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Separating Truth From Lies Around the Kermit Gosnell Case

1:50 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.

See all our coverage of the Kermit Gosnell case here.

Kermit Gosnell mugshot

Kermit Gosnell goes to trial soon for his torture of vulnerable women.

Kermit Gosnell, the sadistic monster who exploited lack of access to safe abortion care among poor and immigrant women to both torture women and kill actual babies, is finally on trial and anti-choicers are having a feeding frenzy. Unable to muster actual compassion for Gosnell’s victims, anti-choicers got right to work seeking ways to exploit his crimes to further reduce access to safe, legal abortion — and to create more Gosnells in the future. In order to achieve the goal of driving more women to monsters like Gosnell and away from safe, legal clinics, anti-choicers are telling more lies than usual. (Which hardly seemed possible, but once you wind them up, they can really get going.)  I don’t usually feel comfortable speaking for pro-choicers as a whole, but in this case, I believe we’re all on the same page, so I thought I’d use this space to get the facts straight.

So here is a list of the facts about how pro-choicers are reacting to the Gosnell case. Anyone who denies these facts is lying, and you have to ask yourself why they feel the need to lie to make their case.

Pro-choicers condemn Kermit Gosnell and hope that he sees justice. When the story broke, there was a rush of feminist journalists who covered the case and the tone was universal condemnation and advice on how to prevent such crimes in the future. A quick search of RH Reality Check demonstrates that, and you can read other feminist takes around the internet. For people who aren’t trying to prop up lies to confuse the situation, this universal pro-choice condemnation of Gosnell was entirely predictable. Not only do we believe he is a murderer and likely a sadist, but we believe he exploited the desperation of low-income women who need abortions but struggle to afford quality care. We agree with the prosecutors who wrote that Gosnell “ran a criminal enterprise, motivated by greed.” As advocates of quality health care for women, we have tried, sadly in vain much of the time, to remind people who simple fixes, such as offering Medicaid coverage of abortion, could take the issue of cost off the table and make it easier for women not to resort to illegal operators who use unsanitary and sadistic methods, like Gosnell.

Pro-choicers are the ones trying to prevent future Gosnells. Gosnell made money exploiting desperate women, so the way to prevent future monsters like him is to make sure women aren’t desperate. Pro-choicers raise money for abortion funds, so more women can afford quality care. They set up volunteer-staffed help lines to get women through the process of seeing a reputable provider. They demand an end to the Hyde Amendment, so low-income women can use Medicaid to pay for quality providers. As pro-choice blogger PZ Myers wrote, Gosnell “could get by with criminally substandard treatment because our government has been actively destroying the ethical and competent competition.” We try to keep the ethical competition afloat to keep men like Gosnell from getting business. Which should not be conflated, as lying anti-choicers are doing, with trying to stop regulation.

Pro-choicers support holding abortion clinics — and all medical facilities of any type — to a high safety standard. Pro-choicers want women to receive safe, clean, ethical abortion care. We fully and completely support government regulations of all medical facilities aimed at making sure patients get this kind of care. We are so supportive of safe, clean abortion care that we have our own organization called the National Abortion Federation to certify quality clinics. (NAF unsurprisingly refused to certify Gosnell, even though he cleaned his clinic up and pretended to have medically trained staff in an effort to trick them.)  The key here is that we believe that abortion clinics should be subject to the regulations like other medical facilities, and that those regulations should be aimed at making sure women get quality care.

Regulations demanded by anti-choicers have nothing to do with securing quality care for women.

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Medicaid Coverage for Abortion Care Elusive Even in States Where It Is Legal

12:56 pm in Uncategorized by RH Reality Check

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

Evidence-Based Advocacy is a monthly column seeking to bridge the gap between the research and activist communities by profiling provocative new abortion research that activists may not otherwise be able to access.

Passed in 1976, the Hyde Amendment prohibits federal Medicaid funding for abortion procedures. Under Hyde, a person with Medicaid as their health insurance can only use their insurance to cover the cost of an abortion if the pregnancy is the result of rape or incest, or the pregnancy endangers that person’s life. While Hyde has placed these deplorable restrictions on abortion coverage for almost 40 years, some states have attempted to correct this injustice — 17 states use their own funds voluntarily to cover abortion. While advocates fight to repeal Hyde and restore federal funding for abortion through Medicaid, we assume that abortion access in the 17 “Hyde-free” states is much more equitable than in the 34 states that do not provide such coverage. But are people in states with voluntary Medicaid coverage of abortion actually able to use Medicaid to pay for an abortion? Do they have insurance coverage of abortion both in theory and in practice?

Two new research briefs from Ibis Reproductive Health document the reality of Medicaid coverage of abortion in Arizona and Maryland, two  of the 17 states that use their own funds to pay for abortions. Arizona is court-ordered to provide states funds to cover “medically necessary” abortions, while Maryland offers voluntary Medicaid coverage regardless of the pregnancy circumstance. In an ideal world, these requirements would mean that individuals in Maryland and Arizona would have no trouble using their state Medicaid to pay for an abortion. As you can probably guess, this is a far cry from what’s really happening in these states.

Ibis conducted in-depth interviews with abortion providers in Maryland to gauge their experiences seeking Medicaid coverage for their patients’ abortions. These providers explained that while their state Medicaid theoretically covers abortion regardless of the circumstances, in practice, it rarely covered abortion at all. Providers reported insurmountable challenges engaging with the Medicaid office. For example, Medicaid staff did not know when and if abortions qualify for coverage, the complicated billing process through Medicaid was confusing and time-consuming, and Medicaid did not reimburse for providing abortions that should have been covered. These barriers sometimes led providers to stop working with Medicaid altogether. This systemic level incompetence is unacceptable and obviously does not meet the needs of people seeking abortions and clinics providing that health care service. 

To gain a more robust understanding of the circumstances in Arizona, Ibis interviewed abortion providers about their experiences with Medicaid and also spoke with low-income women about their how they paid for their abortions. Similar to the Maryland findings, Arizona’s Medicaid coverage does not meet women or provider’s needs. Women shared that it’s extremely difficult to enroll in Medicaid, that Medicaid rarely covers abortion services even in “qualifying circumstances,” and that they often go without other reproductive health care, such as pap smears and pre-natal care, because Medicaid refused to cover these costs as well. Just like in Maryland, abortion providers reported that they face administrative challenges dealing with Medicaid, and that Medicaid often refuses to cover abortion care because a woman’s medical condition is, unbelievably, “not life threatening enough.”

Both abortion providers and women seeking abortion services were incredibly critical of the Medicaid system. One woman interviewed in Arizona summarized her experience this way:

“I had to put off a lot. I sacrificed so much just so I could come up with the money…Like, my light, I had to do payments ’cause they were about to shut it off…and it was embarrassing…I had to survive off food boxes too…I had to sacrifice real quick.”

We’ve come to expect and denounce these awful circumstances in states in which Medicaid doesn’t cover abortion, but these Ibis research reports reveal that having Medicaid coverage of abortion doesn’t necessarily guarantee access to timely safe abortion care ostensibly covered by a state. Medicaid coverage is in theory an invaluable resource, but in reality it is not accessible at all if the system does not work properly or actually cover the procedures it is supposed to cover. As the experiences of low-income women and abortion providers in both Arizona and Maryland suggest, mandating Medicaid coverage of abortion is a far cry from guaranteeing that people can access an abortion when they need one.

These findings also make clear that at the federal level, repealing the Hyde Amendment is a necessary but not sufficient condition for ensuring access to safe abortion care for people in need. In addition to advocating for the repeal of the Hyde Amendment, Ibis provides action steps to improve the experiences that women and providers have with Medicaid. They suggest streamlining the Medicaid enrollment and application process, educating patients, providers, and Medicaid staff about the law, increasing reimbursement rates for abortion providers and lowering the administrative burden of dealing with Medicaid offices, as well as involving pro-choice stakeholders and organizations in advocating for these changes. Many abortion funds, such as the Massachusetts and California Funds, are already doing this — it would be wonderful to see mainstream pro-choice organizations take this on as well.

Pushing for Medicaid reform is not sexy, especially when we’re talking about insurance enrollment and doing away with bureaucratic red tape. The pro-choice movement has a lot on its plate, but in order to guarantee abortion access for all, we have to put as much effort into making Medicaid a just and equitable system as we put into our efforts to repeal Hyde and guarantee private insurance coverage of abortion. Medicaid can be a critical resource in theory, but in order to meet the needs of low-income people, the system must function properly in reality. And we must address the reality, however complex and daunting, that repealing the Hyde Amendment doesn’t guarantee universal abortion care coverage for low-income people.

New Study Finds Less Access for Women and Higher Costs for Texas With Elimination of Planned Parenthood

12:53 pm in Uncategorized by RH Reality Check

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

Photo: Bad Lyric Police / Flickr

A new university study has found Texas wanting when it comes to reproductive health care in the state. Researchers at George Washington University have found that if Texas manages to exclude Planned Parenthood from participating in the Texas Women’s Health Program (WHP), “tens of thousands of low-income Texas women could lose access to affordable family planning services and to other women’s health services.”

GWU has had its eye on the state since May, when it released a report questioning claims by Texas’s Department of Health And Human Services that non-Planned Parenthood providers could easily see the 50,000 or so Texans who currently rely on Planned Parenthood for breast and cervical cancer screenings, contraceptive supplies, and other basic preventive care. Lawmakers in Texas want to exclude Planned Parenthood from the program because they consider it an abortion “affiliate,” even though no Planned Parenthood clinic enrolled in the WHP provides abortions and the WHP itself cannot ever be used to serve a pregnant person — it’s intended solely for the use of Texans who do not want to be, and who are not, pregnant.

The study released this week casts even more doubt on the state’s ability to find new providers to pick up the slack, focusing especially on poorer rural areas where alternatives to Planned Parenthood are few.

Where alternatives do exist, researchers concluded, “they are generally at, or close to, the limits of their capacity and will not be able to expand much, if at all, due to other resource or staffing constraints. There is no evidence that they are prepared to sustain the very large caseload increases that would be required to fill the gaps left after Planned Parenthood affiliates are excluded.”

In a statement released today by HHSC Executive Commissioner Kyle Janek in response to the study, the department says it intends to add new providers to the program on top of the 500 added since the spring. “We’re confident that we’ll be able to provide women with access to family planning services and fully comply with state law that bans abortion providers and affiliates from the program.”

In his statement, Janek said that HHSC has “five family planning clinics and more than 70 individual physicians waiting to take the place of every clinic that won’t qualify under the new rule.”

Indeed, if the WHP provider base is not increased in Texas, existing providers will be asked to take on huge numbers of former Planned Parenthood clients. From the GWU study, which looked at five Texas markets, including rural Lubbock, Hidalgo and Midland counties as well as urban Bexar County, which contains San Antonio, and Dallas County:

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Evidence-Based Advocacy: What Do Low-Income Women Think about Public Funding for Abortion?

10:18 am in Uncategorized by RH Reality Check

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

Evidence-Based Advocacy is a bi-monthly column seeking to bridge the gap between the research and activist communities. It will profile provocative new abortion research activists may not otherwise be able to access. 

September 30th marks the anniversary of the Hyde Amendment, which prevents Medicaid coverage of abortion in most circumstances. When activists and advocates talk about Hyde, we discuss the injustice of health care denial, the importance of grassroots abortion funds, and the stories of people who’ve sacrificed rent, food, and monthly bills in order to pay for an abortion their insurance won’t cover. And rightly so—there’s no denying that the more we talk about the horrific ramifications of the Hyde Amendment and the more awareness we raise, the better. We know what we think about Hyde. But what do women who are on Medicaid, the very people who are most affected by Hyde, think about the restrictions it places on their insurance coverage?

Amanda Dennis of Ibis Reproductive Health interviewed 71 low-income women who had  abortions while living in Arizona, Florida, New York, and Oregon, states that represent those operating under Hyde’s restrictions and those that have pro-actively provided Medicaid coverage for abortion. These women ranged from 18 to 35 years old, most reported having some college education, and a majority of them had surgical, first trimester abortions within the past two years. All of them met their state’s Medicaid income qualifications.

Most of the women supported government funding for abortion care; in fact, 82 percent said that they support Medicaid coverage of abortion. When asked about whether funding should be available in specific circumstances, however, they wavered. The interviewees didn’t think abortion should be covered if a woman could not afford another child. Similarly, they didn’t think Medicaid should cover abortion if a woman was not in a relationship with the person with whom she had sex. These views held constant even for women who were themselves in these same circumstances when they had their abortions. For example, a majority of the women cited financial instability as the most salient factor in their personal abortion decision, yet when specifically asked if Medicaid should cover abortion as a result of not being able to afford another child, 40 percent said no. Similarly, women often used disparaging language to talk about people who seek abortions for reasons they don’t approve of, again, even if they themselves had abortions in those circumstances.

This seems contradictory: why would women who have abortions for financial reasons disapprove of Medicaid coverage of abortion for the exact same reason? Dennis and her colleagues points to abortion stigma, explaining:

“Women said that they did not support coverage in these circumstances because they felt coverage would promote ‘irresponsible’ behavior…these circumstances conjured images of irresponsible, promiscuous, and callous women, which participants sought to distance themselves from in order to view their own abortion decision as consistent with their moral values.”

Dennis and colleagues propose that abortion stigma operates differently for low-income women, as they are battling both abortion stigma and welfare stereotypes. The researchers note that the overlap between stereotypes of women who have abortions and women on welfare are notable—they’re both thought of as irresponsible, lazy, and promiscuous, the exact qualities from which the women in this study were trying to distance themselves. Indeed, the shame associated with welfare reflects an American view that holds individuals accountable for their own poverty rather than recognizing the systemic determinants of poverty and health.

The point of this research is not to suggest that we should keep Hyde in place because low-income women themselves don’t believe that Medicaid should cover abortion in every circumstance. A person’s character, whether upstanding or “irresponsible,” should not determine whether or not they receive insurance coverage. This particular study uncovers just how pervasive abortion stigma is, so much so that even women who need Medicaid to cover abortion because they can’t afford another child don’t believe women like them deserve to have this coverage. 

The Hyde Amendment has made it acceptable to debate whether different pregnancy circumstances merit abortion coverage. As we see in this particular study, parsing out who does and doesn’t deserve abortion coverage based on the circumstances of a pregnancy only further embeds stereotypes about people who seek abortions, especially among those who need access to these services (in this case, low-income women). Research like this demonstrates that our work on the Hyde amendment can’t just be at the policy level. Repealing Hyde is not enough—it does not undo the damage of stereotypes associated with people who have abortions. We must advocate for policy change coupled with culture change, in which we both repeal Hyde and challenge the multiple stigmas and stereotypes associated with those who need Medicaid coverage of abortion.

If you are interested in having your research profiled, leave your contact information in the comments section. 

Is Rick Perry’s Rejection of the Affordable Care Act Political Posturing or a Portent of What’s to Come?

10:27 am in Uncategorized by RH Reality Check

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

Texas Governor Rick Perry

Texas Governor Rick Perry (Photo: Ed Schipul / Flickr)

On Monday, Texas Governor Rick Perry publicly rejected two major tenets of the Affordable Care act, saying the state would not participate in the individual state exchanges nor in the federal Medicaid expansion. In a letter to U.S. Health and Human Services Secretary Kathleen Sebelius released yesterday, Perry wrote that the “Orwellian-named PPACA” would “make Texas a mere appendage of the federal government when it comes to health care.”

Texas, which has the highest rate of uninsured people in the country – about one in four Texans currently have no insurance — could receive over a hundred million dollars from the federal government over the next few years, enabling the state to dramatically expand Medicaid overage to low-income adults who are not currently eligible. But, instead, Perry wrote that he believes the Medicaid expansion would “exacerbate the failure of the current system, and would threaten even Texas with financial ruin.”

Texas is already in serious financial trouble, and Perry’s dedication to rejecting any help, or dipping into state reserves, has put it in ever more dire straits. The state notably grappled with its multi-billion dollar budget shortfall during last year’s legislative session; Perry has repeatedly refused to tap into the state’s “Rainy Day Fund” to address the state’s health and education needs, opting instead to cut public services. Perry also turned down millions in federal Medicaid funding for the Women’s Health Program in order to exclude Planned Parenthood from participating in the program in Texas.

Perry’s claims in the Sebelius letter are woefully misinformed, according to one public health policy expert at Houston’s Rice University. Elena Marks, a Baker Institute Scholar in Health Policy at and former director of health and environmental policy for the City of Houston, says it’s a “shame” that Perry can’t see the good a state-run insurance exchange could do for Texas, because if Texas doesn’t set up its own exchange, the ACA ensures the federal government will do it for the state instead.

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Why the Affordable Care Act is Critical For Women Living With HIV

9:27 am in Uncategorized by RH Reality Check

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

In January 2012, Women Organized to Respond to Life-threatening Diseases (WORLD) and 16 other organizations led by Lambda Legal filed with the Supreme Court a friend-of-the-court brief in support of the Affordable Care Act (ACA). This week, the Supreme Court held a three-day hearing on the constitutionality of health care reform. As we hold our breath to see how the Court will decide the fate of the ACA, now is a good time to remind ourselves of the importance of health care reform for women living with HIV and affected by HIV.

We know that the HIV epidemic thrives on a lack of quality, acceptable, affordable and accessible health care. We also know that discrimination in health care based on race, ethnicity, gender and gender identity, pre-existing conditions, and economic status is rampant. No one law can solve all of these problems but the Affordable Care Act is a first and necessary step toward reforming our health care system to better meet the needs of all people.

The full implementation of health care reform is vital to women living with and affected by HIV for a number of reasons:

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Kansas in 2012? A Prediction of More Legal Battles, Higher Tax Bills, and Declining Access to Services

1:43 pm in Uncategorized by RH Reality Check

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

I work for Kansas NOW.  Our mission encompasses a broad expanse of issues linked to equality and justice.  In Kansas, equality of opportunity and social supports are currently being eliminated through a multitude of administrative and legislative maneuverings and measures via the leadership of Governor Brownback.  The vast array and sheer volume of the changes that are being attempted and implemented in this state could make it difficult to prioritize where time, energy and resources of a small nonprofit should be spent.

However, as my organization looks ahead to 2012, we don’t need a crystal ball to tell us where a great deal of our time, energy and resources will be spent.  My organization stands in support of women’s reproductive rights, which means much of our prioritizing will be done for us.  The 2012 Kansas Legislature will be introducing another slew of abortion restrictions.

These may include expansion of the already existing religious “conscience clause”.  Like the failed Personhood Ballot measure in Mississippi (which was voted down) an expansion to the Kansas Right of Conscience could reach far beyond the medical procedure of abortion.  Such legislation could affect access to many common medications and medical procedures.  The medications range from oral contraception and IUD’s to Viagra and procedures such as vasectomies, surrogate motherhood and in vitro fertilization.  It could also be interpreted to deny lifesaving abortions, which is currently part of Federal Medicaid requirements.  This opens up possibilities for further litigation at taxpayer expense.

We also expect the pursuit of “tax code legislation” aimed at nonprofit organizations that advocate for or even present abortion as an option.  We believe it will be similar to what has recently been blocked in an Arizona court.

As I mentioned, a piece of our organizational mission is advancing reproductive freedom.  These days, it’s not so much advancing, as it is defending.  Right now, we are defending something that barely exists within our state.  There are no abortion clinics in Wichita and just three in the Kansas City area.  Kansas is a state of 82,282 square miles.  Why is the Kansas legislature focused upon three small medical clinics within these 82,282 miles?  Why will legislative time, energy and resources be spent on this during difficult economic times?

Last session, six different reproductive health restrictions were introduced, including the de-funding of Planned Parenthood of Kansas and Mid-Missouri’s family planning services.  Five of the measures passed and three of the five are currently in the midst of litigation.  It is estimated that current court proceedings have cost Kansas taxpayers $476,000.  This should be considered just the tip of the monetary iceberg.   In these cases, witnesses have not yet been deposed, motions are being filed, the system is in motion and court cases take time.

In 2012, abortion legislation will continue to be sponsored by legislators. Committees will hear these bills and votes will be cast.  The large anti-choice majority will act as a rubber stamp for this entire process.  These unconstitutional bills will be presented to Governor Brownback and he will sign them.  In doing so, he will also be signing his name on the check to the lawyers that will be needed to defend these laws in court.

Our history with former Kansas Attorney General Phill Kline shows us the longevity in these abortion wars.  He is still costing Kansas taxpayers money a decade later.  As of April, taxpayers had spent $400,000 for his defense surrounding his alleged misconduct in his pursuit of abortion doctors in Kansas.  Not to mention the $350,000 settlement paid to settle a sex discrimination suit, but that’s another matter.

How much the citizens of Kansas are willing to shell out remains to be seen.  The extent of their support for ideological candidates has had its limits in the past.  While I remain ever-hopeful that sanity will eventually prevail within the state, I’m just not quite sure how much damage will be done before Kansans demand a change of course.  Until then, our elected oppressors will no doubt continue to spend state time, energy and resources toward the never-ending pursuit of being the first state in the union to eliminate abortion through the eradication of access.  Meanwhile, during the course of this process, they are ensuring that the taxpayers of Kansas will be saddled with a substantial ideological debt.

Do New Health Law Mandates Threaten Conscience Rights and Access to Care?

1:31 pm in Uncategorized by RH Reality Check

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

This testimony was submitted to the US House of Representatives Committee on Energy and Commerce’s Subcommittee on Health on November 2, 2011. It is written testimony for the hearing record on “Do New Health Law Mandates Threaten Conscience Rights and Access to Care?”

The article was amended at 12:38 p.m., Thursday, November 3rd to correct links in one paragraph.

Mr. Chairman, Ranking Member Pallone and Members of the Subcommittee, thank you for this opportunity to present testimony on behalf of Catholics for Choice on this important question of conscience rights and access to comprehensive healthcare.

For nearly 40 years, Catholics for Choice has served as a voice for Catholics who believe that the Catholic tradition supports a woman’s moral and legal right to follow her conscience on matters of sexuality and reproductive health. Throughout the world, we strive to be an expression of Catholicism as it is lived by ordinary people. We are part of the great majority of the faithful in the Catholic church who disagrees with the dictates of the Vatican on matters related to sex, marriage, family life and motherhood. We represent those who believe that Catholic teachings on conscience mean that every individual must follow his or her own conscience — and respect others’ right to do the same.

Certainly, at Catholics for Choice, we are no strangers to the intersection of religion, sex and politics. While religious voices and traditions are a vital part of public discourse, religious views should not be given disproportionate weight in public policy discussions. When this happens the lives of men and women can suffer greatly. We believe in a world where all voices, the voices of the religious and of the secular, of Catholics and non-Catholics alike, are heard in public policy discussions.

This hearing seeks to answer the question: Do new health law mandates threaten conscience rights and access to care? I firmly believe the requirements under the Affordable Care Act, and the slate of regulations being created to implement it, infringe on no one’s conscience, demand no one change her or his religious beliefs, discriminate against no man or woman, put no additional economic burden on the poor, interfere with no one’s medical decisions, compromise no one’s health — that is, if you consider the law without refusal clauses. When the question is asked in light of these unbalanced and ever-expanding clauses, the answer becomes yes, it would do all these things. When burdened by such refusal clauses, the new health law absolutely threatens the conscience rights of every patient seeking care for these restricted services and of every provider who wishes to provide comprehensive care to their patients. These restrictions go far beyond their intent of protecting conscience rights for all by eliminating access to essential healthcare for many, if not most patients, especially in the area of reproductive healthcare services. This will make it harder for many working Americans to get the healthcare they need at a cost they can afford.

The Affordable Care Act has many positive elements to it. Millions will now be able to access insurance coverage for their health needs and, with the basic level of coverage required under the new law, these newly insured and the millions of those better insured will now have greater access to a wider range of services than ever before. However, the law includes a refusal clause which has been expanded in the past decades to threaten the consciences of both those who seek to receive and those who want to provide services. Advocates of these expansive refusal clauses claim these are necessary to protect conscience rights. Others believe that refusal clauses such as these are simply part of attempts to derail the Affordable Care Act and to curb access to reproductive healthcare services entirely. Moreover, proposals to expand existing refusal clauses increase threats to the conscience rights of patients and providers by including not just abortion but also family planning services and, should some get their way, any other service deemed “unacceptable” by a tiny minority.

In recent years, under the guise of protecting religious freedom and “conscience rights” we have seen a dramatic upswing in attempts to expand the scope of refusal clauses, their application, and the entities able to utilize them. These new, ever-broader refusal clauses do far more than allow those healthcare professionals or social service providers with conscience objections to opt out. Instead, they are effectively being used as a means to refuse some treatments, medications, benefits and services to all comers.

These expansions have increased not only the services that may be refused—including reproductive health services as well as insurance coverage for those services and even training for medical professionals—but they have also the number of those who may claim these protections. Almost everyone, including most Catholics, agrees that it is reasonable to allow healthcare professionals, including doctors, nurses and pharmacists, to opt out of providing essential reproductive healthcare services and medications to which they conscientiously object. There is no doubt that there are times when the conscience of an individual doctor, nurse or pharmacist may conflict with the wishes orneeds of a patient. This often happens in cases related to abortion. Except in emergency situations, it is reasonable and indeed prudent to allow those who are opposed to abortion to opt out of providing the service. In these situations, women seeking these services should not have to worry about the religious and moral beliefs of their healthcare providers interfering with the provision of the best possible care. Therefore, it is in the best interests of all that only medical professionals committed to providing such services do so. Women need support and compassionate care when they access reproductive healthcare services, not judgment and disdain.

When this is not possible, a reasonable ethical fallback is for the institution to guarantee timely referrals to ensure that patients receive continuity of care without facing an undue burden, such as traveling long distances or encountering additional barriers to obtaining the desired services. Moreover, good practice should also compel a religious institution to make sure that the consciences of both the healthcare (or social services) provider and the patient (or client) are accommodated by having policies in place that enable individuals to receive whatever medications they are prescribed, procedures they require or services they seek.

Like many Catholics, I accept that conscience has a role to play in providing healthcare services, but recent moves to expand conscience protections beyond the simple right for individual healthcare providers to refuse to provide services to which they personally object go too far. Increasingly, demands and regulatory proposals attempt to grant that option to an institution or any individual along the spectrum of care, funding and coverage. It is incredible to suggest that a hospital or an insurance plan has a conscience. Granting institutions, or entities like these, legal protection for the rights of conscience that properly belongs to individuals is an affront to our ideals of conscience and religious freedom.

Allowing religious institutions to dictate the medical care available to their employees or religiouslyaffiliated organizations to dictate what services their beneficiaries are allowed to access would encroach on the individual consciences of those seeking care and assistance. Refusal clauses such as these fly in the face of true religious freedom by promoting the interests of certain elements of particular religions over the consciences and beliefs of individuals. They ignore the moral agency of the many who do not share the beliefs of a particular religious ideology. If allowed to stand, these refusal clauses do nothing but endanger many women’s access to the healthcare they need. When codified into law at the federal or state level, these “protections” actually constitute state-sponsored discrimination against women based on where they are employed, where and how they buy health insurance and where they seek to receive care.

Today, the 98 percent of sexually active Catholic women in the US who have used a form of contraception banned by the Vatican have exercised their religious freedom and followed their consciences in making the decision to use contraception. Thus, they are in line with the totality of Catholic teachings, if not with the views of the hierarchy. The problem is very clearly with the Catholic hierarchy and not the Catholic church, which includes the vast majority of the 68 million Catholics in the United States who use and support the availability of comprehensive reproductive healthcare services for all those who choose to utilize them.

Having failed to convince Catholics in the pews, the United States Conference of Catholic Bishops (USCCB) and other conservative Catholic organizations are now attempting to impose their personal beliefs on all people by seeking special protection for their “conscience rights.“ They claim to represent all Catholics when, in truth, theirs is the minority view. The bishops have identified several sympathetic high-profile allies in healthcare, education and social service provision to assist them in promoting their demands, but these allies are heavily reliant on the bishops for funding and prestige. Hospitals and colleges can lose their Catholic designation at the bishop’s whim, as happened recently in Phoenix, Arizona.

At a Catholic hospital in Phoenix, medical professionals acted to save the life of a pregnant woman by performing a life-saving abortion on a mother of four. The local bishop decided that his authority over the hospital allowed him to second-guess the medical decisions they made and he stripped the hospital of its Catholic designation. This is antithetical to the Catholic social justice tradition, which would not leave a woman’s life out of any healthcare equation.

What occurred in Phoenix helps to illustrate the problem with the bishops’ intrusion into medical decisions. The personal and professional freedom to make healthcare decisions is being threatened by expansive refusal clauses. The exemptions that the USCCB and other conservative Catholic organizations are demanding do not offer any more protection for religious freedom, but rather impede the religious freedom of millions of Americans, taking reproductive healthcare options away from everybody.

The USCCB and some Catholic organizations, many that receive taxpayer money, are asking to be allowed to:

  • deny condoms as part of HIV outreach;
  • ban employees and their dependents from getting the benefit of no-cost contraceptive coverage that other insured Americans enjoy;
  • opt out of providing emergency contraception to victims of sexual violence who come to Catholic hospitals for help; and
  • deny abortion care to everybody — even those women whose lives are threatened by their pregnancy.

They claim that they are representing all Catholics, but this is not true. The majority of Catholics support equal access to contraceptive services and oppose policies that impede upon that access. 

Two-thirds of Catholics (65 percent) believe that clinics and hospitals that take taxpayer money should not be allowed to refuse to provide procedures or medications based on religious beliefs. A similar number, 63 percent, also believes that health insurance, whether private or government-run, should cover contraception. A strong majority (78 percent) of Catholic women prefer that their hospital offer emergency contraception for rape victims, while more than half (55 percent) want their hospital to provide it in broader circumstances. This support for the full range of contraceptive services is unsurprising, as restrictions such as refusal clauses or prohibitive costs affect Catholics just as often as non-Catholics — 98 percent of sexually active Catholic women have used a modern method of birth control,mirroring the rate of the population at large (99 percent).

Advocating for expansive refusal clauses in healthcare delivery regulations would affect all patients — whether those patients are Catholic or not. Seeking exemptions for religious organizations to cover essential health benefits, such as full coverage of recommended preventive services including contraception, under the Affordable Care Act will only serve to endanger many women’s access to the healthcare they need — whether those employees share those religious beliefs or not. In reality, these exemptions would deny the right of everyone seeking comprehensive healthcare.

When religious voices are allowed to direct policymaking, the best interests of those seeking healthcare services can be ignored. This is clear in the case of the Catholic healthcare industry which, despite providing much valuable service, persists in refusing to provide a full range of reproductive healthcare services, even to those who are in desperate need of them.

Respect for individual conscience is at the core of Catholic teaching. Catholicism also requires deference to the conscience of others in making one’s own decisions. Our faith compels us to listen to our own consciences in matters of moral decision-making and to respect the rights of others to do the same. Our intellectual tradition emphasizes that conscience can be guided, but not forced, in any direction. This deference for the primacy of conscience extends to all men and women and to their personal decisions about moral issues.

Our faith also compels us to respect religious pluralism and religious freedom. Religious freedom is an expansive rather than restrictive idea. It has two sides: freedom of religion and freedom from religion. It is not about telling people what they can and cannot believe or practice, but rather about respecting an individual’s right to follow his or her own conscience in religious beliefs and practices, as well as in moral decision making. The protections we put in place to preserve religious freedom do not permit religious institutions or individuals to obstruct or coerce the exercise of another’s conscience.

Sweeping refusal clauses and exemptions allow a few to dictate what services many others may access. They disrespect the individual capacities of women to act upon their individual conscience-based decision. They impede the rights of women and men to make their own decisions about what is best for their own health, and that of their families, as well as restricting their right to act upon those decisions without undue and unjust burdens.

One woman who saw these burdens placed on her conscience rights is “Sandra,” a science teacher at a Catholic school in the Midwest. Her story is an example of the many Americans who fall under these types of expansive refusal clauses being pushed by the bishops and their allied organizations. What is a reality for Sandra today is what many women can look forward to in their future.

As with almost all Catholic schools, Sandra’s employers follow diocesan rules regarding employees’ insurance — meaning no contraceptive coverage, regardless of medical necessity. When she first learned of the refusal clause proposed in the recent regulation to implement the preventive health services under the Affordable Care Act, she was outraged. As she explained to us, they added “insult to injury” by ignoring the healthcare needs of women like her and allowing her employers to continue to deny her coverage.

“I just never assumed that in 2011 I would be denied birth control,” she said. “I’m in my mid-twenties. I have no intention of having kids at the moment. I like teaching kids, but it’s a whole other thing having them.”

Sandra lost coverage when she began working under the jurisdiction of her local diocese. “I went to fill my birth control prescription like I always do. I say ‘Here’s my new insurance card,’ and they say I’m not covered,” she related. “They thought that it was weird and asked where I worked. As soon as I said I worked in a Catholic school, they said, ‘Oh, 99 percent of Catholic schools will not cover it. We’ve never had it covered before.’ I had no clue.”

For Sandra, this posed a significant hardship. She had taken a salary reduction in order “to go to work every day saying that it’s what I love.” She and her husband had carefully considered their insurance plans and determined that it was more economical for them to remain on separate policies, but once she had to pay out of pocket for the birth control that was best for her, a non-generic prescription, their careful financial planning was all for naught.

“Birth control is a lot of extra money on top of the salary reduction, but the principle of it is really what gets me,” she told us. “I don’t like being told by some guy that I’ve never met that I can’t use it. The bishops are not even having sex in the first place. How are they supposed to know how to tell me what to do in that situation?”

Her story, as she recognized, is all too common and reflects the repeated marginalization of many women by the Catholic hierarchy—the same women whose voices have been deemed unimportant by those on both sides of the recent debates. Sandra is just one of the many individuals whose conscience is not being protected by refusal clauses exempting entire institutions from covering their employees for services guaranteed to everyone else by the new law.

Catholic teachings on conscience require due deference to the conscience of others in making decisions — that the employer should not be allowed to dismiss the conscience of the employee seeking coverage for the healthcare services guaranteed to any other. In light of this precept, the public policy efforts of the hierarchy should take into account the experiences of individual Catholics as well as the beliefs of patients and clients, workers in social services and healthcare providers of other faiths and no faith, so that patients will not be refused any legal and medically appropriate treatment or be denied services they seek.

You have heard from some conservative Catholics on this issue, but it would be a grave mistake to confuse the individual positions of a few powerful interest groups with the majority view of the more than 68 million Catholics in the United States. For Catholic employers to claim to be the arbiter of any person’s good conscience is clearly disingenuous. When medical professionals refuse to provide legal reproductive health services, or provide timely referrals to other providers, they violate the right to conscience of the person seeking those services. This does not fall under anybody’s definition of a good conscience. Catholics for Choice and the majority of Catholics respect everybody’s individual conscience and their ability to act in accordance with their personal beliefs. However, we expect the hierarchy and their allied organizations, in keeping with the teachings of our shared Catholic faith and our American tradition, to respect our consciences and the consciences of the patients and clients who seek the services they need. We hope that those who serve to represent all of us in public service and in government will respect our consciences, too.

Protecting the freedom of conscience for all Americans no matter what their beliefs may be — for the atheist, for the employee of a Catholic institution, for the sexual assault victim who seeks care at a Catholic hospital — is indeed the job of the government. Expanding individual refusal clauses to include institutions and exemptions for religious institutions to deny the rights of all would sacrifice these people’s rights. Public policy should be implemented to further the common good and to enable people to exercise their conscience-based healthcare decisions.

Lawmakers of all political hues can come together to support a balanced approach to individual conscience rights and access to comprehensive healthcare. It makes sense for all those who want to provide more options to women seeking to decide when and whether to have a child. It makes sense for those who want to keep the government’s involvement in healthcare to a minimum. And it makes sense for those who think that it is the government’s role to facilitate the healthcare decisions that people want to make. Above all, it makes sense for a society that believes in freedom of religion — a right one can’t claim for oneself without extending it to one’s neighbor. The bottom line is that protecting conscience rights and preserving access to care shouldn’t just be about protecting those who seek to dictate what care is and is not available to all. Nor should it be for those who would dismiss the conscience of others by imposing their view of which consciences are worth protecting.

Protecting individual conscience and ensuring access to affordable, quality care is not just an ideal, it is a basic tenet of our society and it is the right thing to do. I thank the Subcommittee for inviting me today and for your attention. I look forward to any questions Members may have.

As Two Deadlines Near, Concern Rises About HHS Adoption of IOM Recommendations on Preventive Care for Women

7:18 am in Uncategorized by RH Reality Check

"Deadline"

"Deadline" by betchaboy on flickr

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

See all of our coverage of the IOM report and HHS guidelines here.

Will women’s health insurance be held hostage to the debt ceiling fiasco?

On July 19th, an expert panel convened by the Institutes of Medicine (IOM) released a set of evidence-based recommendations on the range of basic preventive care services for women that should be covered by insurance plans without a co-pay under health reform.  The recommendations were requested by the Department of Health and Human Services (HHS) to guide its final decision-making on these issues, and to put the imprimatur of peer-reviewed public health and medical science as well as evidence from clinical practice behind the final guidelines.

Services recommended by IOM for coverage without a co-pay include an annual well-woman visit as well as contraception, sterilization, gestational diabetes screenings, cervical cancer screenings, HIV/STI annual testing, domestic violence counseling, and breastfeeding support.  The Administration could have included these same services–including those on family planning services and contraceptive supplies–as part of its initial guidelines based on existing evidence. But the IOM process was seen by some as necessary not because these findings were not already self-evident to clinicians and public health experts, but because it is widely known that fanatical anti-choice groups and legislators would object to and fight against anything that improves the reproductive and sexual health of women or enables them to exercise their right to self-determination. Read the rest of this entry →

Defund It All, Let God Sort It Out

7:21 am in Uncategorized by RH Reality Check

Written by Robin Marty for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

As the tale is told, during the crusades, a monk was asked how soldiers could separate the Catholics from their enemy.  The monk infamously replied, “Kill them all. For the Lord knows them that are His,” the anecdotal origins of the phrase “Kill them all, let God sort it out.”

We’re in the midst of a new crusade, just as religious, and growing to be just as dangerous – the crusade against sexuality, fertility and human rights.  Sex, our newly empowered conservative leaders seem to believe, is something that should only happen for procreation, should never involve people who aren’t either married or willing to be married should they get pregnant, and should definitely never occur for the sake of pleasure and intimacy.

To push their agenda, they’ve replaced their swords with the newest and sharpest weapons they own – their tax dollars.  Their new rallying cry is to defund: Defund Planned Parenthood!  Defund Sex Ed! Defund Websites! Defund Prenatal Care! Defund WIC! Anything that in any way is associated with the sex or procreation with which they disagree should be defunded, disbanned and eliminated.

Even when these projects actually support their goals.

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