Womenstake

With Senate Health Reform Passage Likely, Women Hold Out Hope for Improvements

by Julia Kaye, Health Policy Associate, 
National Women's Law Center 

At 9:30am on Saturday morning, my cell phone buzzed. “Blizzard AND healthcare reform?” my friend texted. “Nelson budged!” Elated, I leapt out of bed and ran over to my laptop. “Democrats Say They Clinch Deal on Health Care Overhaul,” the New York Times declared. 

By all accounts, the Senate will pass a comprehensive health reform bill by Thursday night that will extend health insurance coverage to millions of women by expanding the Medicaid program, prohibiting harmful and discriminatory insurance industry practices, and making health insurance more affordable. If all goes according to plan, the House and Senate bills will be moved into conference within the next few weeks. It is thrilling to be this close to the historic passage of health care reform legislation.

And yet my excitement is muted; much has been sacrificed to get us to this point. Women in the United States desperately need health reform and will benefit tremendously from many of the provisions in these bills. But the Senate bill falls short on two key issues: it fails to provide adequate subsidies for lower income women, and it includes a so-called abortion “compromise” that is unworkable and unfair. 

Assuming the Senate passes its health reform legislation—and we hope they do—and the bills move into conference, women in this country will have to come together to lobby Congress for the best possible combination, for a package that adequately addresses women’s unique health care needs. We hope that leadership will ensure that the strongest and fairest policies rise to the top. Stay tuned for an NWLC side-by-side on the key provisions in the House and Senate bills for women. 

One thing is clear: women in this country should not be forced to hold their noses and swallow arbitrary and burdensome restrictions on access to abortion care in order to receive sorely needed and long overdue improvements to the health care system at large. We strongly urge Congress to produce a conference report that truly meets women’s needs.

The Omnibus Appropriations Bill Gives Reproductive Health Advocates (Long Overdue) Cause for Celebration

by Julia Kaye, Health Policy Associate, 
National Women's Law Center 

On Sunday, the Senate passed an omnibus appropriations bill for fiscal year 2010 that  gives a few of my favorite communities (namely: DC residents, comprehensive sex ed advocates, and the pro-choice community) something to celebrate. The omnibus, which passed the Senate 57-35 and includes six of the seven remaining appropriations bills for FY2010, would remove the funding restrictions that currently prohibit DC from using locally raised tax dollars to fund abortion coverage under the Medicaid program. Though the Hyde Amendment prohibits federal funding for abortion coverage under Medicaid except in cases of rape, incest, or life endangerment, states are free to use their own money to provide additional abortion coverage under Medicaid — and 23 do. Arguing against the DC abortion funding ban, Del. Eleanor Holmes Norton (D) commented: "The D.C. abortion rider has created severe hardships for low income women in the District. It has singled out the District and its women for unfair and unequal treatment." Delegate Norton is spot-on.  While we’re gratified that these restrictions have finally been lifted, it’s painful to think of the damage they’ve already done.  

The omnibus also eases the restrictions on DC’s use of federal funds for needle-exchange programs, a critical intervention strategy aimed at decreasing HIV transmission among injection drug users.  This policy is particularly important for DC women, as DC has a higher AIDS rate than any state — by far. 

But there’s more. In a victory for common sense, justice, and science-based public health strategies, the omnibus provides $114 million in funding for a new evidence-based teen pregnancy prevention initiative, which replaces the Community Based Abstinence Education (CBAE) program. The initiative will be implemented and administered by the newly authorized Office of Adolescent Health (OAH) in the Office of the Secretary at the Department of Health and Human Services (HHS). The bulk of that money ($110m) will be put towards “competitive contracts and grants to public and private entities to fund medically accurate and age appropriate programs that reduce teen pregnancy.” The remaining $4m are dedicated to program evaluation funding, including longitudinal evaluations, of teenage pregnancy prevention approaches. Hooray for evidence.

The House passed the omnibus bill last week, and President Obama is expected to sign it imminently.  

Provision to Prevent Future Presidents from Reinstating Global Gag Rule Stripped from the Foreign Operations Bill

by Julia Kaye, Health Policy Associate, 
National Women's Law Center 

Disappointing news: on Wednesday, a provision to prevent future presidents from unilaterally reinstating the “Global Gag Rule”—originally introduced as an amendment by Sen. Frank Lautenberg (D-NJ) over the summer—was stripped from the final conference report of the State Foreign Operations bill over anti-choice lawmakers’ threats that they would prevent the bill’s passage unless it were removed.

The Mexico City Policy—or “Global Gag Rule”—requires all foreign, non-governmental organizations (NGOs) that receive funding from the U.S. Agency for International Development (USAID) to agree not to “perform or actively promote abortion as a method of family planning” or to “provide financial support to any other foreign nongovernmental organization that conducts such activities.” NGOs may not spend any of their resources on abortion-related activism or services, even if such funding is not U.S.-based, stifling public debate in countries where clandestine abortion threatens the health and lives of women. The Global Gag Rule has led to enormous cut backs in services, closures of health care centers, and dramatic shortfalls in contraceptive supplies.

The policy was introduced by President Reagan in 1984, overturned by President Clinton in 1993, reinstituted by President Bush in 2001, and overturned by President Obama on only his third day in office. Thankfully, the restrictions are not currently in place, but advocates fear that the a future President will flip the switch yet again and turn this harmful policy back on.

It’s deeply disappointing that Congress has lost this opportunity to permanently right this wrong. For now—at least until next year’s appropriations process—international organizations receiving U.S. aid to provide critical family planning services that help save women’s lives can only continue to hope that their funding doesn’t evaporate on the whim of a future U.S. President.

Perhaps My Favorite Senate Amendment So Far

by Julia Kaye, Health Policy Associate, 
National Women's Law Center 

Reading through the list of amendments that senators have filed so far on the Patient Protection and Affordable Choices Act, I've stumbled upon a few gems. Senator Coburn (R-OK) has been busy lately—developing a substitute health reform bill (which fails to meet women's needs), voting against expanding access to affordable preventive health services for women, voting in support of a de facto ban on coverage of abortion in the new health insurance exchanges—but has found time to file a number of amendments to the Senate's health reform bill. Here's one example:

Coburn Amendment 2825 imposes a "Bureaucrat Limitation" by adding a new section to the bill that states:

"For each new bureaucrat added to any department or agency of the Federal Government for the purpose of implementing the provisions of this Act (or any amendment made by this Act), the head of such department or agency shall ensure that the addition of such new bureaucrat is offset by a reduction of 1 existing bureaucrat at such department or agency."

Seems kind of counterintuitive from someone who's so concerned about Americans losing jobs, eh?

Come On, Abstinence-Only Programs Shouldn't Have to Prove They're Effective to Get Funding

by Julia Kaye, Health Policy Associate, 
National Women's Law Center 

Last night, in a “hat-tip” to common-sense and efficacy, the Senate Finance Committee approved an amendment introduced by Chairman Baucus to provide funding for evidence-based comprehensive sex education. The Chairman introduced his amendment as an alternative to an amendment introduced by Senator Hatch, which would restore $50 million in annual funding for abstinence-only programs through 2014. The Chairman and his staff explained that abstinence-only programs would still be eligible for the new pot of teen pregnancy prevention money — they simply had to prove, like any other pregnancy prevention program, that the program is effective and that the information it provides is medically-accurate and complete. Fair, no?

The Committee didn’t think so. Fearing, I suppose, that abstinence-only programs would not meet the standards for the new pregnancy prevention funding and loath, it seems, to end the dedicated funding stream to ab-only programs (which have been demonstrated ineffective by study after study  after studies), the Committee also approved Senator Hatch’s amendment (in a 12-11 vote).

As we’ve previously discussed, over 80 percent of abstinence-only curricula provide information about contraception and other reproductive health services that is medically inaccurate, exaggerated, and misleading, such as grossly exaggerated failure rates for condoms, false information about the risks of abortion, and subjective, moral judgments treated as scientific fact. The abstinence-only curriculum, Me, My World, My Future (1998), used by eight federal grantees, refers to a 43 day-old fetus as a “thinking person.” Why kNOw (2002), a curriculum used by seven grantees, asks rhetorically “could condoms be just another stupid idea?”

Some federally funded abstinence-only programs also promote stereotypes about gender and relationships. WAIT Training, a curriculum used by nine former federal grantees, lists “Financial Support” as one of the “5 Major Needs of Women,” and “Domestic Support” as one of the “5 Major Needs of Men.” Moreover, all abstinence-only programs discriminate against GLBTQ teens, and all programs stigmatize adolescents without two, heterosexual, married parents, and youths who do not foresee themselves one day living in a traditional family structure.

Baucus’ common-sense amendment is in line with President Obama’s 2010 budget proposal, which would phase out abstinence-only funding in favor of comprehensive sex education programs. The amendment would provide $50 million annually to states for evidence-based, medically accurate and age-appropriate programs to educate adolescents on both abstinence and contraception, as well as at least three “adulthood preparation subjects,” such as healthy relationships and financial literacy. The amendment also provides an additional $25 million for innovative teen pregnancy prevention strategies, allotments to tribes, and research, evaluation and technical assistance.

Without Providers, There is No Choice

by Julia Kaye, Health Policy Associate, 
National Women's Law Center 

“The Last Abortion Doctor.” “The Abortion Evangelist.” “Abortion Stigma Affects Doctors’ Training and Choices.” In the wake of Dr. Tiller’s murder last May, news articles are finally trumpeting a steadily emerging reality: the number of abortion providers in the U.S., and particularly providers that perform abortions after the 20th week of pregnancy, is plummeting.  An article in yesterday’s Washington Post attributes this steady decline to a toxic combination of violence and/or the threat thereof, and a lack of urgency among young doctors and medical students who never had to witness the horrific consequences of back-alley abortions in the pre-Roe era.  The result is that legality doesn’t guarantee access to abortion, even—especially—for women and families in the most desperate and dangerous of situations.

There now remains only a handful of doctors in the country specializing in the 1 percent of abortions that take place after the 20th week—including Dr. Warren Hern and Dr. Leroy Carhart.  The doctors work in war-time conditions, driving bulletproof cars and avoiding rooms in their clinics where the windows are too exposed.  They are the ones who care for a woman whose fetus would be born with a lethal heart abnormality, or without a face.  The ones who help a woman who may face a life-threatening uterine rupture were she to carry the pregnancy to term.  The ones who provide relief to a rape victim who would rather commit suicide than carry to term a fetus whose every kick induces flashbacks of the attack.  They provide life-saving care to women and families in dire situations; they are doctors in the most heroic sense.  But they are few, and they don’t have enough hours in the day.  Though they are doing all that they can to cover the patients that Dr. Tiller would have seen, his death was a profound loss that has made it all the more difficult—and in some cases, impossible—for women to find the care they may desperately need.

Health Reform: Good for Mothers, Good for Families

by Julia Kaye, Health Policy Associate,
National Women's Law Center 

Cross-posted from Say Ahhh!

There is a common misconception that all low-income people -- or, at least, all poor parents -- are eligible for Medicaid. It may derive from a mistaken comparison with Medicare; an assumption that just as Medicare covers all people above a certain age, Medicaid must cover all people below a certain income level. In fact, only certain, limited categories of low-income people -- children and pregnant women are two examples -- are currently eligible for Medicaid, and the income threshold for each of these eligible populations varies by state.

While most states do not provide Medicaid coverage to childless adults at all -- even those without any income -- parents with dependent children are categorically eligible for Medicaid. In other words, states must cover some parents. However, because states are given great flexibility in setting the income eligibility threshold for parents, even very low-income parents often do not qualify for coverage. In Arkansas, a parent is only eligible for Medicaid if her income is below 17 percent of the federal poverty level (FPL) -- $3,112 a year for a family of three. In Alabama, Idaho, Indiana, Louisiana, Missouri, and Texas, a parent of two making more than $5,310/year is ineligible for Medicaid. It's no wonder that, as Martha Heberlein previously noted, 41 percent of parents with incomes below 150 percent FPL are uninsured.

It is important to note that when we talk about "parents" and Medicaid, we're mostly talking about women. Over 20 million women are covered under Medicaid, comprising the majority (69 percent) of the program's adult beneficiaries. Women are more likely than men to qualify for Medicaid because they tend to be poorer and are more likely to meet the program's stringent eligibility criteria. Women are also more likely to hold low-wage or part-time jobs that do not offer employer-sponsored health benefits, so Medicaid may be their only possible source of coverage.

Whole Foods CEO Fails to See the Whole Picture When it Comes to Health Reform

by Julia Kaye, Health Policy Associate, 
National Women's Law Center 

I, like some Presidents who shall remain nameless, happen to be a big fan of both arugula and Dijon mustard. When I can afford it, I love to splurge on Whole Foods produce and dairy. John Mackey, co-founder and CEO of Whole Foods Market Inc., clearly has a vision when it comes to creating a high-quality, environmentally-friendly grocery store.

However, his op-ed on health reform in yesterday’s Wall Street Journal reveals a significant blind-spot when it comes to the realities of low- and moderate-income people’s lives and the barriers they, particularly women, face to accessing health care. Mackey argues that health reform as currently envisioned is too expensive and unsustainable; that health care is not an “intrinsic right”; and that first and foremost, American adults are responsible for their own health (just eat better, ok?). In addition, Mackey’s op-ed promotes eight health reform policies that fail spectacularly to address the challenges women face in accessing affordable, comprehensive health care—and in some cases, exacerbate them.

Let’s assess his op-ed point-by-point:

1)    Health reform is too expensive: Though Mackey includes the perfunctory “While we clearly need health-care reform” before arguing that we nevertheless can’t afford health care reform that will create “new unfunded deficits,” he fails to acknowledge the high costs of failing to pass health reform. The Urban Institute estimates in a new report that, “absent reform, total health care expenditures, public and private, will total $33.0 trillion, over the ten years 2010-2019.” Without reform, “there would be considerable loss of employer coverage, particularly among the middle class, and a substantial increase in the number of uninsured.” Additionally, “employer costs would also increase substantially, as would costs to individuals and families from higher premiums and out-of-pocket costs.”

Moreover, the House Tri-Committee health reform legislation (H.R.3200) raises questions about Mackey’s dire warnings of so-called “unprecedented new taxes” and “unfunded deficits.” The House bill is paid for fairly and responsibly. It achieves this through a combination of measures: reducing excessive subsidies to the insurance industry and pharmaceutical companies; reforms to slow the growth of health care costs; requiring individuals, employers, and government to share responsibility for obtaining or providing coverage; and proposing a progressive tax on the richest 1.3 percent of Americans for a total tax increase that is far less than the amount this group received from the Bush Administration’s tax cuts for the 2001-2010 period.

Wishing My Health Policy Work Weren't So Terribly Relevant

by Julia Kaye, Health Policy Analyst, 
National Women's Law Center 

Last night, I was sitting in my dining room chatting with a friend about an obscure philosophical text he’d read for his Master’s program.  My roommate, who’d been busy cooking us (a delicious) dinner in the kitchen, ran in – oven mitts on – unable to contain himself any longer.  It seems he’d written his undergraduate thesis on this very concept and had had few opportunities to discuss it in the decade since.

I envied his excitement.  I’m becoming increasingly familiar with the experience of having one’s professional/academic life become profoundly relevant to the topic at hand while at a social gathering.  Indeed, I find myself putting on my health policy hat more and more often.  It’s not a good thing. 

Last Friday, a friend confided in me that her boyfriend badly needed to go to the doctor and dentist for a check-up—it had been years, and he had some health concerns—but could only afford a plan with a terribly high deductible, and didn’t have the cash to pay for the visits.  A few weeks earlier, in another, “You-do-realize-that-this-is-what-I-do-for-a-living, right?-yes-of-course-I’m-interested” moment, I learned over dinner and drinks that another friend of mine was uninsured.  She works as a waitress and doesn’t have benefits.  Unsurprisingly, she can’t find anything affordable in the individual health insurance market, so she tries to stay healthy and hopes for the best—and has her cousins bring her birth control whenever they come visit from Spain, where you don’t need a prescription.

BREAKING: President Obama Makes Clear That Health Care Reform Must Include Critical Insurance Market Reforms (Which are Particularly Important for Women!)

by Julia Kaye, Health Policy Associate, 
National Women's Law Center    

At a health reform town-hall this morning in Raleigh, N.C., President Obama made clear that health care reform will mean increased security and stability of health coverage for all Americans, including those that already have health insurance.  It will achieve this, in part, by imposing critical insurance market reforms to make health insurance more fair and affordable and thus improve Americans’ health and financial security.  The President identified eight specific consumer protections that Americans can expect—and must demand—to be included in health care reform.  These consumer protections affect all of us, whether or not we’re currently insured.  And for many women in particular, these reforms mean the difference between accessing and maintaining affordable, high-quality health insurance—or going without: