National Educ. Ass'n of RI v. Garrahy, Civ. A. No. 82-0399P

• Decision Date: 03 December 1984
• Docket Number: 83-0406P.,Civ. A. No. 82-0399P
• Citation: 598 F. Supp. 1374
• Parties: NATIONAL EDUCATION ASSOCIATION OF RHODE ISLAND, et al., v. J. Joseph GARRAHY, et al. PLANNED PARENTHOOD OF RHODE ISLAND, et al., v. Thomas J. CALDARONE, Jr., et al.
• Court: U.S. District Court — District of Rhode Island

598 F. Supp. 1374

NATIONAL EDUCATION ASSOCIATION OF RHODE ISLAND, et al., v. J. Joseph GARRAHY, et al.

PLANNED PARENTHOOD OF RHODE ISLAND, et al., v. Thomas J. CALDARONE, Jr., et al.

Civ. A. Nos. 82-0399P, 83-0406P.

United States District Court, D. Rhode Island.

December 3, 1984.

Lynette Labinger, Providence, R.I., for plaintiffs.

Donald Elbert, R.I. Atty. General's Dept., Providence, R.I., Albert West, Providence, R.I., for defendants in No. 82-0399P.

Donald Elbert, R.I. Atty. General's Dept., Providence, R.I., for defendants in No. 83-0406P.

OPINION

PETTINE, Senior District Judge.

Plaintiffs in this consolidated action seek permanent declaratory and injunctive relief, pursuant to 42 U.S.C. § 1983, against the enforcement of two statutes enacted by the Rhode Island General Assembly which regulate the availability of health insurance coverage for abortions. The first statute, Rhode Island General Laws § 27-18-28 ("the health insurers' prohibition"),¹ requires all insurers doing business in Rhode Island to exclude from comprehensive health insurance policies coverage for all induced abortions, except those where the life of the mother would be endangered if the fetus were carried to term or where the pregnancy is the result of rape or incest. Coverage for the abortions excluded by the statute may be obtained only by a separate, optional rider for which an additional premium must be paid. The second statute, R.I.G.L. § 36-12-2.1,² prohibits the State of Rhode Island and its municipalities from providing public employees with health insurance covering the same class of excluded abortions. Plaintiffs challenge this statute only insofar as it applies to municipal employers ("the municipal prohibition"). Plaintiffs challenge the health insurers' prohibition as violative of the Supremacy Clause insofar as it is inconsistent with Title VII, as an impermissible burden on the right of a woman, in consultation with her doctor, to choose to terminate her pregnancy, as that right is protected by the First, Fourth, Ninth and Fourteenth Amendments to the United States Constitution, and as a violation of the Equal Protection Clause of the Fourteenth Amendment. Plaintiffs challenge the municipal prohibition as violative of Title VII of the Civil Rights Act of 1964, and as an impermissible burden on the protected right of abortion.

A temporary restraining order having been issued against the enforcement of both statutes, the matter is now before the Court on cross-motions for summary judgment, in support of which the parties have filed stipulations of fact. Jurisdiction is invoked pursuant to 28 U.S.C. §§ 1331, 1343(3), 2201, 2202, and 42 U.S.C. § 2000e-5(f).

I. PARTIES

Plaintiffs challenging the health insurers' prohibition are Planned Parenthood of Rhode Island ("PPRI"), a class of physicians and a class of individual women. PPRI is a licensed facility in Providence which provides abortion services. The class of individuals consists of all women of childbearing age in the state who have or will have comprehensive health insurance covering the cost of abortions, including the excluded abortions. The class of physicians consists of all licensed physicians who perform or wish to perform abortions in the state for women whose health insurance covers the cost of abortion. The defendant is the State Commissioner of Insurance, who would be required by law to enforce the prohibition.

Plaintiffs challenging the municipal prohibition are the Rhode Island Federation of Teachers ("RIFT"), the Rhode Island Chapter of the National Education Association ("NEA") and a class of individual women. Both RIFT and NEA are labor organizations whose members include women of childbearing age and capacity who are employed by municipal subdivisions of Rhode Island. The class of individual women consists of all women of childbearing age and capacity who have been, are now, or will be employed by any municipal or other subdivision of Rhode Island. The class is represented by plaintiffs Krause and Doe, each of whom is of childbearing age and capacity, does not presently wish to bear children and would consider abortion if she became pregnant. Defendants are the State Commissioner of Insurance, who would be required by law to enforce the prohibition, and most of the school committees in Rhode Island. By agreement of the parties, the Lincoln School Committee shall serve as the sole active municipal defendant; the remainder of the school committees have agreed to be bound by any judgment rendered against Lincoln.³

II. BACKGROUND

A. The Health Insurers' Prohibition

At issue here is whether, consistent with the Pregnancy Discrimination Act of Title VII⁴ and the constitutional protection afforded a woman's right to choose abortion, the state may properly compel all insurers in Rhode Island, including private insurers, to effectively impose a surcharge on insurance coverage for the excluded abortions.

The relevant facts are undisputed and may be briefly summarized. Before the planned effective date of the prohibition, virtually all comprehensive health insurance policies in Rhode Island which covered pregnancy-related conditions also covered all induced abortions. Stipulation of the Parties ("Stip.") II, ¶ 8. Blue Cross and Blue Shield of Rhode Island ("Blue Cross") and the Rhode Island Group Health Association ("RIGHA"), who between them provide the vast majority of health insurance policies in Rhode Island, Stip. II, ¶ 8b, have stated that but for the prohibition, they would not have deleted or segregated from their comprehensive policies the abortion coverage at issue here. Stip. II, ¶ 9. The insurers have also stated that the abortions excluded by the statute represent the majority of all abortions performed in Rhode Island. Stip. II, ¶ 11a. Before the Court entered its restraining order, Blue Cross and RIGHA had formulated their responses to the restrictions imposed by the General Assembly. Stip. II, ¶ 15. Under the plans which the insurers intended to submit for approval to the Commissioner, the monthly cost of comprehensive coverage would be reduced for consumers who do not seek coverage for the excluded abortions. Those wishing the "abortion rider" would be required to pay an extra premium, calculated by the insurers to represent the incremental cost of abortion coverage.⁵ The effect of this implementing plan would be to render comprehensive insurance, including abortion coverage, available at the rates which prevailed prior to the statutory restriction—but nonetheless at a price higher than the one charged for a policy without abortion coverage.

The implementing plan, however, would not make abortion coverage available to all who wished to purchase it, even at a higher price. For those women insured through employer-financed group plans, the decision whether to purchase the rider would be left solely to the employer. Id. Similarly, for women insured through a non-employer group plan, one hundred percent of the group's members would be required to select the rider in order for the policy to include it. Id. Accordingly, any employer or any single group member could veto the rider for all the women insured under such plans. Women wishing to retain abortion coverage would then be required to leave the group plan—which could mean losing an employer-subsidy or group discount.⁶ Furthermore, Blue Cross would make available abortion and maternity coverage only under a family plan. Stip. II, ¶ 15b. Hence, a single woman seeking to maintain coverage for abortions could not do so with Blue Cross at any price. Stip. II, ¶ 15b, 21. Rather, she would be required to switch to RIGHA which, unlike Blue Cross, does not permit its subscribers to choose their own physicians or facilities. Thus, the transition would carry substantial adverse consequences for at least some Blue Cross subscribers.

The plaintiffs highlight the fact that insurance coverage for no other medical procedure is regulated in this fashion. Stip. II, ¶ 22. Further, plaintiffs allege and defendants concede that loss of insurance coverage for the excluded abortions may delay or deter some employees from having abortions which they desire, Stip. II, ¶ 23-26, and that such medically unnecessary delay in securing an abortion may operate to the detriment of women's health. Id. at ¶ 27. Plaintiffs submit the uncontroverted affidavit of Dr. Lynn Lowe in further support of these medical claims.

Defendants stipulate to all the facts marshalled by plaintiffs in opposition to the health insurers' prohibition. They assert that the Legislature has merely expressed a policy preference for childbirth over abortion—a preference which defendants claim is shielded from constitutional scrutiny by the Supreme Court's decisions in Maher v. Roe, 432 U.S. 464, 97 S.Ct. 2376, 53 L.Ed.2d 484 (1977) and Harris v. McRae, 448 U.S. 297, 100 S.Ct. 2671, 65 L.Ed.2d 784 (1980). In those cases, the Court held that state governments and the federal government, respectively, may encourage childbirth over abortion by declining to subsidize abortions with government funds.

B. The Municipal Prohibition

At issue here is whether the state has run afoul of either Title VII or the federal Constitution by barring all municipal employers in Rhode Island from providing employees with health benefits covering the excluded abortions.

The relevant facts are again undisputed. Prior to the enactment of the municipal prohibition, the Lincoln School Committee provided its employees, as part of their fringe benefits, with health insurance that covered the cost of any induced abortion. Stip. III, ¶ 13. The policies were provided by either Blue Cross or RIGHA. Stip. III, ¶ 13e. Prior to the state legislation, Lincoln had made no determination to eliminate coverage for the excluded abortions, Stip. III, ¶ 13f, although it has not objected to the state's determination. Since enactment of the statute, at least Blue Cross, and...