A few days ago, we learned that Arkansas Works, a proposed Arkansas health insurance plan for poor people, must include coverage for contraceptives that in rare cases cause abortions. The legislature is debating this proposal that would go into effect in addition to our current Medicaid program.
Arkansas Works is a proposed continuation of the Private Option which was passed in 2013 and is set expire at the end of 2016. Under the Private Option, over 267,000 Arkansans have signed up to receive tax-funded health insurance purchased from private insurance companies with public funds.
Last year, the Obama administration began requiring health insurance plans to pay for all eighteen types of FDA-approved contraception in order to comply with Obamacare. The Obama administration has put Arkansas and other states in a very difficult position. Arkansas has two primary choices. If Arkansas refuses to pay for contraceptives that cause abortions the federal government will withhold funding for the Private Option and 267,000 Arkansans will lose their health insurance coverage. If Arkansas approves Arkansas Works and accepts the federal funds, we will have to pay for contraceptives that can cause abortions.
Family Council has been on record for quite some time as opposing emergency contraceptives—also known as “Plan B,” and “the morning after pill,”—which can cause an abortion by preventing a fertilized egg from implanting in the womb. These are the types of contraceptives being funded.
I met with Governor Hutchinson yesterday, and he read me a letter he has drafted in which he has promised to seek a waiver from the federal government exempting Arkansas from the contraceptive requirement. This is a positive move that previous governors would never have taken, and we deeply appreciate the Governor’s intent and effort. However, the Obama administration’s commitment to the pro-abortion agenda makes a waiver much less likely now than it will be if a more pro-life president takes office in January. If passed, Arkansas Works will replace the current Private Option and take effect in July of this year.
Our lawmakers are faced with some very difficult choices. They can end funding of abortion-causing contraceptives through the Private Option by letting the entire program expire at the end of 2016. This would leave 267,000 people without health care, and under the Affordable Care Act those people would be forced to buy insurance out of their own pockets or find it elsewhere.
Another possibility would be that the Legislature could offer amendments or alternatives to Arkansas Works that might result in no public funds paying for abortion-causing contraceptives and still maintain health coverage for the 267,000 Arkansans who were on the Private Option. Achieving this would be difficult since Arkansas might have to pay for it all and the Affordable Care Act still might apply the contraceptive mandate to insurance plans bought solely with other funds.
Finally, the Legislature could approve Arkansas Works and hope for a waiver if not now, maybe in January when a new presidential administration takes over.
Lawmakers I have spoken to are not pleased with any of the alternatives. Please pray that every member of the legislature, the governor, and all who are concerned will vote their consciences—as they can best see what is right—on this issue.
Below is some additional information on this issue.
Family Council Overview of Medicaid Funding of Morning-After Pill
April 19, 2016
Emergency contraception pills (also known as the “morning-after” pills) are drugs taken by women shortly after intercourse to prevent pregnancy. According to the Guttmacher Report the drug can prevent or delay ovulation, prevent or delay fertilization, and it can prevent the implantation of a fertilized egg in the uterus, depending on when the drug is taken. Dr. James Trussell, Senior Fellow at the Guttmacher Institute confirmed in 2010 and 2013 that emergency contraception can inhibit implantation of a fertilized egg, and the FDA-approved label for Plan B, a popular emergency contraceptive, states it may prevent the implantation of a fertilized egg. Since our view has always been that human life begins at the moment of fertilization, any drug that prevents a fertilized egg from implanting in the uterus is an abortifacient. Based on available evidence, we are certain the morning-after pill and other forms of emergency contraception can cause an abortion.
The federal Hyde Amendment generally prevents direct funding of abortions with federal funds through the federal Medicaid program. Exceptions are made for Medicaid recipients who are victims of rape or incest or if the mother’s life is at stake. However, federal authorities say the Hyde Amendment does not apply to emergency contraception, because they define “pregnancy” as occurring after the fertilized egg implants in the uterus. In other words, preventing a fertilized egg from implanting in the uterus does not constitute an “abortion,” as far as the federal government is concerned.
Under the federal Medicaid program, states are required to provide family planning services. Since at least as recently as 2003, Arkansas’ traditional Medicaid program has funded FDA approved contraceptives—including emergency contraception—if prescribed by a doctor. Between 800,000 and 900,000 Arkansans are enrolled in the traditional Medicaid program.
In 2013 the Arkansas Legislature enacted the Private Option, a plan to use Medicaid tax dollars to purchase health insurance from private insurance companies for over 250,000 low-income Arkansans. Initially, we are told, the Private Option plan approved by the Arkansas Legislature included no funding for emergency contraception, because the private insurance companies offering plans for the Private Option did not cover those particular drugs in their plans.
This changed in May of 2015 when the Obama administration issued a “clarification” for health insurance plans complying with the Affordable Care Act. They directed plans to cover at least one of each type of contraception, including sterilization, implants, pills, injections, and emergency contraception. Since then, Arkansas’ Private Option plan has been required to offer emergency contraception. Any future plans under the Affordable Care Act will have to cover those drugs as well. Arkansas could ask the federal government to revise these requirements, or the state could request a waiver of the requirements, but the Obama Administration seems unlikely to grant one.
It is important to point out that changing or eliminating the Private Option or the subsequent program called Arkansas Works will not fully address the larger problem of abortions resulting from morning-after pills obtained through the traditional Medicaid program, which has nearly one million enrollees. If the state chooses not to move forward with Arkansas Works or a similar program, the number of abortions resulting from the morning-after pill likely would decrease, assuming that roughly 300,000 fewer Medicaid recipients would be enrolled. While the discussion over Arkansas Works has highlighted a serious problem with how Medicaid tax dollars are being spent, this problem stems from the Affordable Care Act and other policies coming from the federal government.
This overview was written by Jerry Cox on April 19, 2016, with the most accurate information available at the time. Our understanding of this complicated issue continues to evolve.
Jerry is the founder and president of Family Council. He began Family Council in 1989 after a successful effort to amend the Arkansas Constitution to prevent the use of public funds for abortions. He and his wife reside in Little Rock. They have four sons.