February
2005
Hallowed
Be Thy Health Care: A Look at Catholic HMOs
By Sara Weinstein
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Picture this scenario: One
night while having sex, the condom breaks. In an effort to prevent
an unintended pregnancy and ultimately an unwanted
abortion, you decide to get emergency contraception from your physician.
Emergency contraception (EC), also known as the “morning-after
pill,” is a higher dose of birth control and when taken within
72 hours of sex reduces the risk of pregnancy.
The clock is ticking so you call to schedule an appointment with
your primary care doctor, but once you meet with her you are told
that the
doctor cannot provide
you with EC. You learn that your managed care plan, which is sponsored by the
Roman Catholic Church, has carved out family planning services from their benefit
plan. If you are lucky, your doctor will inform you that you can go out of
network and take the time to locate a provider that accepts Medicaid
as payment for EC.
By the time you are able to locate a health care provider that accepts Medicaid
and get an appointment, it is all too likely that the window in which EC works
will have closed. As a result, you may be forced to decide between having a
child you cannot care for both emotionally and financially, or having
an abortion.
Though fictional, it’s safe to assume that this story plays itself out
in the experiences of many low-income women enrolled in a Catholic managed care
plan. Twelve million women are covered by Medicaid, and three out of four Medicaid
beneficiaries are female. Today, hundreds of thousands of women are enrolled
in Catholic-run plans that place the religious views of the managed care plan
above the health care needs of women. This is a prime example of the problem
with “faith-based” managed care.
The U.S. Conference of Catholic Bishops regulates American Catholic health
systems through the issuance of the Ethical and Religious Directives for Catholic
Health
Care Services. The Directives forbid the payment of delivery of services that
contradict church teachings and prohibit, among other things, tubal ligations,
vasectomies, in vitro fertilization, prescribing or dispensing of contraceptive
devices, and abortions.
Even though federal law requires state Medicaid programs to include family
planning care as a mandatory covered service, Catholic-run managed care organizations
are allowed to “opt out” of providing family planning services
to their enrollees based on their religious doctrine. Women are still legally
entitled
to this care, but now have to go out of network and navigate their way through
bureaucratic red tape to get time-sensitive care to which federal Medicaid
law entitles them.
In an effort to control costs and provide higher quality care for consumers,
states are increasingly enrolling low-income women enrolled in Medicaid into
managed care programs. Under managed care, beneficiaries are promised a “medical
home,” a place where they can receive their health care on a regular
basis, allowing for a better coordination of care.
When a Catholic-run managed care plan opts out of providing family planning
services, they compromise the goal of providing patients better coordinated,
continuous
care. Normally, women visit their in-network gynecologist or family physician
to avert unintended pregnancies, ensure healthy pregnancies, and prevent a
range of health problems including cervical cancer and sexually transmitted
disease.
Instead, when a woman is enrolled in a Catholic managed care plan, she must
now obtain these services from other providers. Unfortunately, obtaining these
services
elsewhere, or even realizing that they must be obtained elsewhere, may not
be easy for the patient due to cultural, socio-economic, and language barriers.
Furthermore, Catholic health care plans often do not inform prospective and current
enrollees of their failure to provide family planning services. As a result,
women do not receive the reproductive health care they need, or they are forced
to navigate through the confusing health care system without assistance, often
resulting in untimely care.
For low-income women, Medicaid is an essential source of financing family planning
needs. Carving out family planning care can result in significant health care
consequences for a population of low-income women who are already besieged
by high rates of unintended pregnancy and sexually transmitted disease.
A comprehensive study in 2000 by Catholics for a Free Choice found that 15
Catholic managed care plans participate in the Medicaid program nation-wide
serving approximately
800,000 people. Fidelis in New York is one such plan. Fidelis serves low-income
individuals enrolled in Medicaid, as well as the state’s other health
care programs for low-income residents, Family Health Plus and Child Health
Plus.
In order for a woman enrolled in Fidelis to get reproductive health care services,
she must go out-of-network to find a provider. Under Medicaid, she will have
to take the time to locate a provider that accepts Medicaid. Under Child Health
Plus and Family Health Plus, she will have to contact an entirely different health
plan, forcing her to navigate not one, but two different health plans to get
the care she needs.
The Institute for Reproductive Health Access conducted a study to determine
the impact of the Fidelis “carve out” on family planning care. First,
the study found that Fidelis fails to educate current and prospective enrollees
about the nature and consequences of its carve out policy. Marketing brochures
are confusing at best and incomplete at worst. Medicaid beneficiaries are rarely
informed that family planning is not covered, and get no guidance about how to
obtain these services elsewhere. Second, the study found that physicians often
gave incomplete or incorrect information about how to get family planning care.
Women reported that they were flatly denied family planning and abortion services
in accordance with Fidelis policy. Women were seldom told that they had a right
to obtain family planning services elsewhere—or informed how to do so.
Family planning care is just as essential to the overall health of a woman
as cancer screening or liver disease treatment. However, government officials
allow
for family planning care to be cut out of service packages, but would never
dream of not providing a woman with treatment for lung cancer, for instance,
because
the Church didn’t support her decision to smoke.
Catholic Medicaid managed care plans fall short of providing their enrollees
with seamless reproductive health care. Any managed care plan that receives
public funding sources should not be able to refuse to provide reproductive
health services
based on religious objections, especially when these objections result in significant
life-altering consequences. As long as religiously affiliated Medicaid managed
care plans are able to opt out of providing their enrollees with family planning
services, women’s reproductive health care will remain in danger.
Sara Weinstein is the Low-income Access Project Coordinator of the Institute
for Reproductive Health Access. The Institute is currently working with the New
York State Legislature to create legislation that would forbid all health plans
operating in the State of New York to refuse to provide family planning care
to its enrollees. For more information on this effort, contact (212) 343-0114
or institute@prochoiceny.org.
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