Biden Administration Threatens Fertility Awareness Methods

When President Barack Obama signed the Affordable Care Act (ACA) into law in 2010, he championed the bill as providing Americans with “basic security when it comes to their health care.” Unfortunately, thanks to a decision made by the Biden administration 11 years later, that lofty promise was betrayed for women who have chosen fertility awareness-based methods of family planning, until an ADF lawsuit corrected the situation.

One provision of the ACA requires most health insurance plans to provide coverage, without cost-sharing, for women’s “preventive services.” The Obama administration defined this to include various methods of contraception, and in 2016, the requirement also included coverage for fertility awareness-based family-planning methods.

In 2021, however, the Biden administration decided it would remove the requirement for insurers to cover fertility awareness instruction. The administration did not inform the public of this change, which it is required by law to do, and it completely ignored several objections filed by various groups.

If this rule change had stood, the government would have had unlimited discretion to pick and choose which family-planning methods women are entitled to, without any meaningful input from the public. Women who object to abortifacient pills or contraceptives, or have other health reasons to choose fertility awareness-based methods, could have been left unable to afford care. That’s why Alliance Defending Freedom attorneys sued to reverse this illegal change.

Who is Dr. Cami Jo Tice-Harouff?

Dr. Cami Jo Tice-Harouff is a licensed nurse practitioner with a doctorate in nursing practice. Based in Tyler, Texas, Dr. Tice-Harouff works with women seeking fertility awareness-based family planning. Women receive care from Dr. Tice-Harouff for a variety of medical and philosophical reasons. Some want to better understand how their body functions, and others want to identify underlying medical conditions so they can seek proper treatment.

Dr. Tice-Harouff became a family nurse practitioner in 2013 and received her doctorate in nursing practice in 2020. She continues to work in nonprofit health programs for vulnerable communities and to teach academic courses to nursing students. Through her work providing fertility awareness instruction, Dr. Tice-Harouff serves women who want to make the best family planning choices for their own families.

When the Biden administration threatened her ability to help many of these women, she knew she had to protect the rights of herself and her clients.

Tice-Harouff v. Johnson

Mandatory insurance coverage for women’s preventive services has been a part of the ACA since its passage in 2010. In 2016, the Health Resources and Services Administration of the United States Department of Health and Human Services (HRSA) added fertility awareness instruction to the coverage requirement.

But in 2021, HRSA mysteriously deleted fertility-awareness instruction from the requirement. Even though the Administrative Procedure Act requires HRSA to inform the public of such a change and respond to the public’s comments on the change, the agency failed to do either.

In May 2022, ADF attorneys filed a lawsuit on behalf of Dr. Tice-Harouff against HRSA because of its illegal change deleting fertility awareness instruction from the coverage requirement. The change harmed Dr. Tice-Harouff and her patients in two main ways.

1. Patients who seek fertility awareness-based family planning make major financial decisions to receive the care that is best suited for themselves and their families. If insurance plans no longer cover this treatment, these families could be substantially burdened.
2. Like other doctors, in order to care for women who need it most Dr. Tice-Harouff bills the insurance companies of her patients. And as a further part of her ministry, she donates those proceeds to her nonprofit health clinic so she can provide a range of care for even more families who need it.

If fertility awareness instruction is no longer included in the ACA’s coverage requirements, women will have to pay health care providers themselves or not obtain the care. This would leave some of the neediest women unable to afford the services that are best for their families, and Dr. Tice-Harouff would no longer be able to help them because of the cost.

Thankfully, a federal district court agreed with Dr. Tice-Harouff’s claims. After issuing a strong opinion temporarily blocking the rule change, the court issued a final order in December 2022 restoring the language that requires coverage of fertility awareness-based methods of family planning for 58 million women.

What’s at stake?

Women should not have to suffer financially because they have medical or philosophical reasons for choosing fertility awareness-based methods of family planning.

The government tried to ensure only certain methods of family planning were accessible without even giving the public a say. ADF put a stop to that.

Case timeline

• December 2021: HRSA removed a requirement for insurers to cover fertility awareness-based methods of family planning as part of the Affordable Care Act.
• May 2021: ADF attorneys filed a lawsuit on behalf of Dr. Cami Jo Tice-Harouff.
• August 2022: A U.S. district court granted Dr. Tice-Harouff’s motion to halt the HRSA’s attempted rule change while her lawsuit proceeds.
• December 2022: Dr. Tice-Harouff received final judgment in an order that restored coverage of fertility awareness-based methods of family planning for 58 million women.

The bottom line

Women shouldn’t have to fear losing their doctor and insurance coverage for fertility awareness instruction due to government decisions made in secret.