Capital Beat: When it comes to contraceptives, battle lines aren’t so clear

Monitor staff
Published: 2/3/2018 11:55:33 PM

Some bills seem to have the deck stacked in their favor. 

Last year, the Legislature approved the creation of a commission to study an idea to empower pharmacists with the ability to prescribe oral contraceptives without a doctor’s visit. The group, representing obstetricians, nurse practitioners and health care officials, unanimously voted in favor of the idea. A bill was proposed, drafted and sent to the House Health and Human Services committee.

The effort had momentum. But it stalled late last month, when the committee recommended it be killed, 13-8. But it was committee Democrats, led by Rep. Mindi Messmer, D-Rye, that led the charge.

Now, members of medical organizations and reproductive rights advocates – taken aback – are deliberating the next step.

“We were surprised at the committee’s recommendation,” said Molly Cowan, spokeswoman for the New Hampshire chapter of Planned Parenthood.

Sara Kellogg Meade, a representative of the New Hampshire Nursing Association, took it a step further.

“I am disappointed, as are other members of the commission,” she said. “Reducing unplanned pregnancy is the goal of the legislation.”

Mary Bidgood-Wilson, executive director of the New Hampshire Nurse Practitioner Association, echoed the sentiment. “The evidence-based reports from multiple associations are that this is best practice,” she said.

As written, House Bill 1822 would allow physicians to issue pharmacists of their choosing standing orders to carry out. Those pharmacists would be trained according to national standards; potential patients would be screened and provided information on the risks.

Proponents called the proposal a step forward to providing easier access to birth control – an argument bolstered, they added, by the unanimous commission vote. But Messmer and others said that those seeking the medications should consult a gynecologist first, to better screen for disqualifying pre-existing conditions.

And Messmer argued that pharmacists are too overstretched to handle the additional responsibility, even if optional.

“I am all for enhanced access, but that is not the right avenue by which I thought it should be done,” Messmer said.

Lucy Weber, D-Walpole, agreed.

“I’m very much of two minds about the bill,” she said. “On the one hand I think it might make access easier, which is a good thing.”

But, she added, “How do we decide from the range of birth control that might be prescribed which one is right for which woman? ... There’s a lot of counseling that goes along with it.”

The bill isn’t finished – the committee’s recommendation will come before the House on Wednesday. But with a bipartisan recommendation that the bill be defeated, the odds on the floor are less than favorable.

For Democrats like Weber and Messmer, who advocate for higher access, it’s an uncomfortable position. But for Messmer, the bill as written is a simple issue of liability.

For Rep. Will Marsh, R-Wolfeboro, a sponsor of the bill and a member of the original commission, the decision was a blow to those sitting on the commission.

“I was totally shocked the way it happened, I mean I thought this bill was going to the consent calendar,” he said, vowing to fight it on the floor.

“I think we wrote a good bill, here I think it has plenty of protections in it, and I think it deserves to be heard,” he added.

Moving target

On a conference call to debrief his trip to Washington, D.C., Republican Gov. Chris Sununu said he made strides with Seema Verma, administrator of the Centers for Medicare and Medicaid Services, on New Hampshire’s waiver application to add a work requirement to its Medicaid expansion program. And he pointed to Kentucky – the first state to have its waiver approved by the federal agency – as a potential model to follow.

Republicans have championed a work requirement as a means to break what they see as a cycle of dependency among some Medicaid recipients. But Democrats have raised concerns that any work requirement could prove an impossible barrier to some without adequate opportunities. Some, including Rep. Cindy Rosenwald, D-Nashua, have called for resources to be linked to the requirement to provide job training and transportation assistance.

Speaking on Wednesday, Sununu said he’s open to the idea.

“I think job creating and education is potentially all part of the discussion in terms of how that fits into a work requirement, sure,” he said. “Workforce is a key issue here and allowing people the dignity and making sure they can get back to work and provide for their families, that’s all part of the incentive here.”

As far as the overall landscape, negotiations are for the most part in leadership’s hands, but answers will need to come soon; the Legislature faces a self-imposed April 30 deadline to approve a work requirement. With job training a potential prerequisite for Democrats, the needle will be tougher than ever to thread.

Second chances

The contraceptives bill is not the only one getting a second chance on the House floor Wednesday. Advocates for a statewide paid family leave program will also be pressing to overturn a 12-8 Commerce committee recommendation against the program.

Perhaps most dramatically: conversion therapy legislation. Early last month, House Bill 587, intended to formally ban the practice in New Hampshire, was rejected in a 166-165 vote – a tie broken by Speaker Gene Chandler. Supporters said it would create a framework to end a widely discredited technique that can cause children lasting harm. Opponents said it would sweep up other forms of therapy and that the practice is not known to occur in the state.

The tiebreaker was dramatic enough, but the story isn’t finished. Rep. Henry Parkhurst, D-Winchester, says he hit the wrong button, voting against the bill erroneously. He’s asked that the bill be reconsidered. With weeks having passed, and no guarantee of who shows to the chamber Wednesday, Parkhurst’s correction could change everything. Or it could be just one vote among hundreds.

(Ethan DeWitt can be reached at edewitt@cmonitor.com, or on Twitter at @edewittNH.)




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