Comment on FR Doc # E8-19744

RE: Comments on Health and Human Services -- “Provider Conscience Regulations” – Notice of Proposed Rulemaking, 73 Fed. Reg. 50274, August 26, 2008. Dear Secretary Leavitt: Aron Compton submits these comments on the proposed rule published at 73 Fed. Reg. 50274 that purports to interpret the Church, Coats, and Weldon Amendments. As applied to Title X recipients and other federally funded health care providers, the proposed regulations could drastically limit access to basic health care for low-income and uninsured patients, and could present a substantial step backwards for the health of women and men in this country. More than 17 million women in America are in need of publicly-funded contraceptive services, a number that continues to rise as more and more people become uninsured and unemployed as our economy struggles. The Department should be working to increase access to these crucial health care services, rather than working to limit them. Plymouth Family Planning, As a member of the National Family Planning and Reproductive Health Association (NFPHRA), we are one of nearly 4,500 private, non-profit health centers, as well as state, local and county health departments, that provide health care services through the Title X family planning program, and are committed to providing patients the full range of comprehensive family planning and reproductive health care services as the program requires. The Regulations Could Make It More Difficult For Women to Obtain Contraceptive Services We are seriously concerned by statements from the Secretary that suggest that the Department intends for the regulations to provide a new right for institutions and individuals to refuse to provide contraceptive services. This would be a dramatic and unprecedented expansion of the existing refusal laws, and couldhave enormous public health consequences. More than 90 percent of American women will use contraception at some point in their lives. Moreover, according to researchers at the Guttmacher Institute – a nonprofit think tank on sexual and reproductive health – without the contraceptive services provided at publicly funded clinics, there would be 46% more unintended pregnancies (1.4 million more) annually in the United States. If adopted, the proposed regulations could thus prevent millions of Americans from making responsible, healthy decisions for themselves and their families. The Regulations Allow Health Care Workers to Refuse to Provide Complete and Accurate Information and Counseling to Women Who Seek Services The regulations could also permit health care workers to withhold even the most basic information and counseling from their patients. For example, Title X program recipients are required by law to provide patients with non-directive options counseling. Similarly, the Department’s own regulations require participants in the Title X program to provide clinical, informational, educational, social, and referral services relating to family planning to any patient who requests such services. The proposed regulations appear to place Title X recipients in direct conflict with these federal mandates. In addition, the regulations could force Title X recipients to violate the legal and ethical principles of informed consent, which oblige health care professionals to provide their patients with complete and accurate information about all their treatment options. Again, there is simply no reason for the Department to undermine a program that has successfully provided services to millions of Americans for almost forty years. The Regulations Could Upset the Careful Balance That Already Exists in Federal Law and Unnecessarily Jeopardize Patient Health Federal law has carefully balanced protections for individual religious liberty and patients’ access to health care services for decades. In addition to the Church, Coats, and Weldon Amendments, Title VII of the 1964 Civil Rights Act has long required employers to attempt to accommodate an employee’s refusal to provide any health care service. Yet the proposed regulations appear to take patients’ health care needs out of this equation. For instance, nowhere in the proposed regulations does the Department spell out the need for patient safeguards in the face of religious refusals; nor do the proposed regulations explain how Title X recipients and other federally funded health care providers are supposed to balance patients’ ability to obtain health care services with protection for individual religious belief. Instead, the proposed regulations seem designed deliberately to upset this balance and to allow religious refusals to trump patients’ basic health care needs. As written, therefore, the regulations could impose an unacceptable burden on both health care providers and the patients they serve. * * * For the reasons discussed above, we urge HHS to withdraw the proposed rule. Should HHS insist upon proceeding with the proposed rule, the agency should substantially modify its proposal in accordance with the forgoing comments. Sincerely, Aron Compton