Testimony of Douglas K.

Laube, MD, MEd Board Chair Physicians for Reproductive Health Before the Senate Committee on Health and Human Services Senate Bill 202 June 5, 2013

I am Dr. Douglas Laube, a practicing physician from Madison. I have been a physician and educator for over three decades, currently teaching at the University of Wisconsin. I also served as president of the American Congress of Obstetricians and Gynecologists from 2006-2007. I offer this testimony today on behalf of Physicians for Reproductive Health, a doctor-led national advocacy organization that uses evidence-based medicine to promote sound reproductive health policies. As the national voice of pro-choice physicians, we work to make quality reproductive health services an integral part of mainstream medicine. As a physician, I support access to comprehensive reproductive health care services for all women. I have counseled women about contraception, delivered babies, provided abortion care, and overseen a weekly menopause clinic. Access to affordable contraception and abortion is essential to the health and well-being of my patients. Therefore, I urge this committee to reject SB 202. SB 202 repeals Wisconsins Contraceptive Equity Law ensuring that all prescription drug plans include contraceptive coverage, attempts to erode birth control coverage requirements under the Affordable Care Act (ACA), and it takes away existing insurance coverage for abortion services from some state employee health plans. Contraceptive Coverage Regular use of contraception prevents unintended pregnancy and reduces the need for abortion.1 Contraception also allows women to determine the timing and spacing of pregnancies, protecting their health and improving the well-being of their children.2 Contraceptive use saves money by avoiding the costs of unintended pregnancy and by making pregnancies healthier, saving millions in health care expenses.3 Several

Deschner, A., Cohen, S.A. (2003). Contraceptive Use Is Key to Reducing Abortion Worldwide. The Guttmacher Report on Public Policy 6(4): 7-10. Testimony of the Guttmacher Institute, submitted to the Committee on Preventive Services for Women, Institute of Medicine, 2011 (available for download at http://www.guttmacher.org/pubs/CPSW-testimony. pdf).
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contraceptives also have non-contraceptive health benefits, such as decreasing the risk of certain cancers and treating debilitating menstrual problems.4 Under the proposed bill, some women, because they work for religious employers that object to contraception, would be denied access to affordable birth control coverage. That is grossly unfair to these women, and from a medical perspective would constitute indefensible health policy. All women deserve access to affordable birth control no matter where they work. Some of the most vocal opposition to the inclusion of birth control as a preventive service comes from the United States Conference of Catholic Bishops (USCCB).5 It is worth noting that virtually all women, including 98 percent of Catholic women, use contraception at some point during their lifetimes.6 Moreover, the decision to use birth control should be left to the individual. Employers should not have the power to interfere in private health care decisions by withholding coverage for care. A key promise of the ACA is that women will no longer be subjected to extra charges for necessary preventive prescriptions and treatments. Birth control should not be treated any differently. Employers should remain entirely free to express their opposition to birth control, but that opposition should never translate into substandard preventive medical care coverage. A physician in our network had a patient called Kristen.* Kristen worked as a nursing assistant at a Catholic hospital where her insurance did not cover contraception. Kristen, who is not Catholic, did not know about this policy until after she started working at the hospital. When Kristen first refilled her prescription for birth control pills, she discovered that she would need to pay fifty dollars per month, a new expense for which she had not budgeted as her last employer had covered contraceptives. Kristen was able to afford her prescription for a few months, but could not continue. She later had an unintended pregnancy and needed an abortion. All women, including women who have religious employers and women in ministerial roles, need insurance coverage that will cover effective treatments, including contraception. The acceptance of inadequate health care coverage should not be a condition of working for a religious employer or agency. Abortion Coverage Every day my colleagues and I we see women struggling to make the best decision for themselves and their families without the financial resources to pay for an abortion. This bill ignores the very real
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Gold, R.B. (2011). Wise Investment: Reducing the Steep Cost to Medicaid of Unintended Pregnancy in the United States. Guttmacher Policy Review 14(3): 6-10. Burkman, R., Schlesselman, J.J., Zieman, M (2004). Safety concerns and health benefits associated with oral contraception. American Journal of Obstetrics and Gynecology 190(4): S5-22.

HHS Mandate for Contraceptive and Abortifacient Drugs Violates Conscience Rights, USCCB press release, August 1, 2011. See also, comments from USCCB submitted to the Centers for Medicare & Medicaid Services, August 31, 2011. Jones. R.K. and Joerg Dreweke, Countering Conventional Wisdom: New Evidence on Religion and Contraceptive Use, Guttmacher Institute, April 2011. Among all women who have had sex, 99% have used a contraceptive method other than natural family planning.

situations women face and, if enacted, would have a devastating impact for state employees and their family members who may need abortion services. In my practice, I had a patient, Beth.* Beth was pregnant with her first child and looking forward to becoming a mother. Three months into her pregnancy, she developed dangerously high blood pressure. Without an abortion, she could have had a stroke or kidney damage. She made the very hard decision to end her pregnancy. Beths medical condition is just one of many that can complicate pregnancy. But SB 202 would leave women like Beth without insurance coverage for abortions necessary to protect their health. In Seattle, my colleague Dr. Deborah Oyer had a patient, Allison, a 34-year old mother of three with an unintended pregnancy. She was still deciding whether to continue her pregnancy when she discovered her youngest child had leukemia. She and her husband quickly realized that they could not have another child at that time. Allison needed to take leave from work and stay at the hospital with their daughter for the many treatments to come. Her husband needed to stay at home, two hours away from the hospital, to work and care for their two other children. Fortunately, her insurance covered her abortion. But Allison and her family would have faced great hardship if they had had to pay out of pocket. Access to affordable insurance that covers abortion is essential for women in Wisconsin and their families. For Beth, Allison and countless other women, abortion was a careful decision made after consultation with their physicians and consideration of the medical issues and life circumstances involved. Abortion was a critical medical procedure that protected their physical health as well as the health and well-being of their families. I urge you to vote against SB 202 and protect the health of Wisconsin women.

All patient names have been changed to protect confidentiality.