Secretary Michael O. Leavitt September 18, 2008

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Washington, D.C. 20201

Re: 'Provider Conscience Regulation,' RIN 0991-AB48

Dear Secretary Leavitt:

I am writing to express opposition to the "provider conscience"
regulation that was formally proposed by the U.S. Department of Health
and Human Services (HHS) on August 26, 2008. If made final, this
regulation could severely impede access to basic health care services
and gut state laws and policies designed to ensure individuals and
families can obtain the care they need. At a time when our country is
engaged in a rigorous debate about reforming our health care system, it
is troubling that the Bush Administration is issuing a regulation that
serves to limit health care options for patients.

The proposed regulation purports to interpret three existing federal
refusal clauses---the Church Amendments, the Public Health Service (PHS)
Act § 245, and the Weldon Amendment,[^1] which focus on allowing certain
health care providers to deny abortion and sterilization services to
patients. In reality, this proposed regulation is unnecessary and will
undoubtedly threaten health care access, including women\'s ability to
access basic health information and services, such as birth control.

At its core, the proposed rule is dangerously vague. For instance, the
proposed regulation does not include a definition of abortion. By
leaving this term undefined, the proposed regulation creates a dangerous
space for ideology and political views to insert themselves into medical
practices, emergency rooms, and clinics all across the country.
Important medical decisions, health care services, and information will
suddenly be open to very personal interpretations and political agendas,
and patients will suffer as a result.

Under this proposed regulation, any employee of a federally-funded
entity can deny any patient access to or a referral for important health
care services, including birth control. Similarly, entire facilities
could refuse to make birth control available---regardless of state laws
to the contrary.

In fact, the proposed regulation could drastically impact states'
ability to enforce their own laws and policies protecting and expanding
access to health care, including laws ensuring contraceptive equity in
insurance, access to emergency contraception for sexual assault victims,
and laws and policies to ensure access to birth control at pharmacies.
Currently, at least 38 states have laws that could be in jeopardy as
result of this regulation[^2]. The proposed regulation would also
undermine efforts to enhance or enact these protections in other states.

In addition, the proposed regulation creates a striking contradiction
with federal programs aimed at providing quality health care services to
low-income Americans. For instance, the regulation appears to create a
direct conflict with the requirements of the Title X family planning
program, which guarantees that the millions of women accessing care
through the program receive un-biased and non-directive counseling
regarding all of the options related to their pregnancy.[^3] Under the
proposed rules, women can no longer be assured that they will be given
information about and referral for all of their health care options,
including abortion.

It is not just family planning services that are at risk. This
regulation effectively creates a culture of health care refusal, whereby
patients can be denied access to any number of health care services. In
fact, quality care is at stake in many areas, including HIV/AIDS care
and fertility care.

This proposed regulation will fundamentally compromise our nation's
already strained health care safety net. By HHS's own estimates, this
proposed regulation will impact almost 600,000 health care entities,
including hospitals, private physicians, and health centers. The
proposed rule is so broad that it would allow any employee to deny the
provision of any health care service for which they were hired to
perform. In fact, an example given in the regulation would allow an
employee whose job it is to clean surgical equipment to refuse to do so.
Similarly, a health center staff person opposed to the provision of
birth control who was hired to schedule patient appointments could
refuse to schedule patients seeking those services.

This proposed regulation is completely out of step with the American
people --- 98 percent of American women use a contraceptive at some
point in their lives. Not surprisingly, it is also out of step with the
American electorate --- 73% of whom strongly support policies that make
it easier for women at all income levels to obtain contraceptives.

As the Sexual Assault Response Team Coordinator for Norton Sound
Regional Hospital I am deeply concerned by the federal government's
effort to strong-arm states into effectively overturning hard won
protections intended to help women and families access basic health
care. As our nation faces a health care crisis, now is the time to focus
on ensuring all Americans have access to affordable, quality health
care. It is for this reason that I strongly urge HHS not to issue a
final regulation on this matter.

Thank you for your consideration.

Sincerely,

Karen McLane FNP-BC

P.O. Box 966

Nome, Alaska 99762

\(907\) 443-4204

<kmclane@nshcorp.org>

[^1]: Church Amendments, 42 U.S.C. § 300a-7; the Public Health Service
    (PHS) Act § 245, 42 U.S.C. § 238n; the Weldon Amendment,
    Consolidated Appropriations Act, 2008, Pub. L. No. 110-161, §
    508(d), 121 Stat. 1844, 2209.

[^2]: 27 states (AZ, AR, CA, CT, DE, GA, HI, IL, IA, ME, MD, MA, MI, MO,
    MT, NV, NH, NJ, NM, NY, NC, OR, RI, VT, WA, WV and WI) have laws
    and/or policies requiring insurers that cover prescription drugs in
    general to provide coverage of the full range of FDA-approved
    contraceptive drugs and devices. 7 states require some insurance
    plans to coverage contraception (CO, KY, MN, ND, OH, OK and WY).

    17 states (AR, CA, CO, CT, IL, MA, MN, NJ, NM, NY, OH (policy does
    not include an enforcement mechanism), OR, PA, SC, TX, WA, and WI)
    require hospital emergency rooms to provide emergency
    contraception--related services to sexual assault victims. 13 states
    (AL, CA, DE, IL, ME, MA, NV, NJ, NY, NC, OR, PA, and TX) have laws
    or policies preventing pharmacists or pharmacies from obstructing
    access to contraception.

[^3]: 42 C.F.R. § 59.5