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Court Orders FDA to Make Emergency Contraception Available Over-the-Counter for All Ages

11:42 am in Uncategorized by RH Reality Check

Written by 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.

In a long-awaited decision released early this morning, U.S. District Court Judge Edward Korman ordered the U.S. Food and Drug Administration (FDA) to make emergency contraception available over-the-counter to women of all ages, marking a major win for public health and women’s rights in a year that has seen science otherwise buried under an avalanche of anti-choice politics. In his decision, Judge Korman orders the FDA to make levonorgestrel-based emergency contraception available over-the-counter without an age or point-of-sale restriction.

Today’s order was issued in response to the Center for Reproductive Rights’ (CRR) renewed lawsuit against the agency seeking to expand over-the-counter access to all brands of the morning-after pill, including Plan B One-Step and Next Choice, to women of all ages.

The court has ordered the FDA to make emergency contraception available without a prescription and without point-of-sale or age restrictions within 30 days, with the option to limit the change to only Plan B One-Step if the agency “actually believes there is any significant difference between the one- and two-pill products” and to require new labeling if necessary.

Women’s rights groups are celebrating the decision.

“Today science has finally prevailed over politics,” said Nancy Northup, president and CEO of CRR, which brought this and other lawsuits. “This landmark court decision has struck a huge blow to the deep-seated discrimination that has for too long denied women access to a full range of safe and effective birth control methods. “Women all over the country will no longer face arbitrary delays and barriers just to get emergency contraception. It’s a true victory for all women, especially young women, women without government-issued identification, and those who live in areas with limited pharmacy hours,” she added.

Susannah Baruch, interim president and CEO of the Reproductive Health Technologies Project, which has been a leading advocate for emergency contraception, concurred: “Today we celebrate a long overdue victory for all women. Our decade long struggle is finally over. Emergency contraception will now sit on store shelves allowing timely access to this important product used to prevent unintended pregnancy. We urge Secretary Sebelius and the FDA to move swiftly to put emergency contraception on store shelves and into the hands of women and couples who need it.”

In a statement, the National Latina Institute for Reproductive Health applauded the ruling:

For Latinas in particular, expanded access to emergency contraception is critical for making the best decisions for our families and ourselves. For too long, this important backup birth control method has been kept behind the counter and out of reach. Immigrant women and new Americans of all ages have been hit particularly hard, since they are less likely to have government identification. This decision removes one barrier for Latinas who need contraception — though others, like poverty, discrimination, language and immigration status, remain.

This victory came after a long and unnecessarily difficult battle that was marred by politics, irrespective of the political party in charge. (See timeline following article.)

The FDA first approved emergency contraception (EC) for prescription use in 1999. Subsequently, study after study showed the safety of EC for women of all ages seeking to prevent an unplanned pregnancy after unprotected sex or contraceptive failure. In 2003, the first application was made to the FDA to approve EC for over-the-counter (OTC) sales. And thus began a long game of politics that has spanned both the Bush and Obama administrations. First, the Bush administration refused to act to make EC available OTC, resulting in the first successful lawsuit by advocates to ensure that science, rather than politics, governed women’s access to this method of basic preventive reproductive health care. EC was first made available OTC for women ages 18 and older, though the science clearly affirmed its safety for younger women.

After years of advocacy and further scientific proof of efficacy and safety, it seemed that finally EC would be made available over the counter for all women. However, in a deeply controversial move in December 2011, Kathleen Sebelius, secretary of the Department of Health and Human Services (HHS), overruled the decision by FDA Commissioner Margaret Hamburg to approve over-the-counter sales of Plan B One-Step. President Obama publicly supported Sebelius’ decision, in what was widely seen as a political move. Public health, medical, and legal groups went into overdrive, conducting a wide-ranging public education campaign, launching a citizen’s petition, releasing statements in support of EC OTC, and filing the lawsuit that led to today’s decision, in which Judge Korman called Sebelius’s actions “politically motivated, scientifically unjustified, and contrary to agency precedent.” Said Judge Korman, “The decisions of the Secretary with respect to Plan B One-Step and that of the FDA with respect to the Citizen Petition, which it had no choice but to deny, were arbitrary, capricious, and unreasonable.”

“It’s shameful it has taken over a decade and a federal court order for the U.S. government to implement in policy what studies and experience have proven time and time again — emergency contraception is safe and effective and should be available for women of all ages,” said Janet Crepps, senior counsel for CRR.

Currently, EC is available to women ages 17 and older without a prescription; young women under 17 are required to obtain a prescription from a physician. Even for women 17 and older, however, the medication is available only at health clinics or pharmacies, upon request and with adequate identification.

This unique and unnecessary dual scheme, notes CRR, has impeded access even for women who are allowed to obtain the drug without a prescription, as evidenced by several studies, including one published in the journal Pediatrics earlier this year. A total of 943 pharmacies in five major cities were contacted twice by researchers at Boston University — once the researchers posed as a 17-year-olds and another time as physicians. The study found that there misinformation was common regarding who can take EC and at what age it is available without a prescription, creating barriers to timely access. According to the research, nearly 20 percent of the drugstores contacted denied the “17-year-olds” access to the pill.

With the court’s ruling today, drug companies can now apply to make EC available to women of all ages and at stores other than just pharmacies — eliminating human error in determining who can and cannot purchase the medication.


CRR Emergency Contraception Case Timeline

July 28, 1999: The U.S. Food and Drug Administration (FDA) approves Plan B, an emergency contraceptive medication, for prescription use.

February 14, 2001: The Center for Reproductive Rights files a Citizen Petition with the FDA on behalf of over 70 medical and public health organizations to make Plan B available without a prescription or over-the-counter (OTC).

April 21, 2003: Women’s Capital Corporation, the manufacturer of Plan B, files an application with the FDA to make Plan B available OTC.

Late December 2003/January 2004: After a panel of FDA experts recommends approval of the Plan B application, Dr. Steven Galson, the head of the office responsible for making the final decision, informs his staff that the regular procedures won’t be followed this time, and that that office won’t make the final decision. (Jenkins deposition)

December 2003 to Jan 17, 2004: Galson confesses to a co-worker that he has to reject the Plan B application because he’s afraid he’ll lose his job. (Jenkins deposition) Dr. Janet Woodcock, the second in command at the FDA, tells a colleague that the agency first has to reject the application, then approve the drug later with an age restriction in order to “appease the administration’s constituents.” (Houn deposition)

May 6, 2004: The FDA denies the manufacturer application and suggests Barr, the drug’s new manufacturer, amend the application to request an OTC switch only for women 16 and older. (Barr revises the application; the FDA schedules a decision for January.)

January 21, 2005: After the FDA fails to meet its deadline, the Center files a lawsuit against the agency for ignoring science and holding Plan B to a different standard than other drugs.

August 26, 2005: The FDA misses its second deadline to rule on Barr’s application. In a peculiar move, the agency requests the public provide input over an indefinite period of time on how to dispense the drug.

February 24, 2006: The Center is cleared to depose high-level FDA officials. The New York magistrate judge cites strong showing of “bad faith and improper behavior” by the FDA.

June 9, 2006: FDA denies Citizen Petition for the first time.

August 24, 2006: The FDA agrees to make Plan B available without a prescription, but only to women 18 and older who can provide government issued identification. The FDA also requires that Plan B be sold behind pharmacy counters.

March 30, 2007: Center files for summary judgment in the case, arguing that the undisputed facts found in evidence gathered through discovery make it unnecessary for the court to hold a trial, and that the court should order the FDA to make Plan B available without a prescription to women of all ages.

March 23, 2009: Court orders the FDA to approve Plan B for those 17 and older without a prescription and to reconsider the Citizen Petition and all age and other restrictions on OTC access.

July 10, 2009: The FDA approves Plan B OTC for those 17 and older. The FDA also approves Plan B One-Step, which is a product that consists of the same drug as Plan B but in one pill rather than two. Both Plan B and Plan B One Step are OTC for those 17 and older and prescription-only for those 16 and younger.

August 28, 2009: The FDA approves Next Choice, a generic version of Plan B, under the same regime: OTC for those 17 and older and prescription-only for those 16 and younger.

November 16, 2010: The Center files a motion for contempt of court against the FDA for failing to reconsider the Citizen Petition and the current restrictions on OTC access to Plan B.

December 1, 2010: After receiving FDA approval for prescription-only use, Watson Pharmaceuticals launches ella, another form of emergency contraception (ulipristal acetate).

February 7, 2011: Teva Pharmaceuticals, the manufacturer of Plan B One-Step, files a supplemental new drug application (sNDA) with the FDA so that the drug will be available OTC for women of all ages.

Dec. 7, 2011: HHS Secretary Sebelius takes an unprecedented step to block FDA Commissioner Hamburg’s approval of Plan B One-Step manufacturer’s application for OTC status, which included additional data that confirmed its safety for all-ages use. The next day, President Obama publicly supports Sebelius’s decision, “as a father of two daughters.”

Dec. 12, 2011: On the eve of a court hearing on the Center’s motion for contempt, the FDA denies the Citizen Petition for a second time based on a lack of teen-specific data for the two-dose medication, despite the volume of data before the FDA on two-pill emergency contraception products, which data for one pill products of emergency contraception confirmed.

Dec. 13, 2011: Judge denies contempt motion because FDA had ruled on the Citizen Petition the night before, but invites CRR to reopen the case. Judge notes striking similarities between recent actions and 2005-2009.

Feb. 8, 2012: CRR reopens its case, filing a motion for preliminary injunction and summary judgment for immediate relief that would allow OTC access for all levonorgestrel-based emergency contraceptives (both one and two pill versions) without any age or point of sale restrictions. CRR also adds Sebelius as a defendant and supplements the complaint.

February 16, 2012: Judge Korman issues Order to Show Cause to Defendants “why the FDA should not be directed to make Plan B available to those persons whom the studies submitted to the FDA demonstrate are capable of understanding when the use of Plan B is appropriate and the instructions for its due.”

March 9, 2012: Teva Women’s Health, Inc., the manufacturer of Plan B One-Step, files a motion to intervene in the case.

April 27, 2012: Hearing held on Court Order to Show Cause and Motion of Teva Women’s Health to Intervene.

April 5, 2013: Judge Korman orders FDA to make levonorgestrel-based emergency contraception available over the counter without age or point of sale restriction.

The Budget Stalemate and the Major Media Fail on Riders

8:06 am in Uncategorized by RH Reality Check

Written by Jodi Jacobson for – News, commentary and community for reproductive health and justice.

As the uncertainty of the very real-life drama about the budget stalemate and threatened shutdown of the federal government drags on, there is one thing you can count on.

Every single major media outlet has gotten the story about riders wrong.

Here is a fact: The GOP and Tea Party want to defund Planned Parenthood. It’s one of the primary targets and sticking points remaining in the ongoing budget talks.

Another fact: Despite GOP talking points, this is not about abortion. The GOP/Tea Party proposal would bar Planned Parenthood from being reimbursed by any federal health program like Medicaid for providing primary and preventive health services including birth control, breast and cervical cancer screenings, and STI testing and treatment, including HIV testing.

This is not a hard concept and, again, it is verifiable fact.

But you might not know this because virtually every single major media outlet continues like synchronized broken records that this is about abortion and funding for abortion.

Read more

Why a Soccer Momma for Obama Hung Up Her Cleats

6:53 am in Uncategorized by RH Reality Check

Written by Jodi Jacobson for – News, commentary and community for reproductive health and justice.

I was a soccer mama for Obama.

And depending on the day and the kids in my car, I was a hockey mama or a baseball mama.

But sometime this year, I hung up my cleats.  And I think losing me is a big problem for the Democrats.

It’s not because I won’t vote on Tuesday.  I will.  And it’s not because I am going to vote for some Republican or Tea Party candidate.  That will never happen. 

It’s not because I am a big-money donor, though I have consistently given thousands of dollars to Democrats, and believe me, this is saying a lot at my level of income as a single, full-time work-for-a-living mom of two kids solidly planted in the middle class.  But in 2008 (as in years before), I gave generously to the DCCC, DSCC, Obama for America and the state and national Democratic party. I answered every email from David Axelrod, David Plouffe, Michele and Barack Obama, Tim Kaine and Chris Van Hollen with my credit card and a contribution ranging variously from $25.00 to $1000.00 (no it’s not a typo….I mean $1000.00) at a clip, giving up virtually all discretionary spending that year so that I could put my money where my politics were.  It was that important to me.

And it’s not because I am a political power-hitter. I am not and have never cared to be, though some would consider me a member of the “professional left.”  I never worked on the campaign to get a job in the Administration; I never thought I’d one day receive an invitation to an Obama wedding. I worked to do what I felt I had to do for my kids and for this county.

But the Democrats have lost me in a more profound way, and I think they should be worried about it because I can safely say that I was one of thousands of people across the country who changed the way other people voted in the last election.

I was a loyal and dedicated team player, and someone who, as a lifelong and passionate progressive feminist, can’t live with herself if she is not doing everything she can.  I know for a fact that I brought many independents and moderate Republicans to the polls for Obama.  And I am not doing that now. Read more

“Third Way” Goes the Wrong Way on Abortion Restrictions in Health Reform

9:20 am in Uncategorized by RH Reality Check

Written by Jodi Jacobson for – News, commentary and community for reproductive health and justice.

At this point it’s not news to anyone that our ostensibly pro-choice President has presided, through a combination of silence and pre-emptive capitulation, over some of the greatest setbacks to women’s reproductive rights in more than a generation, culminating with the recent ban on coverage of abortion care for women entering high-risk insurance pools because they have high-risk health conditions that may be complicated or exacerbated by pregnancy.

In a mid-July article on the abortion coverage ban published by RH Reality Check, Jessica Arons, Director of the Women’s Health and Rights Program at the Center for American Progress wrote:

a commotion arose over the question of whether Pre-existing Condition Insurance Plans, also known as high risk pools, can include abortion coverage.  The Obama Administration responded immediately by imposing a total ban on abortion coverage in the pools that echoes the Stupak Amendment, even though nothing in the law requires such action.

Repeat: "…nothing in the [health care reform] law requires such action."

How we got here under President Obama is the focus of another and forthcoming analysis.

For now, it’s worth examining the claims being made about the abortion coverage ban by the self-proclaimed "progressive" group that appeared at the front of the line last week to apologize for this newest setback.

Enter Third Way.

Third Way is one of those groups that has pushed hard for so-called common ground on abortion issues. You know, the "common ground" on which the most fundamental rights of individual women to decide whether, when, and with whom to bear children–and to act in accordance with their own consciences, morals, and religious traditions in the best interests of their own and their family’s health and well-being–would be subject to a modern-day sacrifice to salve the qualms of religious fundamentalists and political opportunists for whom huge gaps in access to contraception, comprehensive sexual and reproductive health education, child care, economic support for poor women, aid to communities beset by environmental toxins, school lunch programs, Head Start and all else that is "life-affirming" never seem to rise to quite the red-level-threat of urgency as does the reality of women having control over their own bodies.

The abortion coverage ban was bad, and the Administration knew it. And if you are going to break a huge promise to a huge constituency that worked incredibly hard to get you elected for no reason other than you can’t stand up to the bullies, than it’s always convenient to have a group or two that will help with CYA on even the most onerous or heinous policies. So when the regulations were put out there, and health and human rights groups cried foul, Third Way, purportedly at the request of some "progressive policymakers," stepped right in with an analysis intended it seems to pat all us womenz on the head and assure us that these regulations are really in sync with the "spirit and the letter" of the health care reform law. Don’t worry your pretty little head, darlin’.

Except they are wrong on both the spirit and the letter of the law as well as the spirit of the President’s repeated, repeated promises that no one would lose current coverage under health reform, and his later "promise" (after breaking the first one) that the so-called status quo in federal funding for abortion care would be preserved.

Third Way makes the following claims to support the coverage ban:

1) Federal funds cannot be used for non-Hyde abortions

2) High-risk pools are not like Medicaid

3) High-risk pools more closely parallel the Federal Employees Health Benefits Program (FEHBP)

4) The ban does nothing to change the rules for private insurance.

Let’s take these claims one by one:

Claim 1: Federal funds cannot be used for non-Hyde abortions

Third Way argues that because the Hyde Amendment forbids federal funding for abortions, and because the high-risk pools are federally funded, it is "fundamentally consistent…to apply to the pools the same limitations that accompany federal funds in other areas of the health care law" even though, as they clearly state, "there is no specific legislative provision limiting coverage of abortion in the pools."

There are a number of things that make this analysis particularly shallow.

First, as Arons points out:

There is not one, over-arching law that restricts abortion funding for all sources of federal funds.  Rather, abortion opponents have had to fight to obtain funding restrictions for each separate source. Moreover, those restrictions are not permanent; they must be re-approved each year through the annual appropriations process and their contours have changed over time.

What, in effect, the Administration has begun to do in its expansive interpretation of existing law is to create a larger umbrella banning abortion coverage than exists in written law, thereby further (and further) eroding already-existing access to abortion care. This is neither the spirit of the health care law as the Administration publicly and consistently described it nor as the majority of Democrats in Congress intended it. In fact, as Arons further points out, the compromise that finally resulted in passage of the Patient Protection and Affordable Care Act (PPACA) was to preserve the "status quo" of Hyde, not expand it.

[T]he whole point of the compromise was to preserve the status quo, which included both restricted and unrestricted spheres of abortion funding.  Moreover, the terms of the agreement were carefully negotiated.  Abortion opponents who participated in the bargaining did not raise concerns about high risk pools or other specific potential sources of federal funding, and they should be able to live with the deal they made.

Second, the compromise was based on the fact that while federal funds would be prohibited from being used to pay for abortion, the law would maintain the availability of abortion coverage in health insurance plans by preserving the rights of women to use private funds to pay for that coverage. The high-risk pools are not "completely federally funded" (as Third Way asserts) because they in fact require participating individuals to use their own private funds to pay for their premiums. While the federal government is providing funding to offset the extremely high costs of providing insurance to those with pre-existing conditions, it is incorrect to say that this insurance will be paid for entirely with federal funds. That is yet another aspect of the "status quo" obliterated and an affront to the rights of all women to purchase and pay for the health care insurance they need.

Finally, the restriction on high-risk pools is not, as Third Way states, the same limitation placed on health care plans in the exchange. Subsidized individuals enrolled in a plan a state exchange will be able to purchase health insurance that includes abortion coverage as long as the health insurance company segregates the federal from private dollars to ensure that federal funds are not used for abortion. Participants in the high-risk pool, on the other hand, will be completely prohibited from purchasing health coverage that includes abortion coverage.

Claim 2: The high-risk pools are not like Medicaid

Third Way argues that the Administration "will apply the same rules to federal contributions in the high-risk pools as currently apply to federal contributions to Medicaid."

This is a misleading analogy. First, the Hyde Amendment does not apply to the high-risk pools because the funding does not go through the Labor-HHS Appropriations Act to which Hyde applies, but is appropriated directly from the Affordable Care Act. 

Even in making an analogy to the Hyde Amendment and the Medicaid program however, this analysis falls short. Third Way distinguishes the availability of abortion coverage in the Medicaid program versus the high-risk pools based on the ability of states to use their own funds to pay for abortion services under the Medicaid program.  While it is true that the newly created high-risk pools will not include state funding, the Hyde Amendment explicitly allows the use of both state and private funds for abortion coverage. If the high-risk pools did fall under the Hyde restriction like the Medicaid program, states could allow the coverage of abortion in their high-risk pools by using private funds to pay for the coverage.

Claim 3: The high-risk pools more closely parallel the Federal Employee Health Benefits Program (FEHBP)

Third Way next likens the high-risk pools to the FEHBP.

But these pools do not closely parallel the FEHB program. The FEHB is employer-based health insurance that provides health insurance benefits exclusively for federal employees, while the high-risk pools will provide coverage for individuals who cannot find insurance elsewhere due to a serious pre-existing condition, and as the Administration stated in the proposed rule, is a “temporary Federal insurance program in which the risk is borne by the Federal government up to a fixed appropriation.”  The fact that both FEHB and the high risk pools will be administered by the Office of Personnel Management (OPM), another assertion made by Third Way, also does not mean that the programs are similar.  In fact, OPM will also administer the multi-state plans established under the Affordable Care Act, which are not only separate and distinct from FEHBP, but will be allowed to cover abortion.

Again, Third Way persistently states that the high-risk pools are run with federal money by federal rules. The high-risk pools however, will actually include a substantial amount of private funds due to premium contributions from participating individuals. According to the federal government’s own health care reform website, the premium for an individual in New York state’s high-risk insurance pool will range to $400 to $600 per month. And while the federal government will administer some of the plans, 28 states will administer their own plans. 

Claim 4: This action does nothing to change the rules for private insurance plans.  

Third Way argues that the rules issued by the Administration do nothing to change the law for private insurance companies.

It is technically true that the Administration’s new restrictions don’t change those on health care plans in the exchanges under the Affordable Care Act.

However, Third Way incorrectly distinguishes the Stupak Amendment from the restriction on high-risk pools. In fact, like the Stupak Amendment, the restrictions prohibit those enrolled in the program from purchasing coverage that includes abortion with their own private money, which is the exact principle that was rejected when the Stupak Amendment failed to be included in the law. 

Third Way states that the restriction on the high-risk pools does not prohibit consumers from purchasing private insurance plans that include abortion coverage as long as they use their own money. However, the individuals who will qualify for coverage under the high-risk pools are by definition unable to purchase health insurance elsewhere on the private market.  Since there is no other way for these individuals to purchase health coverage, they are in fact prohibited from purchasing health insurance coverage that includes abortion with their own private money.

Third Way concludes that the Administration has applied “existing federal law and precedent.”

As Jessica Arons pointed out in her original piece, there is no existing federal law that requires this restriction for the newly-created high-risk pools. And the Congressional Research Service confirmed in a July 23rd 2010 memo to the Senate Committee on Health, Education, Labor and Pensions that the Hyde Amendment does not apply to the high-risk pools and that there is no other federal law or regulation, including the Affordable Care Act and the subsequent Executive Order, that requires this result.  

What Third Way’s analysis further neglects is the reality of abortion politics today, in which far right politicians, bereft of any ideas whatsoever to address profound economic, environmental and social challenges instead spend entire legislative sessions thinking up ways to make it increasingly difficult for women to prevent unintended pregnancies in the first place, or secure terminations of a pregnancy even when their lives are at imminent risk.

On all of these counts, Third Way’s analysis is a completely indefensible effort to excuse  a completely indefensible policy.

Let’s just call it what it is: This is a new restriction on coverage of abortion care for those who are most in need of comprehensive coverage, imposed by an Administration capitulating–yet again–to pressure from anti-choice groups. Last I remember, those groups did not vote for the President, contribute money to his campaign or campaign for him. Quite the contrary.

Still, Third Way for some reason sought to excuse it.  But the shallow nature of the analysis suggests that either Third Way didn’t read the laws involved, or doesn’t quite understand them, or both. Or perhaps the group is so enamored of its own limited analyses of the abortion debate that it completely misses or disregards what really motivates debates around sex and reproduction in this country–race, class, control of women, and craven power grabs by fundamentalist religious figures and politically opportunistic politicians.

The President broke a fundamental and profound promise by reaching outside an already-restricted law to further undermine women’s fundamental rights. There is no "third way" or other way to slice it.

Stupak and Health Reform’s Second Trimester

6:27 am in Uncategorized by RH Reality Check

Written by Rebecca Sive for – News, commentary and community for reproductive health and justice.

In the (political) heat of late March, in the first trimester of President Obama’s proposed, and then signed, Executive Order “codifying” The Hyde Amendment (a deal done for Rep. Bart Stupak, he of the Stupak Amendment), in order to get the President’s healthcare reform legislation, “The Patient Protection and Affordable Care Act”) passed, I called on the Speaker of the House, the women U.S. Senators, and the leaders of the national pro-choice organizations to call for aborting the Executive Order. 

They didn’t, and a few days later, surrounded, (only, and with no press present), by Bart Stupak and his equally rabid, anti-choice ring members, the President signed Mr. Stupak’s evil Order.

Why was I so direct, so inflammatory in my call-to-action? Well, exactly because I wanted to sound a very loud alarm, for fear of what might be coming down the pike, if we failed to “bust the cap” on this disingenuous (keep reading) Executive Order. I feared that unless we busted it, we’d be faced with just the sort of (hatred-of-women) next steps we’ve–surprise, surprise– experienced this week.

You ask: What happened? I thought this was a great week, what with financial reform and capping the BP oil well and all? Well, not so fast, it turns out.

Turns out, earlier this week, in this, the (equally hot, politically), but second trimester of the President’s Hyde-redux-and-more, Stupak-evil, though the President said otherwise, (keep reading) Executive Order, it became clear that the White House had instructed Kathleen Sibelius, Secretary of Health and Human Services, to avoid any dustups about abortion in her regs’-writing for the healthcare reform bill, no matter the cost to America in the loss of American women’s lives.

How to do this?

Well, for starters, deny women, any woman in any state, even a woman proposing to spend her own money (lest there be any doubt about how The White House really feels about abortion), from obtaining an abortion, if she’s (we thought lucky, but how wrong we were), a member of her state’s high-risk insurance pool, part of the President’s Patient Protection and Affordable Care Act).

No matter, the lives of women in ill health (and, therefore, in the high-risk pool), for whom an abortion might be a vitally needed medical procedure. The President’s poll numbers are in the dumpster. Unless you’ve been raped, are a victim of incest, or your life has been endangered, you’re SOL.

Mr. President: A word to the wise:  Better not further jeopardize your standing, when we’re not sure whether the BP cap won’t go bust. Mr. President:  A word to the wise, even if it becomes clear you’ve gone back on your staff’s statements that your Stupak-evil Order doesn’t do anything more than “codify” existing law. Better to continue to say, albeit falsely, that the Stupak Amendment you once said you wouldn’t abide (either) wouldn’t be a part of anything you do. This abortion matter? Well, it’s just too touchy to do otherwise (even if “otherwise” is the right thing for half of all Americans).

In fact, and as we all know, the Executive Order was nothing but a most willingly made sop to Rep. Stupak. For, after all (after months and months and months of all—all that healthcare wrangling), it was Mr. Stupak’s vote that stood in the way of passage of the healthcare reform law, the one for the history books the President most wanted.

As such, the Executive Order’s creation and signing was a deeply hypocritical and cynical act.  “Hypocritical,” because it did not do (only) what the President’s men said it would do—“codify” existing law, i.e., The Hyde Amendment. “Cynical,” because the Order’s utility depended on the willingness of White House women-leader allies to suspend disbelief, and say: Oh, yes, we agree, when you say that this isn’t going beyond The Hyde Amendment (knowing that it did).

Do you think for one minute that Bob Bauer, the President’s campaign and personal, political lawyer, now his White House Counsel, didn’t know all the potential ramifications (read: opportunities) of the Executive Order—both for the law and for the politics—when he directed his staff to draft the Executive Order?

Do you think for one minute that Don Verrilli, an Associate White House Counsel, rumored to be appointed U.S. Solicitor General–once Elena Kagan is confirmed as a Supreme Court Justice–missed this either? 

Not, hardly: These guys are really, really smart. These guys don’t miss these things: That’s why they are doing what they are doing. That’s why they are where they are.

Putting the best face on it, Mr. Bauer and Mr. Verrilli saw what the White House women-leader allies also saw, and, again, like the pro-choice leaders, didn’t protest, for fear the whole healthcare reform applecart would be upset.

But, make no mistake:  Mr. Bauer and Mr. Verrilli also saw the Executive Order as a useful context for massaging federal healthcare reform regulations that could help diminish dustups over abortion; dustups never good for a President or a President’s men’s futures.

Why was the Executive Order AT ALL NECESSARY if all it did was “codify” existing law? The answer is it wasn’t, because it didn’t. And now we’re in the dumpster: Read here:

So now, in the Executive Order’s second trimester, we have the leaders of our pro-choice movement asking the government to “reconsider” (Marcia Greenberger for the National Women’s Law Center); expressing their “deep disappointment,” and calling on us to protest (Cecile Richards for Planned Parenthood); and remonstrating that these regulations are neither necessary as a legal matter (for they go beyond The Hyde Amendment), nor useful as a policy matter (because the women most likely to be in the state-based high risk pools are among those most likely to have complications from pregnancy and therefore needing an abortion (Laura Murphy for the ACLU)).

Like I said:  The Executive Order should have been aborted.

I’ve argued in these pages for many months that the ameliorative approach national pro-choice leaders have pursued with this Presidential administration –pursued both by the leaders representing the big organizations, and by those making the laws in Congress–is fatally flawed. I think we now have proof. [It’s a short distance from the dumpster to the graveyard.]

Further, I believe this acquiescence, and its requisite suspension of disbelief, has led to the abandonment of American women in most need, i.e., to the presence of anti-choice wolves at their doorsteps, in every state.

The strategy is accomodationist. It’s post-facto. It violates the first rule of organizing to win (on the people’s behalf):  Know your bottom line, and how to get it, before you walk into any meeting. Otherwise, don’t walk in:  Scream, holler, embarrass, and demand, until you’re on equal footing and can negotiate a fair deal.

Sure, I’ll negotiate with you ad nauseum, instead of refusing to participate until my demand for equal treatment is met (Barbara Boxer in the Senate). Sure, I’ll send threatening letters with no force of law or policy (Diana DeGette in the House), in hopes that you’ll do the right thing. Sure, I’ll support you when you tell me it’s a good idea to (only) “codify” in an Executive Order something, (The Hyde Amendment), which, by any measure, has been horrible for women for over two generations (The Speaker and her pro-choice Member leaders). Sure, I’ll believe you when you say that this Executive Order won’t have any additional force of law in any upcoming circumstance that matters to women’s health (again, the Speaker and the women Members).  Sure, I’ll believe you, Mr. President–when you sign Mr. Stupak’s evil Order–with no press present and surrounded by the architects of hateful acts against my sisters–when you tell me nothing is amiss.

In no way that I can see is this a strategy for winning the war to protect America’s women and ensure their equal rights. This is appeasement. And history tells us that, until appeasement is set aside, people die. Today, in America, those dead people will be American women.

“Bust the cap (on it);” bust the cap on this well of cowardice.

Earlier this week, I drove across upstate New York on my way home to Chicago. Mid-afternoon, I approached the Thruway exit for Seneca Falls. I thought:  Why not stop?  Why not pay my respects to our foremothers, to women who wouldn’t know acquiescence or appeasement if it hit them over the head.  So, I did. And here’s what I got to read when I got there:

‘We hold these truths to be self-evident: that all men and women are created equal; that they are endowed by their Creator with certain inalienable rights; that among these are life, liberty, and the pursuit of happiness; that to secure these rights governments are instituted, deriving their just powers from the consent of the governed

“….[W]hen a long train of abuses and usurpations, pursuing invariably the same object, evinces a design to reduce them [American women] under absolute despotism, it is their duty to throw off such government…Such has been the patient sufferance of the women under this government, and such is now the necessity, which constrains them to demand the equal station to which they are entitled.”

Obama Administration Applies Stupak Amendment to High Risk Pools

6:42 am in Uncategorized by RH Reality Check

Written by Jessica Arons for – News, commentary and community for reproductive health and justice.

This week, a commotion arose over the question of whether Pre-existing Condition Insurance Plans, also known as high risk pools, can include abortion coverage.  The Obama Administration responded immediately by imposing a total ban on abortion coverage in the pools that echoes the Stupak Amendment, even though nothing in the law requires such action.

PCIPs are temporary health insurance pools that states or the federal government must establish or expand in every state to cover people who do not currently qualify for individual health insurance because of a preexisting condition.  PCIP coverage will expire in 2014 when enrollees become eligible for the new health insurance exchanges that will become operational that year.  PCIPs will be funded with a combination of federal, state, and private money.

Women entering these plans are, by definition, those who have experienced serious medical conditions—so serious that insurers are unwilling to sell them insurance.  In other words, those who get pregnant are already at a heightened risk for needing an abortion for health reasons when compared to the general population.

Pennsylvania–apparently unintentionally–walked into the abortion debate by approving a program that potentially covered abortion.  The plan said no “elective” abortions would be covered, but referenced a statute that does not define the term “elective” and allows an abortion if it is deemed “necessary” by a physician based on “all factors (physical, emotional, psychological, familial and the woman’s age) relevant to the well-being of the woman.”  The only situation deemed categorically unnecessary by the statute is sex selection.

Rep. John Beohner and the National Right to Life Committee raised a stink, and the very next day, HHS Spokeswoman Jenny Backus had this to say:

As is the case with FEHB plans currently, and with the Affordable Care Act and the President’s related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIP) except in the cases of rape or incest, or where the life of the woman would be endangered.

Our policy is the same for both state and federally run PCIP programs. We will reiterate this policy in guidance to those running the Pre-Existing Condition Insurance Plan at both the state and federal levels. The contracts to operate the Pre-existing Condition Insurance Plan include a requirement to follow all federal laws and guidance.

But here’s the catch, nothing in federal law actually restricts the use of federal or state money for abortion in PCIPs.

The language that was inserted by Sen. Ben Nelson into the Patient Protection and Affordable Care Act that prohibits federal money from being spent on abortion in circumstances beyond the Hyde Amendment exceptions of life, rape, and incest clearly applies only to plans operating in insurance exchanges.

Sec. 1303 of the PPACA says a state may elect to prohibit or allow “abortion coverage in qualified health plans offered through an Exchange” and that, subject to whether a state has made such an election, “the issuer of a qualified health plan shall determine whether or not the plan provides coverage of [abortion] services.”  If a qualified plan decides to offer coverage of abortion beyond the Hyde exceptions, it must collect separate premiums from each enrollee to pay for abortion coverage and all other coverage, and it may not pay for abortions with federal tax credits or cost-sharing reductions that were allocated under the PPACA for the purpose of subsidizing premiums for plans offered in the exchanges.  There are no other restrictions on abortion funding contained in the PPACA.

In an eleventh-hour political compromise to obtain health reform votes from antiabortion Democrats, President Obama agreed to sign an executive order that reiterated the funding restrictions in health insurance exchanges and also, in direct response to last-minute concerns raised by abortion opponents, applied funding restrictions to community health centers.

The Act maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly created health insurance exchanges… I hereby direct the Director of the OMB and the Secretary of HHS to develop, within 180 days of the date of this order, a model set of segregation guidelines for State health insurance commissioners to use when determining whether exchange plans are complying with the Act’s segregation requirements, established in section 1303 of the Act, for enrollees receiving Federal financial assistance….

The Act establishes a new Community Health Center (CHC) Fund within HHS, which provides additional Federal funds for the community health center program. Existing law prohibits these centers from using Federal funds to provide abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), as a result of both the Hyde Amendment and longstanding regulations containing the Hyde language…. I hereby direct the Secretary of HHS to ensure that program administrators and recipients of Federal funds are aware of and comply with the limitations on abortion services imposed on CHCs by existing law.

A common method of legal interpretation posits that when items in a legal document are specifically listed, they exclude any items that are not mentioned unless there is a catch-all statement that says unenumerated items are not excluded.  Case in point: the Ninth Amendment says of the Bill of Rights, “The enumeration in the Constitution of certain rights shall not be construed to deny or disparage others retained by the people.”  That means the Constitution can be interpreted to contain rights that are not explicitly designated.

The Executive Order, on the other hand, contains no such statement indicating that it might cover more than the addressed items, namely the exchanges and the CHCs.  In fact, when the Executive Order was signed, it was widely seen as simply reiterating what was already in the PPACA and current law.  Indeed, abortion opponents repeatedly lambasted it as a “worthless piece of paper.”  And a colloquy between reporters and Obama spokesperson Robert Gibbs after the Order was signed confirmed that it did not otherwise expand the scope of current funding restrictions:

MR. GIBBS: Well, I would say the President believed that the law — the President has always believed that health care reform should be about that, not about other issues. The President did not, in health care reform, believe we did change the status quo and believes that this reiterates that it’s not changed….

Q I read the executive order, and it says that’s a reiteration of what already exists.

MR. GIBBS: Well, there you go.

Q So it’s not necessary?

Q Not legally necessary?

MR. GIBBS: We reiterated –

Q Might have been necessary for other reasons, but it’s not legally necessary.

MR. GIBBS: No, we reiterated the status quo, and we’re comfortable reiterating that status quo.

Q — comfortable for a legal purpose?

MR. GIBBS: We’re comfortable reiterating that status quo.

Q Doesn’t it diminish the whole purpose of a presidential — of an executive order if all he’s doing is reiterating what’s already in the law? Why would he do that?

MR. GIBBS: No. No. We don’t see that as diminishing.

While the status quo, at the time of the PPACA’s passage, restricted abortion funding in numerous areas, it did not restrict it in all areas.  There is not one, over-arching law that restricts abortion funding for all sources of federal funds.  Rather, abortion opponents have had to fight to obtain funding restrictions for each separate source. Moreover, those restrictions are not permanent; they must be re-approved each year through the annual appropriations process and their contours have changed over time.  In fact, should the scope of the Hyde Amendment’s restrictions on Medicaid funding change in the future, it will trigger similar changes in the health insurance exchanges and elsewhere.

It is understandable that the Administration might now feel the need to honor the “spirit” of the compromise that resulted in the Executive Order.  But the whole point of the compromise was to preserve the status quo, which included both restricted and unrestricted spheres of abortion funding.  Moreover, the terms of the agreement were carefully negotiated.  Abortion opponents who participated in the bargaining did not raise concerns about high risk pools or other specific potential sources of federal funding, and they should be able to live with the deal they made.

The worst of it is that the Administration could have at the very least set up something akin to the Hyde Amendment and the PPACA by giving states the option of using state or private money to cover abortion care costs.  Instead, the Administration cited the Federal Employees Health Benefits Plan specifically as the controlling precedent for the PCIPs.  Again, the Backus statement:

As is the case with FEHB plans currently, and with the Affordable Care Act and the President’s related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIP) except in the cases of rape or incest, or where the life of the woman would be endangered.

Our policy is the same for both state and federally-run PCIP programs. We will reiterate this policy in guidance to those running the Pre-existing Condition Insurance Plan at both the state and federal levels. The contracts to operate the Pre-existing Condition Insurance Plan include a requirement to follow all federal laws and guidance.

The FEHBP, like the Stupak Amendment, imposes a total ban on non-Hyde abortion care, meaning that non-federal money cannot be used to supplement premiums in order to purchase a plan that includes abortion coverage.  Thus, without even any political or legislative benefit to receive in exchange, the Obama Administration has imposed a more restrictive abortion funding rule on PCIPs than is required for health insurance exchanges or Medicaid.

One would expect a Bush-style administration to “assume” that Hyde applies to the high risk pools or to interpret the Executive Order broadly to cover more than the exchanges and CHCs.  But it is extremely disappointing to see an ostensibly pro-choice administration go out of its way to appease those who have always opposed health reform and who will continue to make political targets of those who voted for reform regardless of what the Administration does on abortion.  It is never ok to trade women’s rights for political reasons, but in this case the calculus seems to be particularly bankrupt.

Kagan Urged Clinton to Ban Late Abortions

6:42 am in Uncategorized by RH Reality Check

Written by Jodi Jacobson, editor of – News, commentary and community for reproductive health and justice.

In 1997, while serving as a White House adviser to President Bill Clinton, current Solicitor General and Supreme Court nominee Elena Kagan urged the president to support a ban on late-term abortions for what appear to be purely political reasons, according to a report by the Associated Press.  The AP article notes this was "a political compromise that put the administration at odds with abortion rights groups."

Documents reviewed Monday by The Associated Press show Kagan encouraging Clinton to support a bill that would have banned all abortions of viable fetuses except when the physical health of the mother was at risk. The documents from Clinton’s presidential library are among the first to surface in which Kagan weighs in on the thorny issue of abortion.

The position favored by Kagan was a "compromise" of abortion rights crafted by Democratic Sen. Tom Daschle in response to efforts by Republicans to pass the so-called partial birth abortion ban. "Clinton supported it," reports AP, "but the proposal failed and Clinton vetoed a stricter Republican ban."

In a May 13, 1997, memo from the White House domestic policy office, Kagan and her boss, Bruce Reed, told Clinton that abortion rights groups opposed Daschle’s compromise. But they urged the president to support it, saying he otherwise risked seeing a Republican-led Congress override his veto on the stricter bill.

Clinton generally supported banning late-term abortions but insisted there be an exception when the mother’s health was at risk.

The memo, reports AP,  is more of a political calculation than a legal brief, but "Kagan and Reed urged Clinton to support the compromise despite noting that the Justice Department believed the proposal was unconstitutional."

”We recommend that you endorse the Daschle amendment in order to sustain your credibility on HR 1122 and prevent Congress from overriding your veto,” they wrote.

The memo noted that another White House adviser, Rahm Emmanuel, also supported the idea. Emmanuel is now Obama’s chief of staff.

Memos reviewed by AP were contained in Reed’s files. "They do not include Kagan’s papers from her time as domestic policy adviser and associate White House counsel. Those records, a several-thousand page collection that could provide the most revealing look at Kagan’s legal work, are expected to be released this summer."

This appears to be the first insight into Kagan’s own thinking around political expediency and women’s rights. "Partial-birth" abortion is a term created by the anti-choice community and is not a medical term. Moreover, late abortions–those in the third trimester–invariably occur because of fetal anomalies incompatible with life, the death of a fetus in utero, or because of threats to the life and health of the mother.  Banning these procedures takes out of the hands of women and men decisions they feel they need to make for themselves and their families often based on wrenching, life-threatening conditions. It is no surprise to hear now that any of these three advisors to President Clinton supported this "compromise" because it has become almost axiomatic that self-described pro-choice politicians these days rarely stand up on principle for the ultimate right of women to make the decisions they need to make for themselves and their families.

That the role of a Supreme Court judge is different than that of a political advisor to the President and that such positions might vary according to the specific role is a given.  However with so little to go on regarding Kagan’s record, it is difficult to feel comforted by that realization.


Where is the National Strategy on AIDS?

6:35 am in Uncategorized by RH Reality Check

During the intense health care reform debate President Obama occasionally mentioned HIV infections and AIDS-related illnesses as among those pre-existing conditions that could no longer be used by health insurance companies to automatically exclude consumers from health insurance coverage. Yet the broader scope and crisis of the HIV and AIDS epidemic in America failed to garner much attention.

Some HIV and AIDS activists and healthcare providers, meanwhile, are experiencing that crisis as if it were the early 1980s when the Reagan administration expressed little concern about the early AIDS epidemic even as the death toll mounted.

Since 2007, activists have clamored for a national strategy on AIDS. And now they are pleading for emergency help as the economic downturn forces drastic cuts in the budgets of non-profit AIDS organizations while new HIV infection rates rise and more people need services.

Where is the sense of urgency in the Obama White House to manage the confusion and handle the crisis, they ask?

In 2006, candidate Obama seemed to understand the need for urgency calling for “an all-hands-on-deck effort.” The first priority of the candidate’s HIV and AIDS platform was to develop a national HIV/AIDS strategyin the first year of his presidency,” a strategy “designed to reduce HIV infections, increase access to care, and reduce HIV-related health disparities” with “measurable goals, timelines, and accountability mechanisms.”

President Obama outlined the scope of the crisis on the front page of the National Office of AIDS Policy (ONAP) website: “When one of our fellow citizens becomes infected with HIV every nine-and-a half minutes, (emphasis added) the epidemic affects all Americans.”

NOAP recently stressed the impact of HIV on women:

The statistics are sobering: Every 35 minutes, a woman tests positive for HIV in the United States. While women in the U.S. represented 8 percent of AIDS diagnoses in the 1980’s, they now account for 27 percent. The HIV epidemic in the U.S. disproportionately impacts women of color: HIV/AIDS is one of the leading causes of death among black women and Latinas.

The demographic disparities of AIDS cases (as of 2007) are dramatic: Whites, who make up 66 percent of the population, account for 30 percent of AIDS cases; Blacks/African Americans, 12 percent of the population, account for 49 percent of AIDS cases; Hispanic/Latino, 15 percent of the population, account for 19 percent of AIDS cases. Asians, American Indians/Alaska Native and Native Hawaiian/Other Pacific account for less than one percent of the AIDS cases.

The CDC statistics for men who have sex with men (MSM) are alarming. Though only an estimated 4 percent of the U.S. male population (ages 13 and older), MSMs account for nearly half (48 percent) of the more than one million people living with HIV and more than half (53 percent) of all new HIV infections each year. The CDC reports that new infections have declined among heterosexuals and injection drug users, but the “annual number of new HIV infections among MSM has been steadily increasing since the early 1990s,” which the CDC attributes to complacency resulting from the availability of antiretroviral treatment and reduced use of condoms. (See CDC Surveillance breakdown here).

But the headline-grabbing news came in August 2008 when the CDC discovered they had been underreporting the annual rate of new HIV infections. They estimated that there were approximately 56,300 new HIV infections in 2006, about 40 percent higher than the 40,000 new infections per year the CDC previously reported.

Dr. Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, made it clear that the new estimate did not represent an actual increase in the number of new HIV infections, but resulted from more sophisticated monitoring systems.

Richard Wolitski, then-acting director of the CDC’s division of HIV/AIDS prevention, said the new estimates "reveal that the U.S. epidemic is — and has been — worse than previously estimated and serve as a wake-up call for all Americans.”

But the wake up call has been largely ignored, according to a survey released by the Kaiser Family Foundation in April 2009. That study found that “Americans’ sense of urgency about HIV/AIDS as a national health problem has fallen dramatically,” as had concern for personal risk of HIV infection.

There are consequences for complacency. Newsweek reported on February 26 — citing a recent report in the New England Journal of Medicine — conditions in Washington, D.C. remain near-overwhelming:

More than 1 in 30 adults in Washington, D.C., are HIV-infected—a prevalence higher than that reported in Ethiopia, Nigeria, or Rwanda. Certain U.S. subpopulations are particularly hard hit. In New York City, 1 in 40 blacks, 1 in 10 men who have sex with men, and 1 in 8 injection-drug users are HIV-infected, as are 1 in 16 black men in Washington, D.C. In several U.S. urban areas, the HIV prevalence among men who have sex with men is as high as 30 percent—as compared with a general-population prevalence of 7.8 percent in Kenya and 16.9 percent in South Africa.

Additionally, “more than 20 percent of the estimated 1 million HIV-positive Americans are unaware of their status.” Newsweek concluded: “It’s time to admit that HIV is still a major threat to Americans.”

Last April, NOAP launched a new five year AIDS Awareness campaign and on April 1 the CDC announced an expansion of their HIV testing initiative by $31.5 million, for another three years to approximately $142.5 million over all. The CDC said they tested over 1.4 million Americans since the initiative began in 2007, with more than 10,000 people newly diagnosed with HIV and “the vast majority” linked to care.

There are other signs the Obama administration is trying to respond to the crisis. This February, the White House released its proposed budget for fiscal year 2011 with increases for domestic HIV and AIDS programs. The total U.S. government-wide spending on HIV and AIDS wouldincrease from $26 billion to $27 billion and the total discretionary funding for the Department of Health and Human Services spending on HIV and AIDS wouldincrease from $6.9 billion to $7.1 billion in 2011. The funding calls for an expansion and focus on treatment, care and prevention “consistent with the President’s pledge to develop a National HIV/AIDS Strategy.” In addition to funding for HIV testing, the budget proposes funding for collaborative efforts to help people with HIV with co-infections of tuberculosis, hepatitis, and sexually transmitted diseases.

The budget proposal also calls for:

  • $40 million increase in funding for the Ryan White HIV/AIDS Program for care and treatment programs to a total of $2.3 billion, of which $679 million is for Ryan White Part A medical and support services in eligible metropolitan areas and transitional grant areas and $855 million is for the AIDS Drug Assistance Program – an increase of $20 million;
  • an increase of $37.9 million for prevention at the CDC;
  • a $98.7 million increase for the National Institutes of Health for research for a total of $3.2 billion in 2011.

Obama also proposes a $5 million increase to  $340 million for the Housing and Urban Development (HUD) Housing Opportunities for Persons with AIDS (HOPWA) program and a request (emphasis added) for $19 billion for the Housing Choice Voucher program to help more than two million extremely low- to low- income families with rental assistance. Obama’s budget also includes $117 million for the Substance Abuse and Mental Health Services Administration Budget.

There has also been some movement on the development of a national strategy on AIDS. The White House convened three consultations plus an inter-agency meeting which is posted online — and ONAP held 14 community meetings with the intention of presenting the national strategy on AIDS by June.

On Friday, (April 9), ONAP released a summary of those meetings and online suggestions in a report, Community Ideas for Improving the Response to the Domestic HIV Epidemic, which cites “a core set of common themes…including: improving access to care, reducing stigma surrounding HIV, and coordinating HIV prevention and treatment.”  ONAP Director Jeffrey S. Crowley said he hopes the report “will serve as a resource as we strive to develop a new strategic approach to tackling the HIV/AIDS epidemic in the United States and take steps to better coordinate the federal government’s response.”  

But Obama’s budget has yet to be approved by Congress and many AIDS activists are frustrated that there is still no overall coordinated AIDS strategy. Crowley promised a plan by the end of 2009 but instead issued a “Call to Action” that appeared to go largely unheeded.

The Coalition for a National AIDS Strategy issued its own call and came up with its own set of recommendations for a strategy. Jeffrey King, executive director of In The Meantime Men, an HIV-focused wellness group for African American MSMs, said the community meeting in Los Angeles occurred on the same Sunday as AIDS Project Los Angele’s popular AIDS Walk. King said only about 100 people attended, many of whom were from an HIV housing facility begging for help not to be closed. It closed anyway.

King said he is trying to keep his small agency afloat during the economic downturn. But finding funding is difficult and the director of the California Office of AIDS plays politics with funding grants, he said. The L.A. County Office of AIDS Programs and Policy has been very helpful, however.

Pedro García, director of Youth Services & Proyecto Orgullo at BIENESTAR, a grass-roots Latino-oriented non-profit that helps underserved communities of color disproportionately impacted by HIV/AIDS (including straight and LGBTs immigrants and a large transgender cliental) said his organization is also facing financial difficulties.

“The cuts in funding that took place last year impacted BIENESTAR heavily. We lost complete funding for the Youth Program from the [LA County] Office of AIDS Programs and Policy. We also were heavily impacted in cuts for Care Services programs such as Case Management, Peer Support, Treatment Education and Housing, to name a few. And in addition, BIENESTAR currently has NO funding for Latina Women at Sexual Risk – however, services for this population have not been interrupted. This is the type of commitment that BIENESTAR has toward the Latino Community.”

“What this decreased funding for programs and services translates to is more cases of HIV infection occurring in the Latino population and making the work that BIENESTAR does, that much harder to achieve,” said Oscar De La O, Executive Director of BIENESTAR.

Ronald Johnson, the African American HIV-positive deputy director of AIDS Action Council, countered the prevailing perception.

“Actually there is a sense of real urgency within the White House both by the President and the National Office of AIDS Policy,” Johnson said. “I realize its taking longer than some of us thought to see a draft [of the Strategy] but it’s our understanding that the draft is underway and I think any delay – and certainly the focus on health care reform – which benefits people living with HIV/AIDS – is a factor.”

Johnson said that evidence of the urgency is in the sheer amount of work the White House is doing to reverse “eight years of absolute neglect of the domestic HIV epidemic from the previous administration.”

He noted that for the first time, the CDC is funding prevention messages that target MSM and the new national surveillance system resulted in the revised estimates of new HIV infections each year.

Further evidence might be the April 5 announcement by Health and Human Services Secretary Kathleen Sebelius of the release of more than $1.84 billion in grants though Health Resources and Services Administration, which oversees the Ryan White HIV/AIDS program.

“These grants help ensure Americans, especially those in underserved rural and urban communities, affected by HIV/AIDS get access to the care they need through quality health care and support systems," Sebelius said in a press release.

The grants are allocated in three areas of the Ryan White program: Part B gets about $1.145 billion sent to states and territories, with $800 million of that total designated for ADAP, with other money going to 16 states based on a formula (list of Part B awards here). Part A gets $652 million for primary care and support services, including $44.8 million for the Minority AIDS Initiative and Part C receives more than $48.1 million for early intervention services administered by community-based organizations.

But Michael Weinstein, president of the Los Angeles-based global treatment and advocacy AIDS Healthcare Foundation is not overly impressed. “The combination of flat funding and steep drug price rises has put the ADAP program in great jeopardy,” Weinstein said. “We should be able to expect something much better from the Democrats on AIDS.”

Johnson said AIDS Action Council and other AIDS groups are gearing up for the expected budget fight as Congress takes up appropriations. “We are going to press the case that even though there are increases in the president’s budget, the need and the epidemic are such that even greater funds are called for.”

But an even larger issue looms: figuring out how to integrate the AIDS appropriations into the National AIDS Strategy – overlayed with the new heath care reform bill, which Johnson said they are still reading, with its implementation “down the road. That is the work we are doing now.”
For instance, the health care reform bill eliminates the coverage cap – otherwise known as the “hole in the donut” for Medicare Part D Prescription drugs  by 2020. While non-HIV infected Americans who need prescription medications may have difficultly deciphering the year changes in the plan, for people living with HIV and AIDS the issue is expensive and could mean life or death.

“We’re still asking ourselves what this means,” Johnson said. Immediately, some people will be eligible for a $250 rebate. “It’s small but in these times, every 50 cents helps for some people,” especially since many people living with AIDS are not able to get out of the donut hole. In 2011, the 50 percent discount for name brand drugs will go into effect for people in the coverage gap.

“People living with HIV/AIDS can use ADAP to count for the true out of pocket expenses requirement,” Johnson said. But reminded that many state ADAPs are in danger of being cut for lack of funding, Johnson said, “above and beyond health care reform, we’ve strongly advocated for a $126 million emergency appropriations for ADAP this year and also for the appropriations bills that Congress will be developing for the fiscal year that begins October 1. The funding situation for ADAP continues to be a critical issue.”

With rising HIV infection rates, with budget shortfalls severely impacting the local service agencies at a time when more services are needed, with state governments cutting funding to deal with their own financial woes, and with a lack of an overall emergency strategy – the day may soon come when AIDS activists will no longer feel as if they were living in the early 1980s – they may actually be reliving them.

Abort the Executive Order

8:02 am in Uncategorized by RH Reality Check

Written by Rebecca Sive for – News, commentary and community for reproductive health and justice.

“The (Patient Protection and Affordable Care) Act maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly-created health insurance exchanges.”

Barack Obama, President of the United States,

March 21, 2010

This text is from theExecutive Order ensuring enforcement and implementation of abortion restrictions in the Patient Protection and Affordable Care Act.”

In Chicago, we call it getting out-hustled. That’s what the President and the Speaker did to their opponents over this weekend; they out-hustled them, in order to get the House of Representatives to pass the President’s healthcare reform bill, the one which, by-the-by, creates new barriers—both federal and state—to American women’s access to reproductive health care.

What does out-hustled mean? Well, in Chicago politics, it means you bust your you-know-what to get what you want, which too often means damn the consequences, most especially those consequences that appear to be (only) niceties, or appear arcane, or appear to affect few, or most-of all, obscure the message of ever-so-needed victory, any victory, if-it-comes-to-that.

But, in out-hustling their opposition, the President and the Speaker forsook the women of America; for they decided, by-the-by, that it was OK to make life–life hard enough already–all that much harder for women of modest resources when they face, for most, the hardest decision of life, the (constitutionally-protected) decision to terminate a pregnancy.

A couple weeks ago, I wrote in these pages regarding the Speaker’s specious claim that "This (the healthcare reform bill) is not about abortion,” 

To the contrary, I said, and I was proved right (keep reading): Getting the healthcare bill passed was going to be  “…about nothing but abortion.”

Of course, the Speaker knew this, too: She’d known this at least since last November when she called the Stupak Amendment for a vote, and it passed.

In fact, the Speaker’s statement to the contrary was just pure political ploy—typically political in that, in its narrowest fact context, it was true– the bill was and is about lots of aspects of healthcare, not just about abortion—but, equally typically political, false regarding the politics of getting the bill passed.

And that’s exactly what happened. Getting the healthcare bill passed was about nothing but abortion; at the end, it was about nothing but abortion-related deals; deals that, to boot, weren’t just any old deals, but deals with thePresident, his own self, to coin another Chicago term-of-art.

Indeed, Mr. I-used-to-can’t-stand-what-the-President-stands-for-if he’s-for-choice Stupak, of all people, got himself a little ole Executive Order, all about abortion.

And, lo and behold, once he got it, the Speaker got Mr. Stupak’s vote, and the bill passed.

Sometimes, being right doesn’t bring much satisfaction with it. Girl: Is that true this time.

For “…about nothing but abortion” turns out to mean that Washington will moot this women’s right with hardly a passing glance: Need an Executive Order, no problema; come on over and negotiate with my lawyers.

Need an Executive Order, no problema; let’s go right ahead and negotiate an Executive Order that no Democratic, nor, for that matter, any Republican, President has ever offered up; a document that Presidentially codifies a law whose sole purpose is to deny poor, and now middle-class (for the healthcare reform bill subsidizes middle-class families’ health insurance, too), women the same access to reproductive health care that wealthy women have.

Need an Executive Order, no problema; let’s just go right ahead and codify that Hyde Amendment in an Executive Order. And, while we’re at it, let’s go ahead and expand the reach of Mr. Hyde’s Amendment; expand it by extending its provisions to those new healthcare exchanges, all fifty of them; those health exchanges already a disaster for women, for what insurer in his right mind is going to want to tussle with local-pol-healthcare regulators regarding the right insure abortion and the right to undertake all kinds of new accounting procedures just to have the privilege of insuring a woman’s abortion. Exactly none.

Need an Executive Order, no problema:  We’ll just blithely ignore the constitutional complications here.

But wait: This Executive Order is about a matter that only affects, maybe, a couple- million-max American women annually. What’s the big deal? Won’t we be able to fix whatever all might be wrong with it later?

I say  “no,” for both policy and political reasons.

Here’s my take on one important policy reason: American history has shown over, and over, and over again that policies sacrificing or mooting constitutional rights, for the supposed “greater good,” are never sacrifices that protect the rights of women, minorities, the poor, or anyone else who doesn’t have the ability to buy her way into the offices of D.C. power brokers, and change powerbrokers’ minds.

What’s next: Sacrificing the notion that creationism is poppycock in order to get the votes of conservative Texas Democrats for education reform?  Sacrificing Miranda rights in the name of security when anyone with a plastic knife and training in martial arts can cause chaos on any airplane?

As to the political reasons, let’s start here, with this morning’s message from one leader of a big D.C. women’s group.  Here’s what she sent along:

“And once that work (Senate passage of the healthcare reform bill) is done, you and I will insist that Congress take the necessary steps to reverse the appalling anti-choice provisions contained in health reform and render the President’s Executive Order null and void.”

I could scream with frustration. But that’s not the point.  Here is the point. Actually, there are two (points).

Politics Rule One: In the words of Frederick Douglass, “Power concedes nothing without a demand. It never did and it never will.

You can insist forever; you can insist till the cows come home; meanwhile, the cows, and all the horses, besides, are out of the barn.

You can, and losers do, “insist,” while those horses run to another barn, a barn whose doors are dead-bolt locked when you try to enter.

Not a plan, that “insisting” thing.

By contrast, as Douglass pointed-out, “demanding” is a plan; demanding without standing down till you get what you want is a really, really good plan, when the chips are down.

So, here’s a corollary to Politics Rule OneDon’t get out-hustled, if your goal is winning.

Why, exactly, did the Speaker insist, “This isn’t about abortion.”

Why? Because she knew that when D-Day (decision day) came, she would do whatever she needed to do, to make the bill’s passage appear to have nothing to do with abortion, or, if about abortion in some way, only in a way that appeared innocuous, e.g., as it then happened, accompanied by an Executive Order that meets this threshold, (supposedly).

To this supposed point, catch these words of Dan Pfeiffer, White House Communications Director: “The President has said from the start that this health insurance reform should not be the forum to upset longstanding precedent. The health care legislation and this executive order are consistent with this principle.

The pro-choice Members obliged. Oh, the bill doesn’t include ‘Stupak;’ oh, OK, we’ll vote for that.

At no time in the course of the Speaker’s march to “wreckonciliation” for poor American women did these Members stand up, and do like Stupak did:  March anywhere, and demand a deal on their terms, the terms their female constituents and millions of other American women need.

Instead, they obliged, and then, blithely, declared victory: We fought back Stupak, as though the Stupak Amendment language were, or could be, the only language used to sacrifice the rights of American women. Well, the President, Speaker, and Mr. Stupak sure proved you wrong on that one.

Out-hustled means you think faster; do harder; stand on that proverbial street corner 24-7, and do what you need to do every minute of everyday. You don’t take people’s words at face value—you negotiate your own terms and your own words.

This is what real “players” do, to use a related Chicago term. They do what Bart Stupak did. They demand to be heard by those in power, in their presence, offer up nothing till they are (heard, in that room), and then get their deal in writing.

Didn’t happen; power conceded nothing ‘cause this wasn’t done, and we women are the worse for it.

But wait, there is one more chance:  Abort the Executive Order.

Of course, this would mean that since the nefarious deed is done, the Executive Order would now have to be rescinded.

No biggie: The President knows signing it was a bad idea (why else would he have prohibited press at the signing; he wasn’t proud of this one).

So,all you Democratic women Senators, who now sit in the catbird’s seat (Harry Reid can’t move without you; just like, apparently, Nancy Pelosi couldn’t move without Bart Stupak); do like Bart did: Walk on over to the White House. But tell the President you want Bart’s Executive Order rescinded.

Senators, for the sake of your less fortunate sisters, please tell the President you can’t abide his Executive Order that everyone in D.C. now understands does change the law and, as a practical matter, will make abortion unavailable. Senators, for the sake of your less fortunate sisters, tell the President you’re not into wreckonciliation; you’re not into wrecking the lives of the American women who most need your help.

“When faced with crisis, we did not shrink from our challenge — we overcame it. We did not avoid our responsibility — we embraced it. We did not fear our future — we shaped it.

These are the President’s beautiful words of last night.

Well, Mr. President: Sadly, you did shrink from your most important challenge—to create equality for all Americans, for all women.

Mr. President: On this point, I call your attention to the words of another great American orator; again, I quote Frederick Douglas.

“Where justice is denied, where poverty is enforced, where ignorance prevails, and where any one class is made to feel that society is an organized conspiracy to oppress, rob and degrade them, neither persons nor property will be safe.”

The Health Care Bill and Women’s Health: Wins, Losses, and Challenges

8:01 am in Uncategorized by RH Reality Check

Written by Jodi Jacobson, editor of – News, commentary and community for reproductive health and justice.

Today, President Obama will sign into law the Affordable Health Care for America Act.  Many aspects of the Act apply across the board to Americans regardless of age, sex, health history or employment status.  Some of the provisions are of particular importance to women.  Below is an initial summary of the wins, losses, and remaining challenges for women’s health and rights.


Elimination of "pre-existing conditions:"

The Act bars insurance companies from denying coverage to children due to pre-existing conditions, including children up to age 19.  This provision becomes effective 6 months after signing.

The Act bars insurance companies from discriminating against adults based on pre‐existing conditions, health status, and gender.  This is a critical provision for women, but one that does not become effective until 2014.

Why is this important? To date, insurance companies have discriminated heavily against women in various markets by categorizing as "pre-existing conditions" a wide range of health concerns and conditions.  For example, insurance companies have rejected victims of domestic violence and rape and have classified women who have undergone cesarean sections as having "pre-existing conditions."  In some cases, prior pregnancies have been considered pre-existing conditions. The new bill expressly prohibits insurers from rejecting an applicant based, essentially, on being a woman.  Again, this provision does not go into effect until 2014.

Increases access to OB-GYN and midwifery care:

Plans can not require pre-authorization or referral for OB-GYN care.  This provision becomes effective 6 months after signing.  New policies sold on the insurance exchanges would be required to cover a range of benefits, including maternity care. 

According to the Association of Certified Nurse-Midwives, the original bill in the House of Representatives, since replaced by the Act to be signed today by the President, would have expanded access to midwifery care by addressing inequities in how Certified Nurse‐Midwives (CNMs) are
reimbursed under Medicare, provided funding for home visitation by nurses for Medicaid families during or after pregnancy and improved Medicaid coverage of freestanding birth centers—a high‐quality, high‐value option for women and their families, according to the Association of Certified Nurse-Midwives.  As of this writing it is not clear whether the bill to be signed today includes these provisions, but look for updates.

Partial elimination of gender rating:

Many insurance plans charge women more for insurance coverage than they do men of the same age and health status, a practice known as "gender rating." The Act eliminates this practice for some women but not for others. Gender rating (and other forms of rating) for individuals and small employers (up to 100 employees) will be prohibited.  It will not apply to plans offered by employers with more than 100 employees, unless a state allows large employers to enter the insurance exchanges after 2017.  In the latter case, rating rules apply to all large employer coverage in that state.  The National Women’s Law Center offers materials that explain the practice of and implications for women of gender rating.

Free preventive care under new plans.

The Act requires new private plans to cover preventive services with no co‐payments and exempts preventive services from deductibles.  Effective 6 months after enactment. This requirement will apply to all plans beginning in 2018.  Preventive care is of course critical for all ages and both sexes, but dramatically expands women’s access to screening for cervical and breast cancer and other forms of preventive reproductive and sexual health care unique to women.

Expands funding for and access to community health centers and primary health care doctors.

The Act increases funding for Community Health Centers, to allow for nearly double the amount of access in terms of patients seen over the next 5 years.  This funding becomes effective in fiscal year 2010 and is an essential aspect of health care particularly for low-income women and their families. 

Expanded access to Medicaid and the Children’s Health Insurance Program

The Act expands eligibility for Medicaid to include all non‐elderly Americans with income below 133 percent of the Federal Poverty Level (FPL) and increases assistance to all states to help cover the costs of additional people to be covered under Medicaid, the nation’s public health insurance program for the low income population.  The Act also maintains current funding levels for the Children’s Health Insurance Program (CHIP) through fiscal year 2015. 

More than 20-million low-income women currently receive coverage for their health and long-term care through Medicaid, and the majority of adult beneficiaries of Medicaid (69 percent) are female.  By expanding the eligibilty requirements, the Act will expand coverage to low-income women and children who urgently need primary preventive and curative care.  This is without doubt a plus for women.

A Kaiser Family Foundation brief states:

In order to qualify for Medicaid, women must meet both categorical and income criteria. That means that one must fit into a certain “category” such as being pregnant, a mother of a child under 18, 65 or older, or having a disability. Each of these groups has different income elibiligy criteria, which vary from state to state.

Medicaid income thresholds for adults have been, however, very low. And states the KFF brief, "because women are more likely than men to fall into one of the categories and are more likely to be poor, women are more likely to qualify for Medicaid. Many very low-income women, however, do not qualify no matter how poor they are because they do not fall into one of the eligibility categories."

Medicaid is also the largest source of public funding for family planning services in the United States, financing contraceptive services for millions of low-income women. A Guttmacher issue brief,  Medicaid’s Role in Family Planning, provides an overview of Medicaid’s role in financing and providing access to family planning services for low-income women. Expansion of Medicaid services means an expansion of critical family planning and contraceptive services for women, one reason that increased access to health care helps reduce the number of unintended and unwanted pregnancies and by extension the need for abortion.

Improves access to and benefits offered under Medicare:

Women make up a majority of those dependent on Medicare services.  Kaiser Family Foundation notes that Medicare is a critical source of health insurance coverage for virtually all older women in the U.S. and for many younger women who have permanent disabilities.

Today, 22 million women–one in five adult women–rely on Medicare for basic health insurance protection, and women make up 57 percent of the Medicare population. Medicare helps to make health care more affordable for older women at a time in their lives when they are most likely to have multiple health problems that require ongoing and often costly medical treatment.

The Act will reduce the economic burden of health care among women and improve their access to services by reducing costs for prescription drugs by

  • providing new, free annual wellness visits to the basic services provided;
  • eliminating out‐of‐pocket copayments for preventive benefits under Medicare, such as cancer and diabetes screenings;
  • providing better chronic care; and
  • reducing overpayments to private Medicare Advantage plans.


The Act also fills the Medicare prescription drug "donut hole.  According to Kaiser, the donut hole is a "unique feature" of the Medicare Part D drug benefit is the coverage gap.  Part D enrollees are required to pay 100 percent of total drug costs after their spending exceeds the initial coverage limit and before reaching the catastrophic coverage limit. In 2010, most Part D plans have a coverage gap, which totals $3,610 in drug costs for plans offering the standard Medicare Part D benefit; by 2019, the gap is projected to be nearly $6,000.

The Act addresses this in 2010 by providing Medicare beneficiaries who go into the donut hole with a $250 rebate, after which they will receive a pharmaceutical manufacturers’ 50 percent discount on brand‐name drugs, increasing to a 75 percent discount on brand‐name and generic drugs to close the donut hole by 2020.


At the broadest scale, the statement from the National Organization for Women (NOW) most succinctly articulates the basic losses in this round of health care reform:

The bill covers only 32 million of the 47 million uninsured in this country, does not contain a meaningful public option and provides no pathway to a single payer system like Medicare for all.

While these aspects of reform affect all people, they again also disproportionately affect women.

Other losses with disproportionate or specific implications for women include:

Continuation of age-rating

The bill continues to permit age-rating, the practice of imposing higher premiums on older people. " This practice has a disproportionate impact on women," notes the National Organization for Women, "whose incomes and savings are lower due to a lifetime of systematic wage discrimination."

Continuation of gender-rating

The bill also permits gender-rating to continue under some policies. "Some are under the mistaken impression that gender-rating has been prohibited," states NOW, "but that is only true in the individual and small-group markets."

Larger group plans (more than 100 employees) sold through the exchanges will be permitted to discriminate against women — having an especially harmful impact in workplaces where women predominate.

NOW states: "We know why those gender- and age-rating provisions are in the bill: because insurers insisted on them, as they will generate billions of dollars in profits for the companies. Such discriminatory rating must be completely eliminated."

Lack of coverage for immigrant women

Under the Act, immigrants, a highly vulnerable population, will continue to face high barriers to acessing basic health care.  The bill imposes a 5-year waiting period on permanent, legal residents before they are eligible for assistance such as Medicaid, and prohibits undocumented workers from even using their own money to purchase health insurance through an exchange.

According to the National Latina Institute for Reproductive Health (NLIRH), "If passed, the reconciliation package (being considered in the Senate this week) will cover an estimated 9 million uninsured Latinos and increase funding for community health centers, which is a lifeline for many in our neighborhoods. In addition, 4.4 million Americans in Puerto Rico and territories will receive $6.3 billion in new Medicaid funding, increased flexibility in how to use federal funding, access to the Exchange and $1 billion in subsides for low-income residents."

At the same time immigrant women are left vulnerable.  In its statement on health reform, NLIRH pointed to these serious weaknesses:

  • Over half of all immigrants are women, and 53 percent of all immigrants are from Latin America.  The bill does not allow undocumented immigrants to buy health insurance in the exchange, and maintains a five-year waiting period for Medicaid for lawfully residing residents.  The exclusion of new immigrants from Medicaid is not only unjust, but also bad public health policy.
  • And although the reconciliation provisions are better than what the Senate originally proposed, residents of Puerto Rico are still a long ways away from receiving Medicaid and other federal health care support at the same level as other states of the Union.

Elimination of abortion care in private insurance market:

Despite the President’s promise that no American would be worse off after health reform than before, the majority of women now covered by private insurance plans now have access to coverage for abortion care, a fundamental aspect of women’s health care.

Under the language currently in the Act, incorporated at the insistence of Senator Ben Nelson (D-NE) and with the acquiescence of the White House, the Senate and House leadership, women will now lose coverage for abortion care for policies paid for with private dollars.  The implications of the Nelson language have been addressed in detail in previous articles published by RH Reality Check, but include the following:

  • Requires every enrollee–female or male–in a health plan that offers abortion coverage to write two separate checks for insurance coverage.  One of these checks would go to pay the bulk of their premium, the other would go to pay the share of that premium that would ostensibly cover abortion care.  Such a check would have to be written separately whether the share of the premium allocated for abortion care is .25 cents, $1.00, or $3.00 of the total premium on a monthly, semi-annual or annual basis.  Employers that deduct employee contributions to health care plans from paychecks will also have to do two separate payments to the same company, again no matter how small the payment.
  • Eliminates the provision in earlier versions of the Senate bill and in the original Capps language in the House bill to ensure that there is at least one insurance plan in each exchange that offers and one that does not offer abortion coverage. 
  • Prohibits insurance companies by law from taking into account cost savings when estimating the costs of abortion care and therefore the costs of premiums for abortion care.
  • Includes "conscience clause" language that protects only individuals or entities that refuse to provide, pay for, provide coverage for, or refer for abortion, removing earlier language that provided balanced non-discrimination language for those who provide a full range of choices to women in need. 

A George Washington University Study suggests that the implications of this language include:

  • moving the industry away from current norms of coverage for medically indicated abortions.
  • inhibiting development of a supplemental coverage market for medically indicated abortions.
  • "Spillover" effects as a result of administration of Stupak/Pitts will result in dramatically reduced coverage for potentially catastrophic conditions.

Women’s groups see this as a major loss.  "This battle was fought on the bodies of women and immigrant women," states NLIRH. 

In the eleventh hour, President Barack Obama caved to the demands of a handful of anti-choice Democrats by agreeing to use the lives of women as trade.  He will use his pen to add weight to the already cumbersome abortion restrictions in the health care bill.  Latinas, immigrants, and women of color are deeply affected by any language restricting abortion access – because women of color and immigrants are disproportionately poor, they are less likely to be able to pay for reproductive health care out-of-pocket, which puts them at risk for seeking alternative, unsafe abortion methods. While health reform might lead to more Latinas being covered, it leaves out a significant portion of the population.  By excluding and stigmatizing immigrants and women who need abortions, we are pushing them to the shadows of our health care system and placing unfair burden on the already-strained system of community health care centers and emergency rooms.  Over half of all immigrants are women, and 53 percent of all immigrants are from Latin America; though it has yet to be signed by the President, this bill is outdated already. 


In the coming months, and to truly fulfill his campaign promises, President Obama–along with Speaker of the House Nancy Pelosi and Senate Majority Leader Harry Reid–must lead the nation and the Congress in making the following changes to the foundation of health reform put in place today.

At a minimum, the Administration and Congress should:

  • Amend the health reform bill to establish a public option thereby increasing competition in the health insurance market.  As most analysts note, the public option is popular and also would prevent insurance companies from increasing rates by exhorbitant amounts as recently happened in California.
  • Eliminate the Nelson language in the health reform bill and revoke the Executive Order signed by the President.
  • Eliminate gender-rating in all policies, starting in 2011. 
  • Eliminate pre-existing conditions for all people in 2011.  It is not clear why we need to wait four years for insurance policies to eliminate pre-existing conditions.  Between this moment and four years from now, untold numbers of people will have to pay exhorbitant premiums to get coverage in high-risk pools due to pre-existing conditions.  It is nice to know these will be eliminated, but waiting four years defeats the purpose.
  • Remove the 5-year cap on immigrants who are legal residents and allow undocumented workers to use their own funds to purchase health insurance through an exchange.