HHS Sec. Michael Leavitt Has No Comment on Contraception and Ab-Only Proposals

Scott Swenson

HHS Secretary Michael Leavitt gets credit for being the first Cabinet Secretary to engage policy discussions on his very own blog. But he ducked substantive questions in person today, perhaps he'll reply by blogging.

Today at a session hosted by the Henry J. Kaiser Family Foundation, entitled, The Health Blogosphere: What it Means for Policy Debates and Journalism, Health and Human Services Secretary Michael Leavitt spoke about his experience being the first Cabinet Secretary to blog. He discussed the impact of new media on policy debates, and the absolute fact that the blogosphere will be important in shaping the coming health care reform debate. He shared some personal writing from his blog.

But he didn’t actually engage the public policy debate by answering a substantive question about health care policy, which I asked;

Mr. Secretary thank you for being here and sharing your thoughts about blogging, I’m hoping you’ll engage a policy question to give us something to blog about. Within the past two weeks, two highly charged issues have surfaced from HHS: a leaked memo redefining some contraceptive devices as abortion; and a waiver of the annual application for Title V abstinence-only programs.

The former will substitute an ideological and political definition of when pregnancy begins for the medical judgment of the American Medical Association and the American College of Obstetricians and Gynecologists. The latter will, for the first time, ignore Congress’ reluctance to make abstinence-only programs permanent — they have had 19 short-term extensions, and Speaker Pelosi said last week that with a stronger majority in Congress it will end. This effort potentially ties the hands of the next administration and promises states money that has not been authorized.

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1) Will it be HHS policy that the 98% of Americans who use contraception at some point in their lives are terminating rather than preventing pregnancy?

2) Can you explain why this grant period should be treated differently than the previous 19 short-term extensions for abstinence-only programs?

 

Very politely, Secretary Leavitt refused to engage in the serious policy questions with a room full of bloggers by saying;

Those are very thoughtful questions. I do not have anything to add to your blog today. Next question.

 

Since the Secretary does believe in engaging the health care debate on his own blog, if not in person with bloggers as Speaker Pelosi did, perhaps he’ll provide a thoughtful reply on his blog. He may have started drafting it on his Blackberry on the way back to the office, a way he told the audience many of his posts start, others on the treadmill, others in international airports. He does write them himself, and the inherent risks of dealing with issues at the level he must, and writing about them in the blogosphere is without question a high wire act. He deserves credit for making the effort and not turning it into a publicity machine handled by staff.

The policies I asked him about were handled by staff, but ultimately the Secretary must address these hyper-politicized and ideological proposals as the spokesperson for the Department, as he said in his talk. The redefinition of contraception was like a prairie fire on the web, with traffic to Rewire and other sites covering it spiking to two and three times the norm. If Secretary Leavitt engages the conversation he’ll likely see the same spike in traffic and introduce new readers to his courageous endeavor.

The abstinence-only funding proposal resonates more with policy watchers. The American people have already largely rejected abstinence-only policies to the point where they have become laughable, as seen in this You Tube video, not likely what Secretary Leavitt has in mind with a partnership between HHS and You Tube that he mentioned is coming this fall. The fact that abstinence-only policies risk teen health by preventing reality-based education makes them no laughing matter, and something many Americans are already blogging about.

The Panel

Panelists that followed the Secretary discussed what it means to be blogging about health care, and how the coming reform debate will be impacted. Much of the discussion was about audience, the blurring of the lines between mainstream journalism and blogging, and the niche nature of health care blogs.

One topic discussed was that of the Frost family, spokespeople for the S-Chip debate, and what E. J. Dionne of the Washington Post called the "ugly underbelly of the blogosphere" when conservative blogger Michelle Malkin invaded the family’s privacy. She reported second-hand information picked up from their neighbors. It was later discovered to have been part of a coordinated right-wing smear operation and Malkin herself complained about people invading her privacy.

Ezra Klein, Associate Editor of The American Prospect, called her "vituperous" and clearly indicated that she’d crossed the lines. Michael Cannon, Director of Health Policy Studies for the CATO Institute, countered by asking if we’d feel better about it if the information were reported by a mainstream journalist, or if a left-wing blogger had asked Leona Helmsley’s neighbors questions about her tax payments. Something about comparing average Americans trying to cover health care costs for their children and Leona Helmsley strikes me as odd, but highlights the ways in which the left and the right differ in their views of the world.

Tom Rosenstiel, Director for the Project on Excellence in Journalism, suggested that the advantage of the blogosphere is that it is conversational, commenting on what the mainstream media is reporting. But Klein noted that many blogs are now regularly breaking news (to our knowledge no one in mainstream media has yet reported the HHS ab-only funding story) and Rosenstiel noted that reporters often have to learn issues in very short periods of time, giving bloggers with expertise an advantage at times.

In these and many other ways, the panelists seemed to agree that the lines between mainstream media and new media blogs is blurring, as more journalists turn to blogging themselves and mainstream media tries to find its role in a dramatically changing world.

John McDonough, Senior Health Reform Advisor to Sen. Edward Kennedy and a veteran of the Massachussetts health care reform process, noted that the blog he contributed to during the Massachussetts debate, Health Care for All, facilitated important conversations and allowed for immediate feedback during the debates and implementation. Jacob Goldstein of the Wall Street Journal Health Blog talked about the moves into new media by the venerable WSJ.

It was an interesting discussion, but the most interesting part is yet to come. Having agreed that reporting on the blogosphere, where perspective is out in the open, and mainstream media where we all know everything is fair and balanced, as Klein noted, "is no longer a place where much tension exists."

So let’s engage the substantive policy questions.

Secretary Leavitt? Let’s blog!

We eagerly await an answer to the substantive policy questions above on your blog.

 

Related Posts:

 

 

 

 

 

 

Analysis Abortion

Attacks on Abortion Rights Continued in 2015, Ensnaring Family Planning Funding and Fetal Tissue Research

Rachel Benson Gold & Elizabeth Nash

The year will be remembered not only because 17 states enacted a total of 57 new abortion restrictions, but also because the politics of abortion ensnared family planning programs, providers, and life-saving fetal tissue research.

During 2015’s state legislative sessions, lawmakers considered 514 provisions related to abortion; the vast majority of these measures—396 in 46 states—sought to restrict access to abortion services. The year will be remembered not only because 17 states enacted a total of 57 new abortion restrictions, but also because the politics of abortion ensnared family planning programs and providers, as well as critical, life-saving fetal tissue research.

2015 may also be memorable for setting the stage for what is widely anticipated to be one of the most significant Supreme Court rulings on abortion since 1992. In November, the Court agreed to hear a challenge to a Texas law requiring abortion providers to adhere to the standards set for ambulatory surgical centers and to have admitting privileges at a local hospital. At stake is the question of how far states may go in regulating abortion before their actions amount to an unconstitutional “undue burden” on women’s ability to access care. The Court will hear the case in March, with a decision expected in June; it is still considering whether to review a Mississippi admitting-privileges law. (Also in 2016, the Court will revisit the contraceptive coverage guarantee under the Affordable Care Act, weighing its importance and approach against the contention of religiously affiliated employers that they deserve to be entirely exempt from the law.)

At the same time, several states made important advances in 2015 on other sexual and reproductive health and rights issues. Some of the new provisions include measures that allow women to obtain a full year’s worth of prescription contraceptives at one time from a pharmacy, that allow a provider to treat a patient’s partner for an STI without first seeing the patient, that prohibit the use of “conversion therapy” with minors, and that expand access to dating or sexual violence education. See our full analysis for details.

Access to Abortion Services

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Including the 57 abortion restrictions enacted in 2015, states have adopted 288 abortion restrictions just since the 2010 midterm elections swept abortion opponents into power in state capitals across the country. To put that number in context, states adopted nearly as many abortion restrictions during the last five years as they did during the entire previous 15 years. Moreover, the sheer number of new restrictions enacted in 2015 makes it clear that this sustained assault on abortion access shows no signs of abating.

StateTrends2015-restrictions

The 288 new restrictions enacted since 2010 include a broad range of approaches, from banning certain types of abortions to putting restrictions on the providers allowed to perform the procedures to limiting insurance coverage.

StateTrends2015-access

Thirty-one states—spanning all regions of the country—enacted at least one abortion restriction during the last five years. The ten states that enacted at least ten new restrictions together accounted for 60 percent of the 288 new abortion restrictions adopted over the last five years. These states are overwhelmingly located in the South and the Midwest, and it is likely that access to services for women in these regions has been impacted significantly. Four states—Arkansas, Indiana, Kansas, and Oklahoma—each enacted at least 20 new abortion restrictions, making this handful of states, which together adopted 94 new restrictions, responsible for a third of all abortion restrictions enacted nationwide over the last five years. Kansas has the dubious distinction of leading the pack with 30 new abortion restrictions since 2010.

heat map

Although the 57 new abortion restrictions enacted during 2015 include a wide range of provisions, four topics stood out as the subject of particular attention among lawmakers:

1. Counseling and Waiting Periods

Five states adopted new (Florida and Tennessee) or lengthened existing (Arkansas, North Carolina, and Oklahoma) waiting period legislation in 2015. (The new Florida law has been temporarily blocked by the courts; the Oklahoma law is also being challenged, but a state court allowed it to go into effect while the case is pending.) Including these new laws, 27 states have waiting periods in effect. The new laws in Florida and Tennessee require the pregnant person to receive state-mandated abortion counseling in person, meaning that she must make two separate trips to obtain an abortion. With enforcement of the Florida law blocked, 13 states have two-trip requirements in effect.

2. Medication Abortion

Three states sought to use longstanding strategies to restrict access to medication abortion. Arkansas, Idaho, and Kansas enacted new measures banning the use of telemedicine for the provision of medication abortion. Arkansas also mandated use of the regimen specified in the FDA-approved labeling, which bans the use of the newer evidence-based regimen that is less costly, has fewer side effects, and can be used several days later in pregnancy; the law is not in effect due to a court case. Currently, 18 states ban the use of telemedicine and four require providers to follow an outdated medication abortion regimen.

Arizona and Arkansas debuted a new approach to discourage a woman from obtaining a medication abortion. Both states adopted laws requiring doctors to counsel women that the abortion could be stopped if the woman takes a high dose of progesterone after receiving the first of the two drugs included in the medication abortion regimen. According to the American Congress of Obstetricians and Gynecologists, this new approach is based on scant scientific evidence; it relies on a single flawed study of only six cases that did not have oversight by an institutional review board. The Arizona law is blocked pending a legal challenge; the Arkansas law is in effect.

3. Abortions After the First Trimester

Anti-choice lawmakers unveiled a new strategy in 2015 by moving to ban the use of the procedure used most often for second-trimester abortions. Kansas and Oklahoma both enacted measures to ban this safe and medically proven method that has long been used for abortions after 14 weeks; both laws are enjoined pending court action.

West Virginia and Wisconsin enacted laws banning abortion at or after 20 weeks post-fertilization (which is equivalent to 22 weeks after the woman’s last menstrual period). The West Virginia measure is in effect; the one in Wisconsin is slated to go into effect in February. Currently, 12 states have similar bans in effect.

4. Targeted Regulation of Abortion Providers (TRAP)

Even as the stage was being set for the U.S. Supreme Court to review TRAP laws, as we reviewed above, legislative action continued apace in several states. Five states adopted TRAP laws in 2015. Following a 2014 ballot initiative that granted lawmakers the ability to enact virtually limitless abortion restrictions, Tennessee enacted a new TRAP law that requires abortion providers to meet the standards that apply to ambulatory surgical centers even though these centers typically provide more invasive and risky procedures than abortion and use higher levels of sedation than commonly provided in abortion clinics.

Arkansas, Indiana, Ohio, and Oklahoma made existing requirements more stringent.

Family Planning Providers

In the aftermath of the release of a series of deceptively edited sting videos aimed at Planned Parenthood, attempts to defund the organization have flared at both the federal and state levels. By the end of 2015, some 11 states had moved to slash funding either for Planned Parenthood health centers specifically or for any family planning provider that also offers abortion services. A Guttmacher analysis shows that defunding Planned Parenthood could seriously impair women’s access to needed services: In two-thirds of the 491 counties in which they are located, Planned Parenthood health centers serve at least half of all women obtaining contraceptive care from safety-net health centers. In one-fifth of the counties in which they are located, Planned Parenthood sites are the sole safety-net family planning center.

PlannedParenthoodIsCritical

States have targeted a variety of funding streams on which family planning providers rely to fund the breadth of their services and activities, and are likely to continue in this vein in the upcoming 2016 legislative sessions:

Medicaid

Mirroring events in Congress, five states—Alabama, Arkansas, Louisiana, Oklahoma, and Texas—took steps to exclude Planned Parenthood from the Medicaid program in 2015. These efforts were blocked by federal courts in Alabama, Arkansas, and Louisiana; a challenge was just filed in November in Texas. Similar efforts made by Arizona and Indiana in recent years were also rebuffed by federal courts.

Other Family Planning Funding

Following the release of the videos, North Carolina expanded its existing provision blocking state funding of “non-public” family planning providers to explicitly apply to family planning providers that also offer abortion services. (Similar measures to bar funding for family planning providers that offer abortion care were introduced in Illinois, Pennsylvania, and Wisconsin.) In addition, New Hampshire’s Executive Council, an administrative board charged with overseeing large funding streams in the state, excluded Planned Parenthood health centers from receiving federal Title X dollars that flow through the state. (Title X funding that Planned Parenthood receives directly from the federal government is not affected.)

Currently, ten states limit eligibility for family planning funding. Eight of these states—Arizona, Arkansas, Colorado, Indiana, North Carolina, Ohio, Texas, and Wisconsin—prohibit abortion providers from receiving state family planning dollars. Kansas and Oklahoma exclude family planning providers not operated by public entities from eligibility.

Funding for Related Services and Activities

North Carolina and Utah moved to exclude family planning providers from eligibility for funding for related services. Legislation enacted in North Carolina bars family planning providers that offer abortion services from receiving funding for adolescent parenting and teen pregnancy prevention programs. Utah Gov. Gary Herbert (R) directed the state department of health to discontinue any funding for Planned Parenthood health centers, including funding for STI surveillance efforts, STI testing and treatment, and abstinence education; a federal appellate court recently prohibited the state from excluding Planned Parenthood from the funds.

Fetal Tissue Donation and Research

As yet another consequence of the release of the Planned Parenthood sting videos, ten states moved to regulate either the process for fetal tissue donation or biomedical research conducted in the state using fetal tissue resulting from induced abortions. Fetal tissue research has been integral to many of the major medical advances of our age. For example, fetal cell lines were used in the development of the polio vaccine and vaccines for diseases such as measles, mumps, rubella, chickenpox, hepatitis A, and rabies. In short, fetal tissue research has saved and improved the lives of millions of people worldwide.

During the final months of 2015, North Carolina and Arizona moved to regulate fetal tissue donation and research. A law enacted in North Carolina prohibits the sale of fetal tissue for a profit, paralleling federal requirements. Arizona adopted an emergency regulation requiring facilities to report any donation of fetal tissue to the state. Measures related to fetal tissue donation and research were introduced last year in Alabama, California, Michigan, New Jersey, Ohio, New York, and Wisconsin.

Editor’s note: Gwendolyn Rathbun and Zohra Ansari-Thomas also contributed to this analysis.

Analysis Politics

Campaign Fact-Check: Rand Paul’s ‘HHS Investigation of Planned Parenthood’s Tissue Practices’

Ally Boguhn

Senator and presidential candidate Rand Paul (R-KY) announced Tuesday that the Department of Health and Human Services (HHS) would be launching an investigation into "Planned Parenthood’s unconscionable" fetal tissue donation practices.

Senator and presidential candidate Rand Paul (R-KY) announced Tuesday that the Department of Health and Human Services (HHS) would be launching an investigation into “Planned Parenthood’s unconscionable” fetal tissue donation practices.

The letter from HHS on which Paul based his comments makes no such promise.

On Tuesday, the senator released a statement touting a response from HHS Inspector General Daniel Levinson agreeing to an earlier request initiated by Paul and 49 other senators for the department to audit “all fetal tissue research support by HHS, specifically examining the Department’s oversight of contractor and grantee compliance with the laws governing fetal tissue research.”

Speaking of what he deemed to be an “HHS investigation of Planned Parenthood tissue practices,” Paul lauded the department for taking up his cause. “I am encouraged to see the Inspector General take action to investigate Planned Parenthood’s unconscionable practices,” the senator claimed, rehashing discredited claims about the organization.

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Rehashing discredited claims about the organization, Paul wrote that it “deserves not one penny more of our taxpayer dollars, and I am confident this investigation will give further proof of that.”

However, the actual response from Levinson on behalf of HHS did not promise to investigate Planned Parenthood or its practices specifically, instead affirming that the department would undertake an internal audit of all fetal tissue research supported by the department and the National Institutes of Health (NIH)—an agency of HHS—as Paul’s letter had originally requested.

Referring to a past discussion on the topic, Levinson explained that HHS would conduct an internal probe and “interview HHS and National Institutes of Health (NIH) officials” with a “focus on gathering relevant documentation related to policies and procedures for monitoring fetal tissue research activities.” 

“Our goal is to obtain information related to fetal tissue research grants, NIH’s monitoring procedures over third-party certifications and those related to the Department’s internal fetal tissue research, and any known violations of Federal requirements,” Levinson continued.

It appears Paul engaged in a bit of wordplay in his rush to promote HHS’ response, suggesting the investigation would be into Planned Parenthood by repeatedly asserting that the probe was into their “practices” and implying the organization was somehow tied to the review. But in truth, Paul’s initial letter simply asked the department for an internal probe of its fetal tissue policies and a review of whether the third-party entities it works with are in compliance with the law—not an inquiry specifically into Planned Parenthood.

Planned Parenthood, for its part, welcomed HHS’ probe of federal fetal tissue research oversight. “We applaud the HHS for this timely review of practices around fetal tissue donation,” Executive Vice President Dawn Laguens said in a statement on the matter. “This work is often critical to lifesaving medical research, and has helped with important breakthroughs, such as the polio vaccine and research into a cure for Alzheimer’s disease.”

The organization’s president, Cecile Richards, also noted the organization would only benefit from the “updated guidance” such a review would grant. “A new review by a blue ribbon panel could help ensure the entire medical community is meeting the highest possible standards for this practice,”  Richards said in a statement, according to the Washington Post. “In addition to Planned Parenthood, other health care providers that make tissue donations could benefit from updated guidance.”

Richards also noted that Planned Parenthood had formally asked NIH to conduct a similar review of their policies in June. Pointing to general public confusion over fetal tissue research in the wake of deceptively edited videos released by the anti-choice front group Center for Medical Progress (CMP), Richard’s letter on behalf of Planned Parenthood asked for a “review of the research and the procedures surrounding it by an independent expert panel.”

HHS has already told congressional Republicans, chomping at the bit to indict Planned Parenthood after the CMP’s video release, that the department has no evidence of any violations of fetal tissue laws.

An August letter from Jim Esquea, assistant secretary for legislation at HHS, to Sens. Joni Ernst (R-IA) and Roy Blunt (R-MO) explained that the department knew of no wrongdoing by Planned Parenthood in facilitating the donation of fetal tissue for patients who requested it. The senators had earlier co-sponsored a failed bid to defund Planned Parenthood over CMP’s videos.

“Currently, we know of no violation of these laws in connection with the research done at our agencies,” wrote Esquea to Ernst and Blunt, according to Politico. “Furthermore … we have confirmed that HHS researchers working with fetal tissue obtained the tissue from non-profit organizations that provided assurances to us that they are in compliance with all applicable legal requirements.”

As Politico further reported at the time, although HHS is involved with an extremely small share of fetal tissue research, all of it appears to be in accordance with federal law:

HHS has gotten re-affirmations from government researchers and government-funded researchers that their tissue procurement is done in accordance with the tissue laws. And it got assurances from the companies that provide that fetal tissue to researchers at NIH and FDA that they are obtaining the fetal tissue and organs in compliance with federal laws, the letter says.

HHS also said that research with fetal tissue conducted by NIH accounts for less than 0.1 percent of its total research budget. It didn’t provide whole numbers.

Other investigations led by states and Congress into alleged wrongdoing on behalf of Planned Parenthood and fetal tissue donations have consistently turned up no evidence that the reproductive health provider has broken any law.

Paul’s unwillingness to accept mounting evidence that fetal tissue laws are not being broken may be due in part to his relentless campaign to politicize CMP’s videos in order to push his stringently anti-choice agenda ahead of the 2016 presidential elections. In July, Paul vowed to use the discredited videos in order to defund Planned Parenthood, and in September he implied he would oppose any measure to fund the government that also funded Planned Parenthood.

“I don’t know about the rest of Congress, but I plan on taking a stand and saying, ‘Not one penny more for Planned Parenthood,’” Paul said at a September anti-abortion rally. “I have never voted for any funds for Planned Parenthood, and I never will.”

Planned Parenthood provides basic reproductive health services to an estimated 2.7 million people in the United States who may not otherwise have access to care. Despite making up just 10 percent of all publicly supported safety-net family planning centers, the organization provides contraception for 36 percent of all low-income women who seek these services at such centers, according to analysis from the Guttmacher Institute.

Although politicians often point to the presence of other health-care organizations and clinics to fill the gap should Planned Parenthood be defunded, the organization’s absence would be difficult to fill. Investigations conducted by Rewire revealed that many of the health-care centers conservatives claim could make up the difference are actually elementary, middle, and high schools; clinics that provide care for homeless people; nursing homes; and other locations ill-equipped to appropriately handle a sudden influx of patients seeking reproductive health services.

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