Wednesday, August 7, 2019
Court of Appeal:
Opinion Says Any Professional Termination of Pregnancy Is ‘Medically Necessary’
By a MetNews Staff Writer
Health care plans—which are legally required to cover a “medically necessary” procedure—must pay for any abortion even if the pregnancy does not put the woman’s life in jeopardy, the Third District Court of Appeal held yesterday.
An abortion is a “basic health care service” which, under the Knox-Keene Health Care Service Plan Act of 1975, plans licensed to operate in the state must cover, the opinion declares.
Authored by Justice Coleman Blease, the opinion affirms a Sacramento Superior Court judgment in favor of California Department of Managed Health Care Director Michelle Rouillard. She is accused in a petition for a writ of mandate of unilaterally adopting a regulation, in violation of the Administrative Procedure Act (“APA”), by telling seven health care plans that they must pay for all abortions.
Seeking the writ was Missionary Guadalupanas of the Holy Spirit, Inc., a non-profit corporation of Catholic women. In asserting that Rouillard skirted the APA when she sent the letters, Blease said, the petition “sets forth a false dichotomy between a ‘voluntary’ service and a ‘medically necessary’ health care service, which health care plans are required to cover.”
“We hold that an abortion is one of two medically necessary options for the treatment of a woman’s pregnancy. A pregnant patient may elect medical services necessary to deliver a baby, or to terminate the pregnancy. Because California law guarantees every woman the right to choose whether to bear a child or obtain an abortion, the only legally tenable interpretation of the law is that abortions are basic health care services, which health care service plans are required to cover.”
Blease said the rulemaking procedures set forth in the APA do not apply to merely carrying out the dictates of an unambiguous statute.
He found that Rouillard’s letters “did not resolve any ambiguity” in the Knox Act “because ‘basic health care services’ are so broadly defined in the statute that they unambiguously include abortion services”. The jurist explained that “abortions would necessarily be performed as one of the listed services, i.e., physician services, hospital inpatient services, ambulatory care services, preventive health services, or emergency health care services.”
The letters, Blease said, reflected “the only legally tenable interpretation of the statute.”
The case is Missionary Guadalupanas of the Holy Spirit v. Rouillard, C083232.
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