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Monday, December 31, 2012

Understanding the Affordable Care Act's Coverage for Preventative Care

As the Affordable Care Act (ACA) continues to move forward for implementation in 2014, one area of controversy refuses to go away. Health care plans will soon include coverage for preventative care, which the Department of Health and Human Resources (HHS) defines as including birth control, emergency contraceptives and sterilization. The specific phrase that continues to cause an uproar is the term "emergency contraceptives."

Recently Hobby Lobby, a major arts and crafts for-profit chain, was refused an exemption based on religious beliefs and is now seeking legal action against the federal government. The company will not pay for what they consider to be abortion-inducing drugs. Their refusal could cost them millions in fines.

So, the question is, what does ACA mean when they refer to emergency contraceptives?

It is important to understand exactly what the Affordable Care Act inferred when including the term emergency contraceptives. Not only does it represent an additional service that health care coverage is going to pay for, but in addition, the difference between preventative versus abortion in understanding the meaning of emergency contraceptives is huge to religious organizations and others.

The emergency contraceptives included in the Affordable Care Act do not include abortifacients, or abortion-inducing drugs, such as RU_486 which, when taken during the first five weeks of pregnancy, blocks the action of progesterone so that the uterus sloughs off the embryo, causing the embryo to die. In a March, 2012 hearing of the Health Subcommittee of the House Energy and Commerce Committee, HHS Secretary Kathleen Sebelius stated, "There is no abortifacient drug that is part of the FDA-approved contraception [list].”

Under the Affordable Care Act, HHS allows exemptions for "certain non-profit religious employers" which would include churches and synagogues, and some primary and secondary religious schools. Organizations and companies outside exemption could be required to cover emergency contraceptives. Justice Sotomayer dismissed Hobby Lobby’s request for an injunction because the issue before the court was not indisputably clear.

The gray area in this controversy centers on whether or not an organization considers an emergency contraceptive as being an abortifacient drug. Specifically, if a drug works by preventing fertilized eggs from implanting in a woman’s uterus, it might be considered an abortifacient drug. So, what do the facts reveal about Plan B One-Step, Ella, and other drugs which are included in ACA as being FDA-approved emergency contraceptives?

There is no proof that these drugs block implantation. Studies have shown that the drugs work by preventing fertilization altogether. Emergency contraceptive drugs may also work by thickening cervical mucus so sperm cannot get through. Further, contraceptive drugs such as Plan B One-Step and Ella, often referred to as "morning-after" pills, do not cause any changes that would either block implantation or abort a fertilized egg.

However, with all this said, some continue to object based on opinion that it depends on when the drugs are taken that determines whether or not they will prevent the implantation of a fertilized egg. In addition, others consider all preventive care, including birth control, emergency contraceptives and sterilization, the same as abortion. The fact is, it remains a complicated issue combining opinions based on science, doctrine and beliefs that will generate more discussion and perhaps even more compromises down the road.

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