Skip to content

Biden Administration Pays for Illegally Limiting Women’s Health Care

The Biden administration tried to harm women by seeking to delete insurance coverage for fertility awareness instruction.
Alliance Defending Freedom
Dr. Cami Jo Tice-Harouff is a licensed nurse practitioner with a doctorate in nursing practice

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.”

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 term 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.

In response, attorneys with Alliance Defending Freedom filed a lawsuit challenging the administration’s illegal attempt to change policies in secret and impose its preferred family planning methods on all women. Read on to learn more about the case.

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, Dr. Tice-Harouff bills the insurance companies of her patients in order to care for women who need it most. 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 were no longer included in the ACA’s coverage requirements, women would 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. In addition, the district court later issued an order requiring the Biden administration to pay $65,000 in attorneys’ fees as part of the settlement of the lawsuit.

Case timeline

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.