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Stupak and Health Reform’s Second Trimester

6:27 am in Uncategorized by RH Reality Check

Written by Rebecca Sive for RHRealityCheck.org – 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.”

Abort the Executive Order

8:02 am in Uncategorized by RH Reality Check

Written by Rebecca Sive for RHRealityCheck.org – 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 RHRealityCheck.org – 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.

WINS:

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.

LOSSES:

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. 

CHALLENGES:

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.

Wreckonciliation

6:28 am in Uncategorized by RH Reality Check

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

On International Women’s Day, I imagined the White House full of cooing, hugging women, celebrating the wonder of the world’s and America’s women, and I had to ask: where’s the wonder?

To coin a cliché:  Where’s the beef?

Here’s my beef: We, the women of America, are being told by those on-high, starting with those who might have been at the White House on International Women’s Day, including Nancy Pelosi–the most important woman in America right about now–that American women’s most fundamental right, our right to control our reproductive destiny, should be of no consequence in the effort to reform healthcare.

Yup, that’s the bottom line for the Speaker, the bottom line she reached Thursday, near the end of her soon-to-be, five-month death march to wreckoncilation. "This is not about abortion," the Speaker said, when even the most politically untrained, outside-the-Beltway bystander knows otherwise.

Well, Madame Speaker: You would be wrong about that.  "Abortion could be health bill deal breaker in House," according to the D.C.-insiders’ bible, Politico. 

Yup, Madame Speaker, right-about-now healthcare reform is about nothing but abortion, as some of us have been saying all along it would be; in fact, as some of us were saying it would need to be, if there were to be any justice in this enterprise. And, Madame Speaker, truth-be-told, you and the President have also known this, at least since last November, four months and counting, ago, when "…[You were] forced to give [Rep. Bart] Stupak a floor vote that incorporated his strict abortion funding provision," in order to pass your healthcare reform bill.

Four months and a day later, Rep. Stupak would be right: "’Nothing has changed,’ said [Rep.] Stupak. ‘I don’t think they have the votes to pass it (a healthcare reform bill without Stupak Amendment-type language re access to abortion)."

Madame Speaker, like it or not, and I say it again, Rep. Stupak is right: The future of (your and the President’s) healthcare reform has come down to this: Can you and the White House come to a winning plan on how to deal with access to abortion.

Why? Because access to abortion is the marker of women’s equality, and who are you and the President, if you’re willing to win without this?

Madame Speaker:  But for legal access to abortion, no American woman has equal opportunity. I can’t believe this is something you don’t want.

And, anyway, Rep. Stupak is playing hardball:  What choice do you have?

Madame Speaker:  I know that you and other inside-the-Beltway women’s-issues’ dealmakers, not to mention your post-racial, post-feminist thirty-something staffers don’t like hearing this, but it’s true. I know you’d all rather spend International Women’s Day lauding one another and having us laud you. Well, no can do.

And anyway, the proof of my point is, so-to-speak, in the (Catholic Bishop’s) pudding. They’re cooking up lots, right about now.

Just look at how hard they are fighting to prevent access to abortion, just because they know what you’ll know too, in your heart-of-hearts, and here I repeat: Access to abortion is the marker of women’s equality.

And, as if all this pudding could get any more distasteful, take a good, hard look at just how the Bishops are cooking it up–doing just what politicians (and bishops) do when things get really right-down-to-it: Covering-up their real intentions with lofty sentiments about morality and justice while they cook-away, and deal-away, behind closed doors, hoping those of us out in the hinterlands are lulled into complacency by talk of morality and justice.

Madame Speaker, to coin another cliché:  "This will never do."  

So, Madame Speaker, please read these theses I’ve nailed to your D.C.-church door, otherwise known as the House of Representatives:

1) There is no proof that we can’t have a healthcare reform bill, providing for unfettered access to abortion, just as it does for all other lawful medical procedures. Why?  Because we haven’t yet heard any at-the-table Beltway-dealmakers, say that healthcare reform is an oxymoron if it doesn’t provide for women’s equal access to healthcare, and then fight for just that.

By contrast, Rep. Stupak and his merry anti-choice band are doing what true believers generally do:  They are fighting really, really smart, and really, really hard for what they (truly) believe in.

Madame Speaker: Are you a true believer (in women’s equality)?

Madame Speaker: Why are you going down without a fight, especially for the sake of rich-as-Croesus-already health insurers, who are just going to get richer, once your Stupak-lite passes, because the risk pool they’ll then be insuring will be getting riskier (once all those people with expensive pre-existing conditions are in the pool), and so premium costs will go up even more than they already have.  

And, Madame Speaker, even if there’s some, as yet unshared-with-the-public proof that the only healthcare bill that could ever be on the table for a vote in 2010 is Stupak-lite, why in the world should the women Members and Senators–led down that rose-garden path by you–vote for Stupak-lite? Because something is better than nothing?

I don’t buy it. See above for starters. There hasn’t been battle-one yet.

How about an equally aggressive fight, led by you? How about saying something this evening at The White House?!

This takes me to thesis two.

2) "I won’t always be there with you."

Some in Chicago heard the President–in the earliest months of his Presidential campaign–say just those words, talking about the issue of abortion.

Yup, just as I’ve been writing in these pages for months:  The President never promised us a Rose Garden. And boy has he kept his promise. Not once during this year of speaking, meeting, deal-making, power-breaking, think-tanking, and healthcare-summiting has the President ever said that women’s health is as important as men’s, and that, therefore, it ought to be recognized as such in his healthcare reform bill.

So, maybe, you’ve been thinking all this time that, ah gee, he’ll come home when it really matters. Well, he hasn’t. Not to our home.

Instead, when the President finally stated his legislative preference for a healthcare reform bill over a year into his Presidency, and almost four months after Mr. Stupak had his say (and his wish come true), the President’s preference was for the healthcare bill passed by the U.S. Senate: Yup, that one.

Stupak-lite, and that’s putting the best face on it. Stupak-lite:  The one that contains noxious, rabidly anti-women language, effectively mooting American women’s constitutionally protected access to abortion.

Stupak-lite:  The one that has no public option, no national health insurance exchange, (but, instead, state-based health insurance exchanges, permitting a network of anti-women local pols to govern American women’s healthcare; boy, that’s worked out really well for women), and no employer mandate to provide health insurance (even at the employee’s own expense). Well, you get the drift.

Stupak-lite:  The one that is really, really light, not-to-say ephemeral, when it comes to protecting the women of America.

3)  Sisterhood is powerful, but it is only powerful when it advances the rights of all sisters. [Neither Stupak-lite, nor the current federal laws governing access to abortion, do that for American women.]

Madame Speaker:  According to published reports, when the proverbial "[healthcare reform] s(…) hit the fan" last Thursday, you called to your office a group of Beltway women’s-issues advocates and power brokers.

Did anyone at that meeting ask you whether you think it’s right–for the women of America–that you and other women Members and Senators are mooting our constitutional right for the sake of Stupak-lite?

Assuming you said "yes," or, alternatively, that you said "no, but that’s the only choice I have," why do you sound so righteous as you discard the rights of your sisters?

Why do you sound so righteous when neither Stupak-lite, nor the current federal laws governing access to abortion, do that for American women?

4)Some bill, any bill, (won’t) do.

Madam Speaker, I feel like we’re all becoming slaves to Baltimore, or Chicago, or Beltway art-of-the-possible approaches to governing, ones you and the President know so well; ones that say some bill, any bill, will do; ones that say that the only failed health reform bill is no health reform bill.

For, God-forbid, Barack Obama should have the same stripe on his back as Bill Clinton: The one that says: I failed to pass a health reform bill. For, God-forbid Rahm should return to Chicago as just another rich investment banker, former D.C. insider who couldn’t get the big one done. God-forbid you should go down in history as a Speaker who couldn’t get the big one done, either. The women of America will just have to be sacrificed to avoid all this unpleasantness.

5) Madame Speaker:  I repeat:  That will never do.

Madame Speaker: Hear this: The only healthcare reform bill that matters right now is about abortion, and that’s a good thing. And here’s why. As you sit in those oh-so-lovely White House and Capitol rooms this International Women’s Day, remember this:  What you give away today will never suffice; they’ll just ask for more tomorrow. That’s how Washington works; that’s how men in power work; that’s how women in power who don’t care about other women work.  That’s wreckonciliation.

So, you might as well fight for what really matters: Fight for our (not God-given, but even better than that, Supreme-Court given) right to abortion. Fight for reconciliation.

AIDS Advocates Question Healthcare and Spending Cuts

6:38 am in Uncategorized by RH Reality Check

Written by Diana Scholl. This article was originally published at HousingWorks.org and is published at RHRealityCheck.org with permission from the author. RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Many AIDS advocates are expressing concern about President Barack Obama’s commitment to combating the epidemic, on the heels of a State of the Union that downplayed the urgency of federal healthcare reform and proposed freezing much government discretionary spending.

While Obama pushed for the passage of healthcare reform, the ask was buried 31 minutes into his speech. That timing felt ominous, given that on Wednesday Nancy Pelosi suggested passing healthcare reform in pieces. There has been some talk of only passing the popular parts of healthcare reform, such as regulations on the private insurance industry. But AIDS advocates say that would be horrendous news for people with AIDS and other disenfranchised people.

"We’re not the popular provisions," said Robert Greenwald, executive director of the Treatment Access Expansion Project. "There’s no question that this comprehensive package is the best we’ve seen in 50 years. We need to remove barriers to Medicaid and Medicare. I don’t think many of those things will happen if what we just see is incremental reform."

Christine Campbell, Vice President for National Advocacy and Organizing at Housing Works agreed. "The majority of this bill takes us strides above where we are. Democrats and Republicans in Congress just need to do their jobs."

People with AIDS in the United States are poorer than the general population and also less likely to have adequate health care. Forty-five percent of people with HIV/AIDS in the United States have incomes under $10,000 a year, and 50 percent lack regular medical coverage. The situation is even more dire for people with hepatitis C, who aren’t co-infected don’t have access to the Ryan White CARE Act safety net.

Campbell and AIDS advocates are recommending the House pass the Senate version of the bill, as imperfect as it is. The Senate bill doesn’t include a public option so people who purchase healthcare must go through an insurance company. The Senate version also includes a provision to appease anti-abortion supporters that would require people to purchase specific abortion-only coverage separately from their regular premiums.

Gregg Gonsalves, a longtime AIDS activist who has been critical of Obama’s policies, said that even though he thinks there are parts of the Senate healthcare reform bill that "stink", he thinks it should still be passed.

"The bill is terrible compared to what it could be but it’s better than nothing basically," Gonsalves said. "I think they should pass this with a reconciliation fix."

Gonsalves expressed concerned with Obama’s commitment to the issue. "He said we can’t give up healthcare now. But he’s taken the backseat."

The HIV Healthcare Access Group sent a letter to House leadership calling on them to pass healthcare reform that includes a largely federally funded expansion of Medicaid to low income individuals; an exchange or regulated marketplace for the uninsured and the under-insured to purchase health insurance; generous subsidies to make coverage affordable for those who need it; stricter regulations that govern the private market preventing discrimination; an investment in reorienting our health system to focus on prevention and public health and critical measures to address primary care and public health medical workforce shortages.

Discretionary spending

Another problematic part of Obama’s agenda was his call for a three-year freeze in spending that wasn’t related to national security, Medicare, Medicaid, and Social Security. A freeze could impact housing, federal aid, health care and other programs essential to poor people with HIV/AIDS, and other disenfranchised people.

"This is a hare-brained idea," Gonsalves said. "Obama’s throwing a bone at Kent Conrad on the backs of poor people."

Although Obama mentioned global AIDS in his State of the Union Address in the context of U.S.‘s global commitment, he has already essentially flatfunded global AIDS spending, even though Congress authorized $50 billion for PEPFAR over five years.

A rally was organized by Health GAP Wednesday near the White House calling on Obama to rethink this proposal, as well as a Campaign to End AIDS-organized phone zap of the White House.

After some listserv chatter questioning whether a protest was necessary, Housing Works President and CEO Charles King defended the "preemptive strike," saying, "The truth is that the Obama administration is already not delivering on global AIDS and we have no idea whatsoever what their intentions are on the domestic front. They have done a good job of collecting information and making people feel like they have been heard. We still don’t know that they have been really listening, and we probably won’t know until the budget is out."

Although some advocates speculated there may be some efforts to shield HIV/AIDS programs from some of the cuts, broader hits to the social services will be devastating both to people with HIV as well.

"There may be some efforts to carve out HIV from the freeze," said David Munar, vice president for policy and communications at AIDS Foundation of Chicago. "But any cuts to health and human services programs, be it Head Start or cuts to the CDC budget, will be harmful for people with HIV."