JEFFERSON CITY— A debate mixing the issues of access to birth control and abortion with those of religious freedom and states’ rights would be an emotional undertaking any time. But it becomes all the more tense when it happens in the middle of a political campaign season.
Earlier this year, Gov. Jay Nixon vetoed a bill that would modify state laws regarding abortion, contraception and sterilization. On Wednesday, members of the Missouri General Assembly will meet for their annual veto session and are expected to try to override Nixon. There’s a good chance they’ll succeed.
Health insurance costs vary widely depending on the age, health and habits of the insured and the trade-off between premiums, co-pays and deductibles, among other considerations. There is also a difference in cost between individual and group plans, in no small part because employers typically pay for at least a portion of group plans.
In Missouri, the statewide average cost of individual health insurance is $2,364 annually, according to the Henry J. Kaiser Family Foundation. Employer-based premiums average $5,019 per year per employee, of which $1,155, or 23 percent, is paid by the employee while the remainder, $3,864, is picked up by the employer.
But those figures don’t account for the potential cost of deductibles.
To get a better sense of how much health insurance might cost on the individual market, the Missourian sought online quotes for preventive care for a 37-year-old woman who doesn't smoke. The lowest monthly premium quoted was $135 and included a $10,000 deductible. The highest monthly premium quoted was $229.74 with a $2,500 deductible.
The core of Senate Bill 749, sponsored by Sen. John Lamping, R-St. Louis, is that insurance companies would not have to cover contraception, abortion or sterilization if they object to those services on religious or moral grounds.
The bill also would allow any employer to prevent such coverage from being added to group insurance plans when it conflicts with its moral, ethical or religious beliefs. State law now allows only religious organizations to prevent that addition to their coverage. The bill contains a retroactive clause that would make it effective Aug. 1 if the General Assembly overrides Nixon's veto.
“It’s basically giving the insurance companies (the right) to not cover additional things, even if the employer and employee want them," Sen. Kurt Schaefer, R-Columbia, said.
Schaefer said he objects to SB 749 on that principle and on the legal grounds that it contradicts federal law.
State Rep. Mary Still, D-Columbia, who is campaigning to replace Schaefer as the 19th District senator, also opposes the bill.
“We’re talking access to birth control,” Still said. “I believe that access to contraception is important to a woman’s health and economic well being” because it allows a woman to plan for a pregnancy.
“To deny that portion (of health insurance) that is uniquely important to women is discrimination,” she said.
While the bill's description implies that it's written to protect religious freedoms, Lamping said he sponsored it as a matter of states’ rights. He denied that the bill restricts a woman’s access to health care.
“This bill does no such thing,” Lamping said.
The price of access
The legislation’s impact on “access” depends largely on how that term is defined.
“You have access under SB 749 just like current employees do now who work for religious organizations,” Lamping said.
If those organizations prevent contraceptive services from being added to their coverage, employees can purchase contraception privately or opt out of their employer-based group plan, Lamping said.
In that case, they can access insurance for contraception elsewhere, such as through a spouse's plan or by purchasing private, individual coverage that includes those services, Calvin Call, executive director of the Missouri Insurance Coalition, said.
“That’s an expensive proposition for women,” Still said.
Access: a federal mandate
An estimated 10.7 million American women use oral contraceptives and 10.3 million opt for sterilization, according to a 2010 report from the Centers for Disease Control.
Yet, almost half of all pregnancies in the United States are unintended — a rate that doubles or triples for women who are 18 to 24, poor, or unmarried and living with their partners.
Partially because unintended pregnancies are associated with increased risk of birth complications, the U.S. Department of Health and Human Services recently changed a policy, under President Barack Obama's direction. Effective Aug. 1 of this year, all insurance policies are to provide contraceptive services, education and counseling directly to women and free of charge.
This rendered moot religious organizations' exemption from the requirement to provide access to contraception. Yet, while they would not be forced to subsidize contraception directly, religious employers argued, those services still would flow through their group health plans.
Lawsuits challenging the federal mandate are pending. In the meantime, legislators such as Lamping are doing what they can to contest it.
“What’s extraordinary … is that it’s the first federal government mandate for state health insurance,” Lamping said. “That’s where 749 became a bill.”
Employees who want coverage for birth control but can’t get it through their employers may feel forced into a take-it-or-leave-it decision: Should they take what they can get through work? In that case, they could go without contraceptive insurance and just buy their contraception privately. Or, should they find an entirely different plan that covers it?
Lamping recognizes this, and he maintains that providing access to those services through group plans forces a parallel all-or-nothing decision for employers with strong objections to contraception: Should they offer health insurance, knowing that it may ultimately be a vehicle for contraception, or should they not offer health insurance at all?
Two colleges in Florida, Ave Maria University and Florida Catholic University, reportedly have cited the mandate as part of their reasons for choosing to discontinue health insurance coverage for their employees.
Lamping listed Catholic hospitals, high schools and adoption agencies as the types of religious organizations that may choose that path as well.
In that case, like anyone who chooses to find their own insurance rather than settle for a plan that doesn’t meet their contraceptive needs, those employees could access — and pay for — health plans on the open market.
Lamping isn’t alone in his belief that Obama’s policy overstepped the federal government's jurisdiction. Rep. Chris Kelly, D-Columbia, said he understands why Lamping would say that.
"It’s a politically popular thing to say, and I actually agree with him,” Kelly said. “But state law cannot abrogate federal law.”
Kelly said he also believes the law is unnecessary because Missouri statutes already protect employers from having to pay for contraception or abortion coverage.
“So what they’re actually doing is denying the employee their moral or religious discretion,” Kelly said. He is urging his colleagues to sustain Nixon’s veto of SB 749 when it comes up for an override vote.
Schaefer takes a similar stance.
“This law is not needed to tee-up a fight with the federal government,” Schaefer said. If Missouri wants to fight the federal mandate, he said, the place to do it is through the courts.
Senate Majority Floor Leader Tom Dempsey, R-St. Charles, said that, from a business standpoint, he thinks most companies will continue to include contraceptive coverage in their group plans.
“Insurance companies will provide a plan that meets the purchaser's requirements,” he clarified by email.
Dempsey is one of four co-sponsors of SB 749, along with 32nd District Sen. Ron Richard, 6th District Sen. Mike Kehoe and 2nd District Sen. Scott Rupp.
“It’s a religious freedom issue,” Dempsey said. “Obama made a ruling related to employers that have a religious mission. He took an option away from them. And we are trying to put that option back in place.”
Still couldn't disagree more.
“If you’re in the business of providing insurance, I think it’s important to consider the needs of the person you’re insuring, and that’s also a religious issue," she said. "To be fair and open-minded about the needs of a woman is an important tenet of my religion.”
Still also is concerned about the very premise of SB 749: that a business regulation could be based on “religious beliefs or moral convictions.”
“It’s a slippery slope of how you define moral convictions,” she said. “What if you are a Christian Scientist? And I think Jehovah’s Witnesses don’t believe in blood transfusions. It’s moving in that direction. The state doesn’t need to be making laws about it,” Still said. (Her impression of Jehovah’s Witnesses’ policy on blood transfusions is partially true.)
Above all, SB 749 is a women’s health issue to Still, she said. She doesn’t buy the argument that it has anything to do with states’ rights.
“We have addressed that issue with the Civil War,” she said. “This bill deals with contraception.” Still said she ties that directly to a woman’s health and economic well-being.
“Your insurance is a benefit of your employment," she said. "To say that an employer can deny birth control (as a women’s health service) is discrimination.”
She also challenged Schaefer to filibuster SB 749 when it comes up for a vote.
“I voted against it previously, and I see no reason I would change my position on that,” Schaefer responded.
“A filibuster in a special session ... Even the Democrats won’t likely do that,” he said, arguing that all filibustering would do is make the session longer and more expensive.
Schaefer said he hasn't decided whether he will speak in opposition to the bill or just vote against it.
“I don’t know. We’ll have to see what the debate is,” he said.
When it passed the General Assembly, representative in the House voted 105-33to approve SB 749, while the Senate voted 28-6. To override a veto, votes of 109 in the House and 23 in the Senate are required.
Supervising editor is Scott Swafford.