Nov. 22, 2011
On Wednesday, November 2, Representative Pitts (R-PA), in his capacity as Chairman of the
Energy and Commerce Committee Subcommittee on Health, convened a hearing to discuss the controversial HHS interim final rule on womens preventive services which forces all health plans to cover, with no cost-sharing, the full range of FDA-approved contraceptives, including drugs and devices that can destroy life.
Interesting moments from the hearing, Do New Health Law Mandates Threaten Conscience Rights and Access to Care? are included below, as well as a few fact checks and a link to the full transcript.
REP. PITTS: In issuing the rule, HHS acknowledged that it bypassed the normal rulemaking procedures in order to expedite the availability of preventive services to college students beginning the school year in August... I believe that on such a sensitive issue there should have been a formal comment period so that all sides could weigh in on the issue and HHS could benefit from a variety of views.
REP. BURGESS: The decision by Health and Human Services to issue an interim final rule, while that sounds like arcane Washington, what that means is that the transparency and accountability of the normal federal rulemaking process has now been circumvented.
...it didn't really allow for the proper input and transparency of the normal federal agency process. The Affordable Care Act is a lot of pages of very densely worded instructions to federal agencies...there's a reason that it does that because it allows the public to comment, and...before the rule is put forward it allows for the people to weigh in on it. But in an interim final rule...this thing can come out with the force of law in a relatively condensed period of time with maybe public input, but maybe it ignores public input.
REP. BURGESS: We live under the rule of the Congressional Budget Office, and all of us on this -- both sides of the dais know, we're not allowed to score savings; we can only talk about cost...
Can you give us an idea of what kind of the range of costs -- let's just stick with oral contraceptives for right now. I know you're interested in long-term contraception, but just for oral contraceptives right now, there's a pretty wide variation of cost, is there not?
(Minority Witness OBYGN, Director of OB/GYN Outreach Services for Women and Infant Services Washington Hospital Center)
The brand name contraceptives probably run in the neighborhood of upwards of $50 per month. The generics are probably in the neighborhood of $30, or somewhere in that neighborhood...
REP. BURGESS: ...[T]here is a cost differential of about $20 a month for a generic Ortho-Novum 1/35, Necon...and there's another one called Seasonique that's, according to research done by my staff, is $1,364 a year, so about $110 a month. So that's a pretty wide discrepancy, isn't it?
... the Institute of Medicine and the interim final rule says without regard to cost we have to provide all methods, now, across the board.
REP. WAXMAN: The question comes down to, what is the scope of the exception that church-provided insurance need not cover family planning? Well, I dont know why that should be even an exception. I disagree with the administration in providing that exception.
STEVENS (Majority Witness MD, MA (Ethics) Chief Executive Officer Christian Medical Association)
Virtually all medical professionals and student members we recently surveyed say its important to personally have the freedom to practice health care in accordance with the dictates of his or her conscience. Over nine out of 10 say they would not prescribe FDA-approved contraceptives that might cause death of a developing embryo...
The potential religious exemption in the conception -- contraception mandate, exempting only a nano-sector of religious employers from the guidelines, is meaningless to conscientiously objecting health care professionals, insurers, and patients...The contraceptive mandate rule sweepingly tramples conscience rights, which have provided a foundation for the ethical and professional practice of medicine.
HATHAWAY: Using contraception is the most effective way to prevent unintended pregnancy.
Fact: Peer reviewed studies out of Sweden, the United Kingdom and Spain  all agree that increased use of contraceptives coincides with an increase in abortions and sexually transmitted diseases (STD). Additionally, here in the United States, less contraceptive use correlates with fewer abortions. From 1995 to 2002, the rate of contraceptive use decreased from 64 percent to 62 percent  and abortion numbers decreased from 1,359,400 to 1,293,000. Also see:
[B]ased on your clinical experience, do you believe that elimination of out-of-pocket costs for birth control pills and other forms of contraception would increase their use?
HATHAWAY: Most definitely. Most definitely.
REP. BURGESS: Can you tell us, between Title X, Medicaid, and Temporary Assistance for Needy Families, how much money is spent on family planning by the federal government every year?
HATHAWAY: I dont know that number.
Fact: Contraceptives are widely available in the U.S. and already are heavily subsidized by the federal government; total public expenditures for contraceptive services were $1.85 billion in 2006.  Medicaid family planning costs during that time totaled $1.3 billion. States additionally contributed $241 million for family planning in fiscal year 2006. Also in the same fiscal year, Title X, an additional funding stream for family planning, contributed another $215 million of taxpayer dollars for family planning services.  In more recent years, Title X costs have been as high as $317 million annually.
Edgardh, K., et al., Adolescent Sexual Health in Sweden, Sexual Transmitted Infections 78 (2002): 352-6, http://sti.bmjjournals.com/cgi/content/full/78/5/352
 Sourafel Girma, David Paton. The Impact of Emergency Birth Control on Teen Pregnancy and STIs.Journal of Health Economics, 2010; DOI: 10.1016/j.jhealeco.2010.12.004
 Contraceptive Use, Facts in Brief, The Alan Guttmacher Institute (March, 2005), http://www.guttmacher.org/pubs/fb_contr_use.html. These numbers represent use among all women age 15-44, and thus, because many women in this age group would not be sexually active, the rate of use among sexually active women would be higher.
A. Sonfield, C. Alrich, and R.B. Gold, Public Funding for Family Planning, Sterilization and Abortion Services, FY 19802006, Occasional Report 38 (Jan 2008): 28-33.
Guttmacher Institute, Facts on Contraceptive Use in the United States (June 2010): p. 1 ( http://www.guttmacher.org/pubs/fb_contr_use.html).