1

2 Putting Patients FirstNew Opinion Research and Messaging on When Religious Beliefs Override Patient Care

3 Welcome Gretchen Borchelt, J.D.Vice President for Reproductive Rights and Health National Women’s Law Center

4 Text to go here in this box Helen, I’ll help with formatting text when we get to this point.

5 Religious Exemption LawsFirst federal law passed shortly after Roe v. Wade Almost every state has one

6 Religious Exemption LawsAllow health care providers, like hospitals, doctors, nurses, clinics, and health insurance companies, to refuse to treat a woman seeking an abortion, birth control, or medical care for a miscarriage.

7 Religious refusals to provide care have real consequencesBody text for Faith Groesbeck Patient Advocate Community Organizer

8 Need for survey The harm to women of religious exemptions laws was not breaking through Status quo should not be acceptable

9 Survey Results Anna Greenberg PartnerGreenberg Quinlan Rosner Research

10 Results Needed Now, More Than EverCongress and Administration Targeting women’s health Prioritizing “religious freedom” above all else Continuing attacks at the state level

11 Must be Proactive Brigitte Amiri Senior Staff AttorneyACLU Reproductive Freedom Project

12 National Women’s Law Center National Survey of VotersMay, 2017

13 Methodology GQRR conducted a survey of 1,650 registered voters across the nation, including oversamples of 200 registered voters each in Michigan, New Mexico and Virginia, 150 registered voters in Florida, 50 registered African American women, and 50 registered Hispanic women. The survey was conducted March , 2017. Forty-five percent of all interviews were completed via cell phone. Margin of error for the entire sample is +/ percentage points. Margin of error is higher among subgroups.

14 Voters believe insurers should cover health services for women, including abortionNow, I am going to read you a statement about health insurance coverage for a range of women's health services. Please tell me whether you agree or disagree with that statement. All health insurance plans should cover all basic health services for women, including birth control, abortion, pre-natal care, childbirth, and post-partum care. +31 Agree Disagree

15 A plurality opposes religious exemption laws that allow health care providers to refuse care to women From what you know, do you favor or oppose these religious exemption laws? As you may know, laws currently allow certain health care providers, like hospitals, doctors, nurses, clinics, and health insurance companies, to refuse to treat a woman seeking an abortion, birth control, or medical care for a miscarriage because of religious or moral beliefs. These laws are sometimes called "religious exemption" laws but you might have also heard them referred to as "conscience clauses." +10 Favor Oppose

16 Strong concerns that laws allow insurers, hospitals to refuse care, referrals, or even informationNow, I want to ask you about a few specific consequences that may occur as a result of religious exemption laws. After each, please tell me whether you favor or oppose laws that allow that specific consequence? Insurance companies can refuse to cover a woman's abortion, birth control, or medical care for a miscarriage because of religious or moral beliefs. Hospitals can refuse to provide a woman with information or referrals about abortion, birth control, or medical care for a miscarriage because of religious or moral beliefs. Doctors or nurses can refuse to provide a woman with information or referrals about abortion, birth control, or medical care for a miscarriage because of religious or moral beliefs. Hospitals can refuse to treat a woman seeking an abortion, birth control, or medical care for a miscarriage because of religious or moral beliefs. Doctors or nurses can refuse to treat a woman seeking an abortion, birth control, or medical care for a miscarriage because of religious or moral beliefs.

17 Best messaging against refusal laws focus on patient care and concerns about government interferenceA patient's health should always come first. Religious exemption laws allow hospitals, doctors, and nurses to determine a patient's care based on their religious beliefs, not based on what is best for the patient's health and circumstances; a provider's religious beliefs should never determine the care a patient receives. Patient care comes first Religious exemption laws put women's lives and health in danger. Some hospitals have turned away women seeking abortion or information about abortion, even when the woman's life is in jeopardy… hospitals have refused to treat a woman whose miscarriage is threatening her life. These practices put religious beliefs over patients' needs and they can - and have - resulted in infertility, infection, and even death. Laws risk a woman’s life/health Religious exemption laws allow hospitals receiving government funding to deny medical care because of religious beliefs. Hospitals that take taxpayer dollars should not be allowed to use religious beliefs as a reason to refuse to treat or serve a patient, including a woman seeking abortion. No taxpayer-funded refusals

18 Opposition to religious exemption laws grows with information on both sides of the debateFrom what you know, do you favor or oppose these religious exemption laws? As you may know, laws currently allow certain health care providers, like hospitals, doctors, nurses, clinics, and health insurance companies, to refuse to treat a woman seeking an abortion, birth control, or medical care for a miscarriage because of religious or moral beliefs. These laws are sometimes called "religious exemption" laws but you might have also heard them referred to as "conscience clauses." +10 +27 Favor Oppose Favor Oppose Initial Final

19 Willingness to hold elected leaders accountableNow thinking about everything you have heard about religious exemption laws, if your representative in the state legislature or Congress voted against a religious exemption law, would you be more likely to support him or her, less likely to support him or her, or would it not have much impact one way or the other? +6 +35 +30 +51 More likely to support Less likely to support More likely to support Less likely to support More likely to support Less likely to support More likely to support Less likely to support Total Democrats Pro-choice Liberals

20 Voters’ lack of awareness about problems with access to abortion presents a challengeDo you think that it is currently too easy to get access to an abortion, too hard to get access to an abortion, or about right? Total Legal Illegal

21 Information on restrictions moves voters, indicating that education is neededAfter hearing more information, do you think that it is currently too easy to get access to an abortion, too hard to get access to an abortion, or about right? In 1973, the Supreme Court gave all women the constitutional right to have an abortion. But since 2010, elected officials in states across the country have quietly passed more than 338 laws restricting abortion. These laws control when, where, and how women can have an abortion. For example, some of these laws mandate that women make multiple, unnecessary trips to a clinic and get a sonogram even if it's not medically necessary. Some mandate that doctors give women medically inaccurate information about abortion. Many prevent women from using their insurance coverage to pay for abortion. Some make abortion illegal at various stages in pregnancy - in one state as early as six weeks. Post information

22 Support for proactive policies to ensure access to women’s health care services, including abortionI am going to read you a few proposals that make sure hospitals, doctors, and nurses will treat a woman seeking an abortion. After each one, please tell me whether you favor or oppose this proposal. Make sure hospitals, doctors, and nurses provide patients with medical services including abortion when a patient's life or health is at risk. Make sure that a hospital that does not provide abortion still provides a woman with correct and complete information and referrals for abortion so that a patient is not left with nowhere to turn. Make sure all hospitals provide a patient with the right care for her situation, including abortion. Stop hospitals from firing, demoting, or otherwise retaliating against doctors or nurses because they treated a woman seeking an abortion or gave her information or referrals for abortion. Stop hospitals from telling doctors or nurses that they cannot give a patient information or referrals for abortion.

23 Final Considerations Voters strongly oppose religious exemption laws that allow providers to use religious beliefs to refuse to cover or provide treatment, information, or referrals to a patient. The most compelling frame to counter religious exemption laws centers on making sure a woman gets the best patient care without interference, including access to abortion, birth control, and miscarriage treatment. The core elements include: Ensuring care is based on what is best for the patient, not on a provider’s religious beliefs. Making sure that patients have access to complete and accurate information and referrals for medical treatment. Stopping hospitals and health care providers refusing treatment and putting a woman’s life or health at risk because of religious beliefs. Preventing taxpayer-funded hospitals to inappropriately interfere in patient care and deny treatment to patients based on religious beliefs. Voters are more likely to support an elected official who opposes religious exemption laws.

24 EUROPEAN HEADQUARTERS CANADIAN HEADQUARTERSWORLD HEADQUARTERS NEW YORK HEADQUARTERS EUROPEAN HEADQUARTERS CANADIAN HEADQUARTERS Greenberg Quinlan Rosner 10 G Street, NE Suite 500 Washington, DC 20002 Phone: Fax: Greenberg Quinlan Rosner 25 Broadway 9th Floor New York, NY 10004 T: (212) Greenberg Quinlan Rosner 3 Waterhouse Square 138 Holborn London, UK EC1N 2SW T: +44 (0) Greenberg Quinlan Rosner 350-1 First Canadian Place Toronto Board of Trade Tower Toronto, ON M5K 1C1 Phone:

25 The impact of religious restriction in healthcare on my communityFaith Groesbeck, Maternal & Child Health Advocate, Certified Birth Doula (BAI) and Certified Cooperative Childbirth Educator Birth Quest, LLC (231) My name is Faith Groesbeck. I was working for Public Health – Muskegon County, in infant mortality reduction when a hospital merger left my county with a sole Catholic hospital that nearly every healthcare provider worked for. Prior to the merger, there was a lot of community discussion about what this might mean for access to reproductive healthcare and hospital officials reassured us that there would be no change in services. They lied.

26 Types of care known to be impacted by Catholic hospital mergersContraceptive coverage for employees Emergency care for ectopic pregnancies Abortions for fetuses with known lethal anomalies Emergency contraception Contraception and sterilizations Miscarriage management Personal stories that healthcare providers and patients share are essential in getting people to understand how denial of care looks in reality and how it effects people. Although some people have come forward, there are good reasons why others do not: Trauma Private High burden of knowledge Economic consequences Making it easier for people to report when their rights have been violated and better support for whistleblowers would go far in helping people who have not experienced discrimination based on religious healthcare exemptions understand the impact on those who have. There has been a lot of attention around how miscarriage can be mismanaged in under the Ethical and Religious Directive that govern care at Catholic hospitals, so today I’m going to tell three stories: Mom denied tubal Woman carrying fetus with lethal anomaly Mom w/UTI

27 Primary Prevention Institutional policies that can restrict access to information about, prevent referrals to and deny treatment for essential reproductive healthcare services impact the entire community and make the prevention work of public health difficult, if not impossible. The majority of our health and human services organizations require employees to sign a statement of faith for employment and do not allow them to share information about family planning with consumers. There are also gatekeepers at government and non-religious organizations that use their positions to restrict access to services. I am going to share with you some examples that created barriers during the time I coordinated the county’s Family Planning , later Reproductive Justice, Task Force: Call center staff denying the inclusion of abortion providers in their database Department of Human Services staff not allowing free condom distribution among items available to families in need Unemployment agency denying information on accessing family planning for the uninsured Receptionist at FQHC incorrectly telling patients that their provider would not write them a script for EC These are just a few of the examples I could share. Despite these barriers, we still were successful in getting information and services to the public and reducing infant mortality, but when I suggested a survey for professionals to examine barriers, the entire task force was eliminated. These denials of care disproportionately affect those who are the most disenfranchised and have the least access to healthcare. They are also impossible to enforce or monitor. Because everyone has personal biases, health and human service providers can act in ways that make already existing inequalities worse. Since surveillance of infant and fetal mortality and the Family Planning Task Force has been eliminated, Muskegon County’s Black infant mortality is currently the highest it has been in over a decade and the highest in the entire state of MI. This is what religious restrictions in healthcare has done to community and it is completely unacceptable.

28 Patient and Provider StoriesMay 2016 we published a qualitative report of stories from patients and providers about the denial of reproductive care at Catholic hospitals. The data was provided by MergerWatch. The stories come from all over the country. On the cover is Tamesha Means who was turned away from the emergency room at her local hospital three times over two days, bleeding, in severe pain, and developing an infection when she was miscarrying at 18 weeks. She was never provided information about her treatment options, or provided the option of terminating her pregnancy

29 Tools in Our Toolbox Litigation – state and federal court using state and federal laws State and federal agency advocacy Pro-active state bills – more than 40 state laws that blanket the country that provide religious exemptions to providing reproductive health care

30 Illinois Health Care Right of Conscience ActPrior to Jan. 1, 2017, the law shielded refusing individuals and institutions from liability and discipline Protocols; patients must receive information in accordance with standard of care; provider must refer, transfer or give information about other providers reasonably believe may offer service; must send medical records Many people did not know about the law, or did not know it caused problems. Patient stories so important. Mindy Swank – denied care for 5 weeks while miscarrying because she was not sick enough. Telling patient stories neutralized Catholic Conference and others.

31 Bills in NM, MI, and WA Introduced and moved this past sessionEnsure that health providers are not prohibited from providing the proper standard of care/information/referrals Some of the bills also ensure that patients receive the proper care when their life/heath is at stake.

32 Chamarro v. Dignity HealthRebecca Chamarro was denied a tubal ligation at the time she delivered her third baby at a hospital in Redding, California that is owned by Dignity Health. Dignity Health is one of the largest Catholic health care systems Physicians for Reproductive Health are also in the lawsuit. Case is pending in California state court under state law. One of those women is Rebecca Chamorro. She was set to deliver at Mercy Medical Center Redding via C-section, and sought a tubal ligation. Her OBGYN sought approval from the hospital to provide the tubal at the time of delivery but the hospital denied the request. With the ACLU of Northern California, we brought suit in state court on behalf of Rebecca, as well as Physicians for Reproductive Health, on behalf of their members who practice in Dignity hospitals. We are in discovery.

33 Q&A Submit questions by typing it using the chat function.