Why the LGBTQ Community Should Be Worried About Trump’s Gag Rule

Cross-posted with permission from Truthout.

The Trump administration is coming after your local family planning clinic. You might have been there recently—maybe it was a Planned Parenthood health center, your local health department or an independent clinic. It’s a place that teens and others can go to get affordable birth control and other kinds of health care services, like screenings for cancer or sexually transmitted infections (STIs).

One reason those places can afford to provide free or low-cost care is a federal program called Title X. Since the early 1970s, the program has given money to clinics and health departments around the country so they can provide family planning services to people with lower incomes. The law creating the program specified that the funds could not be used to pay for abortion care, but sites that provide both family planning and abortion have always been able to receive Title X funds—as long as they only use them for contraception and not abortion.

So what’s the problem? Well, Trump and the people he has put in charge of federal agencies don’t like abortion. Now they’re trying to make it impossible for family planning clinics to get Title X money if they continue to provide abortion care—even though abortions are paid for using entirely different money. They have changed the rules to make these health clinics either stop providing abortion, or give up their Title X money. For many facilities, losing Title X funding would mean closing their doors altogether.

But that’s not all. The new Trump rules also say that doctors and nurses who work in Title X clinics must steer patients seeking abortions toward childbirth instead. If a patient is pregnant and wants an abortion, the doctors must provide information on prenatal care. If the patient asks for a referral to go somewhere to get an abortion, the health care providers can’t comply. Instead, they can only give patients a list of other health care providers without telling them which of those places actually do provide abortion care.

If that sounds like it doesn’t make sense it’s because it doesn’t. This is why people are calling the new regulation the “gag rule”—it restricts open and honest communication between patients and providers. Planned Parenthood, which up until now has served 40 percent of Title X patients, announced this week that it would withdraw from the program entirely rather than tell its providers to compromise their medical ethics.

Five different lawsuits have been filed to stop these harmful new rules from going into effect. My organization, the National Center for Lesbian Rights, joined by 13 other national LGBTQ organizations, has been filing “friend-of-the-court” briefs in all of these cases to help the courts understand the true extent of the harm that would result if the new rules are allowed to stand, including harm to LGBTQ people.

Why would the new Trump rules for the Title X program hurt queer people? Because many within the LGBTQ community—including lesbian and bisexual women, as well as transgender, nonbinary and gender nonconforming individuals—can become pregnant and need affordable access to birth control, treatment for STIs to preserve future fertility and other reproductive health options.

Not only that, but in recent years, many reproductive health care providers—like Title X clinics—have filled a critical gap in the provision of health care to the LGBTQ community. These clinics have created welcoming spaces and health care services designed to serve LGBTQ people, who otherwise face a lot of discrimination in the health care system.

These clinics are particularly well suited to provide LGBTQ care because of their expertise in providing services that are still stigmatized, such as abortion, contraception, and screening and treatment for STIs. In other words, they get it—they’ve been doing the hard stuff in health care for years and have no problem seeing a trans guy who needs a pap smear and birth control pills, or a non-binary kid who doesn’t want to have to explain why “they” and “their” are their preferred pronouns.

So, while Trump and his cronies want to punish Title X sites that provide abortion care, for many of these facilities, it is the very fact that they do provide abortion that led them to embrace LBGTQ care in the first place. Providers of abortion care recognize that those who defy gender norms and face mistreatment in the health care system need competent, affirming services from practitioners who understand what they’re going through.

If the new Trump rules for the Title X program are allowed to go into effect, it will devastate the Title X program, as many providers will just leave so they don’t have to lie to their patients or stop providing abortion care. This means that not only will there be fewer family planning services, but queer kids who rely on places like Planned Parenthood and other Title X facilities will lose their only source of non-judgmental care.

Congress and the courts are now getting involved, and there will be opportunities for you to speak up and stand up for Title X. So keep an eye out on social media for these hashtags: #SaveTitleX and #ProtectX. The Title X program is too important to all of us to let it be co-opted for ideological reasons at the expense of the people it was designed to serve.

Copyright, Truthout.org.

Everything You Need to Know About the Helms Amendment’s Restriction on Abortion Funding

Abortion rights are a high-profile issue for Democrats on the 2020 presidential campaign trail. Candidates have stated their opposition to abortion funding restrictions like the Hyde Amendment and the Trump administration’s expanded global “gag rule.” But little attention has been paid in the race or the media to the Helms Amendment, a ban on foreign assistance funding for abortion.

Rewire.News asked the 2020 candidates about their stance on the anti-choice policy; ten thus far say they oppose it. The Helms Amendment—named for its sponsor, the late-Sen. Jesse Helms (R-NC)—states, “No foreign assistance funds may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions.” The abortion funding ban was passed as part of the Foreign Assistance Act in 1973 in the aftermath of the U.S. Supreme Court’s decision in Roe v. Wade legalizing abortion in the United States.

“In effect, it’s a ban on abortion services, referrals, information—really basically talking about anything about abortion, equipment that can be used for abortion—for any U.S. funding for all of those types of things,” explained Patty Skuster, senior legal advisor at Ipas, an international nonprofit organization that seeks to expand access to contraceptive and abortion care.

Research shows the vast negative effect the Helms Amendment has had on access to reproductive health care abroad. A report published by Ipas and Ibis Reproductive Health in 2016 found that the anti-choice restriction “has tied the hands of government officials, U.S.-funded grantees, and reproductive health providers working to ensure access to comprehensive reproductive health care for women overseas.”

“The blanket ban application of the law by U.S. government officials has led to the avoidance of abortion-related service provision, information and counseling; censorship; and reduced access to life-saving equipment and supplies,” the report explained.

“Around the globe, governments have been taking steps to make safe abortion more accessible through programs, policy change, legal reform—over 40 countries since the ’90s have changed laws and policies to make abortion more available,” Skuster said. “The United States is the largest government funder of reproductive health services in the world, and by carving out abortion through the Helms Amendment, the U.S. curtails abortion access for women who actually have the legal right to abortion.”

The Helms Amendment vs. the Global ‘Gag Rule’

Helms is easy to confuse with the Trump administration’s expanded global “gag rule,” also known as the “Mexico City Policy,” a policy implemented by the president on his first day in office banning U.S. global health assistance from going to foreign nongovernmental organizations that perform or refer patients for abortion care. But it differs from the policy in key ways.

To start, the global gag rule is a restriction on eligibility for funding—meaning who is able to apply for it—while Helms is a prohibition on the spending of funds. The Helms Amendment specifically “restricts what gets done with U.S. funding,” said Brian Dixon, senior vice president at Population Connection Action Fund. The global gag rule, meanwhile, “goes further and bars any global health assistance to any organization that uses other non-U.S. funds to provide or support legal safe abortion in their own countries.” The gag rule “ties funding to what organizations are doing with privately raised money or money from other governments, including their own.”

The funding restrictions also apply to different institutions, according to analysis from PAI, a global organization working on reproductive health and rights issues. Helms applies to other countries’ governments, U.S. nongovernmental organizations (NGOs), foreign NGOs, and multilateral organizations. Trump’s global gag rule applies to only foreign NGOs receiving U.S. funding for global health assistance.

Another difference: The gag rule is issued through the executive branch and has historically been rescinded by Democratic presidential administrations, whereas Helms remains permanent law—meaning Congress must repeal it, though presidents can clarify its enforcement.

But the two restrictions do have some things in common, according to Dixon: “They’re both terrible.”

“They both are designed to restrict access to safe abortion in parts of the world where unsafe abortion remains a pretty serious public health crisis,” he said.

Since its implementation, reproductive health and rights advocates say the Helms Amendment has been enforced in an unnecessarily broad manner. During the Obama administration, advocates urged the president to clarify that the restriction allowed funding for abortion in cases of rape, incest, and life endangerment, arguing that no language in the amendment itself precludes that funding.

Those groups weren’t alone in their calls for action. Democratic members of Congress also urged the administration to act. That included several of the U.S. senators running for the 2020 presidential nomination—such as Sens. Kirsten Gillibrand (D-NY), Michael Bennet (D-CO), Cory Booker (D-NJ), Elizabeth Warren (D-MA), Amy Klobuchar (D-MN), and Bernie Sanders (I-VT)—who signed on to a 2015 letter asking Obama to “take action to correct the overly constrained implementation of the Helms Amendment.”

The senators sent the letter in response to what they described as the “increased use of rape as a tool of warfare,” including by Boko Haram. The letter said the Helms Amendment’s enforcement “serves as a critical barrier to safe abortion, particularly impacting women and girls fleeing conflict.”

U.S. Reps. Beto O’Rourke (D-TX) and Tim Ryan (D-OH), who are also running for the Democratic presidential nomination, signed onto a similar letter sent to the president by House Democrats.

But the Democratic administration never took action on the matter, and nothing changed.

“Administrations of all parties have enforced this as [meaning] no foreign assistance funds can be used for abortion under any circumstances,” Dixon said. “It’s a bad law, badly enforced.”

Looking Forward: Helms as a 2020 Issue

Though candidates’ positions on the Helms Amendment hasn’t been a visible campaign issue so far in the 2020 presidential race, ten candidates running for the Democratic presidential nomination told Rewire.News they supported ending it. Sens. Elizabeth Warren (D-MA), Cory Booker (D-NJ), Kirsten Gillibrand (D-NY), Bernie Sanders (I-VT) as well as Rep. Beto O’Rourke, Julián Castro, Marianne Williamson, Andrew Yang, and Tom Steyer all oppose the policy. Washington Gov. Jay Inslee also said he opposed Helms, but has since dropped out of the race.

During the 2016 elections, Helms received significantly more attention. Democratic presidential contenders Hillary Clinton and Sanders both said they opposed the policy amid pressure from advocacy groups, and the official party platform included support for ending Helms for the first time that election cycle.

Ending the Helms Amendment is still a key priority for advocates. A coalition of nearly 80 reproductive health, rights, and justice organizations released a blueprint in July that included abolishing the restriction.

“Unsafe abortion is a global health crisis driven by criminalization of the procedure and an inability to access safe abortion care,” the blueprint says. “Annually, there are more than 25 million unsafe abortions worldwide that lead to millions of injuries and tens of thousands of preventable maternal deaths. The Helms Amendment exacerbates this crisis, and it is long past time for the U.S. to support safe abortion services.”

The blueprint calls on federal lawmakers to take action. The groups urge Congress to pass legislation repealing the Helms Amendment and to “replace it with [an] endorsement of using U.S. funding for safe abortion services worldwide.” The groups also urge the president to “champion” Helms’ repeal and work with Congress to do so while simultaneously seeking “to mitigate the harms of the Helms Amendment.”

Jonathan Rucks, senior director of policy and advocacy at PAI, told Rewire.News that ending the Helms Amendment was included in the blueprint “with the very clear understanding that the Helms Amendment, just like the Hyde Amendment,” which bans federal funding for abortion domestically, “disproportionately affect[s] young poor women of color across the United States and around the globe—underscoring how dangerous those types of restrictions are.”

Rucks said he believes the Helms Amendment has gotten less attention than some other abortion restrictions because candidates tend to speak “to their base” about the issues that affect them most directly. “I think that there’s still work for us to do as an advocate community to make those connections,” he said. “The same challenges that women and girls experience here as a result of the Hyde Amendment are the challenges that women and girls are experiencing in countries around the world as a result of the Helms Amendment.”

“Governments around the world are grappling with high rates of maternal mortality from unsafe abortion and also recognizing that abortion services are not only health care but also a human right,” said Skuster when asked why candidates should address the Helms Amendment. “We really need to change our foreign policy to really join the rest of the world in this regard. And, candidates absolutely should make abortion funding a priority for their campaigns.”

Dixon told Rewire.News that the Population Connection Action Fund would like “all of the Democrats [running for president] to take that stand” against the Helms Amendment. In the 2016 election cycle, the organization sent activists and organizers to speak with candidates about the issue and were ultimately successful in getting their positions on the record. Dixon said Sanders had already reiterated his stance from 2016 and that the organization would “try to get the rest of [the presidential candidates] to make the same kind of pledge.”

It is an issue that deserves more attention, Ruck said. “If we want to ensure that women and girls, not just in the [United States] but globally, have full autonomy and access to sexual and reproductive health services, harmful policies like the Helms Amendment need to go away.”

How a Mother in Sanctuary Became the Center of ICE’s ‘Crackdown on U Visas’

Carmela Apolonio Hernandez doesn’t like tension. Any altercation, disagreement, or confrontation makes her “blood run cold,” she said. It’s rooted in a violent past. The asylum seeker fled Mexico in August 2015 after her brother and nephew were murdered by narco-traffickers for refusing to pay “taxes” on their businesses to local gangs. The gang members eventually came for Apolonio Hernandez, prompting her to flee with her four children to the United States, where she would eventually settle in Vineland, New Jersey. But a terrifying interaction with a man less than two years after her migration dashed any hopes Apolonio Hernandez had for safety, and it placed her at the center of what attorneys close to the situation are calling an unprecedented investigation into the federal U visa program.

Apolonio Hernandez, 37, spoke to Rewire.News in May with the help of an interpreter in the Germantown Mennonite Church, the second Philadelphia church she has taken sanctuary in since December 2017. Like other immigrants with final orders of removal, Apolonio Hernandez and her children were forced to take sanctuary under the Trump administration after the Board of Immigration Appeals denied the appeal for her asylum case and Immigration and Customs Enforcement (ICE) gave her a deadline to leave the country.

While in sanctuary, Apolonio Hernandez’s attorney, David Bennion, helped her petition for a U visa based on her experience in Vineland. U visas are for undocumented migrants who assist law enforcement or government officials in the investigation or prosecution of criminal activity, and must be signed by an authorized official who can confirm their cooperation with the case. The law enforcement official who certified Apolonio Hernandez’s U visa was Edwin Alicea, Vineland’s public safety director and the top civilian administrative official for the local police department. This role allows Alicea to certify U visas along with Vineland Police Chief Rudolph Beu.

Everything with Apolonio Hernandez’s application seemed to be going as planned until news broke in February that federal agents with the Department of Homeland Security (DHS) had raided Alicea’s home office as part of a probe into fraudulent U visa certifications. What wasn’t reported at the time: It was Apolonio Hernandez’s certification that put Alicea in DHS’ crosshairs, according to local attorneys who have spoken multiple times to the public safety director about the investigation against him.

Apolonio Hernandez’s ongoing fight for a U visa and the investigation into Alicea have created a domino effect that could have widespread consequences for the federal U visa program, the only hope for many immigrant victims of violence. The U visa program is already facing severe backlogs and processing delays because of current restrictions on the number of applications approved per year: As of March, there are at least 239,933 pending cases.

Immigration attorney Kerry Hartington told Rewire.News she is “100 percent certain ICE is coming down on Alicea like a ton of bricks” because he certified Apolonio Hernandez’s U visa. ICE said it could not comment on an ongoing investigation. But the immigration agency has already targeted migrants in sanctuary through steep fines and collaboration with U.S. Citizenship and Immigration Services (USCIS), as Rewire.News has reported.

Hartington is one of a few immigration attorneys working in Vineland, and her work is directly affected by ICE’s investigation of Alicea. She said she has at least 13 U visa clients who were certified by the director of public safety, and she is concerned their applications may now be called into question.

ICE officials have long criticized the U visa program and warned they would restrict it in some way. Hartington said that in the fall of 2018, ICE authorities told her they were going to “crack down on U visas” at a liaison meeting between the federal agency and the New Jersey chapter of the American Immigration Lawyers Association.

“They expressed great skepticism about the U visa program very openly in front of a room full of lawyers,” Hartington said. “They said most claims were fraudulent. I’m not joking. They really said most claims were ‘a scam’ and they were going to begin looking into them.”

Hartington sees what has happened to Alicea as ICE’s “test case,” and warns of similar investigations occurring in other regions. “There is nothing sketchy or underhanded about him or the way he has handled cases,” she said. “Every one of these cases 100 percent meets the criteria for a U visa.”

What Happened in Vineland

Apolonio Hernandez’s ordeal with the U visa program began in the spring of 2017. She was home alone—a rarity in the house she shared with her children, husband, and another family—when there was a knock on the door. It was a man who couldn’t really speak Spanish, her only language, but managed to communicate that he had found a check and wanted money in exchange for returning it. The check apparently had “blown out of the mailbox” next to her door.

“He gave me [the mail], but I told him—I was very honest with him—I said, ‘Look, I don’t have any money. I can’t give you any money for this,’” Apolonio Hernandez told Rewire.News through an interpreter. “I closed the door and he became very angry, he started to pound on the door. It sounded like the door was going to break. He kept yelling at me to give him the check back because he said … it was his to keep unless I gave him money.”

The man remained outside the home “for a while,” Apolonio Hernandez said, yelling, cursing, and pounding on the door. She took a few pictures of him through a window, but other than that she didn’t know what to do. She was afraid to call the police due to being an enforcement priority as a newly arrived immigrant. She hid behind the couch in the living room and made a video call to her husband, who convinced her to call the police.

The police dispatcher “kept asking all of these questions as the man was banging on the door,” Apolonio Hernandez said. “I finally said, ‘Please just come right away. I’ll tell you everything you want to know when you get here.’”

Apolonio Hernandez told Rewire.News it took the police 20 minutes to get to her home. By the time they arrived, the man had left. Apolonio Hernandez showed the officers the pictures she took and the check addressed to someone at the house. The police wrote up a report and left. But the man returned later that afternoon. The house was full this time, but Apolonio Hernandez said she was still terrified. Her legs cramped up, she said, and she felt like she was going to throw up.

The man began banging on the door again. Apolonio Hernandez called the police, and again they showed up too late.

The man didn’t return, but Apolonio Hernandez lived in a perpetual state of fear. She lectured her young children about what to do if he returned when she wasn’t home, and she called them constantly when they were home while she was at work.

“I would tell my children to look around always, and not to open the door for anyone,” Apolonio Hernandez said. “I was afraid he would hurt my children when they were walking home from the bus stop because he knew where we lived; he knew our address.”

Apolonio Hernandez insisted on walking her son in special education up to his bus, which pulled up in front of the house, but he became annoyed with her. “He said he was too big for me to walk him to the bus. But I was so scared; I needed to make sure he got on the bus.”

Shortly after that experience, Apolonio Hernandez entered sanctuary in Philadelphia. She had outstayed a previous deportation order and was quickly targeted as a priority under the Trump administration.

While in sanctuary, her attorney prepared the lengthy paperwork for her U visa application, as extortion is one of the qualifying criminal activities for the program. Alicea certified Apolonio Hernandez’s U visa application in mid-February 2018, and Bennion sent it off for processing in March, along with a request for expedited processing and prima facie determination from USCIS. Prima facie determination, which Apolonio Hernandez received, essentially means that all of the elements required for the U visa petition are present and USCIS doesn’t need anything else to make its decision. This determination typically allows ICE to grant the U visa applicant a stay of removal.

ICE denied Bennion’s initial request for a stay for Apolonio Hernandez, filed in February. In August 2018, ICE instructed Bennion to file for a new stay of removal, which the attorney took as “a favorable sign,” especially since it would override the removal order against Apolonio Hernandez. He filed it on August 20, but seven days later the federal immigration agency denied the request.

In September, Bennion said he received a call from Apolonio Hernandez’s deportation officer, who asked about Alicea and requested a copy of Apolonio Hernandez’s U visa packet. Bennion did as he was instructed, hoping ICE was requesting additional information to reconsider Apolonio Hernandez’s stay of removal. But he was wrong.

“The Lady in the Church”

When Apolonio Hernandez’s deportation officer contacted Bennion in September 2018 for more information related to her U visa and potential stay, it seems the investigation into Alicea was already building. In October, Hartington said officials from three different agencies sat down for a meeting with Alicea prior to raiding his home in January⁠—and it wasn’t friendly.

Richard Tonetta, Vineland’s solicitor, told Rewire.News that Alicea would not comment on this story. But Hartington and another Vineland immigration attorney, Elizabeth Trinidad, who said they spoke to Alicea around the time of his meeting and after the raid on his home, confirmed that they believe the attacks on the safety director are directly related to Apolonio Hernandez, based on what Alicea told each of them about the details of the meeting.

“When federal officials met with Alicea, they said it was ‘about the lady in the church,’” Trinidad said, referring to Apolonio Hernandez and describing what Alicea told her after the meeting. “They called into question Alicea’s certification, and implied it was fraudulent. They said awful things to him; they asked him if immigration attorneys were paying him or bribing him to sign off on U visa certifications. That is so deeply offensive.”

This was echoed by Hartington, who told Rewire.News that she spoke on the phone with Alicea after federal officials requested the meeting and then after the meeting took place. Alicea told her that three people from different agencies met with him, including an anti-terorrism task force, ICE, and ICE’s Homeland Security Investigations (HSI) arm.

“They told him he should have representation because they were not his friends. They implied he was taking money, and they specifically asked about Carmela. Her name was referenced in the meeting. I know for sure she is what triggered this whole thing,” Hartington said.

“Total Overreach”

A local news outlet broke the story that DHS raided Alicea’s home office on January 31. Federal agents with HSI seized his personal computers and other equipment as part of its investigation into whether Alicea fraudulently certified U visa applications for immigrants. Tonetta told Rewire.News in a statement Wednesday that the Vineland Police Department has not been advised “on what, if anything, ICE HSI is doing or not doing regarding the ‘investigation.’” But Tonetta did report that federal authorities “have almost completed” their review of the content of the electronics removed from Alicea’s possession and have returned “most” to the public safety director.

“The unfortunate circumstance is that if ICE would have requested any item or document, the City would have gladly complied without the need for any ‘raid,’” Tonetta told Rewire.News. “The City’s Administration is transparent and has nothing to hide, especially in light of the fact that all U-Visa certifications are reviewed and approved by ICE HSI and those agencies have the right to reject any U-Visas they believe to be non-compliant. None have ever been rejected.”

The local legal community saw the raid as “a total overreach in authority,” Hartington said, “and it’s something none of us have seen before. Everyone I talk to⁠—advocates, attorneys, law enforcement⁠—is shocked.”

Like Hartingon, Elizabeth Trinidad represents immigrants in Vineland. She too is familiar with Alicea because he certified her immigrant clients’ U visa petitions, some of which are still pending.

Trinidad told Rewire.News it’s important to remember that the U visa was “literally created” to benefit law enforcement and prosecutors. “This is not like DACA, fought for by a grassroots movement of people who came here as children and bleeding-heart liberals,” she said. “By stark contrast, the U visa came about out of the concerns of police chiefs and prosecutors across the country who invested precious time and resources building a case against a perpetrator, only to have it fall apart because the victim or witness was afraid of getting deported.”

This was echoed by Tonetta, who characterized U visas as a “valuable tool” in the investigation and apprehension of criminals who target undocumented immigrants with the assumption they are less likely to cooperate with law enforcement for fear of deportation.

“Assistance from victims is a necessary component in bringing perpetrators to justice, which is one of the primary duties of law enforcement,” Tonetta said. “The Vineland Police Department keeps all of the citizens safe by bringing criminals to justice by any legal means available to them.”

Trinidad said that in her experience, ICE views U visas with disdain and members of the agency routinely characterize U visas as a “loophole” that is being “exploited” in conversations with other agency officials, including ICE attorneys.

“Well before they went after Alicea, I can’t tell you how many conversations I’ve had with ICE officials where they make snarky, cynical comments about U visa clients and U visa laws and protections,” Trinidad said, noting that she began taking U visa cases in 2004, four years after the Victims of Trafficking and Violence Protection Act was signed into law. “There is a history of hostility.”

“All Hell Has Broken Loose”

Attorneys who spoke to Rewire.News worry the investigation into Alicea will have far-reaching implications for their clients, as they have witnessed with previous cases.

For example, a 2013 indictment involving fraudulent Violence Against Women Act (VAWA) cases affected some of Hartington’s clients. According to the complaint, paralegal Maria James began working with New Jersey attorney Jeffery Krain in 2004 to file the fraudulent cases. James found U.S. citizens to marry immigrants and helped concoct fake stories of abuse to get immigrant clients VAWA. It was “100 percent fraud,” Hartington said.

At an April 2011 meeting with HSI officials investigating James and Krain, Hartington was surprised to see HSI had pulled not just the cases of confirmed victims, but all of the VAWA cases filed by Krain over the last several years, including people who had already become U.S. citizens. This is why Hartington said she’s “almost certain” that HSI has reviewed all the files for her clients who have had certifications signed by Alicea. At a minimum, she said, this “sham investigation” into Alicea will delay her clients’ U visa processing times, some of which have already been pending since 2014. The worst-case scenario is that federal authorities will revoke certifications by Alicea that successfully led to clients obtaining U visas. Either way, the attorney believes it will be bad.

The repercussions could extend beyond applicants and affect the number of officers certifying visas. Trinidad, Hartington, and Bennion said this type of investigation will likely discourage law enforcement officers from certifying U visas—not just in New Jersey, but around the country. “This is law enforcement going after their own,” Bennion said.

The chilling effect may be the point. If the immigration attorneys are correct about the investigation into Alicea being an attack on Apolonio Hernandez and U visas more broadly, it’s a perversion of law enforcement for political purposes. It’s also an incredibly effective tactic for scaring small city and county agencies out of certifying U visas. Why would a small law enforcement agency continue certifying U visas if it meant potentially having the full force of the federal government on their backs?

The general consensus among the immigration attorneys is that if ICE could do this to Alicea, the agency could “do it to anyone.” Indeed, Alicea is an unlikely candidate for such an investigation. He has all of the characteristics of a “friend” of federal immigration agencies working under the Trump administration. The staunch Republican is a former Marine, a former police officer, and even now as Vineland’s director of public safety—a position he still holds, since he has not been prosecuted—he is an instructor at a police academy and an adjunct professor at two colleges where he teaches subjects directly related to DHS, including domestic and international terrorism.

Tonetta told Rewire.News that as a “retired Lieutenant from the Glassboro Police Department and United States Marines,” Alicea is “always ready, willing and able to cooperate and assist with any proper law enforcement activity.”

The fact that ICE succeeded at getting a judge or federal magistrate to approve a warrant in this matter is alarming, Trinidad said.

“It seems like a lot of people have come together … to make an example of Edwin Alicea,” Trinidad said. “People need to be really concerned about this, about the lengths ICE is willing to go to silence a critic or someone fighting back. Because let’s not forget, this isn’t really about Alicea. This is about Carmela. She has spoken out, she’s fought back, she’s entered sanctuary, and now all hell has broken loose.”

More of the Same Anti-Immigrant Agenda

Although this story may be about Apolonio Hernandez, it’s also about the deep suspicion with which the Trump administration treats any humanitarian remedy. Administrative officials have gone to great lengths to limit or eliminate humanitarian programs and immigration benefits, including Temporary Protected Status, Deferred Action for Childhood Arrivals, VAWA applications, asylum designations, refugee programs, and now U visas.

In short, Trump’s immigration officials have regularly positioned these benefits as “loopholes” immigrants take advantage of. Raiding churches and dragging immigrant families out of sanctuary would lead to a “public uproar,” Bennion said, so the agency has had to find other ways to target asylum seekers in sanctuary. For Apolonio Hernandez, this has involved ICE blocking her ability to obtain a U visa.

Apolonio Hernandez told Rewire.News she feels bad about what ICE is doing to Alicea, and the ways it may harm his job, his reputation, and his future. She said that if she could talk to Alicea, she would tell him that it’s not his fault he’s being attacked and that he did nothing wrong.

“I understand what he is going through,” she said. “I haven’t done anything wrong either. I have committed no crime. There is nothing to investigate, but that won’t stop them.”

These 2020 Democrats Support Repealing the Helms Amendment’s Ban on Foreign Assistance Funding for Abortion

At least ten Democrats vying for the 2020 Democratic nomination have come out in opposition to the Helms Amendment, a ban on using foreign assistance funds for abortion.

The U.S. Congress passed the Helms Amendment in 1973 as part of the Foreign Assistance Act in the wake of the U.S. Supreme Court’s landmark decision in Roe v. Wade legalizing abortion in the United States. It states, “No foreign assistance funds may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions.” Though no language in the amendment specifies doing so, the ban has long been enforced without exceptions for rape, incest, and life endangerment—leaving those facing sexual violence in conflict zones especially vulnerable.

Discussion of the Helms Amendment hasn’t bubbled up much this election cycle, but it was a topic of discussion in the 2016 race. In that election cycle, eventual nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) voiced their opposition to Helms during the primary, while the Democratic Party’s official platform for the first time included ending the Helms Amendment.

This time around, the issue of foreign aid funding bans on abortion hasn’t gone entirely undiscussed. Rebecca Traister reported in The Cut in March that in 1981, Joe Biden introduced a measure “prohibiting foreign aid to be used in any biomedical research related to abortion.” Biden’s campaign didn’t respond to Rewire.News about his stance on the Helms Amendment—but the 2020 campaigns of ten other Democrats running for president did.

Spokespeople for the campaigns of Sens. Elizabeth Warren (D-MA), Kirsten Gillibrand (D-NY), and Cory Booker (D-NJ), as well as entrepreneur Andrew Yang, confirmed to Rewire.News that the candidates opposed the Helms Amendment. Other campaigns specified their stances and how they factored into their platform on reproductive rights.

The campaign for Sen. Bernie Sanders (I-VT) in a statement doubled down on Sanders’ promise to work with Congress to end Helms permanently and stated that he would sign an executive order allowing for U.S. foreign aid to fund abortion services.

“Sen. Sanders believes health care is a human right, and reproductive care, including the right to abortion, is a fundamental part of health care,” a campaign spokesperson said. “As president, he will repeal the Trump administration’s global gag rule, which is a disgraceful assault on women’s rights, and sign an executive order to allow for U.S. foreign aid to pay for abortions services. He will also work with Congress to permanently repeal both the Hyde and Helms amendments.”

Washington Gov. Jay Inslee’s presidential campaign also noted that Inslee would take executive action on Helms. “Governor Inslee believes that all women should have access to abortion and reproductive health care. As such, he opposes the Helms Amendment and its ban on the provision of abortion and reproductive care in foreign assistance funding,” a spokesperson said. “Governor Inslee would exercise executive authority to relieve the burden created by the Helms Amendment, and would aim to repeal it along with the Hyde Amendment.”

Marianne Williamson also vowed to take prompt action to address Helms. “I would immediately give an interpretation of the Helms Amendment to include exceptions for situations outside of family planning—namely for rape, incest, and a threat to the woman’s life. I would work to completely overturn the ban in Congress,” she said in a statement.”

A spokesperson for former Rep. Beto O’Rourke’s presidential campaign said, “Beto supports the repeal of the Helms Amendment to ensure the United States government does not stand between women and the access to the health care they need. As president, Beto would allow organizations that receive federal U.S. financial aid to both offer information on, and provide comprehensive, reproductive health care, including abortion.”

A spokesperson for Julián Castro’s campaign said that the former U.S. Housing and Urban Development secretary supported repealing Helms but didn’t specify how he would address the issue. “Secretary Castro supports both repealing the Helms Amendment that restricts foreign assistance funding for a full range of family planning services, including abortion, and rescinding the global gag rule/Mexico City policy, which makes organizations that conduct such activities ineligible for U.S. foreign assistance funding for family planning,” the spokesperson said.

The campaign of billionaire Tom Steyer, who launched his presidential bid last month, noted his opposition to Helms as well. “Tom opposes all attempts to deny women health care services, including the Helms Amendment,” a campaign spokesperson said. “Tom’s Five Rights Plan includes the Right to Health, and reproductive health services are absolutely key health care services for women around the world…We must support women around the globe not make their health care choices for them.”

Fired for Being Transgender or for Violating Company Dress Code? The Supreme Court Will Decide.

On Friday, the Trump administration told the U.S. Supreme Court that federal employment anti-discrimination laws do not protect LGBTQ workers. This fall, the justices will hear a trio of cases on the matter and decide whether they agree.

The administration made the arguments in a brief filed in one of those three cases: that of Aimee Stephens, a transgender Michigan funeral director who was fired once she came out at work. Stephens had been a funeral director for Harris Funeral Homes from 2008 until 2013, when she told her supervisor, funeral home owner Thomas Rost, that she had gender identity disorder and would begin transitioning at work. In response, Rost fired Stephens, saying that things “were not going to work out” if she intended to “no longer represent [herself] as a man.”

Stephens then filed a complaint with the Equal Employment Opportunity Commission (EEOC), alleging Harris Funeral Homes and Rost had violated Title VII of the Civil Rights Act’s prohibition on sex-based discrimination by firing her. A lower court initially ruled in favor of Harris Funeral Homes, but the Sixth Circuit Court of Appeals reversed that decision and held that the federal anti-employment discrimination law protects workers from being fired because they are transgender.

On Friday, the U.S. Department of Justice (DOJ) told the Roberts Court that the Sixth Circuit was wrong.

The EEOC was initially pursuing the charge on Stephens’ behalf, but that changed once Donald Trump became president. Headed by Trump appointee Janet Dhillon, the agency—which helped shape pro-LGBTQ worker policy—is still a party in the case. But the DOJ represents the agency before the Supreme Court. And given that the DOJ is now openly hostile to civil rights and has taken the position that federal law does not protect workers like Stephens, the American Civil Liberties Union has taken over her case. The rift between the two agencies became more apparent Friday, when the DOJ filed its brief without a single EEOC attorney joining, despite reported pressure to do so.

It is not surprising that the DOJ is arguing federal law does not protect transgender employees. In October 2017, then-Attorney General Jeff Sessions reversed an Obama-era federal guidance declaring Title VII’s ban on sex-based discrimination includes discrimination on the basis of gender identity. But Friday’s filing takes that one step further: It asks the Supreme Court for a sweeping ruling enshrining the reversal into federal civil rights jurisprudence.

“Title VII does not prohibit discrimination against transgender persons based on their transgender status,” the DOJ’s brief states. “It simply does not speak to discrimination because of an individual’s gender identity or a disconnect between an individual’s gender identity and the individual’s sex.”

Instead, the administration argues, “Title VII prohibits treating an individual less favorably than similarly situated individuals of the opposite sex.”

In defending Stephens’ termination, the DOJ claims Stephens wasn’t fired for being transgender, but for failing to abide by her employers’ dress code policy. “Harris Homes did not discriminate against Stephens based on sex stereotypes in violation of Title VII,” the brief continues. “It terminated Stephens for refusing to comply with Harris Homes’ sex-specific dress code.”

The administration goes on to argue that Harris Funeral Homes’ dress code is nondiscriminatory because it “burdens men and women equally.”

This regressive read of federal civil rights laws could bless any number of discriminatory employer policies based on outdated beliefs regarding gender roles.

It’s also an argument that strikes at the heart of civil rights protections for sex-stereotyping and sexual orientation discrimination claims. In siding with Stephens last year, the Sixth Circuit explained “it is analytically impossible to fire an employee based on that employee’s status as a transgender person without being motivated, at least in part, by the employee’s sex.” That logic applies equally to the other two LGBTQ employment rights cases the Court will hear alongside Harris Funeral Homes that seek to answer whether sexual orientation discrimination is also protected under Title VII. The administration’s brief in those cases is due later this week, and it’s fair to expect the administration will argue, again, that the answer is no.

The Court is hearing these cases at a time when the stakes couldn’t be higher for LGBTQ employees. Only 20 states and the District of Columbia have laws that explicitly prohibit discrimination on the basis of sexual orientation and gender identity. Three states—Arkansas, Tennessee, and North Carolina— have laws affirmatively preventing passage and enforcement of local laws and ordinances that would protect LGBTQ employees. But if the Court accepts the Trump administration’s position, the impact would reach all employees. Workplace policies that mandate appearance standards based on an employer’s religious beliefs pertaining to assigned sex at would be perfectly fine, so long as both men and women were expected to adhere to them.

In the late 1980s, Ann Hopkins was denied partnership at her accounting firm for not being “feminine” enough. The Supreme Court would ultimately rule in Hopkins’ favor in 1989, holding for the first time that gender stereotyping is a form of sex discrimination prohibited under Title VII. The Trump administration—and attorneys from the conservative litigation mill Alliance Defending Freedom (ADF) representing Harris Funeral Homes—ultimately want the Court to undo the very notion that it’s wrong for employers to ground their policies and practices in gendered assumptions. This is regressive to the point of dangerous absurdity. It’s a terrible mashup of Mad Men meets The Handmaid’s Tale. But it’s a stance we should expect from an administration that wants the women who work for it to “dress a certain way.”

In 2015, the Supreme Court protected the dignity rights of LGBTQ people by striking down bans on same-sex marriage. This fall, the Court could wipe away much of the meaning of that dignity doctrine by siding with the Trump administration and ADF and erasing LGBTQ workers from protection under Title VII.

The Court hears oral arguments in the cases on October 8.

Planned Parenthood Leaves Title X Amid Trump’s Anti-Choice Restrictions

Planned Parenthood health centers will leave the Title X family planning program rather than comply with the Trump administration’s domestic “gag rule” restrictions, the organization announced Monday.

Planned Parenthood plans to leave the family planning program before the administration’s August 19 deadline for showing “good faith efforts” to comply with the new restrictions. Planned Parenthood gets around $60 million a year from Title X, according to the New York Times.

The $286 million federal family planning program serves around 4 million people with low incomes across the United States.

While Democrats in the U.S. House of Representatives passed a federal spending bill in June that would stop enactment of the domestic gag rule—which bars Title X funds from going to health-care providers who perform or refer patients for abortion services—the provision is unlikely to survive the Republican-controlled Senate or be signed by President Trump.

Planned Parenthood officials, reproductive health-care advocates, and Illinois Gov. J.B. Pritzker (D) denounced the rule’s implementation during a Monday press call. Pritzker, who along with the Illinois legislature has agreed to give state funds to family planning clinics so they don’t have to comply with the anti-choice rules, said immediate congressional action is needed.

“We call on Congress to join our fight to protect women,” Pritzker said. “An attack of this magnitude clearly calls for a federal solution.”

Clinics were informed in mid-July that the U.S. Department of Health and Human Services (HHS) would begin to enforce its ban on federal family planning dollars going to health-care providers that refer patients for abortion care, despite an ongoing legal battle against the anti-choice policy. The administration also announced plans to begin enforcing its requirement that clinics financially separate their Title X-funded services from abortion services. A third part of the gag rule requiring clinics to physically separate those services will go into effect in 2020.

Though Planned Parenthood clinics will operate on “emergency funds” for now, said Acting President and CEO of Planned Parenthood Federation of America Alexis McGill Johnson, the impact of the health-care organization being forced out of Title X will be felt across the United States. In Utah, Planned Parenthood is the only Title X grantee, and it serves 90 percent of Title X patients in Minnesota, she said. “Wait times for appointments will skyrocket and people will delay or go without care,” McGill Johnson said. “This gag rule could mean that we now will see women driving hundreds of miles just to find a provider who could help them access birth control, like an IUD. That’s why we need Congress to act, and to do so now.”

“We’re committed to keeping our doors open for as long as possible,” McGill Johnson added.

McGill Johnson said “lives depend” on the Senate passing a spending bill that stops the Trump administration from enforcing its restrictions on family planning clinics serving those at or below the poverty line.

“I want our patients to know: While the Trump administration may have given up on you, Planned Parenthood never will,” McGill Johnson said. “Our doors are open today, and our doors will be open tomorrow. The Trump administration’s gag rule will reverberate across the country. This reality will hit hardest people struggling to make ends meet—including those people in rural areas and communities of color.”

Jessica Pinckney, vice president for government affairs at In Our Own Voice: National Black Women’s Reproductive Justice Agenda, said Trump’s domestic gag rule would disproportionately affect the health and lives of Black women across the country.

“Every individual should have the right to make informed decisions about their fertility and to plan a family without coercion by the government,” she said on Monday’s press call. “They should be able to plan whether or when to start or add to their families without outside interference, no matter where they seek care and without discrimination.”

Title X funds, Pinckney said, are “crucial to the health of Black women.”

Planned Parenthood officials said the health-care organization would continue monitoring pending lawsuits against the rule, even after the U.S. Court of Appeals for the Ninth Circuit gave the green light to the anti-choice policy and then refused on Friday to grant Planned Parenthood’s request for emergency judicial relief.

Illinois, Maryland, and Washington state have so far stepped in to fund family planning clinics that will withdraw from Title X. The governors of New York and Hawaii have are exploring how to do the same. Meanwhile, Title X funding is already flowing to some anti-choice clinics.

More than 110 public health organizations came out against the proposed family planning restriction in May 2018, calling the rule “nothing less than an effort to eviscerate access to care and information for people with low incomes and underserved populations.”

Native Americans Want More Than Empty Promises From 2020 Democrats

Treaties made between Native Americans and the federal government are part of a distant, hazy past to most people in the United States. Although the federal government signed about 374 treaties with tribes, today’s public discourse seldom mentions the subjects of these agreements. These contracts made with sovereign tribal nations in exchange for vast expanses of Native lands include promises for health care, education, goods, and tools, as well as fishing and hunting rights in ceded territories.

The U.S. government has broken or only partially lived up to many of its treaty agreements. The standout failure has been its chronic underfunding of the Indian Health Service. As I wrote in a 2017 article for Rewire.News, the government has never fully funded the Indian Health Service despite treaty agreements dating back to 1787 promising health care for tribes.

It is these types of broken federal government promises that should lead the discussion during the Native presidential forum Monday and Tuesday at the Orpheum Theatre in Sioux City, Iowa.

Four Directions, a Native voting rights nonprofit organization, organized the Frank LaMere Native American Presidential Forum. LaMere of the Winnebago tribe died earlier this year; he was a longtime and well-known activist in Indian Country and was chairman of the Native American Caucus of the Democratic Party.

Democratic presidential candidates Sens. Elizabeth Warren, Amy Klobuchar, Julian Castro, and Bernie Sanders; author Marianne Williamson; New York City Mayor Bill de Blasio; Montana Gov. Steve Bullock; and former Reps. John Delaney and Joe Sestak have agreed to participate in the forum. Navajo Nation’s Mark Charles, who is running as an independent, will also participate, as well as Democratic Sen. Kamala Harris, who will be joining via video livestream.

The Native American Rights Fund is set to provide livestreaming of the event on its Facebook page, while over 30 media outlets have signed on to cover the event. Indian Country Today will offer extensive coverage as its editor, Mark Trahant, moderates the two-day event. The candidates will face questions from a panel of three Native people, as well as questions from the audience.

Castro and Warren have the most specific and informed policy proposals regarding Native people. Released in July, Castro’s Peoples First Indigenous Communities Policy shows a genuine depth of understanding of the history and needs in Indian Country. For instance, he describes the need to implement the Carcieri fix, an amendment to the U.S. Supreme Court’s 2009 decision in Carcieri v. Salazar that reaffirms the authority of the U.S. secretary of the interior to take land into trust for tribes. He also promises to fully fund the Indian Health Service; work with tribes to ensure they are consulted in federal land-use projects involving Native lands; and repeal the Hyde Amendment, which restricts access to abortion for Native people.

Warren released on Friday an extensive proposal, Honoring Promises to Native Nations Act, based on recommendations from the 2018 U.S. Commission on Human Rights report. Democratic Rep. Deb Haaland of the Laguna Pueblo in New Mexico, who’s one of the first two Native American women to be elected to Congress, helped Warren create the proposal. As Indian Country Today reported, Warren and Haaland’s plan would take federal support for agencies serving Indian Country out of the appropriations process and guarantee ongoing funding.

Both Warren and Castro, like their opponents, have prioritized the problem of missing and murdered indigenous women (MMIW). To that end, both have promised to pass Savanna’s Act, legislation that would improve federal crime data collection regarding MMIW.

Support for Savanna’s Act and MMIW have become popular bully pulpits for politicians in recent years. Not surprisingly, all the other Democratic presidential candidates have made similar statements expressing outrage over the issue and promised to enact legislation. But their support should not be without scrutiny.

As I wrote last year for Rewire.News, Savanna’s Act as introduced by former Democratic Sen. Heidi Heitkamp of North Dakota and co-sponsored by Warren, has little accountability or detailed action items for the federal government, nor does it contain a funding allocation plan. Until a congressional bill funds actual solutions to the issue, nothing will change.

As most Native people know, it’s been a consequence-free open season on our women in this country for a long time. “The MMIW issue is older than America, but 243 years after the colonists’ Declaration of Independence we’re still waiting for the United States Government to address the epidemic,” Lynnette Grey Bull, senior vice president of the Global Indigenous Council, said in a recent press release for Four Directions.

The reality is that, for political candidates, denouncing violence against Native women is a convenient and easy way to take a stand. Indian Country and our collective plights of poverty and other ills are easy pickings for politicians looking for audience roars of support. Real solutions, however, lie a few giant steps upstream from our latest media-hyped “epidemic.”

“Let’s be honest, if the United States had honored their treaties as they were written years ago, we wouldn’t need their assistance,” OJ Semans of the Rosebud Sioux and co-executive director of Four Directions told Indian Country Today.

Article VI of the U.S. Constitution classifies treaties as the supreme law of the land. For Native peoples, this is no idle declaration.

Treaties obligate the United States to fund health care, education, and critical infrastructure in Indian Country; had these obligations been met adequately, it’s possible that issues such as entrenched poverty, high rates of violence against women, and other ills would not have grown to the terrible proportions we see now.

The U.S. Constitution also includes language recognizing the sovereign status of Native peoples. Article 1, section 8 vests the U.S. Congress with the authority to engage in agreements with tribes. And yet few people in the United States understand the relationship between the federal government and tribes is that of sovereign to sovereign nations.

An elder on the Rosebud reservation in South Dakota once described to me his reaction to a non-Native co-worker who complained that treaty rights represented special rights. “I told him if your relatives had negotiated an agreement in which you and your family were promised things like health care, you’d have that document laminated and carry it around in your back pocket in case anyone questioned you,” he said.

“I told him treaties are legally binding agreements negotiated by my relatives,” he added.

Trahant of the Shoshone Bannock Nation and a longtime political wonk noted to me that political grandstanding aside, the presidential forum offers a precious opportunity to elevate Indian Country and our concerns within the national political discourse.

The U.S. people will be reminded that treaties aren’t ancient history, according to Trahant, who during our interview quoted the late U.S. Supreme Court Justice Hugo Black: “Great nations, like great men, should keep their word.”

These States Are Protecting Family Planning Clinics Under Trump’s Domestic ‘Gag Rule’

A handful of states are withdrawing from Title X and replacing the funding so reproductive health clinics won’t have to comply with the Trump administration’s restrictions on the family planning program that serves 4 million low-income patients across the United States.

Meanwhile, Planned Parenthood Federation of America will withdraw its clinics nationwide from Title X if the U.S. Court of Appeals for the Ninth Circuit doesn’t intervene before August 19. The national nonprofit will lose around $60 million by withdrawing from the program, according to the Washington Post.

The restrictions, which went partly into effect in mid-July, ban federal family planning money from going to health-care clinics that refer patients for abortion care. Just a few days later, the administration created confusion by announcing that it “does not intend to bring enforcement actions” against health-care clinics making “good-faith efforts” to comply with the restrictions.

The National Family Planning and Reproductive Health Association called the notice “wholly insufficient.” It said in a statement, “It’s just absurd to think that a few bullet points amount to guidance.” Michelle Kuppersmith, director of Equity Forward, in a statement said the administration’s mixed signals on Title X are “meant to hinder clinics’ ability to operate and encourage health care providers to drop out of the grant program.”

Another domestic “gag rule” restriction that requires clinics maintain physical separation between abortion services and all other health-care services will go into effect next year.

Three states have already stepped in to compensate clinics for the lost federal funding. Officials in other states have said they would assist clinics but haven’t yet clarified their plans. Hawaii Gov. David Ige (D) said in 2018 that the state would reject Title X funding if the administration’s “gag rule” went into effect, and on Friday a spokesperson for the Hawaii State Department of Health said the department is “discussing options and evaluating alternatives for funding services affected by the changes to Title X requirements.” New York Gov. Andrew Cuomo (D) also pledged last year to withdraw from the family planning program if the rule survived court challenges. A spokesperson for the New York State Department of Health told Rewire.News, “We are thoughtfully weighing options that will allow organizations to provide access to critical services without interruption.”

Illinois

Illinois Gov. J.B. Pritzker (D) said July 18 that the state would reject the federal government’s family planning funding, allowing the state’s Title X clinics to continue providing the full spectrum of reproductive health care.

The Illinois Department of Public Health will step in and fund the Title X clinics, which will lose around $2.4 million when the state leaves the program, according to NPR. That money does not include Planned Parenthood of Illinois, which had already announced its plans to reject the Title X dollars. Planned Parenthood served more than 50,000 “female contraceptive patients” in 2015 at its Title X-funded health centers in the state, according to a statement from the organization.

“We will not let that stand in the state of Illinois,” Pritzker said, NPR reported last month. “Under my administration, Illinois will always stand with women and protect their fundamental right to choose. While I’m committed to bringing as many federal dollars to the state as possible, I refuse to sacrifice our values and allow vital care to lapse. In this state, we trust women to make their own health care decisions and will guarantee access to reproductive health care for all of our residents.”

Maryland 

After the administration indicated through its early staffing decisions that it would go after Title X funding, Maryland’s Democratic-held legislature passed a 2017 law to create a state-funded family planning program to help fill any potential gap. Since then, the legislature has continued to support the state’s Title X clinics.

Maryland Democrats passed legislation this year that would fund family planning clinics at the same level as last year despite the state’s loss of federal funding. The move will cost around $4.2 million starting in fiscal year 2021.

The state’s Title X clinics serve more than 67,000 female contraceptive clients, according to 2015 data from the Guttmacher Institute.

“Maryland is very fortunate that our legislators safeguard a woman’s right to access family planning services,” Karen Nelson, CEO of Planned Parenthood of Maryland, told the Associated Press in April. “Our state has to step in far too often to fulfill the responsibility of the federal government.”

Vermont 

Vermont has withdrawn from Title X and will use a contingency fund that the state’s Democratic-majority legislature created for health clinics that rely on federal family planning dollars. The emergency funding will last until the end of June 2020, VTDigger reports.

Complying with the Trump administration’s anti-choice restrictions would violate state law, according to Vermont’s health department. Vermont Gov. Phil Scott (R) has opposed the “gag rule,” saying in an August 19 statement that it’s “important that we maintain women’s rights and access to health care.”

Around 10,000 people in Vermont receive Title X-funded health-care services at ten Planned Parenthood clinics across the state.

“These changes by HHS will disrupt one of our state’s most essential public health programs,” Vermont Health Commissioner Mark Levine said in a statement announcing the state would reject federal funds for Planned Parenthood of Northern New England.

Vermont Attorney General T.J. Donovan in March joined a lawsuit against Trump’s domestic “gag rule.”

“Thousands of low-income Vermonters rely on these funds for their basic healthcare,” Donovan said in a statement after joining the lawsuit. “It’s unreasonable to ask healthcare providers to withhold crucial information from their patients.”

Washington

Washington Gov. Jay Inslee (D) announced in late July that the state would ensure Title X clinics receive state funds, shielding the health-care facilities from complying with the Trump administration’s “gag rule.”

Officials said the state began reimbursing Title X clinics July 15, shortly after the administration started enforcing the restriction. More than half of the people who benefit from Title X funding in Washington state live at or below the poverty line, an Inslee spokesperson told Rewire.News.

Title X funds allowed 18,000 people in Washington state to avoid unintended pregnancies in 2017, according to the state’s lawsuit against the “gag rule.” The lawsuit calls the rule “arbitrary and capricious.”

“It reverses longstanding policies and agency interpretations of Title X with no rational explanation or evidentiary support, backtracks from evidence-backed standards of care included in HHS’s own Program Requirements and guidance, and adds unsupported, illogical, and counterproductive new requirements, while ignoring contrary record evidence and failing to consider the grave public health harms the new requirements will cause,” the lawsuit says.

State officials have been among the most vocal opponents of the restrictions.

“The Trump Administration’s effort to muzzle doctors and keep patients from receiving medically sound care and advice is simply not something we will tolerate in Washington state,” Inslee said in a statement shortly after the Ninth Circuit gave the green light to the rule.

State Attorney General Bob Ferguson called the family planning restrictions “outrageous and unlawful.”

This piece will be updated as more states announce plans to circumvent Trump’s domestic “gag rule.”

Disability Advocates Are Fighting a Dangerous Insurance Policy in the Midwest

It took seven years before Dantia MacDonald was able to get the right treatment for her mental illness.

Up until then, she had experienced persistent paranoia and delusions that led her to believe she wasn’t sick. After multiple hospitalizations, a stint in jail for a nuisance crime, and the loss of her career, MacDonald finally found relief in 2015 when she switched medications. Her symptoms subsided within three days.

This February, the Kansas resident and Medicaid recipient stood before the state senate public health and welfare committee and testified in favor of a bill challenging “step therapy,” a health insurance policy that would require her to try cheaper—and most likely less effective—drugs before she’d be able to take the medicine that actually made her better.

In a letter to the committee, MacDonald wrote that she would essentially lose Medicaid benefits if she married her partner—a heartbreaking reality that many disabled people in relationships face—and his insurance would require her to go through step therapy.

“I could lose another seven years of my life and end up costing the system much more money due to stays in psychiatric hospitals or even jail,” she wrote in the letter.

Step therapy, also known as a “fail-first” protocol, forces people to try and “fail” cheaper drug alternatives as an attempt to cut costs for insurers. But experts say it’s a physically, mentally, and financially exhausting process for patients, who essentially must prove that they actually need the medicine that works best for them.

Step therapy is a fairly common policy for both public and private health insurers. As of 2014, nearly 75 percent of large employers around the country reported offering employees health-care plans that use step therapy protocols, according to the American Journal of Managed Care. It can be complicated and lengthy: One September 2018 analysis by the journal Health Affairs found that, among 1,208 coverage decisions involving step therapy by 17 of the top commercial health insurers, 63 percent of decisions required patients to step through one drug, 37 percent required steps through multiple drugs, and 15 percent included at least three steps.

Although step therapy has an impact nationwide, activists are focusing on Kansas as a potential “target state” in the Midwest to pass step therapy-related reform. Although several neighboring states have passed step therapy-related reform, the state’s political tug-of-war on Medicaid expansion has stalled progress. Among Midwestern states, North Dakota, South Dakota, Michigan, and Nebraska have not established any step therapy reform or protections at all.

In some cases, step therapy does make sense, said Kari Ann Rinker, senior advocacy manager for the National Multiple Sclerosis Society who focuses on policy in Kansas, Missouri, and Oklahoma. For people who need antibiotics or have a temporary health issue, shifting to a generic medication may be an appropriate cost-saving method for both patients and insurers.

But for people with chronic illnesses and health conditions like diabetes, multiple sclerosis, or cancer, Rinker says, insurers that overwrite a doctor’s drug prescription can do more harm than good.

It can lead to more medical exams, more hospital visits, and higher health-care costs overall, since patients using the wrong medication—including people with mental illness, like MacDonald—may develop health complications that could have been avoided in the first place, says Sherrie Vaughn, executive director for the Kansas branch of the National Alliance on Mental Illness.

“If they can’t get the medications that they need to help them with their mental illness symptoms, then they’re not going to be able to function at the level that they want to,” said Vaughn, who is based in Topeka.

Ironically, people with chronic health issues are more likely to go through step therapy than others because specialty medications cost significantly more, Rinker says. But for many of those patients, that medicine is their only option.

“A lot of times, shifting them to a different medication has negative consequences that can result in death,” Rinker said.

Lower Costs for Whom?

Rinker, Vaughn, and MacDonald are just three of the many disability advocates who are fighting to reform step therapy policies in the Midwest. Theirs is part of a broader nationwide effort to increase access to medications for people who need them.

Insurance carriers, including Aetna, have previously been fined hundreds of thousands of dollars for violations related to step therapy and for failing to address a patient’s grievance for denial of his medication. In reality, however, few patients have the time, energy, money, and resources to appeal insurance claims that have been denied, let alone submit grievances or go to court.

In fact, out of 41 million claims denied in 2017 by insurers offering individual plans through healthcare.gov, consumers appealed fewer than 200,000 of them—a rate of less than 0.5 percent, according to a February report published by the Kaiser Family Foundation.

The policy’s high stakes, and potentially deadly consequences for patients, aren’t new.

In May 2010, an infant with epilepsy in Oklahoma died after being forced to “step through” multiple ineffective drugs. He was in the midst of failing his third drug when he died, shortly before his first birthday.

More recently, disability activist Carrie Ann Lucas died in February after UnitedHealthcare reportedly denied her request for medication and she was forced to use a less effective drug. “United Healthcare’s attempt to save $2,000 cost over $1 million in health care costs over the past year,” the obituary on her Facebook page read.

Some individual states, including Kansas, are attempting to pass legislation to address the issue. SB 93, the Kansas legislation for which MacDonald testified, would reinforce existing patient protections that allow Kansans to request an exception and appeal a denial. The protections, which were established when Kansas passed its step therapy policy for Medicaid recipients in 2016, also require insurance companies to respond to such requests within 72 hours, or 24 hours in emergency cases. Exception requests that meet certain criteria — for instance, if a patient is already stable on a medication or if the drug alternative would cause irreversible harm — must be honored.

Activists say SB 93 will bolster these protections by legislatively enshrining them for all insurance plans, including Medicaid and private coverage, as well as adding other requirements. To ensure accountability, exceptions processes must be posted on insurers’ websites and medications will be approved automatically if exception requests aren’t addressed within the time limit, to help ensure accountability, Rinker says.

“It puts some basic guardrails in the process that allows the physician and patient to have more of a voice,” Rinker said.

Alongside MacDonald, members from well over a dozen patient advocate groups, including the National MS Society, Alliance for Patient Access, and the Disability Rights Center of Kansas, testified about their experiences with step therapy. The only presenters who spoke out against the bill were from the health insurer Cigna and Prime Therapeutics, a pharmacy benefit company.

In her testimony to the committee, LuGina Mendez-Harper, a pharmacist with Prime Therapeutics, said SB 93 doesn’t provide insurers enough time to review exceptions. She also argued that step therapy saved customers of Prime Therapeutics around $11.6 million in premiums and out-of-pocket costs in 2017, although that doesn’t take into account the cost of hospital visits and other health-care bills that patients may have taken on from taking less effective medicine.

Additionally, “a higher cost does not necessarily mean a drug is better,” Larrie Ann Brown, legislative counsel for Cigna, wrote in testimony.

Ultimately, the senate public health and welfare committee took no action on the bill, and it’s been shelved until next session.

A “Possible Vehicle” for Medicaid Expansion

More than 20 states, including Texas and Iowa, have already passed step therapy reform bills that provide exemptions for patients who need to access the right medications in a timely manner.

Most recently, in April, Oklahoma unanimously approved legislation in a single session that would allow exceptions for patients who need their prescribed drugs and can’t afford, medically at least, to go through trial runs with various other drug alternatives — especially if those drug alternatives are already expected to “cause an adverse reaction or harm” or be ineffective. The law also requires 72-hour standard and 24-hour emergency responses from insurers.

And yet, in Kansas, even with more than 20 people providing testimony in support of SB 93, the senate public health and welfare committee still failed to take a vote. February’s hearing was disability advocates’ third attempt at passing it out of committee. By the time the committee revisits the bill in 2020, it’ll be year four.

Rinker believes Kansas is struggling to pass the bill, which she called “commonsense reform,” because of one primary reason: the state’s fight about Medicaid expansion. Although most Midwestern states have already adopted Medicaid expansion, South Dakota, Kansas, Missouri, and Wisconsin are among the 14 in the country that still have yet to do so.

The step therapy reform bill would apply to all patients whose insurance plans use step therapy policies, including patients who use KanCare, the state’s privatized Medicaid program. Bills that are even remotely relevant to Medicaid expansion are viewed by legislators as “possible vehicles for amendments” to force the Republican-controlled legislature to vote on Medicaid, Rinker said.

Democratic Gov. Laura Kelly would likely support legislation expanding Medicaid, as well as the step therapy reform bill and other health-care bills that haven’t yet reached her desk.

Kansas seems to be falling behind neighboring states that have already passed step therapy reform, Rinker said, including Oklahoma, which also has a GOP-controlled legislature.

“The fact that a state very similar, politically speaking, was able to do this in one year’s time shows the momentum of this issue,” said Rinker, who does similar policy work in Oklahoma as well. “So it just shows what a large impact not expanding Medicaid has had on health policy discussion in the state of Kansas.”

Disability advocates have met similar opposition in Missouri, which passed a modest but—as Rinker puts it—“inadequate” compromise bill in 2016 that allows health-care providers to request an exception to step therapy protocol on behalf of their patients.

“I would like to see a stronger bill introduced in the future but don’t know if there is the legislative appetite for it,” Rinker said of Missouri.

Lacy Fowler, 36, is a Missouri resident who has been repeatedly denied the medication she needs to treat her arachnoiditis, a chronic pain disorder of the spinal cord. In 2014, Fowler founded Arachnoid Chronicles, which supports patients struggling to get through step therapy and brings awareness to policy campaigns like Fail First Hurts.

Step therapy reform is important, she said, for patients like her who need pain medication to be able to function every day and do things like drive a car.

“Your body has to have time to heal, and you cannot centralize your pain,” said Fowler, who lives outside Springfield. “It eliminates so many things that you can do.”

In Kansas, the struggle to improve medication access and health care for all Kansans is expected to continue through 2020.

“Until that issue of Medicaid expansion has been laid to rest, that a bill has been passed, other health-care initiatives will languish,” Rinker said, adding that patients are the ones who end up bearing the brunt of delays in health-care reform.

“Just because you’re living with a disability or diagnosis doesn’t mean that you’ll automatically get health care,” she said.