Want Insurance to Cover Your Reproductive Health Care? White House Advisor Tells Grassroots “It’s Time to Bring It.”

Jodi Jacobson

As various health reform bills move through House and Senate committee, coverage of reproductive health care, including but not limited to abortion care, hangs by a thread, and the drumbeat from the far right against coverage of primary reproductive health care has been growing louder. Last week, White House Advisor Tina Tchen told women's advocates from across the country, that it will be up to the grassroots to win the campaign to cover reproductive health care.

Want your basic reproductive health services covered under health reform? Want to keep the coverage for reproductive health care, contraception, and abortion care you already have? Want to ensure that you, your mother, daugher, sister, friends, neighbors and the millions of women in the United States living without health insurance get coverage for primary reproductive health care once Congress gets through serving up sausage for your health benefits?

Then it’s time for women to "bring it" and get back into campaign mode, according to Tina Tchen, director of the White House Office of Public Engagement, speaking to more than 400 attendees at the 2009 Planned Parenthood Organizing and Policy Summit last week. PPFA is one among many national and state groups, including the National Women’s Law Center, NARAL Pro-Choice America, and the National Partnership for Women and Families working "night and day" and mobilizing constituents to protect coverage of basic reproductive health care.

Tchen, who shared a panel with Representative Jan Schakowsky (D-IL) and
PPFA President Cecile Richards, provided participants with a status
update on health care reform and reiterated the Obama administration’s
commitment to women’s health.

"I can say this directly from the White House, the President
reiterated to all of us in the senior staff that health care is the
most important issue," said Tchen.

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It is the signature issue that he ran on, it is what
he believes is one of the singularly most important reforms that need
to be made that affects America, that affects our economy.

Tchen also reminded the group that they had elected a pro-choice president. President Obama publicly re-affirmed his support for a woman’s right to choose just days after his inauguration, on Thursday, January 22nd, the 36th anniversary of Roe v. Wade. He stated:

Roe v. Wade "not only protects women’s health and reproductive freedom,
but stands for a broader principle: that government should not intrude
on our most private family matters," Obama said in a statement.

But, the PPFA panelists warned, his support for a woman’s right to choose and for access to the services needed to prevent unintended pregnancy, stem the spread of infections and ensure all women have primary reproductive health care won’t be enough to secure passage of a health reform bill that includes these essential health services.

In fact, both Republicans and conservative Democrats are pushing for restrictions in health reform legislation that could result in the loss of current benefits to millions of women.

"Health care reform must not leave women worse off than they are under our current system," wrote Richards in a recent action alert. But as various bills move through Congress, the "steady assault from anti-choice groups has become an avalanche," she said.

If the Right Wins, Women Will Lose

Today, the majority of American women with private or employer-provided
health insurance have policies that cover both contraceptive supplies
and abortion care, as well as pap smears, well-woman exams, testing and treatment for sexually transmitted infections, pregnancy care and other forms of primary, preventive reproductive health care.

A federally supported study conducted by the Guttmacher Institute assessing levels
of insurance coverage for a wide range of reproductive health services found that 87 percent of typical employer-based insurance policies in 2002
covered medically necessary or appropriate abortions. It also found that 86 percent of typical plans covered all five of the leading contraceptive
methods. Using different methods of collecting data, a 2003 Kaiser Family Foundation (KFF) study found that 72 percent of employees had coverage for five reversible
methods of contraception (88 percent for oral contraceptives specifically) and that some 46 percent of covered workers had coverage for abortion. (Differences in the two studies are explained here.)

This coverage would be lost if reproductive health becomes the "bipartisan" bargaining chip for which it has been used by Democrats and Republicans for far too long.  You know the refrain: "We need a ‘common-sense,’ ‘bipartisan’ compromise to pass this bill."  Translation: Women get thrown off the bus. 

But if reproductive health care including but not limited to
abortion is not covered under whatever health care reform results, we
can be sure that both women and society will continue to pay a high
price.  There will be more infection and disease, more unintended pregnancy, and more, not fewer, abortions.

A number of recent articles on Rewire have explored in depth the social, economic and health costs of disparities in access to reproductive health care that currently exist. For example, today, roughly 16.7 million women are uninsured, and thus likely to
postpone care and delay or forego important preventive care.  This means preventable illness goes undiagnosed. For example, increased access to pap smears for women who do not have these services will save lives and money. The American Cancer Society estimates that in 2009, about
11,270 cases of invasive cervical cancer will be diagnosed in the
United States.
Non-invasive cervical cancer is estimated by some researchers to be 4 times more common than invasive
cervical cancer.
About 4,070 women will die from cervical cancer in the United
States during 2009 according to the ACS. Early detection and early treatment = lives–and money–saved.

Poor women also rely heavily on publicly funded contraceptive services,
which prevent 1.94 million unintended pregnancies, including almost
400,000 teen pregnancies, each year. These pregnancies would otherwise
result in 860,000 unintended births, 810,000 abortions and 270,000
miscarriages. Taken together, all of these are critical to being able
to prevent an unintended pregnancy and hence a potential abortion.

Not surprisingly, the groups experiencing the highest rates of
unintended pregnancy have the least secure access to contraception
. Of
the 36.2 million women in the United States who expressed a need for
birth control in 2006, 17.5 million were in need of publicly funded
services and supplies, more than 71 percent of which were adults and
the vast majority of which were already parents.

Yet in 2006, only
about half
(54 percent) of those in need of publicly funded birth
control actually had access to services provided by Medicaid, Title X
and other sources of government funding. Indeed, as Elisabeth Sowecke wrote here just this week, the number of women who qualify for but are as yet unable to access Medicaid-funded abortion services is large and growing. This denial of care represents a particularly insidious level of discrimination against both the women and their families and a violation of basic human rights.

The reality of these costs also are not lost on the governors of some of the largest states, whose budgets are reeling from a combination of high unemployment and growing demands on social safety nets, including Medicaid.

Today, 16 governors, led by Governor Ted Strickland of Ohio, sent a letter to congressional leaders urging them to support the inclusion of the Medicaid Family Planning State Option in health care reform. This critical provision provides basic preventive health care, including breast and cervical cancer screenings and contraception, to millions of women and is currently in President Obama’s fiscal year 2010 budget.

"Currently, 27 states have sought and recieved federal waivers to expand eligibility for family planning services," wrote the governors.

States have repeatedly demonstrated that expanding health care coverage for women in this way also results in significant cost savings. Expanding the Medicaid Family Planning State Option would allow states to expand Medicaid coverage for family planning services, without a waiver, to those who don’t otherwise qualify for full Medicaid benefits. These cost savings could help states avoid additional cuts to critical health programs and allow them to use the savings for other pressing needs.

The Medicaid Family Planning State Option will also save federal funds. The Congressional Budget Office determined that the Medicaid Family Planning State Option saves the federal government $200 million over five years and $700 million over 10 years.

Where’s the Opposition?

Irrespective of the cost savings, these benefits are in fact in danger at the hands of a
majority-male Congress whose coverage for Viagra remains
well-protected.

Some of the opposition comes from likely suspects and is based on misinformation campaigns that belie their true purpose. Republicans in Congress, like Senator Orrin Hatch and Representative Mike Pence–who introduced an amendment today to the House appropriations bills to defund Planned Parenthood–just can’t seem to get the connection between increased access to prevention services, improved health and reduced need for abortions, the women’s right they love to hate.

And it is no surprise that groups like Family Research Council and the National Right to Life Committee are against not only funding for abortion services, but also for contraception. FRC, for example, continues to perpetuate myths about an amendment to the Senate Health, Education, Labor and Pension (HELP) Committee health reform bill originally sponsored by Senator Barbara Mikulski (D-MD). This amendment, which passed as part of that bill, would ensure coverage of well-woman care, HIV prevention and testing, pap smears, pregnancy care, and contraceptive supplies. FRC continues to claim it forces taxpayers to pay for abortions for the first time in 30 years.

It does not address abortion coverage. At all.

Watch Your Frenemies

But then there are Democrats who may either "cut a deal" on coverage of abortion services or who oppose it outright.

For example: while the House and Senate HELP Committees have passed their bills, and neither of those includes any restrictions on coverage of reproductive health care, Tchen noted:

This was not easy to achieve in committee and won’t be easy to hold on to the Senate floor or on the House floor. And the President can not do it alone. His efforts alone will not be enough. It will take each of you to raise your voices when you go home and here in DC and to spread the word.

In fact, as of this writing, trouble may be brewing in the Senate Finance Committee and is boiling up in the House Energy and Commerce Committee. Senate Finance has been promising a bill "for weeks" according to one source, but nothing has as yet materialized publicly. Meanwhile, Senator Max Baucus (D-MT), chairman of Committee has according to Dana Goldstein, "indicated some openness to compromising on abortion rights in exchange for Republican support for a final reform bill."  While Baucus’s office underscores his pro-choice position, co-Chair Charles Grassley (R-IA) is not pro-choice, and in the still largely old boys club that is the Senate, that "bipartisan" thing trumps women’s rights every time.

"Republicans on the Senate Finance Committee are pushing for language in
health care reform legislation that would eliminate coverage for
abortion services," stated a coalition of religious groups that
support abortion rights.  "If this happens, many women could lose
coverage for abortion services that their private insurance currently
includes.  Plus, millions of uninsured women will still lack a basic
health care service despite having been promised a better quality of
life," says Rev. Carlton Veazey, president and CEO, Religious Coalition
for Reproductive Choice
.

"If these senators are allowed to deny
coverage of abortion services," Veazey continued, 

the burden will inevitably fall on
low-income women and widen the huge gap in health status and access to
health care services that reforms are meant to remedy.  Compared to their higher-income counterparts, low-income women are
four times as likely to have an unintended pregnancy and five times as
likely to have an unintended birth.

"As people of faith, we
believe that health care reform should expand coverage to provide for
the basic services that every human being deserves; it should not deny
essential services to half of the population and aggravate the
troubling disparities in health care affecting minorities and
low-income individuals," Veazey adds.

In the House, Congressman Bart Stupak (D-MI) (who this week helpfully tried to re-insert funding for abstinence-only-until-marriage programs into the House appropriations bill) has threatened to halt passage of legislation unless it explicitly "excludes public funds for abortions." Stupak claims to have 39 House Democrats in line to vote against passage. Today’s Congress Daily reports that:

Stupak said he will consider voting against the health reform bill if leaders do not allow a floor vote on an amendment that explicitly prohibits using public funds for abortions. If the vote is not allowed, he and other Democrats opposing abortion rights will likely vote against the rule allowing consideration of the health reform bill, he said.

Even the Senate HELP Committee–which as noted above has passed its bill–debated a half-dozen abortion-related amendments, defeating most on identical 12-11 votes, including one that would have barred people who get government insurance subsidies from buying private insurance plans that include abortion coverage.

In fact, even the "contraceptive option" was deemed to controversial for at least one Democrat.  Senator Bob Casey (D-PA) voted against the Mikulski Amendment ensuring coverage of contraception and of essential service providers. Calls to his office inquiring as to the reason for his vote against contraceptive coverage were not returned.

Public v. Private: Confusing the Issues

The basic argument for those who are trying to completely eliminate even the possibility of coverage for abortion services under health care reform is that "no public funds should be allocated for abortions" because "we don’t do that."

But that is, not surprisingly, a misleading argument because health reform is intended to completely transform insurance coverage and to expand the range of essential coverage, and as noted earlier, most private plans today already cover these services.

In order to ensure all Americans are covered, most health reform proposals include options for "insurance exchanges" and other methods through which the federal government might partially subsidize the costs of insurance coverage for those without employer-based insurance, or those who can not afford to pay out-of-pocket for an insurance policy. What the Republicans and the Democrats opposed to continuing current coverage (including current abortion coverage) for women want to do is to elminate the possibility of coverage from either subsidized or private plans whether or not the federal government is subsidizing a particular person.

This is sort of like applying the "global gag rule" to private insurance plans because even if you are paying for 90 percent of your policy, the restrictions apply both to the federally funded portion (10 percent) as well as to the 90 percent of the policy you pay for. Moreover, some analysts believe the implication is that even in cases where you pay for 100 percent of the policy you choose, if the federal government is involved in any way in that insurance plan by subsidizing others, your coverage would still be restricted.

Sen. Sheldon Whitehouse (D-RI) told NPR last week that not letting people use what might be very small subsidies to buy private coverage was going too far.

"The next step in this logic will be to require anybody seeking these services to walk to the clinic, lest they use federal highways, supported by federal highway funds," he said.

What is more: The public is against having the Senate or the House dictate their medical choices.

A survey conducted by the Mellman Group for the National Women’s Law Center of 1,000 likely voters found that:

  • Voters overwhelmingly support the broad outlines of reform and requiring coverage of women’s reproductive health services. Seventy-one percent of voters support requiring health plans to cover women’s reproductive health services, as opposed to 21 percent opposing this coverage.
  • Absent coverage for women’s reproductive health services, majorities oppose reform. If reform eliminated current insurance coverage of reproductive health services such as birth control or abortion, nearly two-thirds (60%) would oppose the plan and nearly half (47%) would oppose it strongly.
  • Voters want an independent commission to make coverage decisions, not politicians. A strong majority of voters (75 percent) prefer that an independent commission of citizens and medical professionals make decisions about what should be covered under reform rather than the President and Congress. Fully 73 percent of voters want an independent commission to decide whether abortion should be covered, while just 16 percent want the President and Congress involved.
  • Even in the face of opposition arguments, majorities support requiring coverage of abortions under reform. After hearing strong arguments both for and against covering abortion under reform, two-thirds (66 percent) support coverage, agreeing that health care, not politics, should drive coverage decisions. A majority of voters (72 percent) reported that they would feel angry if Congress mandated by law that abortion would not be covered under a national health care plan.
  • Voters want rules to stop insurance companies from discriminating against women. Even in the face of industry claims of too much government interference, 62 percent agree that reform should establish new rules to treat everyone fairly and stop discrimination, while far fewer (32 percent) side with opponents’ claims.

Where does it go from here?

Even despite the evidence, the benefits and the clear public support for women to continue making their own medical decisions with their families and their doctors, and for full coverage of these services, anti-choice activists and politicians continue to play the same political shell games with women’s health and lives.

So groups are heeding the call to "bring it."

And you can join them.

Here are links to action by some of the organizations mobilizing to ensure reproductive health services remain available to women and their families:

Planned Parenthood Action Fund

National Women’s Law Center

NARAL Pro-Choice America

National Partnership for Women and Families

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Human Rights

What’s Driving Women’s Skyrocketing Incarceration Rates?

Michelle D. Anderson

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

Local court and law enforcement systems in small counties throughout the United States are increasingly using jails to warehouse underserved Black and Latina women.

The Vera Institute of Justice, a national policy and research organization, and the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge initiative, released a study last week showing that the number of women in jails based in communities with 250,000 residents or fewer in 2014 had grown 31-fold since 1970, when most county jails lacked a single woman resident.

By comparison, the number of women in jails nationwide had jumped 14-fold since 1970. Historically, jails were designed to hold people not yet convicted of a crime or people serving terms of one year or less, but they are increasingly housing poor women who can’t afford bail.

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

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Overlooked: Women and Jails in an Era of Reform,” calls attention to jail incarceration rates for women in small counties, where rates increased from 79 per 100,000 women to 140 per 100,000 women, compared to large counties, where rates dropped from 76 to 71 per 100,000 women.

The near 50-page report further highlights that families of color, who are already disproportionately affected by economic injustice, poor access to health care, and lack of access to affordable housing, were most negatively affected by the epidemic.

An overwhelming percentage of women in jail, the study showed, were more likely to be survivors of violence and trauma, and have alarming rates of mental illness and substance use problems.

“Overlooked” concluded that jails should be used a last resort to manage women deemed dangerous to others or considered a flight risk.

Elizabeth Swavola, a co-author of “Overlooked” and a senior program associate at the Vera Institute, told Rewire that smaller regions tend to lack resources to address underlying societal factors that often lead women into the jail system.

County officials often draft budgets mainly dedicated to running local jails and law enforcement and can’t or don’t allocate funds for behavioral, employment, and educational programs that could strengthen underserved women and their families.

“Smaller counties become dependent on the jail to deal with the issues,” Swavola said, adding that current trends among women deserves far more inquiry than it has received.

Fred Patrick, director of the Center on Sentencing and Corrections at the Vera Institute, said in “Overlooked” that the study underscored the need for more data that could contribute to “evidence-based analysis and policymaking.”

“Overlooked” relies on several studies and reports, including a previous Vera Institute study on jail misuse, FBI statistics, and Rewire’s investigation on incarcerated women, which examined addiction, parental rights, and reproductive issues.

“Overlooked” authors highlight the “unique” challenges and disadvantages women face in jails.

Women-specific issues include strained access to menstrual hygiene products, abortion care, and contraceptive care, postpartum separation, and shackling, which can harm the pregnant person and fetus by applying “dangerous levels of pressure, and restriction of circulation and fetal movement.”

And while women are more likely to fare better in pre-trail proceedings and receive low bail amounts, the study authors said they are more likely to leave the jail system in worse condition because they are more economically disadvantaged.

The report noted that 60 percent of women housed in jails lacked full-time employment prior to their arrest compared to 40 percent of men. Nearly half of all single Black and Latina women have zero or negative net wealth, “Overlooked” authors said.

This means that costs associated with their arrest and release—such as nonrefundable fees charged by bail bond companies and electronic monitoring fees incurred by women released on pretrial supervision—coupled with cash bail, can devastate women and their families, trapping them in jail or even leading them back to correctional institutions following their release.

For example, the authors noted that 36 percent of women detained in a pretrial unit in Massachusetts in 2012 were there because they could not afford bail amounts of less than $500.

The “Overlooked” report highlighted that women in jails are more likely to be mothers, usually leading single-parent households and ultimately facing serious threats to their parental rights.

“That stress affects the entire family and community,” Swavola said.

Citing a Corrections Today study focused on Cook County, Illinois, the authors said incarcerated women with children in foster care were less likely to be reunited with their children than non-incarcerated women with children in foster care.

The sexual abuse and mental health issues faced by women in jails often contribute to further trauma, the authors noted, because women are subjected to body searches and supervision from male prison employees.

“Their experience hurts their prospects of recovering from that,” Swavola said.

And the way survivors might respond to perceived sexual threats—by fighting or attempting to escape—can lead to punishment, especially when jail leaders cannot detect or properly respond to trauma, Swavola and her peers said.

The authors recommend jurisdictions develop gender-responsive policies and other solutions that can help keep women out of jails.

In New York City, police take people arrested for certain non-felony offenses to a precinct, where they receive a desk appearance ticket, or DAT, along with instructions “to appear in court at a later date rather than remaining in custody.”

Andrea James, founder of Families for Justice As Healing and a leader within the National Council For Incarcerated and Formerly Incarcerated Women and Girls, said in an interview with Rewire that solutions must go beyond allowing women to escape police custody and return home to communities that are often fragmented, unhealthy, and dangerous.

Underserved women, James said, need access to healing, transformative environments. She cited as an example the Brookview House, which helps women overcome addiction, untreated trauma, and homelessness.

James, who has advocated against the criminalization of drug use and prostitution, as well as the injustices faced by those in poverty, said the problem of jail misuse could benefit from the insight of real experts on the issue: women and girls who have been incarcerated.

These women and youth, she said, could help researchers better understand the “experiences that brought them to the bunk.”

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