ACA Myth: Sterilizing Minors in Oregon

Earlier this week, I came across an article that seemed so outrageous that I couldn’t believe that people were actually trusting its veracity. The claim of the article, which has been reported only on blogs and news sites to the right of Fox news, is that due to the horribleness of the Affordable Care Act, minors in Oregon as young as fifteen can get sterilized for free against their parents’ wishes.

Let me say that again: people believe that one of the drawbacks to Obamacare is that fifteen-year-olds in Oregon are going to start getting free hysterectomies and vasectomies without telling their parents.

Since the very beginning of Obama’s administration, his critics have taken proposed portions of health care reform, bastardized them, and started a damaging rumor. Sarah Palin’s rants against death panels, for example, were linked back to the end-of-life planning that the Affordable Care Act made available to people who agreed to participate in fully voluntary counseling from health care professionals. Knowing that, I wondered what the truth was that had been manipulated and strangled to the point that people could actually believe that Obama wants to secretly sterilize children. (Anyway, wouldn’t that damage the right-wing claim that he is the most “pro-abortion” president in history? Seems like a conflict of interest to prevent pregnancies if you like abortion so much.)

Let’s start from the beginning.

The Affordable Care Act’s contraception mandate requires insurance companies to cover contraception with zero copay. There are discussions to be had about the Constitutionality of this mandate, but those can be held elsewhere, like on your political rival’s Facebook page. The important thing to the discussion of sterilization is that if you have insurance in the United States, your insurance company must provide you with zero-copay contraception. According to the Wikipedia page for the mandate, the list of covered contraceptives includes anything that is FDA approved. So: male and female condoms, hormonal/oral birth control, IUDs, implants, patches, spermicide, diaphragms, etc.

It also includes sterilization. Interestingly, sterilization is not contradictory to the religious beliefs of many who oppose birth control, although it is still prohibited by the Catholic church.

The basic reasons for sterilization and contraception to be covered without a copay is that they are categorized as preventative drugs. If you have insurance, you may have noticed that after the ACA initially passed, insurers began providing preventative drugs and services without charging co-pays.  The widely accepted theory is that by providing preventative services for free, our national health improves and our overall costs go down.

What does this have to do with minors in Oregon?

In Oregon, minors as young as fifteen can give informed consent for many medical procedures, which means that they are allowed to make decisions without their parents’ approval. According to Oregon’s Public Health website, minors can consent to things like: treatment of sexually transmitted infections, dental procedures, and treatment for mental health or emotional disorders. Oh, yeah, and sterilization.

Before you start listening to people talking about how fifteen-year-olds aren’t emotionally developed enough to make a lifelong decision like getting surgically sterilized, tell them this: Oregon does not allow minors to flippantly walk into a doctor’s office on summer break, request a sterilization, and then get operated on without ever telling their parents. The statutes that govern a minor’s ability to give informed consent for a sterilization are incredibly strict and nearly impossible to accomplish.

In 2011, the following guidelines were in place for a minor who wants to be sterilized:

• prove that the procedure is in their “best interest.”
• exhaust every possible method of treatment other than sterilization first.
• be fully capable of giving informed consent, which includes knowing all of the associated risks and side effects of sterilization.
• find a doctor who will consent to doing a surgery, which can’t create a threat to the patient’s life or health.
• GO TO COURT to get a judge to approve the procedure.

The only difference that the Affordable Care Act could make in regards to these statutes is that now there is no determination of who would pay for the procedure, because the insurance company will do that. (If, of course, the minor has insurance.) Versions of these statutes have been passed and repealed every two years since the 1950s, and they will be revisited again 2013. The statutes also include rules like “no hysterectomies” and lists of admissible and inadmissible evidence for the court proceedings.

Why does Oregon have these statutes? Because, according to the statutes, “The Legislative Assembly finds and declares that sterilization procedures are highly intrusive, generally irreversible and represent potentially permanent and highly significant consequences for individuals incapable of giving informed consent. The Legislative Assembly recognizes that certain legal safeguards are required to prevent indiscriminate and unnecessary sterilization of such individuals, and to assure equal access to desired medical procedures for these Oregon citizens.”

In other words, Oregon lawmakers aren’t out there championing the right of teenagers to get their tubes tied. They do, however, recognize that there are situations where a minor might be in need of a medical procedure that their parents are not willing to approve, and if so, that teenager has the right to petition the court for approval. The only example I could think of that could meet all of these standards would be if a minor with a physical disability or illness was informed by his or her doctor that sterilization could lead to an increased quality of life. If that minor wanted to have the procedure done and understood the risks, but was not given parental permission, then he or she could get a lawyer, go to court, and try to convince a judge that their lives would be greatly improved by the procedure.

With apologies to the fear-mongers who are trying to convince people that Obama wants to sterilize the youth of American FOR FREE and WITHOUT PARENTAL PERMISSION, the scenario in which a young person with a disability can petition the court to undergo a medical procedure just isn’t scary. To make the claim that the Affordable Care Act is somehow encouraging children to make lifelong decisions about their fertility without parental guidance is irresponsible and unethical. It’s like a friend of mine said when she read the original article’s headline: “There really ought to be rules about who can use the word ‘news’ in their URL.” If your claim is so outrageous that not even Fox News or Glenn Beck will pick it up, and it can be debunked by sleuthing for public documents for all of fifteen minutes, maybe you shouldn’t try to pretend it’s factual.