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TREASURY AND GENERAL GOVERNMENT APPROPRIATIONS ACT, 2000 -- (House of Representatives - July 15, 1999)

   So, therefore, Mr. Chairman, I would just ask us to allow a program that is really working, that is providing basic health care for women, to move along as it is. And I would like to work with the gentleman, as I mentioned many times, in preventing unintended pregnancy, and it seems to me that one of the best ways to do this is to provide for contraceptive services. That is the way we reduce the number of abortions and prevent unintended pregnancies.

   Mr. HOYER. Mr. Chairman, I move to strike the last word.

   Mr. Chairman, we had a very extensive debate on this issue last year. The extensive debate really dealt with the gravamen of the central point of the providing of contraceptive services through the insurance plans. Very frankly, the gentleman from New Jersey (Mr. SMITH) and I, as many people in this body know, are very close personal friends and work very closely together, and I have the greatest respect and affection for him, but we disagree on this issue. We have a different perspective.

   But during the course of that debate and during the course of the compromise on trying to come to grips

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with how to provide for what the overwhelming or significant majority of this House believed ought to be provided in the health care plans available Federal employees was the fact that we ought not to have insurance companies who had a religious affiliation and religious base do something that was inconsistent with their religious tenets. Most of us agreed that that was appropriate. What the gentlewoman who worked so hard on this amendment and so effectively on this amendment said when developing a conscience, the gentleman from New Jersey now seeks to add moral conviction to the language that exists for religious organizations.

   Now, clearly, executives of insurance companies have moral convictions; clearly, employees of insurance companies have moral convictions. But those moral convictions, I would suggest to my colleagues, are probably pretty diverse. And the executive vice president in charge of negotiations with the Federal Employee Health Benefit Plan may have one moral conviction, and the operating vice president may have another moral conviction. Now I am not sure whether the stockholders would vote on what a moral conviction is at any given time, but clearly, in fairness, that is an impractical standard to add to the standard that exists.

   What we were trying to do is make sure that religiously based and centered insurance offerers were not compelled to do something that was against their religious beliefs. We all understand that. But I defy anybody to explain to me how one is going to determine on insurance plan A or B or C that are not religious affiliated what their moral convictions are without, in effect, polling or voting or having included in their charter something that says moral convictions.

   The fact of the matter is that we had this debate last year, and we rejected this proposal because of the lack of clarity in the proposal.

   So I would hope my colleagues would reject this again this year because, quite clearly, it goes far beyond the exemption that we all agreed was appropriate; that is, the religious-based exemption, and goes to a further step, which moral convictions are critically important. Hopefully, all of us hold moral convictions; and, hopefully, as I said, insurance executives hold moral convictions as well. But they do not operate, unlike religiously based insurance companies, to promote their moral convictions. They hopefully operate legally, ethically and morally, but they operate to offer insurance programs to their clients. And, therefore, Mr. Chairman, this amendment, while I frankly would call it an imperfecting amendment, Mr. Chairman, in that it adds a provision that will be extraordinarily if not impossible to apply and interpret, for that reason I would hope the House would reject this amendment.

   Mr. WELDON of Florida. Mr. Chairman, I move to strike the requisite number of words.

   Mr. Chairman, I rise in support of the Smith amendment. I believe the Smith amendment is a significant enhancement to the current conscience clause language in the bill. The current conscience clause language does not sufficiently cover all those individuals who would like to take a moral as well as a religious exemption.

   It is well known that some of these products that are being referred to as contraceptives are not in reality contraceptives but are abortifacients, and this indeed causes many people who are of strong personal moral conviction, pro-life, or people who take a very strong religious perspective on this issue to have a problem, and I believe the gentleman's amending language is a significant improvement over the underlying bill.

   Mr. Chairman, I yield to the gentleman from New Jersey.

   Mr. SMITH of New Jersey. Mr. Chairman, I just want to point out to our colleagues that there are at least four laws, and I can give my colleagues all the citations, and I will put them in the RECORD, where plans organizations and institutions can raise objections on either moral or religious grounds.

   Why ``moral'' was left out is a gaping oversight, and I hope it was an oversight, and to suggest that people with moral convictions should not be able to express them and somehow manifest them, maybe through a vote of the board of directors or in some other way, would be wrong and would disenfranchise people, especially those who do not believe in God. Say someone is an agnostic, but has a strongly held conviction about a certain practice. To disenfranchise that person would be wrong.

   Let me also point out that the language of this amendment says, the underlying language says, the prescriber, the doctor that writes the prescription, does not have to do so if he or she, as a matter of moral conviction, does not want to prescribe an abortifacient, for example, an abortion-producing pill or drug. Well, everyone else in the line, including the dispenser, the person that actually gives the abortion chemical, cannot conscientiously object and say, ``Wait a minute, I'm all for family planning, but this crosses the line.''

   And there is a case of that right now that just made the Associated Press, and it was in the San Diego Union Tribune, of five nurses who quit their positions at a county-run health clinic because they did not want to be compelled to dispense abortifacients. These are women who routinely counsel and provide family planning. They are all for family planning, but they felt that they hit their breaking point when a clinical administrator said that they had to cross this line, and this could be the beginning.

   Let us not compel people in the health care delivery service to do something against their deeply held convictions. This is a conscience clause. Unfortunately, we did not vote on anything comprehensive last year, as the membership will note. Much of this was done in conference. It is infirm as it exists today. We ought to make it a real conscience clause. Do not force people to do things they do not want to do. Please do not do that.

   Mr. WELDON of Florida. Mr. Chairman, in closing let me just say that the gentleman's amendment, I believe, is a relatively modest amendment. By adding this moral clause I believe it will allow people to exercise their moral convictions and in many ways improve the underlying provisions in the language of the bill.

   In 1998, Congress included an amendment in the Treasury-Postal Appropriations bill requiring almost all health plans that participate in the Federal Employees Health Benefits (FEHB) Program to provide ``contraceptive coverage,'' including early abortifacient methods, to the same extent that they provide prescription drug coverage generally. (The Treasury-Postal Appropriations bill became law as part of the FY 1999 Omnibus Supplemental Appropriations Act, H.R. 4328, PL 105-277.)

   The FY 2000 Treasury-Postal contains the same language.

   The effect of this policy is to force health plans participating in FEHB 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 called contraception 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.

   The FEHB mandate lacks adequate conscience protection for some sponsors of health plans and individual providers who are opposed to providing such drugs and devices. Five religious plans are exempt by name, 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.

   The conscience protection for individual providers also needs to be clarified to protect any health care provider--including but not limited to physicians, nurses and physician assistants--who objects to providing these drugs or devices on the basis of religious beliefs or moral convictions. The current law only protects individuals who decline to ``prescribe'' such drugs and devices and may be interpreted too narrowly.

   The conscience protection language enacted in 1998 and currently in this year's bill marks a departure from other federal conscience laws. The lack of an exemption for those whose moral convictions are offended by abortion sends the message that religious beliefs are the only foundation for respecting human life before birth. In fact, objections

   to

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the destruction of living human embryos--and, in particular, forcing taxpayers and others to support this killing--is widely opposed by many people. We saw this in 1996 when 256 Members of House Representatives voted against funding research in which human embryos are destroyed, discarded or even put at risk.

   Prior to last year's enactment of the contraceptive mandate, most health plans participating in the Federal Employees Health Benefits (FEHB) Program paid for prescription drugs approved by the FDA as ``contraceptives''--including abortifacients. In 1998, each woman who participated in FEHB and who used contraception already had the choice of at least three (3) plans which provided coverage for whatever prescription method she used.

   Last year pro-life Members did not try to end this coverage, but to preserve the right of federal employees--including many women--to choose a health plan which did not cover abortion-inducing drugs characterized by the FDA as ``contraceptives.'' That choice was taken away from Federal employees when the mandate was enacted.

   One significant effect of the new coercive mandate was to force plans to cover--and force federal employees and taxpayers to pay for--the new ``morning after'' drug regimens such as Preven, which is to be taken after intercourse, or in the case of ``contraceptive failure,'' to ensure that a developing embryo will be expelled and not implant in the mother's womb.

   The controversy surrounding this drug is widespread. Many pharmacists, who have no objection to dispensing contraceptives, are strongly opposed to dispensing a drug which is primarily intended to kill a developing human embryo.

   Outside the federal context, individual pharmacists have had their jobs threatened because of their refusal to provide so-called ``emergency contraception.''

   Just this year, five nurses in Riverside, CA, quit their jobs at a county health department because of the department's insistence that they violate their religious beliefs and provide ``emergency contraception.'' (These nurses had spent years working in family planning, telling women about contraception.)

   Walmart, the nation's fifth largest distributor of pharmaceuticals, including contraceptives, recently announced that it would not dispense Preven in its stores because of concerns with objections from its customers.

   Conscience clauses are common both in federal and state law and are based on respect for individual freedom and individual beliefs. Forcing someone to engage in activity that violates his or her deeply and conscientiously held beliefs is a violation of human rights and a gross abuse of the power of government.

   Among the more recent conscience clauses enacted into law is legislation passed by Congress in 1996 to protect medical education programs from being required to provide abortion training. The exemption was provided regardless of whether their opposition is religiously or morally based. We recognized that abortion--the killing of an innocent human being--is simply not the kind of practice in which anyone should be forced to participate for any reason.

   As Senator OLYMPIA SNOWE--who is also a supporter of the contraceptive mandate--said during the debate on the amendment to protect doctors and training programs from having to perform abortions:

   This amendment accomplishes two things. One, it does protect those institutions and those individuals who do not want to get involved in the performance or training of abortion when it is contrary to their beliefs.

   I do not think anybody would disagree with the fact--and I am pro-choice on this matter, but I do not think anybody would disagree with the fact that an institution or an individual who does not want to perform an abortion should do so contrary to their beliefs.

   By mandating coverage of contraception and abortifacients by health plans, Congress has increased the pressure on individual physicians, nurses and pharmacists providing services under these plans to violate their own consciences. In fact, currently only those who may be asked to ``prescribe'' the drug have any conscience protection under the law, and unless they are familiar with it, they may not even know of their right to refuse.

   In addition to the abortion training conscience protection described above, Congress provided conscience clauses for plans offered under Medicare+Choice if the sponsoring organization offering the plan objects on ``moral or religious grounds.'' (42 U.S.C. 1395w-22(j)(3)(B))

   Another section protects Medicaid managed care organizations from being required to ``provide, reimburse for, or provide coverage of, a counseling and referral service if the organization objects to the provision of such service on moral or religious grounds.'' (42 U.S.C. 1396u-2(b)(3)

   Also, in yet another section, Congress provided that Legal Services Corporation funds could not be used to attempt to ``compel any individual or institution to perform an abortion, or assist in the performance of an abortion, or provide facilities for the performance of an abortion, contrary to the religious beliefs or moral convictions of such individual or institution....... (42 U.S.C. 2996f(b)

   Clearly federal law has established that conscience protection should not be limited to individuals, nor should it be limited to objections based on religious beliefs.

   Ironically, some who support the mandate have been critical of attempts to clarify the conscience provisions in the mandate, claiming that it already exempts health plans with ``moral or religious'' objections (The Boston Globe, October 1, 1998) and that, under the mandate, ``individual doctors and nurses can refuse to provide contraceptives on moral grounds.'' (The New York Times, October 16, 1998). Neither of these protections is actually in the contraceptive mandate's conscience exemption. Presumably they would not object to their addition now.

   While some pro-abortion Members may in fact believe that a drug which does not prevent fertilization but prevents implantation of an embryo is not an abortion-inducing drug, what these Members think is not important. What is important are the beliefs and convictions of those who will be required to carry out the mandate.

   No one should be forced to do what he or she believes would cause the death of an innocent human being, particularly in the name of health care.

   This is not, however, the view of those at the front of the fight for abortion on demand throughout pregnancy.

   At a March 5, 1999, briefing sponsored by the Center for Reproductive Law and Policy (CRLP)--which has challenged state Partial-Birth Abortion Ban laws around the country--and the People for the American Way, Janet Benshoof, President of CRLP said, ``I don't think there should be conscience clauses.''

   Do you?

   Mr. PITTS. Mr. Chairman, I move to strike the requisite number of words.

   Mr. Chairman, I rise in support of the Smith amendment. This amendment is common sense. It is not a threat to any contraceptive coverage. What it does is expand the choices of women and health providers. All this amendment does is add two simple things to the current conscience clause in the contraceptive mandate.

   Number one, it expands the conscience protection to plans which object on moral not just religious grounds. Religion is not the only reason one would object to abortion, and this should be accounted for.

   Number two, it expands the conscience protection not only to those who prescribe medication as in current law but also to those who provide for the abortifacient drug. All this means is that a nurse who does not prescribe but might be asked to administer an abortifacient drug has a right to refuse if it goes against her conscience.

   Conscience clauses are common both in Federal and State law. They are based on respect for individual freedom and on individual beliefs. Forcing someone to engage in activity that violates his or her deeply and conscientiously held beliefs is a violation of human rights. It is a gross abuse of the power of government.

   We have similar moral and religious provisions in conscience clauses in medical education programs, in the Medicaid managed care organizations law, in the Legal Services Corporation law. By mandating coverage of contraception and abortifacients by health plans, Congress has increased the pressure on individual physicians, nurses and pharmacists providing services under these plans to violate their own consciences. In fact, currently only those who may be asked to prescribe the drug have any conscience protection under the law, and unless they are familiar with it, they may not even know of their right to refuse.


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