Major
Developments in the States in 2004
Improving Access
to Care
Contraceptive
Coverage
Twenty-one
states require insurance plans that cover prescription drugs to
cover contraceptive drugs and supplies approved by the U.S. Food
and Drug Administration. Twelve of these mandates permit employers
or insurers to refuse to provide contraceptive coverage if doing
so would be against their conscience; thus, a key challenge facing
advocates of contraceptive coverage is to ensure that any exemptions
are narrowly tailored to minimize the number of people denied coverage.
This effort received a major boost in March when the California
Supreme Court upheld a narrow provision that permits an employer
to refuse to cover contraceptives only if it has as its mission
the inculcation of religious values, primarily employs and serves
people who share its religious tenets, and falls under a U.S. tax
code provision that applies to churches, church auxiliaries and
religious orders. The U.S. Supreme Court declined to hear an appeal.
Emergency Contraception
Maine enacted
legislation permitting pharmacists to provide emergency contraceptives
without a prescription. The measure requires the pharmacist to undergo
training on emergency contraception and to provide the patient with
a factsheet on the medication. This brings to six the number of
states that give women the option of obtaining emergency contraceptives
without a prescription.
[Last year
was the first, however, in which legislatures moved to restrict
their expansion programs. The measure adopted in Connecticut would
limit the state's expansion to adults. Indiana 's would implicitly
exclude coverage for emergency contraception, even though emergency
contraception is covered for other Medicaid recipients. The Texas
legislation is quite restrictive: It contains both of the above
provisions, requires that contraceptive counseling emphasize sexual
abstinence for unmarried women and bars participation in the program
by any family planning provider that also provides abortion-related
services with other funding.]
Impeding Access to
Care
Comprehensive Abortion
Bans
Two states
enacted legislation aimed at significantly limiting abortion services:
- Michigan enacted a measure that will limit
abortions to cases where the woman's life is endangered; the law
is to go into effect in March.
- A law enacted in Mississippi would require
that abortions after the first trimester be performed in a hospital.
However, since no hospital in the state provides procedures after
the first trimester, the law effectively would ban second trimester
abortions. Enforcement of the law is blocked pending the outcome
of litigation.
Feticide
Kentucky,
Mississippi and Virginia enacted measures that allow a fetus to
be considered a human being for purposes of the states' homicide
statutes. (Similar measures were vetoed in Iowa and West Virginia.)
This brings to 31 the number of states with similar laws.
'Partial Birth' Abortion
Utah enacted
a measure amending its existing ban on 'partial-birth' abortions
to no longer allow the procedure when the woman's health is endangered.
The measure also broadened the ban so that it is potentially applicable
to a wide range of abortion procedures. Enforcement of the measure
is blocked pending the outcome of litigation. Thirty-one states
ban “partial-birth” abortions; four of these include an exception
for the woman's health. (In 2003, President Bush signed a federal
ban on the procedure. This measure has been declared unconstitutional
by three federal district court judges, and enforcement of the law
is blocked pending appeal.)
Refusal Clauses
In May,
Mississippi enacted legislation described by the governor as
"the single most expansive" refusal law in the nation.
The law permits individuals and institutions who provide or pay
for health care to refuse to be involved in any service to which
they object on moral, ethical or religious grounds, regardless of
the impact of their decision. The law covers activities such as
counseling, diagnosis and research, as well as dispensing or administering
any type of drug, device, surgery, care or treatment. Individuals
able to refuse include any employee of a hospital, clinic, nursing
home, pharmacy or medical school, along with students, counselors
or "any other person who furnishes, or assists in the furnishing
of, a health care procedure." Similar legislation was vetoed
in Wisconsin.
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Production of the State Update is made possible by support from The David and Lucile Packard Foundation and the Prospect Hill Foundation.
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