Each week, Lindsay Beyerstein brings us the best of progressive reporting on health care. This week, Lindsay examines Obama's progressive, pro-choice cabinet picks, health care reform, a fun fact for your Thanksgiving meal and more!
It’s finally official: Sen. Hillary Rodham Clinton will be Barack Obama’s Secretary of State.
Some observers thought Clinton was a curious pick because she made a point of differentiating her foreign policy views from Obama’s during the Democratic primary.
However, optimism is running high in the reproductive health community that Clinton will use her new office to champion women’s health issues worldwide. They expect that Clinton will push for changes in foreign aid criteria to make it easier to provide comprehensive sex ed and reproductive health services to the world’s neediest girls and women.
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Back in the U.S., Clinton and Sen. Patty Murray introduced legislation to block the finalization of the rules changes at Health and Human Services that would have given employees the right to refuse to administer any birth control or abortion-related services that offended their religious beliefs. These changes would have restricted access to reproductive health services nationwide.
Emily Douglas of RH RealityCheck notes the deadline for submitting rules changes is 60 days before the inauguration, but the HHS has classified these "conscience clause" changes as "non-major," thereby giving themselves a 30-day extension. It’s a sneaky procedural move, but the stalling won’t circumvent the Clinton/Murray bill.
Additional presidential appointments are starting to give shape to President-elect Obama’s health care agenda. Melody Barnes has been named Obama’s Senior Domestic Policy Adviser. Barnes is one of the few cabinet appointees so far who can be regarded as an unequivocally progressive choice. Barnes is a former executive policy director for the Center for American Progress and well-known in the progressive community.
"By appointing policy leaders like Barnes who see the connections between health and the economy, Obama appears to have pulled together an economic team that reflects many of the goals he set out during his campaign," wrote Todd Heywood in Rewire.
Ezra Klein of the American Prospect compares satisfaction ratings across several countries, and between Americans on Medicare vs. private insurance: "Medicare has much higher satisfaction ratings than private insurance. Americans are much less satisfied with their health system than they are in other countries."
Healthcare reform is gathering momentum in Congress and the White House. The health insurance industry can’t help but take notice and offer a few preemptive reassurances, in the hopes of forestalling more fundamental change.
As part of his ongoing coverage of the health insurance industry: Ezra Klein of the American Prospectphones Robert Zirkelbach, America’s Health Insurance Plans’ director of strategic communications to discuss the trade organization’s recent pledge "[…] too guarantee that health plans provide coverage for preexisting conditions in conjunction with mandate that individuals keep and maintain healthcare coverage." Zirkelbach admits that the insurance companies have not pledged to make this coverage affordable. He also says that the Association resists competition from public plans as a strategy to drive down costs.
Here’s a fun fact courtesy of Mother Jones to bring up around the Thanksgiving dinner table: Scientists have shown that obesity in mice is linked to the diets of their grandmothers. If pregnant mice were fed a high-fat diet, their offspring were more likely to be obese and insulin insensitive. The surprising result was that the next generation were predisposed to the same problems.
Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.
Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.
Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.
Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.
This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.
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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.
Where Funding Comes From
The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.
This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.
As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.
Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.
“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”
Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.
According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.
Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.
Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazettereported in April that at least some of the money appears to have been designated for programs outside the state.
Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.
“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”
“Every Other Baby … Starts With Women’s Care Center”
Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.
Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.
In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.
The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.
“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.
Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.
Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.
“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.
Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”
In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.
Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”
Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.
Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.
“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.
There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.
Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.
“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”
“Life Is Winning in Indiana”
Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.
These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.
Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.
A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”
Hunsberger denies any deceit on the part of Women’s Care Center.
“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”
Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”
“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.
Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.
“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.
If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.
In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.
Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.
The Arkansas gubernatorial race features one firmly anti-choice candidate, and one with a vacillating stance on abortion rights.
Arkansas Gov. Mike Beebe is one of the last Southern Democratic governors, and due to term limits he is not eligible for reelection. The campaign to replace him is between two politicians who were born and raised in the state, and who are both attempting to appeal Arkansas’s moderate electorate.
Democrat Mike Ross and his Republican opponent, Asa Hutchinson, both easily won their primary elections without significant opposition.
Ross is a traditional Southern Democrat who began his political career as a staffer for former Gov. Bill Clinton. Ross has spent most of his adult life in politics, having served ten years in the Arkansas State Senate and another 12 years in the U.S. House of Representatives.
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Hutchinson is running for governor for a second time, having lost in 2006 to Gov. Beebe.
Hutchinson has had a diverse career in public service and politics, beginning with his appointment as U.S. Attorney by President Reagan. He would lose an election for U.S. Senate and state attorney general before being elected to Congress in 1996. Hutchinson served in Congress from 1997 until 2001.
The gubernatorial campaign has focused on a variety of issues, but one of the critical issues to the campaign is healthcare and how best to expand access to the state’s low income residents.
Arkansas has historically struggled with poverty and poor public health. According to the United Health Foundation, the state ranks 49 in health-care outcomes. This is in large part due to the state having the fourth highest percentage of residents living in poverty. The median household income, over the past decade, has been among the lowest in the nation, and has seen little improvement.
The Private Option
A bipartisan compromise was brokered in the Republican-controlled legislature that created a path for the state to expand Medicaid under the Affordable Care Act (ACA) through a private health insurance exchange. Gov. Beebe has been a vocal supporter of the policy that he signed into law, and has advocated that the state continue the program.
The criticism of the private option stem in large part from Republican opposition to the ACA. Both Ross and Hutchinson have said that they oppose the health-care reform law.
Ross has a long legislative record of opposing the ACA. While in Congress he voted against both the House version and on final passage. During the months of negotiations Ross was one of a handful of lawmakers to broker compromise with Democratic leadership to reduce cost of bill by limiting subsidies to the uninsured and doubling exemptions for small businesses.
After the Republicans regained control of the House in the 2010 midterm elections, Ross was one of only three Democrats to join with the Republicans in voting to repeal the new health-care law.
“An overwhelming majority of my constituents continue to oppose this healthcare reform law and I believe we should repeal it, start over and listen to the majority of the American people – not the special interests and party leaders in Washington,” Ross said in a press release following voting to repeal the law in January 2011.
“I voted against the federal healthcare law, or the Patient Protection & Affordable Care Act, four times and I voted to repeal Obamacare 23 times,” Ross says on his campaign website. “But, at the time, I said there were good parts and there were bad parts to Obamacare. I think Arkansas’s Medicaid expansion, which passed with overwhelming Republican support, is one of the good parts.”
“I know further reform in healthcare is needed,” said Hutchinson in a campaign statement. “I look forward to working with our health care professionals and the legislature to determine what changes will be needed in the future. The reforms I will advocate will reflect those needed changes while balancing the need for a stable budget.”
In fact, the Arkansas Insurance Department is projecting that insurance policies will see a decrease by 2 percent in premiums for the Arkansas Health Insurance Marketplace, the health insurance exchange created by the ACA.
Like many state that expanded Medicaid under the ACA, Arkansas saw significant increases to access to health care for low-income residents. More than 183,000 residents have received health insurance through the program. According to Gallup polling, the uninsured rate in Arkansas has dropped from 22.5 percent to 12.4 percent.
During a meeting of the Southern Governors Association, incumbent Arkansas Gov. Mike Beebe (D) lauded the private option for reducing the number of the state’s uninsured more than any other state in the country since the ACA was fully implemented.
Ross has criticized Hutchinson for being evasive on his position on the state’s private option. Hutchinson has repeatedly said that the way in which the state has decided to deliver healthcare to low-income residents has been badly designed, but has been vague in saying how he would have designed it differently.
Hutchinson, who has said that there is a “debate on whether we’re going to extend insurance coverage for the working poor,” opposes the expansion of Medicaid under the ACA. “I would have designed the healthcare plan for Arkansas differently. But as governor, I will inherit the decisions the governor and General Assembly made in the fiscal session.”
“We’ll do the right thing in terms of making the adjustments that are needed to reflect the values of Arkansas and to make sure this program is an incentive for people to work and not an incentive for people not to work,” said Hutchinson at a Delta Grassroots Caucus conference in Little Rock.
“Over the past few months, some misguided politicians have taken over the state legislature and have made divisive issues of the past their top priority instead of working to create jobs, improve education and strengthen the economy. Here lately, it seems the only time Arkansas makes national news is when these divisive politicians succeed at pushing through their attacks on women and families,” said Ross.
As governor, Hutchinson says that he would have signed both the 12-week and 20-week abortion bans passed by the Arkansas General Assembly.
Ross opposition to restricting reproductive rights is a dramatic change from his legislative record, as over the course of his political career he does not have a history of supporting reproductive rights. During his time in Congress he has received low ratings for his votes on reproductive rights-related issues from organizations such as NARAL Pro-Choice America and Planned Parenthood.
When asked why he now is opposed to restrictions on reproductive rights, Ross told the Arkansas News that his position has not changed. “I am personally opposed to abortion. My position is the same as Gov. Beebe’s – I think from a public policy standpoint it should safe, legal, and rare,” said Ross.
Ross and Hutchinson served in Congress together for one year in 2001 during the 107th Congress, during which time Hutchinson would be appointed by President George W. Bush as director of the Drug Enforcement Administration. Ross received a rating from Planned Parenthood for 50 percent for votes on issues concerning reproductive rights, while Hutchinson received a rating of 0 percent for those same votes.