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The Final Contraceptive Coverage Rule: Why You Should Stay Away From Any Organization That ‘Self-Certifies’

9:43 am in Uncategorized by RH Reality Check

Written by Bridgette Dunlap for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

increase contraception, duh.

Increase contraception

On June 28, the Obama administration released the final version of the contraceptive coverage rule. Beginning January 1, 2014 women who aren’t already benefiting from the Affordable Care Act’s mandated contraceptive coverage, like those employed at religiously affiliated organizations that took advantage of the enforcement safe harbor, will be able to receive contraceptive coverage directly from their insurance companies, rather than their employer-provided plans. This “religious accommodation” makes employers’ involvement in contraception use even more remote, while ensuring that women still have access. [1]

The bishops and other anti-contraception crusaders will not be happy with the religious accommodation, so expect the lawsuits dismissed as premature or held in abeyance back in court soon. That aside, it is important to understand how far the Obama administration bent for the contraception opponents and how little it demanded in return. Organizations are not even required to make their religiously based objection to birth control public.

Granting the religious accommodation without abandoning women with religiously affiliated employers is possible because of the unusual economics of contraceptive coverage: the Obama administration can tell insurance companies to cover contraception without a co-pay, because providing it is cost-neutral for insurers. All (reasonable) parties can have their way—employers don’t have to provide plans with coverage, but employees can still get it, and insurers don’t have to pick up “the bill” because there really isn’t one. But the problem remains that religiously affiliated employers are being excused from the law without having to make even the smallest disclosures about their organizations in return. This sets an unwelcome precedent for future demands for special treatment.

I argued both in a piece for RH Reality Check and in a comment to the rule that the “self-certification” for the religious accommodation should entail explicit and public disclosures about how the organization “holds itself out as religious,” who determines what constitutes the religious beliefs of the organization, and what those beliefs are. In releasing the final rule, the government acknowledged it received comments to that effect, but further reduced the disclosures required for the accommodation. In order to qualify for the religious accommodation, organizations need only fill out a two-page form and file it with their insurer. And the form no longer even requires organizations specify the contraceptive services to which they object.

This is an invitation for organizations to characterize themselves as religious when they want an exemption from the law but secular when they want government funding. For example, Manhattan College and St. John’s University tell the state of New York they are not church-controlled to get taxpayer funds, then turn around and tell courts they are church controlled when they don’t want to have to deal with employees unionizing or abide by the Americans with Disabilities Act.

There are lots of reasons the claim that requiring contraceptive coverage is a religious freedom violation shouldn’t fly. But given the increasing frequency with which religiously affiliated organizations get what they want, simply requiring them to own up to whatever they purport to believe would be a big step in the right direction. Instead, they are currently free to make opposite representations depending on who is asking without any consequences.

The self-certification is insufficient, but it can still serve as a useful litmus test. Before you enroll or accept a job at any religiously affiliated organization, find out if it self-certified. If it did, steer clear. I realize, that may not be possible if you are a social worker in an area where Catholic Charities has a monopoly, or if you need to go to whatever school gives you the best financial aid, or if you’ve worked somewhere for years that has just now discovered it opposes contraceptive coverage. But the general rule should be: stay away from institutions that self-certify. It is impossible to anticipate on what other grounds they will claim an entitlement to discriminate or otherwise impose religious doctrine in the future. Even if they tell you separate birth control coverage is one quirk at an otherwise welcoming place for women, or gay people, or Jews, or whoever else—stay away. They probably have or would take the opportunity to discriminate in other contexts.
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The Bishops’ Lawsuit: A Colossal and Purposeful Drain on Public Funds

1:09 pm in Uncategorized by RH Reality Check

Written by Bridgette Dunlap for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

stack of papers

Government lawyers filed an emergency motion to dismiss lawsuit over contraceptive coverage mandate citing exorbitant costs in responding to document requests.

This week, the government filed an emergency motion in the New York Archdiocese’s lawsuit against the contraceptive coverage mandate, requesting that the court halt proceedings and dismiss the case. The emergency is that the government is hemorrhaging money defending a regulation it will never enforce against the Archdiocese.

Roman Catholic Archdiocese of NY v. Sebelius is the only lawsuit out of the 23 brought by religiously affiliated organizations not to be dismissed at the district court level for lack of standing or ripeness. The cases have been dismissed because religiously affiliated non-profits are currently completely exempt from the contraceptive coverage requirement. They enjoy a one-year safe harbor period provided for the religious accommodation to be finalized. If you haven’t been injured, you can’t sue.

The government swore up and down from the day the case was filed that the rule in its current form would never be enforced against the Archdiocese and its co-plaintiffs and that a new rule with a new religious accommodation was on the way. As promised, the Obama administration released a new proposed rule, is now reviewing comments from the public on it, and will release the final rule by August. However, in the New York Archdiocese case, Judge Brian M. Cogan found that the administration’s assurances were not enough and that the impending threat of the rule was injury enough for the plaintiffs to proceed.

The Archdiocese et al. proceeded to serve the government with requests for every document under the sun. “Discovery” is the process in which litigating parties get evidence by requesting relevant documents from each other. To respond to a document request, a party has to review documents to determine whether they are responsive to the request and make a log of documents that are responsive but won’t be turned over because they are protected by attorney-client or another privilege. Computer searches only get you so far; a human attorney or paralegal has to determine if a document is responsive or privileged.

Plaintiffs in these cases being 1 for 23, the Archdiocese may have sought to make the most of its unique situation. It made discovery requests the government calls “enormously burdensome and irrelevant.” The Archdiocese also noticed a deposition of Health and Human Services (HHS) Secretary Kathleen Sebelius. Lawsuits are brought over regulations all the time — it is pretty audacious to demand a cabinet member show up in person for yours. That was indeed too far, and Judge Cogan granted Sebelius a protective order.

The plaintiffs didn’t stop there. The Archdiocese subpoenaed the Executive Office of the President (EOP), even though it isn’t a party to the lawsuit, many of the requested documents are protected by various privileges, and you must have an extra good reason to get documents from the president. Also, the EOP being in D.C., the subpoena was issued in a district that has thrown out three of these 23 lawsuits for lack of jurisdiction.

The Archdiocese later withdrew the subpoena. We don’t know why. Perhaps it realized it was an unreasonable request. This did not happen, alas, until after our tax dollars were put to work on a very lengthy motion to quash the subpoena. But whatever that cost, it pales in comparison to the expenditures of various agencies on the New York document requests; in the emergency motion, the government estimates completing the requested document production would take eight years and cost over $10 million.

We should take that estimate with a grain of salt, of course, but the government has sought to back it up. Attached to the emergency motion are declarations from officials of various offices and agencies as to what they have spent so far on this one case and what they estimate it will cost to finish. Two-hundred HHS employees have spent have spent over 2,000 hours and located over 7.6 million pages of potentially responsive documents so far. That has cost over $177,000. Those documents haven’t been reviewed by HHS or their Department of Justice counsel yet. The Internal Revenue Service has spent over a quarter of a million dollars.

The lawyers, paralegals, and IT professionals needed to complete discovery are expensive — even those of the lower-paid government variety. Offices that don’t have enough staff for this have hired contract lawyers, but they can’t afford to do that anymore because of the sequester. Lest you think it’s not a big deal to have government lawyers tied up or that the effect is minimal in the scope of things, consider one example contained in the declaration from the Department of Labor (DOL). The DOL’s Plan Benefits Security Division investigates and litigates cases of fraud or mismanagement in employee benefits. The division, which recovered $1.38 billion for U.S. workers in 2011, argues that the impact on the public interest of putting its attorneys on document review will be far greater than the financial loss.

The Archdiocese, which employs 10,000 people in programs receiving many millions of dollars in government grants each year, will never have to provide health plans with contraceptive coverage under the rule as proposed. Despite this, it is waging a legal battle that is imposing significant costs on the taxpayers who fund its work. And this is only one lawsuit. With the additional cases brought by secular for-profit corporations, over 60 lawsuits have been filed in this scorched earth litigation campaign — which we have to pay to defend.

On the same day the emergency motion was filed, Judge Cogan granted it in part, staying all discovery and proceedings until the contraceptive coverage rule is final. So the government lawyers can get back to other business for the moment. But once the rule is final, I expect we will see that some if not all of those 22 dismissed cases (the ones that haven’t already been appealed) will be refiled.

Back in February, with the sequester looming, the U.S. Conference of Catholic Bishops, which, like the Archdiocese of New York, is led by Cardinal Timothy Dolan, signed a statement by religious leaders urging legislators to protect the interests of the poor. The Bishops’ litigiousness does not reflect the same awareness of our limited resources nor concern for those who will be hurt most by the sequester. Instead, the Archdiocese seeks to deprive its employees of affordable contraception — provided by an outside company — that will enable employees to limit their families to the size they want and can support, using up resources that are needed elsewhere in a time of economic distress.

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Self-Certification and the Contraceptive Coverage Rule: What Does It Mean for an Institution to “Hold Itself Out as Religious?”

12:53 pm in Uncategorized by RH Reality Check

Written by Bridgette Dunlap for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Birth Control Pills

The Obama administration is considering who should be exempt from providing contraceptive coverage under the Affordable Care Act.

The Obama administration is accepting comments from the public until April 8th on the Notice of Proposed Rule-Making for the birth control benefit or contraceptive coverage rule. The proposed rule amends the exemption for houses of worship and their affiliates and adds an accommodation for other non-exempt non-profits opposed to birth control.

The accommodation requires that insurance companies offer separate contraceptive coverage directly to the employees of objecting organizations at no additional cost. To take advantage of the accommodation, an organization need only self-certify to its health insurer or plan administrator that it is a non-profit opposed to some of the required contraceptive services and that it “hold[s] itself out as a religious organization.”

It is not enough for an institution seeking special treatment to simply assert that it holds itself out as religious. I expect the Obama administration is loathe to define what it means to be a religious organization or police whether an institution is in fact holding itself out as such, and rightly so. Nevertheless, the institution should have to make a statement describing how it holds itself out as religious and what that religiousness entails. This statement should be made easily available to the public and organizations should have give to notice of it to those with whom it seeks to contract, such as employees, students, patients, and funders.

This is necessary due to a pattern of religiously-affiliated institutions characterizing themselves one way when recruiting or seeking public funding and another when demanding to be exempt from laws that govern secular institutions. The trend in First Amendment Establishment Clause jurisprudence has permitted increasing public funding for religious organizations. This means we need whatever protections the free market can provide individuals from the imposition of religion by institutions active in the public sphere. We can only avoid involvement with institutions that will discriminate on the basis of religious control if we know which institutions those are.

To understand some particularly flagrant examples of religiously-affiliated institutions trying to have it both ways, we turn to a bit of state constitutional law. Over 37 state constitutions contain explicit prohibitions on the use of public money for religious institutions or instruction. New York is among them and its Constitution prohibits public funding of any educational institution “wholly or in part under the control or direction of any religious denomination.”

In the mid-60s many private universities throughout the country were in dire financial straits. New York sought to rescue its private universities with taxpayer funding through a program known as “Bundy aid.” However, giving public funds to religiously-controlled universities was clearly unconstitutional. So religious universities, particularly Catholic ones, underwent re-organizations to separate themselves from the control of their founding religious orders and other church authorities and endeavored to become more suitable places for people of any or no faith to work and study. By becoming non-sectarian, while maintaining only a religious affiliation, they qualified for public funding.  The motivation behind secularization was not exclusively financial, but part of a larger attempt by Catholic universities to strengthen their academic and intellectual legitimacy.

By accepting funds each year, a New York college makes a representation to the state that it is an independent institution free from religious control. Despite this, a number of universities receiving Bundy aid, have asserted that they are church-controlled in order to be free from various generally applicable laws.

In 2010, adjunct professors at Manhattan College sought to unionize. To block them, Manhattan College claimed it was not subject to the jurisdiction of the National Labor Review Board because it is “church-operated.” Among the evidence on which the NLRB board relied in rejecting the claim Manhattan College holds itself out as a religious institution was the fact that Manhattan College deliberately eliminated church control to get Bundy aid and continues to claims to be non-sectarian by accepting it.

In 2009, St. John’s University argued it was exempt from the Americans with Disabilities Act because it is “controlled by a religious organization.” Prior to that, St. John’s successfully argued it was eligible for an exemption from New York’s Human Rights Law for the same reason. In agreeing that St. John’s is controlled by a religious organization, the Court did not take notice of the fact that St. John’s represents to the state that it is not controlled, even in part, by a religious organization in order to get taxpayer funding each year.

Multiple universities that receive Bundy aid have health policies that are controlled by the U.S. Conference of Catholic Bishops through the USCCB’s Ethical and Religious Directives for Catholic Health Care Services.  The Directives are 43 pages long and as detailed as a statute. These schools tend to be less than forthcoming as to how the Directives are implemented in school policy, and some fail to give notice that the Directives control at all.

For a further example of conflicting self-characterizations, we now turn to the permissibility of funding under the federal Constitution. In 2000, the University of Notre Dame received a $500,000 federal grant that funded a program that included training teachers to work in parochial schools. Taxpayers sued the federal government, alleging the grant violated the First Amendment’s prohibition of government establishment of religion. Notre Dame intervened in the case as a defendant to defend its interest in the funds. Inherent to Notre Dame’s argument that the funding did not violate the First Amendment, is the fact that Notre Dame engages in many secular activities. In fact, just by applying for the grant, for which the “[u]se of funds for religion” was explicitly prohibited, Notre Dame represented to the government that despite its religious affiliation, not everything it does is an exercise of religion.

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As Notre Dame Appeals Birth Control Benefit, Costs to Catholic Universities of Discriminatory Health Plans Increases

12:21 pm in Uncategorized by RH Reality Check

Written by Bridgette Dunlap for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

On Friday, Notre Dame filed a notice of appeal in its lawsuit challenging the contraceptive coverage rule.  So, game on. It was not exactly a surprise when the bishops rejected the Obama administration’s latest overture to religiously-affiliated institutions. And it is now clear that no “compromise” short of freeing all health plans from any regulation whatsoever having to do with contraception will suffice. I didn’t expect all of these lawsuits to go away, but I was hoping, perhaps naively, that Notre Dame might accept the court’s dismissal of its lawsuit given the vocal disagreement with the legal and theological claims therein that has come from students and faculty at Notre Dame. (See hereherehere, and here. A dissent here.)

The lower court dismissed Notre Dame’s lawsuit for lack of standing and ripeness because Notre Dame is not currently required to provide contraception, having taken advantage of the one-year safe harbor period the Obama administration provided while the rule’s accommodation for objecting religiously-affiliated institutions is amended.  All but one of the courts to consider the issue have essentially said that no final rule means nothing to sue about. These cases are pre-mature. (Like I been sayin’!) The Obama administration released a new proposed rule on January 30th, but the rule still isn’t final yet.  Still, the closer we get to implementation of whatever the final rule is, the stronger the plaintiffs’ arguments become that it is time to reach the merits in these cases. (Though I believe Notre Dame lacks standing for other reasons that the government hasn’t argued.)

So why did I think Notre Dame might accept the court’s decision?  My general theory is that the administrators of these plaintiff universities would like to do what is in the best interest of their students and employees and understand that going out of their way to provide a substandard, discriminatory health plan is not the best route to doing so. But the administrators of these institutions are under significant pressure from bishops, donors, and other off-campus orthodoxy-enforcing bullies like the Cardinal Newman Society. The promoters of the litigation campaign against contraceptive coverage likely saw Notre Dame as the crown jewel of plaintiffs, given its place in the American Catholic imagination. Plus, there are few big name schools that could be plaintiffs since so many of them currently have health plans with contraceptive coverage: at least for employees that is, who have more legal protections and bargaining power than students. (I’m looking at you, Georgetown.)

Still in hot water over inviting President Obama to speak at Notre Dame, I doubt University President Rev. John Jenkins had much choice about the lawsuit. Once the suit was dismissed, I thought the Notre Dame administration, having done its part for the bishops’ campaign, might turn its energies to more pressing concerns. Or, if it wants to make sure its health plans are consistent with Catholic concern for access to healthcare, it could fix the inadequate maternity coverage in the student plan. Instead, it is doubling down on claims about contraception that are inconsistent with the legal and theological understandings of the majority of the Notre Dame professors and students who have weighed in on the issue.

This is especially unfortunate given the important role Notre Dame played in the development of Catholic thought on contraception historically. Adding to the history of Notre Dame faculty members’ advocacy for contraceptive access I recounted previously, Kathryn Pogin pointed me to the voice of Notre Dame students in the debate within Catholicism in the sixties. For example, in a 1965 letter (page six here), a Notre Dame student argued for a change in the Vatican’s position and noted Dr. John Rock, a devout Catholic who was integral to the development of modern contraceptives, had lectured on Notre Dame’s campus the year prior.

Since that time, the number of Catholics who accept the Church’s teaching on contraception has dwindled to almost nothing.  Even those who do accept it must make a further leap to accept the claim that the Catholic ban on birth control translates to the impermissibility of compensating employees of varying beliefs with a normal health plan, or even allowing employees access to separate coverage provided by third-party plan administrators per the new rule proposal. In the case of students, they must accept the claim that Notre Dame has a sincere religious belief that requires interference in a money-for-health-insurance transaction between the student and a third-party insurer that involves no university funds at all.

I believe these lawsuits are bad for Catholic education. How bad, only time will tell. Multiple professors at Catholic-affiliated schools have told me they don’t want their kid going to their own universities now that their student health policies have come to light. I’ve tried, with mixed success, to convince concerned students admitted to Fordham Law that the University’s health center policies are not reflective of the Fordham experience, we are working on the problem, and they should come here anyway. More generally, the uncritical acceptance of the idea, by the media and even the Obama administration, that Catholic-affiliated institutions are conservative places where women should have expected discrimination in their healthcare benefits (and who knows what else) is making prospective students and employees rightly wary.

These cases have further implications for our academic reputations. Notre Dame claims to have a sincere religious beliefs that Plan B and Ella are abortifacients, when in fact science has proven otherwise. Are Notre Dame biologists expected to accept the authority of the bishops as to how a drug works? In what other disciplines should we expect Catholic doctrine to trump the knowledge of academics?

These lawsuits are a warning not to accept the assurances of recruiters that any given Catholic-affiliated school is a welcoming place for scholars of all faiths, genders, orientations, or academic persuasions. They undermine the idea that Catholic-institutions are home to research and education equal to that of secular schools, painting them as places one should expect to be controlled and indoctrinated. And sadly, these lawsuits must be viewed in the context of an ongoing crackdown on Catholic nuns, scholars and scholar-nuns.

I’ve been to more Catholic school than most priests. (I stole that line from a Notre Dame grad, but I’ve been to more than him.)  I am extremely grateful for my education and experience, but the claims of Notre Dame and other plaintiff schools cause me to question whether I can continue to recommend it to anyone else.

**If you are an employee or student of a Catholic affiliated institution of any kind and would like information about potentially signing onto a comment to the proposed Health and Human Services rule, an amicus brief in one of the lawsuits challenging the rule, or other cross-campus organizing and advocacy, please send me your contact information via this link.

Affirmative Action, Marriage Equality, and Voting Rights: A Look at the New Supreme Court Term

10:33 am in Uncategorized by RH Reality Check

Written by Jessica Mason Pieklo for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Last year’s historic decisions upholding the constitutionality of the Affordable Care Act and striking as unconstitutional most of Arizona’s “papers please” immigration law set the tone for what promises to be an even more exciting and historic 2012-2103 term at the high court.

The term, which begins today, Monday, October 1, already promises a handful of marquee cases, including a direct challenge to affirmative action in the case of Fisher v. University of Texas. In 2003, the Supreme Court ruled in two separate but parallel cases — Grutter v. Bollinger and Gratz v. Bollinger — that universities have a compelling interest in creating a diverse student body and that they may consider race as one factor, among many, in deciding which students to admit. In 2005, after those cases were decided and in an effort to increase diversity of its student body, the University of Texas adopted an admissions program that was modeled in part on the Michigan program the Supreme Court had upheld in those decisions and as a supplement to its Ten Percent Plan — which automatically admitted the top 10 percent of each high school graduating class. The shift was based on the assumption that, de facto, most Texas schools are still segregated.

Abigail Fisher, a white student who was not in the top ten percent of her class, was denied admission to the school and challenged the policy by arguing that the court erred in looking at race as a factor in her admission decision. Now the Roberts Court will decide the case, a fact that makes many affirmative-action defenders anxious since the Chief Justice is on record as opposing any kind of policy that is not “race neutral” across the board.

The other sure-thing case before the Court is Kiobel v. Royal Dutch Petroleum, a case the Court will hear on the first day of arguments. In that case the Court will consider whether Congress intended the Alien Tort Statute, a law that says non-citizens can sue American corporations in American courts for conduct of those corporations abroad, to also hold American corporations accountable for human rights abuses committed abroad. The Kiobel challenge gets to the very heart of the law by questioning whether individuals who suffered severe human rights abuses abroad can sue those responsible for the abuses in the United States or whether those individuals are stuck with the laws and jurisdiction of where the abuses took place. If there’s been one consistent theme from the Roberts Court it is the expansion of corporate rights at the expense of individual rights and Kiobel looks to be another case that may cement that theme at a time when corporate accountability abroad is needed now more than ever.

There are two other big issues likely to come before the Court this term: marriage equality and a challenge to the Voting Rights Act. The question is how they get before the Court because that answer will tell a lot about how the Court will likely rule.

E.J. Graff has a great overview on the various challenges to the Defense of Marriage Act (DOMA) working their way up to the Court, as well as the challenge to California’s Prop 8. Which case the Court decides to hear will make all the difference in outcome, because Supreme Court law all depends on the way an issue is framed. There are five challenges to DOMA from which the Court could chose; each are limited in their scope and framing and each places the issue of same-sex marriage in the context of federal power. Specifically, the DOMA challenges ask: Does the federal government have the right to pick and choose which state marriages it recognizes without violating the equal protection guarantees of the Constitution?

In many ways that’s an easier question to frame for a conservative-leaning court than the question at the heart of the Proposition 8 challenge: Do same-sex couples have a fundamental right to marry under the Constitution? The Roberts Court has been outright hostile to the idea of any kind of fundamental rights, and would undoubtedly see this as an expansion of constitutional access, something the most strident of its justices have made a career trying to prevent. If the Court decides to hear Perry v. Brown in an effort to answer this question it could spell bad news for marriage equality.

Similar to marriage equality the Court has several avenues to attack the constitutionality of the Voting Rights Act (VRA). First is the possibility of the Court agreeing to review Shelby County v. Holder, a case where the Department of Justice objected to changes in Alabama voting law on which the DOJ has since backed off, or through several other challenges to the VRA in the appellate courts from Florida and Texas.

Each of the possible challenges question Section 5 of the VRA which requires the federal government to “pre-clear” any changes to election laws in certain jurisdictions with a history of racial discrimination. In an earlier voting rights challenge Chief Justice Roberts questioned the constitutionality of Section 5 but did not rule on it outright. This term may give him a chance to strike one of the most important achievements of the modern civil rights statutes.

There are a handful of other important questions the Court will also answer with regard to the rights of criminal defendants, and with a future challenge to Roe v. Wade only a year or two away at most, history may look at the Roberts Court as the conservative response to the great progressive days of the Warren Court. At least that’s how it is shaping up right now.

Health Reform’s Quiet Victory: Pregnancy Assistance Fund Benefits Vulnerable Populations

12:24 pm in Uncategorized by RH Reality Check

Written by Sheila Bapat for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Shauna Humphreys has been leading programs that serve at-risk teens of the Choctaw Nation in Oklahoma for several years. But the impact of her work has increased dramatically over the past two years because of the Pregnancy Assistance Fund (PAF), a provision of the Affordable Care Act supporting a range of services for pregnant teens and young adults.

Humphreys’ program, known as Support for Pregnant and Parenting Teens (SPPT), serves nearly 100 Choctaw mothers under the age of 22 by building their parenting skills, providing sex education to help prevent repeat teen pregnancies, and encouraging young mothers to obtain high school degrees and pursue higher education.

Vastly more robust than the program Humphreys ran prior to receiving a 3-year PAF grant at $900,000 per year, SPPT is staffed with six caseworkers who visit clients’ homes monthly to deliver parenting and life skills training. Caseworkers also serve as a general support network for young women who are experiencing domestic violence.

“These young women need this level of support. They typically don’t have anyone helping them to meet their personal goals,” said Humphreys, herself a mother of twins. “I can’t imagine being pregnant in high school and trying to figure out my life after having a child.”

While the battle over the ACA rages on in the states, with the Medicaid expansion and the birth control benefit persisting as the most contentious provisions of the law, PAF is an under-the-radar boon of health reform. Needless to say, if the ACA is repealed, PAF will likely be eliminated as well–jeopardizing Humphreys’ program and all PAF-funded programs.

United States rates of teen pregnancy, while declining steadily over the last decade, continue to be high compared with other developed countries. Native American communities consistently see higher teen pregnancy rates than other ethnic groups in the United States.

PAF’s focus is holistic — it funds programs that serve pregnant women who are victims of intimate partner violence and sexual assault. This resource is critical for all communities, and particularly for Native American communities: According to the Center for American Progress, Native Americans are victims of rape or sexual assault at more than twice the rate of other racial groups.

Clients of SPPT who have experienced domestic violence often confide in Humphreys’ caseworkers, who then refer the clients to domestic violence programs that offer shelter and other resources. “Our caseworkers hear about the range of difficulties clients are experiencing and that’s good, we want that, because we want to help in all aspects of their lives,” Humphreys said.

Equally critical is PAF’s focus on education, as children of teen parents are more likely to grow up poor if their parents do not at least make it through high school. For example, the Virginia Department of Health received a $1.5 million PAF grant to aid pregnant and parenting students in colleges and universities, helping them navigate the hurdles to staying in school and obtaining a four-year degree.

Quietly aiding some of the most vulnerable US populations, PAF demonstrates the economic justice potential of the ACA. As long as the ACA is not repealed in full by Congress or a Republican administration, PAF should be intact through 2019. Senator Bob Casey of Pennsylvania sponsored the bill to expand funding for PAF last year — I reached out to Casey’s office for comment about how a repeal of the ACA could impact PAF but haven’t yet heard back.

PAF and the work of its grantees makes the political wrangling over health reform seem completely petty. Writer Sarah Kliff recently pointed out that states’ opposition to the ACA is just as political as it seems, driven primarily by state leaders’ party affiliation. As it happens, none of the 17 states where PAF funding has been disseminated currently plan to oppose the Medicaid expansion.

So while the funding lasts, Humphreys and her team are hard at work. “We hope to hire more caseworkers and serve more women,” said Humphreys. “I don’t want to think about what could happen to these young women if our program loses support.”

ACA Qué (What)? A Policy Wonk’s Mother Still Wonders How it Affects Her and Latin@ Families

4:11 pm in Uncategorized by RH Reality Check

Written by Marisol Franco for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

We are now in the aftermath of the historic and significant Supreme Court ruling in favor of the Affordable Care Act (ACA). Our celebrations have simmered down and now we are analyzing what it all truly means and educating our  communities, while pushing back against the relentless opposition (i.e. the 33rd vote by the House to repeal ACA).

As I monitored the SCOTUS blog at the crack of dawn on the day of the ruling, I reminded myself that my mother, who had already been at work since 5 a.m. inside the hotel where she has worked for over 35 years, probably did not hear about the decision. While those who work on reforming our health care delivery system blasted emails, tweeted, blogged, and spoke with media, I wondered what she would have thought if she heard President Obama speak. Despite having a health policy wonk for a daughter, she would probably still wonder how this decision affects her, as most people did that morning and still do.

Despite the onslaught of reporting that day, the majority of discussions did not address how the ACA would benefit Latina/o individuals and families. Based on a xenophobic narrative, coverage about the fastest growing ethnic group in the country falsely pegs Latinas/os as immigrants who “drain” the system, and ignores contributions of immigrant and non-immigrant families as well as the less than half of Latinas/os who have access to job-based health insurance.

Overall, California Latinas/os stand to gain the most with the ACA, whether currently insured or uninsured. Latinas are the most uninsured group in the state with 4 out of 10 of us lacking health coverage. With this decision, over 2 million more California Latina/os will have access to affordable health care in 2014. It will also help the Latinas/os who already have employer-based coverage through regulatory and broader public health provisions.

My family is part of the 38 percent of Latinas/os in California who have employer-based coverage. Despite a debilitating work-related injury to her shoulder, my mother continues to work full-time through the pain she feels when cutting fruits and vegetables for the hotel restaurant, so that she can obtain health coverage for herself and two of my younger siblings. Latinas/os value health care and will often go to great lengths to obtain affordable health care for their families.

For California Latinas/os, the ACA means:

  • About 1.1 million California Latinas/os who are low-income citizens or qualified immigrants with incomes under 133 percent of federal poverty level ($30,657 for a family of four) will qualify for Medi-Cal.
  • More Latinas will have access to no-cost basic women’s preventive health, including contraception and cancer screenings.  This is extremely important for Latinas who are disproportionately affected by breast cancer and cervical cancer.
  • More families will have access to no-cost preventive care, including physical exams and immunizations.
  • More funding will go to community health centers, where anyone regardless of insurance or immigration status can receive care.
  • For those whose employers do not offer health coverage, which is a large percentage among Latinas/os, the ACA will provide tax credits to families on a sliding scale to purchase their own insurance through new insurance marketplaces called Exchanges.

The ACA also keeps insurance companies in check:

  • Insurance companies now have to justify to the Insurance Commissioner if they plan to raise their rates by more than 10 percent.
  • Insurance companies can no longer charge women more than men for the same insurance policy.
  • Insurance companies can no longer deny coverage to children for pre-existing conditions.
  • Insurance companies must spend the bulk of our premiums on providing care and not CEO bonuses. Families will receive rebates for un-spent premium dollars.

While we share and celebrate the positive changes that the ACA has already accomplished and those to come, we must also continue to fight for equal access to health care for everyone in our communities, specifically our undocumented brothers and sisters. Twenty-six (26) percent of uninsured Latinas/os in California would be excluded due to citizenship and immigrant clauses that prohibit undocumented residents from participating in public programs, receiving tax credits and using their own money to purchase coverage through the Exchange. We must inform immigrants about which public programs and health centers they can access, and at the same time work on solutions to cover all Californians, regardless of immigration status.

Opponents of the ACA can use scare tactics to inflame “the taxpayers” about all of the immigrants they would have to be responsible for providing health care – but the bottom line is that when families in our community cannot access care we all lose. Emergency care costs are mounting and safety net providers are over-burdened and under-resourced. And let us not forget that our immigrant families are also “taxpayers” and contribute invaluably to California’s and the nation’s vitality. Immigrants, regardless of status, are equally entitled to their human right to health care.

This “win” was not just for the policy and advocacy community, it was for families–like mine, like yours, and many other Latina/o families in California. Because of the Supreme Court ruling, I can rest assured that when my mother, who is still far from Medicare eligibility, can no longer work the required hours, we will be able to find her affordable health coverage.  

While most people have moved on to the latest breaking news, the decision did pique people’s interest. They want to know more about the ACA and how it will affect them. We all have a responsibility to inform our family, friends and broader communities about the details and importance of the ACA especially as conservative politicians push back and muddle the facts. We must speak clearly, loudly and relentlessly. Now is the time to drown out the naysayers and stand up for health care for all.

Why “Free Birth Control” Is Not Free

4:01 pm in Uncategorized by RH Reality Check

GOP Aspirin Birth Control

(photo: DonkeyHotey/flickr)

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Yesterday, August 1, 2012, was a momentous day for women, marking the official beginning of a process of ensuring that millions of women across the United States will–finally–have access to a full range of preventive health care services without a co-pay.

These include a wide range of services and interventions identified by the Institutes of Medicine as essential to women’s health and well-being, including breastfeeding support, supplies, and counseling; screening and counseling for interpersonal and domestic violence; screening for gestational diabetes; DNA testing for high-risk strains of HPV; counseling regarding sexually transmitted infections, including HIV; screening for HIV; contraceptive methods and counseling; and well-woman visits. Likewise, the ACA also ensures that plans must cover an array of services, vaccinations, and interventions, including those specifically needed by women, infants, children, and adolescents at different points in their lifecycle.

Unquestionably, due to the efforts of religious and political fundamentalists at the state and federal level to deny women access to reproductive health care of virtually every kind, the benefit that has gotten the most media attention is the one involving contraception without a co-pay. Many media outlets (see ABC, NBC, Grist, Shape.com) and some columnists, including our colleague Amanda Marcotte, have described the new birth control benefit as making contraception “free,” most frequently, for example, stating that now women will have access to birth control for free.

This is not the case, and it is misleading–and politically dangerous–to say so.

To get birth control without a co-pay means you have an insurance policy. No one can walk into any pharmacy today and get the pill without a prescription, which in any case first entails a visit to a doctor’s office. No one without insurance can walk into a doctor’s office and get an IUD for for free, nor any kind of contraception, unless they pay out of pocket or meet the means test for and are covered by Medicaid, an increasingly difficult enterprise in itself but the subject of a different article. Ten percent of women in the United States who work full time are currently uninsured and without coverage, they do not have access to “free” birth control. Nor do other women without insurance, or those whose plans are, for logistical reasons or because they were grand-fathered, not yet compliant with the ACA on preventive care. None of these women have “free” birth control now, and they will not later even if they get insurance. (See the National Women’s Law Center Guide on what to do if you have questions about your insurance plan and contraception without co-pay.)

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Questions for Paul Ryan, Mitt Romney and Other Opponents of Health Care Reform: Where Are Your Facts?

12:09 pm in Uncategorized by RH Reality Check

Written by Amanda Marcotte for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Paul Ryan (United States Congress / Wikimedia Commons)

The Supreme Court ruling on the Affordable Care Act (ACA) on Thursday has caused a rush of panic from the opponents of universal health care. Lots and lots of claims about what the law does are being tossed around, and many of these claims are what you might call puzzling to those of us who actually know what’s in the ACA. Now, I don’t want to accuse anyone of intentionally lying without gathering more evidence, but without a deeper understanding of what various conservatives mean by their claims, it’s hard to suppress the sense that they may perhaps just be lying. So, I’ve made a list of questions I want opponents of health care reform to answer so I can better understand how their seemingly outrageous claims about the ACA make sense outside of the most obvious “lying” angle.

How does one “go on” Obamacare? Paul Ryan, denouncing the bill: “Millions of people who are otherwise going to go on Medicaid, are now going to go on Obamacare which costs a whole lot more money.” What is this “Obamacare” that people can go onto? I looked around to see if I could get an insurance plan through the “Obamacare” that Ryan and other conservatives are talking about Americans going on to and all I can find are the same old private insurance companies that existed before. The way Ryan & Co. talk about “Obamacare,” it sounds an awful lot like they think there’s a public option people can buy if they don’t want private insurance and aren’t eligible for Medicaid. But those of us who recall the big political fight over the ACA can tell you that there was originally a public option in the bill, but it was removed in order to get more votes from conservative Democrats. So what is this “Obamacare” conservatives keep insisting you can buy into and where do I find it?

How does the ACA remove your choice or get between you and your doctor? Various claims are being tossed around about health care reform “getting between you and your doctor” or taking away people’s choices in what medical treatments to pursue. In his remarks after the ACA ruling, Romney repeated this claim by saying the government is getting “more and more intrusive in your life” and “separating you and your doctor.”

So my question is: How? What medical decisions will the government now be making for you under the ACA? (Obviously, under conservative-supported legislation, the government has a lot of power to make decisions for women seeking abortion or contraception, but those laws aren’t part of ACA.) If you’re referring to the fact that insurance companies will retain the right to deny coverage for certain procedures they deem unnecessary, well, insurance companies already do that. If anything, the ACA has limited the ability of insurance companies to deny you the ability to pursue medical treatments you and your doctor choose, because the ACA has removed spending limits and banned insurance companies from denying you coverage based on pre-existing conditions.

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A Pyrrhic Victory? In ACA Ruling, Roberts Court Takes Big Swipe At Social Safety Net

11:12 am in Uncategorized by RH Reality Check

Written by Jessica Mason Pieklo for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Photobucket

When the legal challenges to the Affordable Care Act first started taking form, the assertion that Congress did not have the power to regulate the health insurance industry under either the Commerce Clause or the Necessary and Proper Clause was largely seen as an academic argument that had percolated in law schools thanks to a robust presence of the Federalist Society. After all, how could an industry that accounts for approximately 16 percent of economic activity in this country be said not to affect interstate commerce? Of course it can be regulated. Under the even the most cynical view opponents of the Affordable Care Act peddled these arguments simply as political cover for the Court to invalidate the law since the tension between the Obama administration and the conservative wing of the Roberts Court was nearly palpable.

The Court declined the political cover, a fact I think speaks loudly to the rumors that Chief Justice Roberts was concerned about the partisanship and rancor brewing within and around the Court, and the implications of this for his legacy. But the Chief Justice hardly “joined the liberal wing” of the Court in upholding the law. In fact, his decision gives conservatives a potentially significant tool to further attack the social safety net in its limitation of the Commerce Clause.

People, for reasons of their own, often fail to do things that would be good for them or good for society. Those failures—joined with the similar failures of others—can readily have a substantial effect on interstate commerce. Under the Government’s logic, that authorizes Congress to use its commerce power to compel citizens to act as the Government would have them act.

That is not the country the Framers of our Constitution envisioned.

For centuries the Court has held that these congressional powers are broad and expansive, and that the main risk an expansive view of federalism poses is a political risk, not any real risk to individual rights or liberties. Then, in 1995, in the Court’s decision in United States v. Lopez, Chief Justice Roberts’ predecessor re-discovered those limits.

The Lopez decision invalidated the law banning the possession of guns near schools on the grounds that the activity challenged — gun possession and presumably gun use — was too far attenuated from the stream of commerce for Congress to regulate. Gun rights activists heralded the decision as a triumph of the Second Amendment, but social conservatives saw much more in the ruling. They saw the dawning of a new Golden Age limiting federal power and future legal avenues to challenge laws and policies they deeply opposed — like the Affordable Care Act.

In rejecting Congress’s ability to regulate the health insurance industry under the Commerce Clause while still upholding the mandate under Congressional taxing authority, Chief Justice Roberts builds on the Lopez line of reasoning in a way that did no broad political damage to the Court — after all, the mandate survived and only those on the hard right seem intent on calling for Roberts’ impeachment — while still giving lots of juicy tidbits for federal judges to cite in future rulings hemming in other Congressional action. And since so much of Congressional action on domestic programs relies on its authority under the Commerce Clause and the Necessary and Proper Clause, it’s too soon to say if this distinction is again merely academic.

More importantly, Roberts extends the logic of Lopez which may prove to be more significant than we realize even now as the Court considers future challenges to Medicaid funding, efforts to defund Planned Parenthood and affirmative action challenges. As the logic goes, just because social ills have a broad economic impact does not mean Congress is empowered to fix them.

It’s a logic that whole-hardheartedly rejects the very premise of the New Deal and our social safety system and one that was just reinforced within the confines of a win on health care reform. Those of us that support the bill should celebrate the victory but we cannot get comfortable now. Chief Justice Roberts made it clear he upheld the law because he had to, both legally and politically. But in many ways the decision is a chilling repudiation of the heart and soul of its reform and a rallying cry for more vigorous challenges to the safety net. And we can expect conservatives to heed the call.