Broad Refusals to Provide Reproductive Care

Currently, federal law provides protections for certain individual and institutional health care providers who refuse to participate in abortion or sterilization services.¹ These laws do not contain critical patient protections that ensure access to reproductive health care in the event of a refusal.

Individual health care providers and health care entities who object to reproductive health care services also receive protection from state law. Forty-seven states have laws that explicitly allow health care providers and/or institutions to refuse to participate in abortion, sterilization, contraception, or other reproductive health care services. The content of these laws varies; some allow refusals with no patient protections, while others attempt to ensure that access to care is not compromised in the event of a refusal. The Report Card examines whether state laws permitting refusals to provide reproductive health care services also attempt to meet patients’ needs to access necessary care.

Impact of the Affordable Care Act

The Affordable Care Act expressly has no effect on existing federal laws that allow certain individual and institutional health care providers to refuse to participate in abortion or sterilization services. In addition, the Affordable Care Act specifies that no qualified health plans offered through the new state-based Exchanges may "discriminate" against an individual health care provider or facility because of a refusal to provide, pay for, provide coverage of, or refer for abortions.

Does the state have a law that attempts to ensure that patient access to reproductive health care services is not compromised in the event of a religious refusal?

States receive a “meets policy” if their law provides sufficient protections so that patient access to reproductive health care is unlikely to be compromised when there is a religious refusal. States receive a “limited policy” if their law provides some critical patient protections in the case of a refusal to provide reproductive health care but does not go far enough in ensuring patients’ needs are met. States receive a “weak policy” if their law is consistent with federal law or they do not have a state law and so are governed by federal law, meaning that patients do not receive protections, or if their law’s patient protections are negated by an expansion of refusal rights. States receive a “harmful policy” if their law significantly compromises patient access to care when there is a religious refusal to provide reproductive health care services or if the law contains expansions that are not counter balanced by patient protections.

This is a new indicator for the 2010 Report Card.

State	Strength of Policy	Change from 2007
Alabama	Weak Policy	N/A
Alaska	Weak Policy	N/A
Arizona	Limited Policy	N/A
Arkansas	Harmful Policy	N/A
California	Meets Policy	N/A
Colorado	Harmful Policy	N/A
Connecticut	Weak Policy	N/A
Delaware	Weak Policy	N/A
District of Columbia	Weak Policy	N/A
Florida	Harmful Policy	N/A
Georgia	Harmful Policy	N/A
Hawaii	Weak Policy	N/A
Idaho	Harmful Policy	N/A
Illinois	Harmful Policy	N/A
Indiana	Weak Policy	N/A
Iowa	Weak Policy	N/A
Kansas	Weak Policy	N/A
Kentucky	Weak Policy	N/A
Louisiana	Meets Policy	N/A
Maine	Harmful Policy	N/A
Maryland	Harmful Policy	N/A
Massachusetts	Harmful Policy	N/A
Michigan	Weak Policy	N/A
Minnesota	Weak Policy	N/A
Mississippi	Harmful Policy	N/A
Missouri	Weak Policy	N/A
Montana	Harmful Policy	N/A
Nebraska	Weak Policy	N/A
Nevada	Limited Policy	N/A
New Hampshire	Weak Policy	N/A
New Jersey	Harmful Policy	N/A
New Mexico	Weak Policy	N/A
New York	Limited Policy	N/A
North Carolina	Weak Policy	N/A
North Dakota	Weak Policy	N/A
Ohio	Weak Policy	N/A
Oklahoma	Harmful Policy	N/A
Oregon	Weak Policy	N/A
Pennsylvania	Meets Policy	N/A
Rhode Island	Weak Policy	N/A
South Carolina	Limited Policy	N/A
South Dakota	Harmful Policy	N/A
Tennessee	Harmful Policy	N/A
Texas	Limited Policy	N/A
Utah	Weak Policy	N/A
Vermont	Weak Policy	N/A
Virginia	Weak Policy	N/A
Washington	Weak Policy	N/A
West Virginia	Harmful Policy	N/A
Wisconsin	Weak Policy	N/A
Wyoming	Weak Policy	N/A

Policy Indicator Counts

Meets Policy:

3

Limited Policy:

5

Weak Policy:

27

No/Harmful Policy:

16

Better:

0

Same:

0

Worse:

0

Data Source: Unpublished National Women’s Law Center data 2010.

Footnotes

¹ The Church Amendment, 42 U.S.C. § 300a-7, specifies that receipt of federal funds does not require an individual or institution to provide sterilization or abortion services and permits individuals to refuse to perform or assist in the performance of a sterilization or abortion procedure, if doing so would be contrary to his or her religious beliefs or moral convictions. The Coats Amendment, 42 U.S.C. § 238n, prohibits the federal government and any state or local government receiving federal financial assistance from “discriminating” against any physician, residency training program, or participant in a health professionals training program on the ground that such person or entity refuses to receive or provide training in induced abortions, to perform such abortions, or to provide referrals for such training on such abortions. The Weldon Amendment Consolidated Appropriations Act, 2010, Pub. L. No. 111-117, § 508d, 123 Stat. 3034, 3280 (2009), provides that no funds made available in the Labor-Health and Human Services appropriations bill can go to a federal agency or program, or to a state or local government, “if such agency, program, or government subjects any institutional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.” The Patient Protection and Affordable Care Act, Pub. L. Nos. 111-148 & 111-152, § 1303(b)(4), prohibits a qualified health plan offered through an Exchange from discriminating “against any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions.”