(CNSNews.com) - Thanks to an Obamacare regulation that took effect on Aug. 1, health care plans in Oregon will now be required to provide free sterilizations to 15- year-old girls even if the parents of those girls do not consent to the procedure.
Health and Human Services Secretary Kathleen Sebelius finalized the regulation earlier this year.
It says that all health care plans in the United States--except those provided by actual houses of worship organized under the section of the Internal Revenue Code reserved for churches per se--must provide coverage, without cost-sharing, for sterilizations and all Food and Drug Administration-approved contraceptives to “all women with reproductive capacity.”
In practical terms, "all women with reproductive capacity" means girls as young as about 12. That, according to the National Institutes of Health, is when girls usually start menstruating.
When the Patient Protection and Affordable Care Act--a.k.a. Obamacare--was enacted in March 2010 it included (in Section 2713) a non-specific requirement that health care plans must provide "additional preventive services" to women. These unspecified "additional preventive services," the law said, were to be "provided for in comprehensive guidelines supported by the Health Resources and Services Administration," a division of the Department of Health and Human Services.
In developing the regulation to define these "additional preventive services," HHS commissioned a federally funded committee at the Institute of Medicine (IOM) to recommend what they should to be.
In July 2011, this committee issued a report that said: “The committee recommends for consideration as a preventive service for women: the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity.”
The committee report said that “with reproductive capacity” meant “from the time of menarche to menopause.” Menarche is the beginning of menstruation--again, on average, about the age of 12 for American women. (Download the report for free here.)
On Aug. 1, 2011, HHS announced that it was adopting the IOM committee's recommendation almost verbatim. In fact, it added just one word--placing "all" in front of "women with reproductive capacity."
Thus, the regulation issued by the Health Resources and Services Administration said: "Non-grandfathered plans and issuers are required to provide coverage without cost-sharing consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012. ... All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity."
HHS said nothing about restricting the provision of these free "preventive services" to women who were 18 or older, or 21 or older, or even 15 or older. The regulation simply said "all women with reproductive capacity."
However, states have varying laws on the age of consent. CNSNews.com took a look at Oregon and its rule of consent for sterilization--one of the free services required by the Obama administration's regulation.
In Oregon, the age of informed consent is 15, and the law and rules on sterilization are detailed in the Oregon Revised Statutes (ORS) 436.205 to 436.335.
Under Oregon law, girls from 15 years of age and up are given complete control over whether to be sterilized or not. The parents or guardians of a minor girl--between 15 and 18--can neither grant nor deny consent for a sterilization.
The Oregon law says: "'Informed consent' means consent given by an individual 15 years of age or older for sterilization that is: (a) Based upon a full understanding of the nature and consequences of sterilization pursuant to information requirements set forth in ORS 436.225(1); (b) Given by an individual competent to make such a decision; and (c) Wholly voluntary and free from coercion, express or implied."
Oregon defines "sterilization" as "any medical procedure, treatment or operation for the purpose of rendering an individual permanently incapable of procreating."
The Oregon Health Authority has created a special consent form called "Ages 15-20 Consent to Sterilization."
"When I first asked for the information, I was told that the decision to be sterilized is completely up to me," says this Oregon form for 15-year-old children. "I was told that I could decide not to be sterilized."
"I understand that the sterilization must be considered permanent and not reversible," says this consent form. "I have decided that I do not want to become pregnant, bear children or father children."
The consent form even includes a section that can be signed by an interpreter, in case a 15-year-old child being sterilized by their own consent in Oregon is incapable of understanding English.
This section says: "If an interpreter is provided to assist the individual to be sterilized: I have translated the information and advice presented orally to the individual to be sterilized by the person obtaining this consent." After specifying what language the interpreter used to explain the sterilization to the child, the form asks the interpreter to stipulate: "To the best of my knowledge and belief he/she understood this explanation."
Additionally, the Oregon government makes the consent form available in Spanish--"15-20 anos Consentimiento para esterilizacion."
CNSNews.com specifically asked the Oregon Health Authority (OHA) by e-mail, “What is the legal age of consent to sterilization in Oregon?”
The OHA media contact, Christine Stone, replied, “In Oregon, the legal age for consent for sterilization is 15 years.”
Because the provision for coverage of sterilization under Obamacare applies to “all women of reproductive capacity,” which means girls younger than 15, CNSNews.com followed up with the OHA, asking, “What is the rule regarding 12-, 13-, and 14-year-old girls who want to be sterilized?”
Stone said she could not provide any information other than what is cited in the Oregon statute.
However, a handbook published by Disabilty Rights Oregon states that the law governing sterilization “prohibits the sterilization of children younger than 15, and mandates that a parent, guardian or conservator may not give consent for sterilization of a minor child or protected person. The law allows a person who is 15 or older to consent to be sterilized. But if a person is not capable of giving ‘informed consent,’ sterilization cannot proceed until age 18, and then only in limited circumstances as determined by court order.” (Handbook: DRO-Sterilization_Handbook(2).pdf)
CNSNew.som also contacted the U.S. Department of Health and Human Services and asked, “Can you confirm that under this regulation a girl as young as 12 must be offered the opportunity to obtain a sterilization free of charge?”
In addition, CNSNews.com asked the HHS, “In Oregon, the age of consent for a sterilization procedure is 15 years or older. Can you confirm that under this regulation, a 15-year-old girl can obtain a sterilization free of charge?”
After following up with multiple phone calls and e-mails, CNSNews.com was told by the HHS office of the secretary that there was no one available to answer these questions.
At a pen-and-pad meeting with reporters in late March at the U.S. Capitol, CNSNews.com asked House Minority Whip Steny Hoyer (D-Md.), “The administration has approved a regulation under Obamacare that says, quote, ‘all women with reproductive capacity,’ end quote, must be offered free sterilization--”
Hoyer then interrupted, saying, “How is that related to a pre-existing condition?”
CNSNews.com continued, “--hold on--free sterilization in their health care plans. Do you support the mandate for free sterilization for college-age women?”
Hoyer expressed surprise, stating, “Free sterilization? I don’t know anything about free sterilization. I don’t know anything about that. I’m sorry. The answer is, I don’t. But I don’t think anybody is proposing that.”
At a press conference in mid-July, which specifically focused on the Patient Protection and Affordable Care Act (Obamacare), CNSNews.com attempted to ask House Minority Leader Nancy Pelosi (D-Calif.) whether she supported the HHS regulation insofar as it extends to teens and college-age women. Pelosi, however, cut the question off before it could be completed.
CNSNews.com asked Pelosi, “You mentioned the preventive services mandate. One of the services that health care plans have to offer free of charge are sterilizations. And I was wondering do you agree with the federal government mandating—”
Pelosi said: “You know what, I told you before, let’s go to church and talk about our religion—"
CNSNews.com asked: “No, no, but it’s—"
Pelosi said: “Right here we’re talking about public policy as it affects women and we’re not, you know that this bill is—"
CNSNews.com asked: “No, it has nothing to do with the religious views but do you—"
Pelosi said: “No, it does.”
CNSNews.com: “--agree that the federal government should be mandating—"
Pelosi: “I believe that the legislation to allow women to determine the size and timing of their families and have access--"
CNSNews.com: “--even for---”
Pelosi: “--to contraception. Next question.”
In another instance on Capitol Hill, CNSNews.com asked Pelosi, "Do you support the regulation taking affect August 1 requiring all health plans to cover free sterilizations for teenage girls?"
Pelosi said, "I don't subsribe to your characterization of it," and then moved on to ther questions.
Also, in late July, CNSNews.com asked Rep. Jan Schakowsky (D-Ill.), “The HHS preventive services mandate requires all health plans to offer free sterilizations, including to girls in their teens. Do you support the mandate as it applies to teens?”
At that point, Rep. Schakowsky started to walk away without answering but, while walking, she said, “I don’t--I’m unaware that it says that sterilization including teens is in that. I’ll check that out.”
CNSNews.com then followed up, “It says all women of ‘reproductive capacity,’ and it defines it as from menarche to menopause.”
“I’ll check that out,” she said.
Edwin Black, author of War Against the Weak: Eugenics and America’s Campaign to Create a Master Race, told CNSnews.com: “I find it abhorrent that a 15-year-old girl who is not old enough to consent to sexual activity, who is not old enough to consent to buying a beer, who is not old enough to drive herself to the hospital could possibly be considered old enough and mature enough to give informed consent for her own sterilization. And the most vulnerable of these girls will be those who are wards of the state who are presented a piece of paper and told ‘sign here,’ as they were in Virginia and California.”
“Right now, when our country is considering compensation, such as in North Carolina for sterilization victims [and] states are hopping on the bandwagon to issue formal apologies … is not the time to reverse years of awareness and dive back into state-sponsored sterilization,” said Black.
“The decades of genocidal sterilization are filled with numerous examples of fake consent forms being executed by young women who were being pressured by the state into sterilization.”
The IOM committee that recommended mandating coverage for free sterilizations to all "women with reproductive capacity" specifically argued that getting rid of cost-sharing requirements would lift a major barrier to what it considered more effective, long-lasting methods of contraception such as sterilization.
“In a study of the cost-effectiveness of specific contraceptive methods, all contraceptive methods were found to be more cost-effective than no method, and the most cost-effective methods were long-acting contraceptives that do not rely on user compliance," said the IOM committee's report.
"The most common contraceptive methods used in the United States are the oral contraceptive pill and female sterilization," said the report. "It is thought that greater use of long-acting, reversible contraceptive methods—including intrauterine devices and contraceptive implants that require less action by the woman and therefore have lower use failure rates—might help further reduce unintended pregnancy rates. Cost barriers to use of the most effective contraceptive methods are important because long-acting, reversible contraceptive methods and sterilization have high up-front costs.”
"The elimination of cost sharing for contraception therefore could greatly increase its use, including use of the more effective and longer-acting methods, especially among poor and low-income women most at risk for unintended pregnancy," said this report recommending free sterilization coverage for all women who could conceive a child.
"A recent study conducted by Kaiser Permanente found that when out-of-pocket costs for contraceptives were eliminated or reduced, women were more likely to rely on more effective long-acting contraceptive methods," said the report.