Massachusetts lawmakers move to protect contraceptive coverage

BOSTON — The House passed a bill to ensure no-cost contraceptive coverage in Massachusetts on Wednesday, a month after the Trump administration opened the door to companies dropping that coverage by expanding exemptions to requirements.

The bill also establishes no-co-pay coverage for over-the-counter emergency contraception and limits insurers' ability to impose restrictions on coverage.

Senate Majority Leader Harriette Chandler of Worcester is lead sponsor of the legislation (H 4009), known as the ACCESS bill.

With formal sessions scheduled to end for the year Nov. 15, House leaders have expedited the bill.

It received a favorable recommendation from the Financial Services Committee on Monday, the Health Care Financing Committee OK'd it Tuesday and the full House took it up Wednesday morning, after it quickly passed through the House Ways and Means Committee.

The bill gained steam after the Trump administration issued two new regulations — interim final rules — to expand available opt-out justifications for employers and insurers that don't want to provide contraceptive coverage.

The rules, released last month through the Department of Health and Human Services, encompass "sincerely held" religious or moral objections for an array of institutions.

Both rules apply to health insurance issuers, nonprofit organizations, institutions of higher learning and at least some for-profit entities.

'Anybody could have a moral objection'

Advocates and legislators contested the rules' exemptions, particularly the lack of clarity regarding what specifically qualifies as a moral or religious objection.

Rebecca Hart Holder, executive director of NARAL Pro-Choice Massachusetts, was particularly concerned about the rule concerning moral objections to contraceptive coverage.

"Anybody could have a moral objection," she said. "And they don't define 'moral.'"

Lora Pellegrini, president of the Massachusetts Association of Health Plans, told The Eagle that the association's 17 members all support the compromise language of the ACCESS bill.

"Our plans have done their part to protect Massachusetts women," Pellegrini said. "I don't know any insurer in our state who would not cover birth control."

A Center for Health Information and Analysis report released last week found that the bill's mandates would cost the health care system $1.9 million to $5.7 million annually over the next five years, adding 84 cents to $2.40 to the annual premium for a Massachusetts subscriber.

Numbers lacking

Several states, including Massachusetts, are also challenging the Trump administration rules in court.

Attorney General Maura Healey sought to bar implementation of the rules for violations of administrative and constitutional law.

California, Washington and Pennsylvania have also sued.

In late August, Healey's office filed a formal request with multiple federal departments for the number of employers who had asked for accommodations regarding birth control coverage.

The federal government failed to provide this information, according to the lawsuit.

The Eagle contacted these departments to verify this claim.

The Department of the Treasury and the Department of Health and Human services did not respond.

The Department of Labor referred The Eagle to the Department of Justice, which provided this statement:

"The Department of Justice looks forward to vigorously defending the President's commitment to protecting religious liberty."

The DOJ otherwise did not respond to The Eagle's questions.

Healey's lawsuit also claims that the Trump administration violated federal law by not allowing time for notice and comment before releasing the rules.

The administration instead said the rules became final immediately upon their release Oct. 6.

'We can only do what we can do'

The rules go beyond previously implemented, narrower exemptions to rules requiring contraceptive coverage.

Both rules expand the types of institutions allowed to claim the exemptions. The religious exemption encompasses all employers, both nonprofit and for-profit.

Under the rules, exempted employers would also be able to decide whether their employees receive independent contraceptive coverage through an accommodation process.

In 2014, the federal Department of Health and Human Services estimated that more than 600,000 nonprofit employees and their dependents were receiving contraceptive coverage through the accommodation process, according to Healey's lawsuit.

"We can only do what we can do," said Bryan Barash, legislative director for Chandler, the Senate majority leader. "There are certain things we can control and certain things we can't at the state level."

The nature of how contraceptive coverage was mandated in the first place — through administrative guidelines, not law — makes the ACCESS bill even more important, Barash said.

"That's why, for us, even before Trump became president ... we thought it was important that there was some sort of mandated state statute," Barash said. "[Mandated contraceptive coverage] wasn't a law. It was subject to change on a much quicker timeline than you can change a law, because it's a rule. It only requires the action of whoever happens to occupy the presidency."

Patricia LeBoeuf can be reached at, at @BE_pleboeuf on Twitter and 413-496-6247.

State House News Service contributed to this report.


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