your family. It could also limit a women in her career if she decided she wanted to change jobs, and then found out the company she is interested in won’t provide that coverage.”

She said insurance cutbacks also would increase the burden on the taxpayer when women have to look elsewhere for birth control, or when they get pregnant with a child they can’t afford.

“Paying for birth control is a cost, especially when people are having to decide between paying the bills and putting food on the table,” she said.

Generally, the cost of birth control pills ranges from $30 to $50 per month, according to Sheree Starrett, a pharmacist and co-owner of the Medicine Shoppe in Joplin.

She said most of the customers served by the pharmacy get some of that cost covered by insurance.

“Most insurance plans cover those costs,” she said. “A few don’t, but most do. I can’t think of many (customers) who pay cash. That would vary from pharmacy to pharmacy, because we all have our own clientele.”

She said pharmacies have not yet received advisories on the potential changes brought on by the Missouri law — post-override — “because it’s so new, and a lot of it is still up in the air.”

Lamping said the biggest change will be that insurance companies have to make plan sponsors and employees aware of what is in their existing policies and whether they include coverage for contraception, sterilization or abortion.

Lamping said the override should not prompt an employer to cut costs by dropping contraceptive coverage “because it’s cheaper to subsidize contraception than it is to cover the birth of a child.”

“I don’t think he can say that for sure, because this legislation puts the employer in charge,” said Gianino. “It puts limits on people who want to plan for their families.

“This bill has nothing to do with abortion, because no insurance plan in Missouri can offer abortion coverage. And we have laws in Missouri that already protect religious organization.”

A 2001 Missouri law states that birth control prescriptions shall be covered under policies that include pharmaceutical benefits at the same co-payment or deductible rates as other medication. That law also allows insurers to offer policies without contraception coverage to people or employers who say it violates their moral or religious beliefs. The 2001 law also ensures people can purchase a plan with contraception coverage if their employer’s plan does not offer it.

That measure was cited in his veto by Gov. Nixon, who said Missouri law for over a decade had provided religious protections to give employers the freedom to abstain from providing contraceptive coverage in their health plans, even if that coverage would be contrary to their religious or moral beliefs.

The bill was overridden 26-6 in the Senate. In the House, the vote was 109-45 — the minimum needed for an override.

The override was backed by Missouri Right to Life and the Missouri Catholic Conference. Conference spokesmen said the religious exemption in the federal law was too limiting and would not extend to organizations like Catholic universities, hospitals and charity organizations.

Sen. Richard said he sees the issue “as a matter of conscience, when you force a religious organization to (pay) for something they don’t believe in.’’

He and Flanigan said they had heard of organizations that would drop employee coverage rather than comply with the federal mandate.

“We don’t want to be telling a private business what they can and can’t do,” Flanigan said. “Companies could use (the requirement) as an excuse to drop health insurance for workers. Our religious organizations do a lot of charitable work and provide services in their communities. Making them chose between providing health care coverage for their employees and their moral conscience is not something we should make them do.”

Gianino said the change in the law will push more women toward organizations such as Planned Parenthood for affordable contraception.

Lamping said he thinks the structure of the federal health care mandate could cause employers to decide to drop coverage and pay employees to buy insurance through health exchanges, to be set up under the reforms.

States are to establish health care exchanges that uninsured residents will use to buy health insurance, under the law. If states don’t act, those residents will have access to a federal exchange. Missouri voters in November will vote on a measure that, if passed, would bar the governor from establishing a state-based health insurance exchange unless it is authorized by a vote of the people.

Nixon has said he won’t establish such an exchange, but the Republican-dominated Legislature proposed the measure, citing Missouri opposition to federal health care reforms. Missouri voters in 2008 voted by a 70 percent majority to reject the individual mandate in the Affordable Care Act.

Provisions of the new law are to be enforced by the Department of Insurance, Financial Institutions and Professional Registration. How some elements of the law might be interpreted were referred back to the bill language by Travis Ford, communications director for the department.

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