On August 1, 2012, a provision of President Barack Obama’s health care law, the Affordable Care Act, will go into effect — one that guarantees coverage in new health plans of a range of preventive services for women, including contraception, with no co-pays or other cost-sharing. Because some religions object to contraception, the Obama administration created an exemption for houses of worship that do not want to provide contraceptive coverage to their employees. The administration also created an accommodation for religiously affiliated hospitals, universities, and charities that gives them a one-year waiver until August 1, 2013, and then requires the insurer to provide contraceptive coverage directly to the employees.

Despite all of these steps to ensure the religious beliefs of those opposed to contraception are protected under the law, some politicians claim that the provision violates religious liberty and have acted to block it. In the nation’s capital the US Senate in March rejected an amendment, introduced by Sen. Roy Blunt (R-MO), which would have allowed employers to deny to their employees coverage for contraception or any other health service to which they had a religious or moral objection. In the US House of Representatives, an appropriations measure is pending that could defund efforts to enforce the contraceptive coverage regulation, but Speaker of the House John Boehner (R-OH) has signaled that no independent legislation akin to the Blunt amendment would be taken up by the House of Representatives.

Conservative efforts to undermine the Obamacare provision to guarantee no-cost contraception also have been happening at the state level. Nine states have considered legislation or ballot measures that would either reject the federal regulation or undermine contraceptive coverage in state law. This fact sheet provides an update on those state-level efforts. We detail the measures in these nine states below, but briefly here is a synopsis of recent developments:

• 4 states (Arizona, Georgia, Missouri, and New Hampshire) considered legislation amending state statutes that required insurance coverage for contraception, expanding employers’ refusal rights.
• 3 states (Colorado, Idaho, and Michigan) considered symbolic measures that explicitly rejected the federal contraceptive coverage guarantee.
• Voters in one state (North Dakota) considered a ballot initiative that would have allowed people to break the law in the name of religious liberty, while an effort in another state (Colorado) to propose a similar ballot measure was withdrawn before it could face a vote.
• One state without its own contraceptive coverage law (Oklahoma) considered legislation that would have allowed employers and employees to opt out of coverage that includes contraception or abortion services.

Below we look in detail at what’s happened in these nine states.

Arizona

The state legislature passed and Gov. Janice K. Brewer (R) signed into law in May a bill that permits a “religiously affiliated employer” to offer health plans that do not cover contraceptives based on the employer’s or beneficiary’s religious objections, changing existing Arizona statutes. In the bill, a religiously affiliated employer is defined as an organization whose incorporation documents make it clear that religious beliefs are central to its operating principles.

Under the new law an employee can “receive reimbursement for contraceptives prescribed for non-contraceptive medical purposes.” But the law removes protections for employees who independently obtain contraception prescriptions or insurance coverage from another source, leaving open the opportunity for religious employers to discriminate against employees who hold different views. The Arizona law is in direct conflict with the federal contraceptive coverage guarantee.

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