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Merger Mania Is Blocking Reproductive Choice

Access to key services is being prevented by religious groups running hospitals and other entities, many of them recipients of public money.

April 18, 1999|SHEILA KUEHL | Assemblywoman Sheila James Kuehl (D-Santa Monica) represents the 41st Assembly District

If you are among the majority of Californians who believe that the ability to make choices concerning reproduction is secured in the Constitution, think again.

The struggle, primarily by women, to secure reproductive health services, such as contraception, sterilization, medically necessary tubal ligation, fertility treatment and abortion has shifted from the halls of justice to the halls of medical centers and hospitals.

Organizations whose religious values seek to limit reproductive choice, having failed in the courts, are utilizing a back-door method to achieve the same goal--closing out access.

The achievement of this goal has been facilitated by the current merger-mania in managed care. To bring down costs, health care providers are merging at an unprecedented rate, many with networks like Catholic Health Care West and other such firms bound by the "Ethical and Religious Directives for Catholic Health Care." These directives, in addition to giving guidance in other areas, forbid all health care providers, even those simply renting space, from offering key reproductive health services including tubal ligations, even where ordered by the physician; vasectomy; contraception, including emergency contraception for rape victims; most fertility procedures, including in vitro fertilization; some sterilization procedures; condoms to prevent the spread of sexually transmitted diseases and, of course, abortion. The directives also preclude direct referrals for these services although "information" may be provided.

Catholic Health Care West (CHCW), the largest owner of hospitals and the biggest merger participant in the state, owns 46 hospitals. Tenet Health Care, by comparison, owns 42. But even secular providers, such as Tenet, are being required in mergers to follow the Catholic Religious Directives, as was recently seen when they acquired Queen of Angelsin Los Angeles and agreed to these limitations as a condition of sale. And because the 20 hospitals and additional clinics owned by the Adventist Health system will not provide access to abortion, the loss of access to reproductive health care has reached critical proportions. Consider:

* In Los Angeles and Orange Counties, the merger of Unihealth with CHCW left patients at eight hospitals without these services.

* In the San Fernando Valley, hospitals with secular-sounding names such as Northridge Hospital Medical Center and Glendale Memorial Hospital, as well as several others, have been acquired by CHW, and reproductive health services are curtailed.

* In Santa Maria, the Valley Community Hospital, owned by Tenet Health Care, is closing and the facility is being leased to CHW, which already owns the only other hospital in the area.

No one criticizes the overall important and good job done by Catholic health care facilities in serving the poor and indigent, it is imperative to organize California's health care system so that those without the means to pay extra for reproductive health services are ensured uninterrupted and complete access.

To that end, I have introduced Assembly Bill 525, the Health Care Access Bill, to require all health plans, including commercial HMOs, to guarantee the full range of services within their provider network, require all HMOs to inform patients about how to access the full range of services and any limitations on services purchased through their plan, and require that any health facility that receives tax dollars through public bond or loan programs make all reproductive services available by contracting with others, where necessary, to provide them. The bill also requires any merger where nonprofit assets are being transferred or acquired be approved by the attorney general and that one aspect of approval involve the impact on the provision of reproductive health services.

The bill would not force any doctor or hospital to provide services contrary to their beliefs. It simply requires that any entity limiting its services contract with others within its geographic area to provide them, or lose access to state funding.

AB 525 simply restores what most Californians believe to be a fact: that patients receiving health care, either paid for by the state or by themsleves, will be able to secure the reproductive health care services they need, when they need them, while respecting individual conscience.

Women, who spend 68% more on health care per year than men yet earn significantly less per capita, deserve at least to be certain that hard-won rights do not disappear, one hospital at a time.

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