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Protection of Conscience Project

Service, not Servitude
Legal Commentary

United States Code

Title 42 - The Public Health and Welfare

Chapter 6A-Public Health Services


This part of the United States Code (U.S.C) is also known as the Public Health Service Act.  In 2012, the Patient Protection and Affordable Care Act amended the law in the course of wide-ranging health care reforms. 

The amended law (reproduced here in part) requires all group health care plans (the kind of plan usually offered by businesses or oganizations) to offer coverage and fully pay for "preventive services."  Another part of the law requires all businesses with 50 or more employees to offer such coverage by 2014, or face penalties.1  Health insurance issuers (like insurance companies) must also make available group and individual plans that fully pay for "preventive services."

 "Preventive services" are not fully defined in the statute.  They are itemized in separate recommendations, and in guidelines that were not proposed until a year after the Patient Protection and Affordable Care Act was passed. 

The Obama administration has decided that, as a matter of public policy, individual women should not have to pay for "FDA approved contraceptive services," which include surgical sterilization, contraceptives, and embryocides.2  The reasons offered for this policy are mainly economic and socio-political. 

Contrary to an administration statement  on 10 February, 2012, the regulation has not been changed to accommodate objecting religious believers.  The wording and legal effect of the regulation remains exactly as it was when it was announced on 20 January, 2012.3

Since sterilization and birth control have to be paid for by someone, the  administration intends to force others to pay for them through insurance plans, even if they object to doing so for reasons of conscience or religion.

What follows is the part of the law that is the basis for the regulation enacted to achieve this.   Key terms are highlighted, links have been added for the convenience of readers, and annotations are provided in text boxes to the right. 

- Administrator

Subchapter XXV-Requirements Relating to Health Insurance Coverage
Part A-Individual and Group Market Reforms
Subpart ii-Improving coverage

§300gg-13. Coverage of preventive health services   [Full Text]
(a) In general

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for-

(1) evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force;

(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and1

(3) and (4) authorize the Health Resources and Services Administration (an agency of the Department of Health and Human Services) to develop "comprehensive guidelines" to implement the law. 

(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.2

The Health Resources and Services Administration later enacted Required Health Plan Coverage Guidelines.

(4) with respect to women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this paragraph.2

(5) for the purposes of this chapter, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.

Nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by such Task Force. . . [Full Text]

1.  So in original. The word "and" probably should not appear.

2.  So in original. The period probably should be a semicolon.

Provided by the Protection of Conscience Project

1.  "The New Health Care Reform Law:  How Will it Affect Non-Profit Employers?"  The Arc, National Policy Matters, Issue #9, July 15, 2012.

2.  The term "contraceptives," as it is used in the guidelines (and, thus, the regulation) includes sterilization and drugs and devices that may cause the death of a human embryo before implantation ("embryocide").  For an explanation of this terminology, see Clearing Rhetorical Minefields.

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