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Catholic Org Dismantles California's Claim That Elective Abortion Is 'Medically Necessary'

Catholic Org Dismantles California's Claim That Elective Abortion Is 'Medically Necessary'

The Cardinal Newman Society has solid evidence that contrary to what the California Department of Managed Health Care (DMHC) attested, the state did not have a long-standing policy of viewing elective abortion as a mandatory, “medically necessary” insurance benefit.

In August, DMHC director Michelle Rouillard sent a letter to seven insurance companies, asserting that “abortion is a basic health care service” while claiming that health plans that had been implemented by two Catholic universities were “erroneously” approved. She announced that the DMHC would force insurers to cover abortions that are not “medically necessary,” thus affecting Loyola Marymount University (LMU) and Santa Clara University.

In January, LMU started offering insurance plans that did not cover elective abortions and only permitted them if the woman’s life were in danger or her health could be severely damaged.  Santa Clara had the same plans for next year.

But the Cardinal Newman Society did some research and found that the California Public Employees’ Retirement System (CalPERS), which falls under the purview of Governor Jerry Brown, lists in its 2014 summaries of benefits for the PERS Choice, PERS Select, and PERS Care plans a limit on abortions, only allowing those that are “medically necessary.” CalPERS has insurance plans that cover “more than 1.3 million active and retired state, local government, and school employees and their family members.” Taxpayers pick up some of the tab for the employee insurance premiums.

This limit of abortions to those that are “medically necessary” by CalPERS is in direct opposition to the claim of Jerry Brown’s administration that insurance plans of that ilk are “discriminatory” and should be disallowed.

The Newman Society also found the claims that the state of California once thought elective abortion to be a mandatory, “medically necessary” insurance benefit are spurious. DMHC has asserted that insurance plans excluding elective abortion coverage flout the Knox-Keene Health Care Service Plan Act of 1975, but Catherine Short, legal director of the California-based Life Legal Defense Foundation, looked into the California Department of Insurance’s history and dug up a 2012 chart of insurance benefits that showed elective abortion was not thought to be a mandatory benefit in employee health plans. The chart also indicated that elective abortion was not covered in some of the insurance plans.

Pacific Care had an online benefits manual from 2005 which made a distinction between “elective” abortions, which were defined as “an abortion initiated by the member for reasons other than medical necessity” and not often covered, and “therapeutic” abortions in cases of a “physical disorder, physical illness or physical injury, including life-endangering physical condition caused by or arising from the pregnancy.”

Patrick J. Reilly, president of The Cardinal Newman Society, fired back at the state’s position, saying, “Why can’t Catholics who are morally opposed to abortion have the same options as California state employees? It’s evidently false that elective abortion has always been a mandatory health benefit in California. The Brown administration’s new and radical claim that ‘elective’ abortion is ‘medically necessary’ defies common sense and the practices of California’s leading insurance companies, and it violates basic religious freedoms.”

DMHC’s policy outlawing the abortion-limited insurance plans ignores the federal Weldon Amendment, which would endanger federal funding for the state because the policy discriminates against the insurance companies that refuse to cover elective abortions. The Cardinal Newman Society, which has attorneys from the Alliance Defending Freedom and the Life Legal Defense Foundation, told the DMHC that they were violating the law.

Rouillard had written Anthem Blue Cross on August 22, threatening them thus: “Blue Cross must amend current health plan documents to remove discriminatory coverage exclusions and limitations. These limitations or exclusions include, but are not limited to, any exclusion of coverage for ‘voluntary’ or ‘elective’ abortions and/or any limitation of coverage to only ‘therapeutic’ or ‘medically necessary’ abortions.”

Yet look at the language from CalPERS’ plans for government employees, through Anthem Blue Cross: “‘Medically Necessary’ services are procedures, treatments, supplies, devices, equipment, facilities or drugs (all services) that a medical practitioner, exercising prudent clinical judgment, would provide to a covered individual for the purpose of preventing, evaluating, diagnosing or treating an illness, injury or disease or its symptoms …” The CalPERS language defines “medically necessary” as “…not primarily for the convenience of the covered individual, physician or other health care provider; and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that covered individual’s illness, injury or disease.”

A customer service representative for CalPERS told the Cardinal Newman Society that in practice, “medically necessary” means that a woman as young as 16 wanting an abortion simply needs a referral from her doctor.

Yet CalPERS’ plan summaries state: “The fact that a provider may prescribe, order, recommend or approve a service, supply, or hospitalization does not in itself make it medically necessary. The Plan reviews services to assure that they meet the medical necessity criteria above. The Plan’s review processes are consistent with processes found in other managed care environments and are consistent with the Plan’s medical and pharmacy policies. A service may be determined not to be medically necessary even though it may be considered beneficial to the patient.”

Bill Madison in the CalPERS Office of Public Affairs told the Cardinal Newman Society that CalPERS is not regulated by California state law, because it is a public pension fund and thus regulated by federal law as self-funded insurance.


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