Harkin: “We Aren’t Dancing Around the Edges” of Health Care Reform

Lynda Waddington

The current state of health care delivery in America is so grim that U.S. Sen. Tom Harkin no longer uses the word "care" in reference to reform.

NORTH LIBERTY – The current state of health care delivery in America
is so grim that U.S. Sen. Tom Harkin no longer uses the word "care" in
reference to reform.

"We need health reform," the Democrat told the roughly 200 individuals who gathered at an AARP forum
in North Liberty on Saturday. "I don’t say that we need health care
reform because you can’t reform something you don’t already have. We
don’t have a health care system in America. We have a sick care system."

Harkin said the World Health Organization ranks
the U.S. health care system 37th in the world, on par with Serbia.
Despite the fact that the U.S. spends twice as much per capita on
health care as European countries, he explained, Americans face twice
the number of chronic diseases.

"We spend 95 cents of every dollar on treating illnesses and
conditions after they occur," he said. "In other words, we’ve been
neglecting wellness and disease prevention. That’s the bad news. The
good news is that right now I think that we have a chance to make a
dramatic change."

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Although Congress is not always known for its ability to act
swiftly, Harkin said President Obama "is adamant" that health reform be
complete by October of this year. In addition, Harkin is optimistic, if
not fully confident, that the deadline will be met.

"What we are doing is marking up our bill … during the last two
weeks of June," Harkin said. "We plan to be done with it before the
July Fourth recess. We will come back after July 4 and will be on the
floor of the U.S. Senate in July with both the finance bill, which
basically covers Medicare and Medicaid and the taxing part of it, and
our bill, the health bill. We plan to have it done before the August
recess. It will go to conference during August and September so that it
can be done in October.

"And I’m telling you, we cannot fail in this. We have got to get it done."

President Barack Obama invoked the same sense of urgency on health
reform during his weekly radio address, released Saturday.  That drew
criticism from Iowa’s other senator, Republican Chuck Grassley, via the
social messaging site Twitter.  Grassley complained that Obama had
"nerve" to tell Congress to deliver on health care while he was off
"sight seeing" in Paris.  Obama is on an oversees trip that took him to
Egypt, where he delivered a major address intended for muslim nations;
Germany, where he visited the site of a Nazi concentration camp; and
France, where he observed the anniversary of D-Day with other world
leaders.

Harkin said that because the country has come together in what
describes as "a critical mass," comprehensive reform is much more of a
certainty now than it was during discussions during the 1990s.

"I want to impress upon you: We aren’t dancing around the edges," he
said. "What we are planning on doing will change the very fabric – the
very fabric – of how we do health in America. It’s not just changing
medicine, but it is changing the kind of medicine we do."

Despite a recently published column by Grassley
listing reasons for his opposition to a public plan option, Harkin
confidently proclaimed that the reform will contain such an option, and
that it will be national. Harkin also lamented the fact that single
payer was not on the table despite his personal support and the growing
support of the majority of Americans for that option.

Noting that there is not enough support in Washington to pass a
single-payer system, Harkin said that "there are a lot of things the
majority of Americans support that Congress won’t do." Harkin also
praised members of the audience who carried signs calling for a
single-payer system, saying that one of the major reasons that a public
plan is now a real possibility is due in large part to their advocacy.

Although members of the audience grumbled during the
question-and-answer portion of the forum when Harkin indicated full
implementation of such sweeping change could take several years, panel
member Cathy Glasson, state president of the Service Employees International Union, pointed to the nation’s looming nursing crisis as evidence of why reform will take time.

"I don’t think people are considering [the shortage of nurses and
other health care professionals] in relation to reform of our nation’s
health care system," said Glasson, who has worked for more than two
decades as a registered nurse. "We are going to be adding between 47 to
52 million currently uninsured individuals into the system. If we don’t
have the qualified professionals to care for the influx of those folks,
we are going to have a major disaster on our hands."

Harkin also wanted to assure those in attendance that existing low federal reimbursement rates that have been negatively impacting Iowa hospitals and health care professionals will be revamped during the course of reform.

"Our Iowa doctors, nurses and professionals have a lot to be proud
of," Harkin said. "I don’t know how many more studies we need from the
Commonwealth Fund and Dartmouth and others ranking Iowa in the top
places nationally for providing quality health care delivery. But our
current reimbursement system is based on volume, not quality. Well, if
you reimburse on volume, you get volume. But if you start reimbursing
on quality, you’ll get quality."

Analysis Politics

Advocates: Bill to Address Gaps in Mental Health Care Would Do More Harm Than Good

Katie Klabusich

Advocates say that U.S. Rep. Tim Murphy's "Helping Families in Mental Health Crisis Act," purported to help address gaps in care, is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.

The need for reform of the mental health-care system is well documented; those of us who have spent time trying to access often costly, out-of-reach treatment will attest to how time-consuming and expensive care can be—if you can get the necessary time off work to pursue that care. Advocates say, however, that U.S. Rep. Tim Murphy’s (R-PA) “Helping Families in Mental Health Crisis Act” (HR 2646), purported to help address gaps in care, is not the answer. Instead, they say, it is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.

“We believe that this legislation will result in outdated, biased, and inappropriate treatment of people with a mental health diagnosis,” wrote the political action committee Leadership Conference on Civil and Human Rights in a March letter to House Committee on Energy and Commerce Chairman Rep. Fred Upton (R-MI) and ranking member Rep. Frank Pallone (D-NJ) on behalf of more than 100 social justice organizations. “The current formulation of H.R. 2646 will function to eliminate basic civil and human rights protections for those with mental illness.”

Despite the pushback, Murphy continues to draw on the bill’s mental health industry support; groups like the American Psychiatric Association (APA) and the National Alliance on Mental Illness (NAMI) back the bill.

Murphy and Rep. Eddie Bernice Johnson (D-TX) reintroduced HR 2646 earlier this month, continuing to call it “groundbreaking” legislation that “breaks down federal barriers to care, clarifies privacy standards for families and caregivers; reforms outdated programs; expands parity accountability; and invests in services for the most difficult to treat cases while driving evidence-based care.”

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Some of the stated goals of HR 2646 are important: Yes, more inpatient care beds are needed; yes, smoother transitions from inpatient to outpatient care would help many; yes, prisons house too many people with mental illness. However, many of its objectives, such as “alternatives to institutionalization” potentially allow outpatient care to be mandated by judges with no medical training and pushed for by “concerned” family members. Even the “focus on suicide prevention” can lead to forced hospitalization and disempowerment of the person the system or family member is supposedly trying to help.

All in all, advocates say, HR 2646—which passed out of committee earlier this month—marks a danger to the autonomy of those with mental illness.

Victoria M. Rodríguez-Roldán, JD, director of the Trans/GNC Justice Project at the National LGBTQ Task Force, explained that the bill would usurp the Health Insurance Portability and Accountability Act (HIPAA), “making it easier for a mental health provider to give information about diagnosis and treatment … to any ‘caregiver’-family members, partners or spouses, children that may be caring for the person, and so forth.”

For the communities she serves, this is more than just a privacy violation: It could put clients at risk if family members use their diagnosis or treatment against them.

“When we consider the stigma around mental illness from an LGBT perspective, an intersectional perspective, 57 percent of trans people have experienced significant family rejection [and] 19 percent have experienced domestic violence as a result of their being trans,” said Rodríguez-Roldán, citing the National Transgender Discrimination Survey. “We can see here how the idea of ‘Let’s give access to the poor loved ones who want to help!’ is not that great an idea.”

“It’s really about taking away voice and choice and agency from people, which is a trend that’s very disturbing to me,” said Leah Harris, an organizer with the Campaign For Real Change in Mental Health Policy, also known as Real MH Change. “Mostly [H.R. 2646] is driven by families of these people, not the people themselves. It’s pitting families against people who are living this. There are a fair number of these family members that are well-meaning, but they’re pushing this very authoritarian [policy].”

Rodríguez-Roldán also pointed out that if a patient’s gender identity or sexual orientation is a contributing factor to their depression or suicide risk—because of discrimination, direct targeting, or fear of bigoted family, friends, or coworkers—then that identity or orientation would be pertinent to their diagnosis and possible need for treatment. Though Murphy’s office claims that psychotherapy notes are excluded from the increased access caregivers would be given under HR 2646, Rodríguez-Roldán isn’t buying it; she fears individuals could be inadvertently outed to their caregivers.

Rodríguez-Roldán echoed concern that while disability advocacy organizations largely oppose the bill, groups that represent either medical institutions or families of those with mental illnesses, or medical institutions—such as NAMI, Mental Health America, and the APA—seem to be driving this legislation.

“In disability rights, if the doc starts about talking about the plight and families of the people of the disabilities, it’s not going to go over well,” she said. “That’s basically what [HR 2646] does.”

Rodríguez-Roldán’s concerns extend beyond the potential harm of allowing families and caregivers easier access to individuals’ sensitive medical information; she also points out that the act itself is rooted in stigma. Rep. Murphy created the Helping Families in Mental Health Crisis Act in response to the Sandy Hook school shooting in 2012. Despite being a clinical psychologist for 30 years before joining Congress and being co-chair of the Mental Health Caucus, he continues to perpetuate the well-debunked myth that people with mental illness are violent. In fact, according to the Department of Health and Human Services, “only 3%-5% of violent acts can be attributed to individuals living with a serious mental illness” and “people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population.”

The act “is trying to prevent gun violence by ignoring gun control and going after the the rights of mentally ill people,” Rodríguez-Roldán noted.

In addition, advocates note, HR 2646 would make it easier to access assisted outpatient treatment, but would also give courts around the country the authority to mandate specific medications and treatments. In states where the courts already have that authority, Rodríguez-Roldán says, people of color are disproportionately mandated into treatment. When she has tried to point out these statistics to Murphy and his staff, she says, she has been shut down, being told that the disparity is due to a disproportionate number of people of color living in poverty.

Harris also expressed frustration at the hostility she and others have received attempting to take the lived experiences of those who would be affected by the bill to Murphy and his staff.

“I’ve talked to thousands of families … he’s actively opposed to talking to us,” she said. “Everyone has tried to engage with [Murphy and his staff]. I had one of the staffers in the room say, ‘You must have been misdiagnosed.’ I couldn’t have been that way,” meaning mentally ill. “It’s an ongoing struggle to maintain our mental and physical health, but they think we can’t get well.”

Multiple attempts to reach Murphy’s office by Rewire were unsuccessful.

LGBTQ people—transgender, nonbinary, and genderqueer people especially—are particularly susceptible to mistreatment in an institutional setting, where even the thoughts and experiences of patients with significant privilege are typically viewed with skepticism and disbelief. They’re also more likely to experience circumstances that already come with required hospitalization. This, as Rodríguez-Roldán explained, makes it even more vital that individuals not be made more susceptible to unnecessary treatment programs at the hands of judges or relatives with limited or no medical backgrounds.
Forty-one percent of all trans people have attempted suicide at some point in their lives,” said Rodríguez-Roldán. “Once you have attempted suicide—assuming you’re caught—standard procedure is you’ll end up in the hospital for five days [or] a week [on] average.”

In turn, that leaves people open to potential abuse. Rodríguez-Roldán said there isn’t much data yet on exactly how mistreated transgender people are specific to psychiatry, but considering the discrimination and mistreatment in health care in general, it’s safe to assume mental health care would be additionally hostile. A full 50 percent of transgender people report having to teach their physicians about transgender care and 19 percent were refused care—a statistic that spikes even higher for transgender people of color.

“What happens to the people who are already being mistreated, who are already being misgendered, harassed, retraumatized? After you’ve had a suicide attempt, let’s treat you like garbage even more than we treat most people,” said Rodríguez-Roldán, pointing out that with HR 2646, “there would be even less legal recourse” for those who wanted to shape their own treatment. “Those who face abusive families, who don’t have support and so on—more likely when you’re queer—are going to face a heightened risk of losing their privacy.”

Or, for example, individuals may face the conflation of transgender or gender-nonconforming status with mental illness. Rodríguez-Roldán has experienced the conflation herself.

“I had one psychiatrist in Arlington insist, ‘You’re not bipolar; it’s just that you have unresolved issues from your transition,'” she said.

While her abusive household and other life factors certainly added to her depression—the first symptom people with Bipolar II typically suffer from—Rodríguez-Roldán knew she was transgender at age 15 and began the process of transitioning at age 17. Bipolar disorder, meanwhile, is most often diagnosed in a person’s early 20s, making the conflation rather obvious. She acknowledges the privilege of having good insurance and not being low-income, which meant she could choose a different doctor.

“It was also in an outpatient setting, so I was able to nod along, pay the copay, get out of there and never come back,” she said. “It was not inside a hospital where they can use that as an excuse to keep me.”

The fear of having freedom and other rights stripped away came up repeatedly in a Twitter chat last month led by the Task Force to spread the word about HR 2646. More than 350 people participated, sharing their experiences and asking people to oppose Murphy’s bill.

In the meantime, Sen. Lamar Alexander (R-TN) has introduced the “Mental Health Reform Act of 2016” (SB 2680) which some supporters of HR 2646 are calling a companion bill. It has yet to be voted on.

Alexander’s bill has more real reform embedded in its language, shifting the focus from empowering families and medical personnel to funding prevention and community-based support services and programs. The U.S. Secretary of Health and Human Services would be tasked with evaluating existing programs for their effectiveness in handling co-current disorders (e.g., substance abuse and mental illness); reducing homelessness and incarceration of people with substance abuse and/or mental disorders; and providing recommendations on improving current community-based care.

Harris, with Real MH Change, considers Alexander’s bill an imperfect improvement over the Murphy legislation.

“Both of [the bills] have far too much emphasis on rolling back the clock, promoting institutionalization, and not enough of a preventive approach or a trauma-informed approach,” Harris said. “What they share in common is this trope of ‘comprehensive mental health reform.’ Of course the system is completely messed up. Comprehensive reform is needed, but for those of us who have lived through it, it’s not just ‘any change is good.'”

Harris and Rodríguez-Roldán both acknowledged that many of the HR 2646 co-sponsors and supporters in Congress have good intentions; those legislators are trusting Murphy’s professional background and are eager to make some kind of change. In doing so, the voices of those who are affected by the laws—those asking for more funding toward community-based and patient-centric care—are being sidelined.

“What is driving the change is going to influence what the change looks like. Right now, change is driven by fear and paternalism,” said Harris. “It’s not change at any cost.”

Roundups Politics

Trump Taps Extremists, Anti-Choice Advocates in Effort to Woo Evangelicals

Ally Boguhn

Representatives from radical anti-abortion group Operation Rescue praised Trump’s commitment to its shared values during the event. “I’m very impressed that Mr. Trump would sit with conservative leaders for multiple questions, and then give direct answers,” said the organization's president, Troy Newman, who was in attendance at a question-and-answer event on Tuesday.

Making a play to win over the evangelical community, presumptive Republican nominee Donald Trump met with more than 1,000 faith and anti-choice leaders on Tuesday for a question-and-answer event in New York City and launched an “evangelical advisory board” to weigh in on how he should approach key issues for the voting bloc.

The meeting was meant to be “a guided discussion between Trump and diverse conservative Christian leaders to better understand him as a person, his position on important issues and his vision for America’s future,” according to a press release from the event’s organizers. As Rewire previously reported, numerous anti-choice and anti-LGBTQ leaders—many of them extremists—were slated to attend.

Though the event was closed to the media, Trump reportedly promised to lift a ban on tax-exempt organizations from politicking and discussed his commitment to defending religious liberties. Trump’s pitch to conservatives also included a resolution that upon his election, “the first thing we will do is support Supreme Court justices who are talented men and women, and pro-life,” according to a press release from United in Purpose, which helped organize the event.

Marjorie Dannenfelser, president of the anti-choice Susan B. Anthony List, told the New York Times that the business mogul also reiterated promises to defund Planned Parenthood and to pass the Pain-Capable Unborn Child Protection Act, a 20-week abortion ban based on the medically unsupported claim that a fetus feels pain at that point in a pregnancy.

In a post to its website, representatives from radical anti-abortion group Operation Rescue praised Trump’s commitment to their shared values during the event. “I’m very impressed that Mr. Trump would sit with conservative leaders for multiple questions, and then give direct answers,” said the group’s president, Troy Newman, who was in attendance. “I don’t believe anything like this has ever happened.” The post went on to note that Trump had also said he would appoint anti-choice justices to federal courts, and repeal and replace the Affordable Care Act (ACA).

Just after the event, Trump’s campaign announced the formation of an evangelical advisory board. The group was “convened to provide advisory support to Mr. Trump on those issues important to Evangelicals and other people of faith in America,” according to a press release from the campaign. Though members of the board, which will lead Trump’s “much larger Faith and Cultural Advisory Committee to be announced later this month,” were not asked to endorse Trump, the campaign went on to note that “the formation of the board represents Donald J. Trump’s endorsement of those diverse issues important to Evangelicals and other Christians, and his desire to have access to the wise counsel of such leaders as needed.”

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Much like the group that met with Trump on Tuesday, the presumptive Republican nominee’s advisory board roster reads like a who’s-who of conservatives with radical opposition to abortion and LGBTQ equality. Here are some of the group’s most notable members:

Michele Bachmann

Though former Minnesota Rep. Michele Bachmann once claimed that “women don’t need anyone to tell them what to do on health care” while arguing against the ACA during a 2012 appearance on NBC’s Meet the Press, her views on the government’s role in restricting reproductive health and rights don’t square away with that position.

During a December 2011 “tele-town hall” event hosted by anti-choice organization Personhood USA, Bachmann reportedly falsely referred to emergency contraception as “abortion pills” and joined other Republican then-presidential candidates to advocate for making abortion illegal, even in cases of rape, incest, or life endangerment. During the event, Bachmann touted her support of the anti-choice group’s “personhood pledge,” which required presidential candidates to agree that:

I stand with President Ronald Reagan in supporting “the unalienable personhood of every American, from the moment of conception until natural death,” and with the Republican Party platform in affirming that I “support a human life amendment to the Constitution, and endorse legislation to make clear that the 14th Amendment protections apply to unborn children.

Such a policy, if enacted by lawmakers, could outlaw abortion and many forms of contraception. A source from Personhood USA told the Huffington Post that Bachmann “signed the pledge and returned it within twenty minutes, which was an extraordinarily short amount of time.”

Bachmann has also claimed that God told her to introduce a measure to block marriage equality in her home state, that being an LGBTQ person is “ part of Satan,” and that same-sex marriage is a “radical experiment that will have “profound consequences.”

Mark Burns

Televangelist Mark Burns has been an ardent supporter of Trump, even appearing on behalf of the presidential candidate at February’s Faith and Family Forum, hosted by the conservative Palmetto Family Council, to deliver an anti-abortion speech.

In March, Burns also claimed that he supported Donald Trump because Democrats like Hillary Clinton supported Black “genocide” (a frequently invoked conservative myth) during an appearance on the fringe-conspiracy program, the Alex Jones show. “That’s really one of my major platforms behind Donald Trump,” said Burns, according to the Daily Beast. “He loves babies. Donald Trump is a pro-baby candidate, and it saddens me how we as African Americans are rallying behind … a party that is okay with the genocide of Black people through abortion.”

Burns’ support of Trump extended to the candidate’s suggestion that if abortion was made illegal, those who have abortions should be punished—an issue on which Trump has repeatedly shifted stances. “If the state made it illegal and said the premature death of an unborn child constituted murder, anyone connected to that crime should be held liable,” Burns told the Wall Street Journal in April. “If you break the law there should be punishment.”

Kenneth and Gloria Copeland

Kenneth and Gloria Copeland founded Kenneth Copeland Ministries (KCM), which, according to its mission statement, exists to “teach Christians worldwide who they are in Christ Jesus and how to live a victorious life in their covenant rights and privileges.” Outlining their opposition to abortion in a post this month on the organization’s website, the couple wrote that abortion is wrong even in cases of rape, incest, or life endangerment. “As the author of life, God considers an unborn child to be an eternal being from the moment of its conception,” explained the post. “To deliberately destroy that life before birth would be as much premeditated murder as taking the life of any other innocent person.”

The article went on to say that though it may “seem more difficult in cases such as those involving rape or incest” not to choose abortion, “God has a plan for the unborn child,” falsely claiming that the threat of life endangerment has “been almost completely alleviated through modern medicine.”

The ministries’ website also features Pregnancy Options Centre, a crisis pregnancy center (CPC) in Vancouver, Canada, that receives “financial and spiritual support” from KCM and “its Partners.” The vast majority of CPCs  regularly lie to women in order to persuade them not to have an abortion.

Kenneth Copeland, in a June 2013 sermon, tied pedophilia to the Supreme Court’s decision in Roe v. Wade, going on to falsely claim that the ruling did not actually legalize abortion and that the decision was “the seed to murder our seed.” Copeland blamed legal abortion for the country’s economic woes, reasoning that there are “several million taxpayers that are not alive.”

Copeland, a televangelist, originally supported former Republican presidential candidate Sen. Ted Cruz (TX) in the 2016 Republican primary, claiming that the candidate had been “called and appointed” by God to be the next president. His ministry has previously faced scrutiny about its tax-exempt status under an investigation led by Sen. Chuck Grassley (R-IA) into six ministries “whose television preaching bankrolled leaders’ lavish lifestyles.” This investigation concluded in 2011, according to the New York Times.

James Dobson

James Dobson, founder and chairman emeritus of Focus on the Family (FoF), previously supported Cruz in the Republican primary, releasing an ad for the campaign in February praising Cruz for defending “the sanctity of human life and traditional marriage.” As Rewire previously reported, both Dobson and his organization hold numerous extreme views:

Dobson’s FoF has spent millions promoting its anti-choice and anti-LGBTQ extremism, even dropping an estimated $2.5 million in 2010 to fund an anti-choice Super Bowl ad featuring conservative football player Tim Tebow. Dobson also founded the … Family Research Council, now headed by Tony Perkins.

Dobson’s own personal rhetoric is just as extreme as the causes his organization pushes. As extensively documented by Right Wing Watch,

Dobson has:

Robert Jeffress

A Fox News contributor and senior pastor of First Baptist Church of Dallas, Jeffress once suggested that the 9/11 attacks took place because of legal abortion. “All you have to do is look in history to see what God does with a nation that sanctions the killing of its own children,” said Jeffress at Liberty University’s March 2015 convocation, according to Right Wing Watch. “God will not allow sin to go unpunished and he certainly won’t allow the sacrifice of children to go unpunished.”

Jeffress spoke about the importance of electing Trump during a campaign rally in February, citing Democrats’ positions on abortion rights and Trump’s belief “in protecting the unborn.” He went on to claim that if Sen. Bernie Sanders (I-VT) or Hillary Clinton were elected, “there is no doubt you’re going to have the most pro-abortion president in history.”

After Trump claimed women who have abortions should be punished should it become illegal, Jeffres rushed to defend the Republican candidate from bipartisan criticism, tweeting: “Conservatives’ outrage over @realDonaldTrump abortion comments hypocritical. Maybe they don’t really believe abortion is murder.”

As documented by Media Matters, Jeffress has frequently spoken out against those of other religions and denominations, claiming that Islam is “evil” and Catholicism is “what Satan does with counterfeit religion.” The pastor has also demonstrated extreme opposition to LGBTQ equality, even claiming that same-sex marriage is a sign of the apocalypse.

Richard Land

Richard Land, now president of the Southern Evangelical Seminary, was named one of Time Magazine‘s “25 Most Influential Evangelicals in America” in 2005 for his close ties with the Republican party. While George W. Bush was president, Land participated in the administration’s “weekly teleconference with other Christian conservatives, to plot strategy on such issues as gay marriage and abortion.” Bush also appointed Land to the U.S. Commission on International Religious Freedom in 2002.

According to a 2002 article from the Associated Press, during his early academic career in Texas, “Land earned a reputation as a leader among abortion opponents and in 1987 became an administrative assistant to then-Texas Gov. Bill Clements, who fought for laws to restrict a woman’s right to an abortion” in the state.

Land had previously expressed “dismay” that some evangelicals were supporting Trump, claiming in October that he “take[s] that [support] as a failure on our part to adequately disciple our people.”