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The Blunt Amendment gives virtually limitless and unprecedented license to any employer or insurance plan, religious or not, to exclude any health service, no matter how essential, in the health services they cover.
The Blunt Amendment Creates a Huge Loophole, Allowing Employers and Plans to Use Religious or Moral Convictions to Eliminate Critical Health Care Services
The Blunt Amendment allows employers and insurance companies to refuse coverage of any health care service required under the new health care law based on undefined “religious beliefs or moral convictions.” This creates a huge loophole in the new health care law’s coverage requirements. For example, any corporation whose CEO opposes contraception based on his “moral convictions” could deny all coverage of contraception or any other service to the company’s employees. Even more disturbing, a CEO’s view of “morality” could potentially include concern for the cost of a particular benefit. Such broad, undefined refusals would result in millions of individuals losing vital health service coverage.
The Blunt Amendment Undermines the Affordable Care Act’s Guarantee that All Insurance Plans Cover Preventive Services
The health care law requires that all new health plans cover certain “preventive services” without cost-sharing, including some that are specific to women. The Blunt Amendment would allow plans or an employer offering a plan to avoid this critical requirement, which is meant to ensure that cost-sharing is no longer a barrier to preventive care. For example, the Blunt Amendment would allow an employer or insurance company to:
- refuse to cover Human Papillomavirus (HPV) screening due to a religious or moral objection to the way the virus is transmitted. HPV can lead to cervical cancer, making early detection critical.
- refuse to cover vaccines because of a religious or moral objection to immunizations.
- refuse to cover HIV/AIDS screening due to a religious or moral objection to the way HIV/AIDS can be transmitted.
- refuse to cover contraceptives because of a religious or moral objection to contraceptive use.
The Blunt Amendment Undermines the Affordable Care Act’s Guarantee that Insurance Plans Cover a Comprehensive Package of Health Care Services Known as the Essential Health Benefits
The health care law guarantees that all plans offered in the individual market or to small businesses will cover a minimum set of “essential health benefits,” including mental health services and maternity care. Yet, the Blunt Amendment would allow plans or employers to refuse coverage of any of these essential benefits if they object on religious or moral grounds. For example, a small employer or a plan in the individual market could:
- refuse to cover prenatal tests due to the employer’s religious or moral objection to such testing.
- refuse to cover certain prescription drugs due to a religious or moral objection to the research methodology used to discover the drug, such as stem cell research.
The Blunt Amendment Allows States to Deny Health Services to the Newly Eligible Medicaid Population
The new health care law requires states to provide, at a minimum, the essential health benefits to the newly eligible Medicaid population. If an “entity,” as provided for in the Blunt Amendment, includes a state, then a state could refuse to cover any of the essential health benefits for being contrary to the state’s “moral convictions.” The impact would be devastating to this vulnerable population.
The Blunt Amendment Undermines the Basic Principle of Insurance
In addition to allowing plans and entities offering plans to undermine the new coverage guarantees, the Blunt Amendment allows individuals who purchase insurance in the individual market to do the same. If one individual claims a particular service is contrary to his or her religious or moral beliefs, the plan does not have to cover it, even if required to by the new health care law.
By allowing each individual to pick and choose specific medical services to be covered in a plan, the Blunt Amendment radically undermines the basic principle of insurance, which involves pooling the risks for all possible medical needs of all enrollees. The language is vague enough that insurers may be able to sell plans that do not cover services required by the new health care law to an entire market because one individual objects, so all consumers in a market lose their right to coverage of the full range of critical health services. For example:
- An individual could object to coverage of vaccines for children, so the plan could then not be required to do so.
- A man purchasing an insurance plan offered to women and men could object to maternity coverage, so the plan would not have to cover it.
The Blunt Amendment Allows Plans to Discriminate Against Individuals
The Blunt Amendment would exempt health plans from fulfilling the critical non-discrimination protections contained in Section 1557 of the new health care law, which prohibits discrimination against individuals in health care based on sex, race, color, national origin, age, and disability. For example, under the Blunt Amendment:
- An insurer could refuse to cover maternity care or routine sonograms during the course of a pregnancy, due to a religious or moral objection to covering pregnancies out of wedlock.
The Blunt Amendment Creates a Private Right of Action for “Threatened” Violations
The Blunt Amendment allows “any person or entity” protected by the refusal provisions to file a lawsuit in federal court for “actual or threatened violations.” The ability to sue for “threatened” violations is a troubling addition to private cause of action language, and is not found in any civil rights law. Even more troubling is that the bill provides no definition of what constitutes “threatened.”
Additionally, this language could be interpreted to allow anyone, including a health plan or a potential beneficiary, to sue a state official for even establishing an essential health benefits benchmark plan that includes coverage of services to which the plan or individual has a moral or religious objection. This could have a chilling effect if state officials fear that any enforcement could be perceived as a threat and lead to costly litigation.
