Biden administration sued after fertility awareness methods cut from health coverage

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A Catholic nurse practitioner is challenging the Biden administration after it removed health insurance coverage for fertility awareness-based methods (FABM), a form of family planning.

These methods enable women to track their fertile cycles by charting one or more biomarkers, such as basal body temperature, cervical mucus, and hormone levels. Among other things, couples can use this information, in line with Catholic Church teaching, to avoid or achieve pregnancy.

Attorneys with faith-based legal organization Alliance Defending Freedom (ADF) filed the lawsuit on behalf of Dr. Cami Jo Tice-Harouff and her patients against the U.S. Department of Health and Human Services (HHS) and its leadership on May 25.

As part of her work, Tice-Harouff instructs patients in FABM, the lawsuit says, and is reimbursed through insurance by about $350-$400 each session. While based in Longview, Texas, she practices in several states. 

“Dr. Cami Jo Tice-Harouff filed this lawsuit because women shouldn’t have to fear losing their doctor and insurance coverage for fertility awareness instruction as a result of back-room government decisions,” ADF Senior Counsel Julie Blake told CNA. “Without insurance coverage for fertility-awareness-based methods of family planning, patients will suffer financially, and many women will lose fertility awareness instruction because of the cost.”

She added: “By eliminating this coverage without public participation in the process, the Biden administration is telling women who choose fertility awareness-based methods of family planning that their choice does not matter.”

The case centers on the Affordable Care Act, which prohibits insurance plans from imposing cost-sharing requirements for women seeking “preventative care and screenings,” ADF’s press release said. Initially, in 2016, that included “instruction in fertility awareness-based methods.”

Five years later, in December 2021, the HHS removed “fertility awareness-based methods” from the list.

“Dr. Tice-Harouff thus challenges the government’s action on two grounds,” the lawsuit reads. “First, the government unlawfully failed to follow notice-and-comment rulemaking procedures. Second, the government’s action was arbitrary and capricious, and not the product of reasoned decision-making. 

The removal is set to go into effect in December 2022.

When asked about who this will impact, Blake responded that “HHS’s removal of this coverage guarantee applies to virtually all non-grandfathered health plans in the country, whether obtained on the government exchanges, through employers, or elsewhere.”

Tice-Harouff is a member of the Catholic Medical Association (CMA), which issued public comments in November recommending that FABM instruction continue to be provided for women, together with the U.S. Conference of Catholic Bishops and the National Catholic Bioethics Center.

In a press release about the lawsuit, CMA stressed that “Women choose FABM for a variety of reasons, including the desire to avoid the use of hormones and devices, to avoid the ill side effects of other forms of birth control, and to understand one’s natural body processes consistent with religious preferences.”

HHS did not respond to CNA's request for comment prior to publication.

Going in-depth

Grace Emily Stark, the editor of Natural Womanhood, a non-profit organization dedicated to promoting fertility awareness and fertility charting as essential tools for women’s health, said that she had been in touch with ADF about the lawsuit.

“What's at stake here is this coverage being rescinded not only for couples to learn fertility awareness for family planning purposes, but also for women to use it for infertility diagnosis, for cycle issue diagnosis and treatment,” she told CNA. “It's really disheartening.”

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Stark criticized the Biden administration for limiting women’s choices not only for family planning but also for identifying reproductive health issues.

“Doctors, like Dr. Cami Jo, who are knowledgeable of fertility awareness methods and restorative reproductive medicine are able to use the information from women cycle charting along with some different diagnostic testing and that sort of thing to actually heal women rather than just put them on kind of this Band-Aid solution of birth control, or, in the case of infertility, IVF,” she said.

Stark explained that, unlike outdated methods like the rhythm method, modern methods rely on “real-time data” by tracking biomarkers that indicate when a woman can or cannot become pregnant.

“Where the Natural Family Planning part of it comes in is where you then use that information to prayerfully discern how and when you're going to grow your family,” she explained.

 Online, Natural Womanhood stresses the low failure rate for various methods, while noting the difference between “typical use” and “perfect use.”

“The most important thing to hammer home is that these methods — if you really care about giving women choice when it comes to family planning and when it comes to their reproductive health — why would you be taking off the table coverage for methods that are as effective or more effective than what you're already covering?” she asked.

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