Women in Arizona trying to get reimbursed for birth control drugs through their employer-provided health plan could be required to prove that they are taking it for a medical reason such as acne, rather than to prevent pregnancy.
A bill nearing passage in the Republican-led Legislature allows all employers, not just religious institutions, to opt out of providing contraceptive coverage when doing so would violate their religious or moral beliefs.
When a female worker uses birth control pills, which can be used to treat a number of medical conditions, the bill would allow an employer who opted out to require her to reveal what she was taking it for in order to get reimbursed.
The bill thrusts the state into a raging national debate about religious freedom and birth control, sparked after the Obama administration required that employers must provide contraception coverage under the federal health care overhaul.
After objections from religious groups, the administration changed course, ordering that insurers, not employers, would have to pay for the coverage. Republicans, social conservatives and some religious groups believe the new order still violates their beliefs.
"We don't live in the Soviet Union," said the Arizona bill's sponsor, Republican Rep. Debbie Lesko. "And so government shouldn't be telling employers, Catholic organizations and mom and pop (businesses) to do something that's against their moral beliefs."
Critics say the bill allows employers to violate their worker's privacy.
"Leave the care of medicine to women and their doctors," said Democratic state Rep. Lela Alston.
Arizona is among at least 26 states that generally require that health plans cover contraceptives, though it's also among those that let churches and other religious entities opt out of providing the coverage, according to the National Conference of State Legislatures.
Under the Arizona bill, employers who opt out could make women provide documentation from their health care provider.
Liza Love, a mental health worker, testified Monday before a Senate committee to oppose the bill, saying she would be required to disclose that she needed contraceptives to treat endometriosis, which is excessive growth of the uterine lining.
"That's nothing that you as my employer ... have a right to know," she said.
Opponents of the legislation suggested that the application process might violate a federal law on privacy of medical information. A supporter, Republican Rep. Edie Farnsworth, said it wouldn't because seeking reimbursements is voluntary.
However, a legislative staff lawyer said it's not clear whether the current opt-out or the expanded one violates other federal law, including the new contraception coverage mandate being implemented by the Obama administration.
House Rules Attorney Tim Fleming noted that attorneys general for seven states sued to challenge the mandate on First Amendment grounds.
A national advocacy group for social conservatives, the Alliance Defense Fund, said the current opt-out provision is too restrictive.
The bill would end uncertainty about "who is sufficiently religious to have their rights of conscience protected," said Gary McCaleb, a lawyer for the Arizona-based group.
McCaleb also said in a letter to Lesko that enactment of her bill could help state officials fight against federal mandates. Another attorney for the group, Matt Bowman, declined to say how that might work. But he noted the existence of the lawsuit by the other states.
Other states that have considered legislation this year to broaden their opt-out provisions on required coverage for contraceptives include Missouri and New Hampshire. Bills in those two states remain alive but appear to have stalled.
The Arizona bill would also erase a law that bans religion-based employers from punishing or firing workers who get contraceptives from a source other than through their employers' health plans.
The American Civil Liberties Union of Arizona opposes the bill, and Public Policy Director Anjali Abraham said supporters shouldn't entangle the state's current coverage requirement with the national debate.
"If they're looking for some sort of tussle with the federal government, I just wish they would keep in mind the consequences for Arizona women and families because they're the ones that are ultimately hurt by this bill," she said.
Citing a policy against commenting on bills, a spokesman for Republican Gov. Jan Brewer declined to say whether she had a position on it.
Associated Press writers Norma Love in Concord, N.H., and Chris Blank in Jefferson City, Mo., contributed to this report.