In 1998, Congress included an amendment in the Treasury-Postal Appropriations bill requiring most health plans that participate in the Federal Employees Health Benefits Program (FEHBP) to provide "contraceptive coverage," including early abortifacient methods to the same extent that they provide prescription drug coverage generally. We opposed this amendment. (The Treasury-Postal Appropriations bill became law as part of the FY 1999 Omnibus Supplemental Appropriations Act, H.R. 4328, PL 105-277.)
FEHBP is the health insurance program for all federal employees, including Members of Congress and their staffs. Individuals covered make contributions to their coverage, but most of the program's cost is paid through federal tax dollars. Before the mandate was enacted in 1998, 350 health plans were available to employees and they could choose a plan with the coverage they desired. A majority of these plans provided some contraceptive coverage. In 1999, 285 plans participate in FEHBP.
"Contraceptive coverage" is not defined in the amendment. However, a November 1998 Office of Personal Management (OPM) Benefits Administration Letter says the plans must offer the "full range of contraceptive drugs and devices approved for use by the Food and Drug Administration."
The effect of this policy is to force health plans to cover controversial abortifacients such as the new so-called "morning after" product, Preven, approved by the FDA for use as "postcoital emergency contraception." Preven and similar drugs work up to three days after unprotected intercourse or contraceptive failure to destroy a developing embryo. Clearly, this is not contraception but it is defined as such by the FDA.
The latest edition of the nation's leading embryology textbook explains the mode of action of such drugs: "The administration of relatively large doses of estrogens ("morning after" pills) for several days, beginning shortly after unprotected sexual intercourse, usually does not prevent fertilization, but often prevents implantation of the blastocyst." K. Moore and T. Persaud, The Developing Human: Clinically Oriented Embryology (6th ed.: 1998), p. 58.
Wal-Mart, the nation's fifth largest pharmacy chain, recently announced that it will not fill prescriptions for "emergency contraception."
The FEHBP mandate also lacks adequate conscience protection for sponsors of health plans and individual providers who are opposed to providing such drugs and devices. Five religious plans are exempt by name: Providence Health Plan, Personal Care's HMO, Care Choices, OSF Health Plans, Yellowstone Community Health Plan, as well as any "existing or future plan, if the plan objects to such coverage on the basis of religious beliefs." Plans and individuals objecting to such coverage based on moral convictions should be protected as well, as they are under many state and federal laws.
Conscience protection for individual providers needs to be clarified to protect any health care provider, including but not limited to physicians, nurses and physician assistants, who object to providing these drugs or devices on the basis of religious beliefs or moral convictions. The current law protects only individuals who decline to "prescribe" such drugs and devices and may be interpreted too narrowly.
This misnamed "contraceptive" mandate is being used to help "mainstream" abortifacient drugs to which many health professionals, pharmacies and patients have serious objections. It reduces federal employees' freedom to choose the health benefits they want; ignores health plans' potential moral objections; and increases pressure on health professionals to ignore their own conscientious convictions. All of this, ironically, is done in the name of "freedom of choice."