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

Commentary Contraception

Hillary Clinton Played a Critical Role in Making Emergency Contraception More Accessible

Susan Wood

Today, women are able to access emergency contraception, a safe, second-chance option for preventing unintended pregnancy in a timely manner without a prescription. Clinton helped make this happen, and I can tell the story from having watched it unfold.

In the midst of election-year talk and debates about political controversies, we often forget examples of candidates’ past leadership. But we must not overlook the ways in which Hillary Clinton demonstrated her commitment to women’s health before she became the Democratic presidential nominee. In early 2008, I wrote the following article for Rewirewhich has been lightly edited—from my perspective as a former official at the U.S. Food and Drug Administration (FDA) about the critical role that Clinton, then a senator, had played in making the emergency contraception method Plan B available over the counter. She demanded that reproductive health benefits and the best available science drive decisions at the FDA, not politics. She challenged the Bush administration and pushed the Democratic-controlled Senate to protect the FDA’s decision making from political interference in order to help women get access to EC.

Since that time, Plan B and other emergency contraception pills have become fully over the counter with no age or ID requirements. Despite all the controversy, women at risk of unintended pregnancy finally can get timely access to another method of contraception if they need it—such as in cases of condom failure or sexual assault. By 2010, according to National Center for Health Statistics data, 11 percent of all sexually experienced women ages 15 to 44 had ever used EC, compared with only 4 percent in 2002. Indeed, nearly one-quarter of all women ages 20 to 24 had used emergency contraception by 2010.

As I stated in 2008, “All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.”

Now, there are new emergency contraceptive pills (Ella) available by prescription, women have access to insurance coverage of contraception without cost-sharing, and there is progress in making some regular contraceptive pills available over the counter, without prescription. Yet extreme calls for defunding Planned Parenthood, the costs and lack of coverage of over-the-counter EC, and refusals by some pharmacies to stock emergency contraception clearly demonstrate that politicization of science and limits to our access to contraception remain a serious problem.

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Today, women are able to access emergency contraception, a safe, second chance option for preventing unintended pregnancy in a timely manner without a prescription. Sen. Hillary Clinton (D-NY) helped make this happen, and I can tell the story from having watched it unfold.

Although stories about reproductive health and politicization of science have made headlines recently, stories of how these problems are solved are less often told. On August 31, 2005 I resigned my position as assistant commissioner for women’s health at the Food and Drug Administration (FDA) because the agency was not allowed to make its decisions based on the science or in the best interests of the public’s health. While my resignation was widely covered by the media, it would have been a hollow gesture were there not leaders in Congress who stepped in and demanded more accountability from the FDA.

I have been working to improve health care for women and families in the United States for nearly 20 years. In 2000, I became the director of women’s health for the FDA. I was rather quietly doing my job when the debate began in 2003 over whether or not emergency contraception should be provided over the counter (OTC). As a scientist, I knew the facts showed that this medication, which can be used after a rape or other emergency situations, prevents an unwanted pregnancy. It does not cause an abortion, but can help prevent the need for one. But it only works if used within 72 hours, and sooner is even better. Since it is completely safe, and many women find it impossible to get a doctor’s appointment within two to three days, making emergency contraception available to women without a prescription was simply the right thing to do. As an FDA employee, I knew it should have been a routine approval within the agency.

Plan B emergency contraception is just like birth control pills—it is not the “abortion pill,” RU-486, and most people in the United States don’t think access to safe and effective contraception is controversial. Sadly, in Congress and in the White House, there are many people who do oppose birth control. And although this may surprise you, this false “controversy” not only has affected emergency contraception, but also caused the recent dramatic increase in the cost of birth control pills on college campuses, and limited family planning services across the country.  The reality is that having more options for contraception helps each of us make our own decisions in planning our families and preventing unwanted pregnancies. This is something we can all agree on.

Meanwhile, inside the walls of the FDA in 2003 and 2004, the Bush administration continued to throw roadblocks at efforts to approve emergency contraception over the counter. When this struggle became public, I was struck by the leadership that Hillary Clinton displayed. She used the tools of a U.S. senator and fought ardently to preserve the FDA’s independent scientific decision-making authority. Many other senators and congressmen agreed, but she was the one who took the lead, saying she simply wanted the FDA to be able to make decisions based on its public health mission and on the medical evidence.

When it became clear that FDA scientists would continue to be overruled for non-scientific reasons, I resigned in protest in late 2005. I was interviewed by news media for months and traveled around the country hoping that many would stand up and demand that FDA do its job properly. But, although it can help, all the media in the world can’t make Congress or a president do the right thing.

Sen. Clinton made the difference. The FDA suddenly announced it would approve emergency contraception for use without a prescription for women ages 18 and older—one day before FDA officials were to face a determined Sen. Clinton and her colleague Sen. Murray (D-WA) at a Senate hearing in 2006. No one was more surprised than I was. All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.

Sometimes these success stories get lost in the “horse-race stories” about political campaigns and the exposes of taxpayer-funded bridges to nowhere, and who said what to whom. This story of emergency contraception at the FDA is just one story of many. Sen. Clinton saw a problem that affected people’s lives. She then stood up to the challenge and worked to solve it.

The challenges we face in health care, our economy, global climate change, and issues of war and peace, need to be tackled with experience, skills and the commitment to using the best available science and evidence to make the best possible policy.  This will benefit us all.

Analysis Human Rights

From Protected Class to High-Priority Target: How the ‘System Is Rigged’ Against Unaccompanied Migrant Children

Tina Vasquez

Vulnerable, undocumented youth who pose no real threat are being stripped of their right to an education and instead sit in detention awaiting deportation.

This is the first article in Rewire’s two-part series about the U.S. immigration system’s effects on unaccompanied children.

Earlier this month, three North Carolina high school students were released from a Lumpkin, Georgia, detention center after spending more than six months awaiting what seemed like their inevitable fate: deportation back to conditions in Central America that threatened their lives.

Wildin David Guillen Acosta, Josue Alexander Soriano Cortez, and Yefri Sorto-Hernandez were released on bail in the span of one week, thanks to an overwhelming community effort involving pro bono attorneys and bond money. However, not everyone targeted under the same government operation has been reprieved. For example, by the time reports emerged that Immigration and Customs Enforcement (ICE) had detained Acosta on his way to school in Durham, North Carolina, the government agency had already quietly deported four other young people from the state, including a teenage girl from Guatemala who attended the same school.

Activated in January, that program—Operation Border Guardian—continues to affect the lives of hundreds of Central American migrants over the age of 18 who came to the United States as unaccompanied children after January 2014. Advocates believe many of those arrested under the operation are still in ICE custody.

Department of Homeland Security (DHS) Secretary Jeh Johnson has said that the goal of Operation Border Guardian is to send a message to those in Central America considering seeking asylum in the United States. But it’s not working, as Border Patrol statistics have shown. Furthermore, vulnerable, undocumented youth who pose no real threat are being stripped of their right to an education and instead sit in detention awaiting deportation. These youth arrived at the border in hopes of qualifying for asylum, but were unable to succeed in an immigration system that seems rigged against them.

“The laws are really complicated and [young people] don’t have the community support to navigate this really hostile, complex system. That infrastructure isn’t there and unless we support asylum seekers and other immigrants in this part of the country, we’ll continue to see asylum seekers and former unaccompanied minors receive their deportation orders,” said Julie Mao, the enforcement fellow at the National Immigration Project of the National Lawyers Guild.

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“A Grossly Misnamed” Operation

In January, ICE conducted a series of raids that spanned three southern states—Georgia, North Carolina, and Texas—targeting Central American asylum seekers. The raids occurred under the orders of Johnson, who has taken a hardline stance against the more than 100,000 families who have sought asylum in the United States. These families fled deadly gang violence in El Salvador, Honduras, and Guatemala in recent years. In El Salvador, in particular, over 400 children were murdered by gang members and police officers during the first three months of 2016, doubling the country’s homicide rate, which was already among the highest in the world.

ICE picked up some 121 people in the early January raids, primarily women and their young children. Advocates argue many of those arrested were detained unlawfully, because as people who experienced severe trauma and exhibited symptoms of post-traumatic stress disorder, generalized anxiety, and depression, they were disabled as defined under the Rehabilitation Act of 1973, and ICE did not provide reasonable accommodations to ensure disabled people were not denied meaningful access to benefits or services.

Just a few weeks later, on January 23, ICE expanded the raids’ focus to include teenagers under Operation Border Guardian, which advocates said represented a “new low.”

The media, too, has also criticized DHS for its seemingly senseless targeting of a population that normally would be considered refugees. The New York Times called Operation Border Guardian “a grossly misnamed immigration-enforcement surge that went after people this country did not need to guard against.”

In response to questions about its prioritization of former unaccompanied minors, an ICE spokesperson told Rewire in an emailed statement: “As the secretary has stated repeatedly, our borders are not open to illegal migration. If someone was apprehended at the border, has been ordered removed by an immigration court, has no pending appeal, and does not qualify for asylum or other relief from removal under our laws, he or she must be sent home. We must and we will enforce the law in accordance with our enforcement priorities.”

DHS reports that 336 undocumented Central American youth have been detained in the operation. It’s not clear how many of these youth have already been deported or remain in ICE custody, as the spokesperson did not respond to that question by press time.

Acosta, Cortez, Sorto-Hernandez, and three other North Carolina teenagersSantos Geovany Padilla-Guzman, Bilmer Araeli Pujoy Juarez, Pedro Arturo Salmeron—have become known as the NC6 and the face of Operation Border Guardian, a designation they likely would have not signed up for.

Advocates estimate that thousands of deportations of low-priority migrants—those without a criminal history—occur each week. What newly arrived Central American asylum seekers like Acosta could not have known was that the federal government had been laying the groundwork for their deportations for years.

Asylum Seekers Become “High-Priority Cases”

In August 2011, the Obama administration announced it would begin reviewing immigration cases individually, allowing ICE to focus its resources on “high-priority cases.” The assumption was that those who pose a threat to public safety, for example, would constitute the administration’s highest priority, not asylum-seeking high school students.

But there was an indication from DHS that asylum-seeking students would eventually be targeted and considered high-priority. After Obama’s announcement, ICE released a statement outlining who would constitute its “highest priorities,” saying, “Specifically individuals who pose a threat to public safety such as criminal aliens and national security threats, as well as repeat immigration law violators and recent border entrants.”

In the years since, President Obama has repeatedly said “recent border crossers” are among the nation’s “highest priorities” for removal—on par with national security threats. Those targeted would be migrants with final orders of removal who, according to the administration, had received their day in court and had no more legal avenues left to seek protection. But, as the American Civil Liberties Union (ACLU) reported, “recent border entrant” is a murky topic, and it doesn’t appear as if all cases are being reviewed individually as President Obama said they would.

“Recent border entrant” can apply to someone who has been living in the United States for three years, and a border removal applies “whenever ICE deports an individual within three years of entry—regardless of whether the initial entry was authorized—or whenever an individual is apprehended by Customs and Border Protection (CBP),” explained Thomas Homan, the head of ICE’s removal operations in a 2013 hearing with Congress, the ACLU reported.

Chris Rickerd, policy counsel at the American Civil Liberties Union’s Washington Legislative Office, added that “[b]ecause CBP refuses to screen the individuals it apprehends for their ties to the U.S., and DHS overuses procedures that bypass deportation hearings before a judge, many ‘border removals’ are never fully assessed to determine whether they have a legal right to stay.”

Over the years, DHS has only ramped up the department’s efforts to deport newly arrived immigrants, mostly from Central America. As the Los Angeles Times reported, these deportations are “an attempt by U.S. immigration officials to send a message of deterrence to Central America and avoid a repeat of the 2014 crisis when tens of thousands of children from Honduras, El Salvador and Guatemala arrived at the U.S. border.”

This is something Mao takes great issue with.

“These raids that we keep seeing are being done in order to deter another wave of children from seeking asylum—and that is not a permissible reason,” Mao said. “You deport people based on legality, not as a way of scaring others. Our country, in this political moment, is terrorizing young asylum seekers as a way of deterring others from presenting themselves at the border, and it’s pretty egregious.”

There is a direct correlation between surges of violence in the Northern Triangle—El Salvador, Guatemala, and Honduras—and an uptick in the number of asylum seekers arriving in the United States. El Salvador, known as the murder capital of the word, recently saw an explosion of gang violence. Combine that with the possible re-emergence of so-called death squads and it’s clear why the number of Salvadoran family units apprehended on the southern border increased by 96 percent from 2015 to 2016, as Fusion reported.

Much like Mao, Elisa Benitez, co-founder of the immigrants rights’ organization Alerta Migratoria NC, believes undocumented youth are being targeted needlessly.

“They should be [considered] low-priority just because they’re kids, but immigration is classifying them at a very high level, meaning ICE is operating like this is a population that needs to be arrested ASAP,” Benitez said.

The Plight of Unaccompanied Children

Each member of the NC6 arrived in the United States as an unaccompanied child fleeing violence in their countries of origin. Acosta, for example, was threatened by gangs in his native Honduras and feared for his life. These young people should qualify as refugees based on those circumstances under international law. In the United States, after they present themselves at the border, they have to prove to an immigration judge they have a valid asylum claim—something advocates say is nearly impossible for a child to do with no understanding of the immigration system and, often, with no access to legal counsel—or they face deportation.

Unaccompanied children, if not immediately deported, have certain protections once in the United States. For example, they cannot be placed into expedited removal proceedings. According to the American Immigration Council, “they are placed into standard removal proceedings in immigration court. CBP must transfer custody of these children to Health and Human Services (HHS), Office of Refugee Resettlement (ORR), within 72 hours.”

While their court proceedings move forward, HHS’s Office of Refugee Resettlement manages the care of the children until they can ideally be released to their parents already based in the country. Sometimes, however, they are placed with distant relatives or U.S. sponsors. Because HHS has lowered its safety standards regarding placement, children have been subjected to sexual abuse, labor trafficking, and severe physical abuse and neglect, ThinkProgress has reported.

If while in the care of their family or a sponsor they miss a court date, detainment or deportation can be triggered once they turn 18 and no longer qualify for protections afforded to unaccompanied children. 

This is what happened to Acosta, who was placed with his mother in Durham when he arrived in the United States. ICE contends that Acosta was not targeted unfairly; rather, his missed court appearance triggered his order for removal.

Acosta’s mother told local media that after attending his first court date, Acosta “skipped subsequent ones on the advice of an attorney who told him he didn’t stand a chance.”

“That’s not true, but it’s what they were told,” Benitez said. “So, this idea that all of these kids were given their day in court is false. One kid [we work with] was even told not to sign up for school because ‘there was no point,’ it would just get him deported.”

Benitez told Rewire the reasons why these young people are being targeted and given their final orders of removal need to be re-examined.

Sixty percent of youth from Central America do not ever have access to legal representation throughout the course of their case—from the time they arrive in the United States and are designated as unaccompanied children to the time they turn 18 and are classified as asylum seekers. According to the ACLU, 44 percent of the 23,000 unaccompanied children who were required to attend immigration court this year had no lawyer, and 86 percent of those children were deported.

Immigration attorneys and advocates say that having a lawyer is absolutely necessary if a migrant is to have any chance of winning an asylum claim.

Mao told Rewire that in the Southeast where Acosta and the other members of the NC6 are from, there is a pipeline of youth who arrived in the United States as unaccompanied children who are simply “giving up” on their valid asylum claims because navigating the immigration system is simply too hard.

“They feel the system is rigged, and it is rigged,” Mao said.

Mao has been providing “technical assistance” for Acosta and other members of the NC6. Her organization doesn’t represent individuals in court, she said, but the services it provides are necessary because immigration is such a unique area of law and there are very few attorneys who know how to represent individuals who are detained and who have been designated unaccompanied minors. Those services include providing support, referrals, and technical assistance to advocates, community organizations, and families on deportation defense and custody issues.

Fighting for Asylum From Detention

Once arrested by ICE, there is no telling if someone will linger in detention for months or swiftly be deported. What is known is that if a migrant is taken by ICE in North Carolina, somewhere along the way, they will be transferred to Lumpkin, Georgia’s Stewart Detention Center. As a local paper reported, Stewart is “the last stop before they send you back to whatever country you came from.”

Stewart is the largest detention center in the country, capable of holding 2,000 migrants at any time—it’s also been the subject of numerous investigations because of reports of abuse and inadequate medical care. The detention center is run by Corrections Corporation of America, the country’s largest private prison provider and one that has become synonymous with maintaining inhumane conditions inside of its detention centers. According to a report from the National Immigrant Justice Center, Stewart’s remote location—over two hours away from Atlanta—hinders the facility from attracting and retaining adequate medical staff, while also creating barriers to visitation from attorneys and family members.

There’s also the matter of Georgia being notoriously tough on asylum seekers, even being called the “worst” place to be an undocumented immigrant. The Huffington Post reported that “Atlanta immigration judges have been accused of bullying children, badgering domestic violence victims and setting standards for relief and asylum that lawyers say are next to impossible to meet.” Even more disconcerting, according to a project by Migrahack, which pairs immigration reporters and hackers together, having an attorney in Georgia had almost no effect on whether or not a person won their asylum case, with state courts denying up to 98 percent of asylum requests. 

Acosta, Cortez, and Sorto-Hernandez spent over six months in Stewart Detention Center before they were released on baila “miracle” according to some accounts, given the fact that only about 5 percent of those detained in Stewart are released on bond.

In the weeks after ICE transferred Acosta to Stewart, there were multiple times Acosta was on the verge of deportation. ICE repeatedly denied Acosta was in danger, but advocates say they had little reason to believe the agency. Previous cases have made them wary of such claims.

Advocates believe that three of the North Carolina teens who were deported earlier this year before Acosta’s case made headlines were kept in detention for months with the goal of wearing them down so that they would sign their own deportation orders despite having valid asylum claims.

“They were tired. They couldn’t handle being in detention. They broke down and as much as they feared being returned to their home countries, they just couldn’t handle being there [in detention] anymore. They’d already been there for weeks,” Benitez said.

While ICE claims the average stay of a migrant in Stewart Detention Center is 30 days, the detention center is notorious for excessively long detainments. Acosta’s own bunkmate had been there over a year, according to Indy Week reporter David Hudnall.

As Hudnall reported, there is a massive backlog of immigration cases in the system—474,000 nationally and over 5,000 in North Carolina.

Mao told Rewire that the amount of time the remaining members of the NC6 will spend in detention varies because of different legal processes, but that it’s not unusual for young people with very strong asylum cases to sign their rights away because they can’t sustain the conditions inside detention.

Pedro Arturo Salmeron, another NC6 member, is still in detention. He was almost deported, but Mao told Rewire her organization was able to support a pro bono attorney in appealing to the Board of Immigration Appeals (BIA) to stop proceedings.

Japeth Matemu, an immigration attorney, recently told Indy Week’s David Hudnall that “the BIA will tell you that it can’t modify the immigration judge’s ruling unless it’s an egregious or obvious miscarriage of justice. You basically have to prove the judge is off his rocker.”

It could take another four months in detention to appeal Salmeron’s case because ICE continues to refuse to release him, according to the legal fellow.

“That’s a low estimate. It could be another year in detention before there is any movement in his case. We as an organization feel that is egregious to detain someone while their case is pending,” Mao said. “We have to keep in mind that these are kids, and some of these kids can’t survive the conditions of adult prison.”

Detention centers operate as prisons do, with those detained being placed in handcuffs and shackles, being stripped of their personal belongings, with no ability to move around freely. One of Acosta’s teachers told Rewire he wasn’t even able to receive his homework in detention.

Many of those in detention centers have experienced trauma. Multiple studies confirm that “detention has a profoundly negative impact on young people’s mental and physical well-being” and in the particular case of asylum seekers, detention may exacerbate their trauma and symptoms of post-traumatic stress disorder. 

“People are so traumatized by the raids, and then you add detention on top of that. Some of these kids cannot psychologically and physically deal with the conditions in detention, so they waive their rights,” Mao said.

In March, Salmeron and fellow NC6 member Yefri Sorto-Hernandez received stays of deportation, meaning they would not face immediate deportation. ICE says a stay is like a “legal pause.” During the pause, immigration officials decide if evidence in the case will be reconsidered for asylum. Sorto-Hernandez was released five months later.

Benitez said that previously when she organized around detention, a stay of deportation meant the person would get released from detention, but ICE’s decision to detain some of the NC6 indefinitely until their cases are heard illustrates how “weirdly severe” the agency is being toward this particular population. Mao fears this is a tactic being used by ICE to break down young people in detention.

“ICE knows it will take months, and frankly up to a year, for some of these motions to go through the court system, but the agency is still refusing to release individuals. I can’t help but think it’s with the intention that these kids will give up their claims while suffering in detention,” Mao said.

“I think we really have to question that, why keep these young people locked up when they can be with their communities, with their families, going to school? ICE can release these kids now, but for showmanship, ICE is refusing to let them go. Is this who we want to be, is this the message we want to send the world?” she asked.

In the seven months since the announcement of Operation Border Guardian, DHS has remained quiet about whether or not there will be more raids on young Central American asylum seekers. As a new school year approaches, advocates fear that even more students will be receiving their orders for removal, and unlike the NC6, they may not have a community to rally around them, putting them at risk of quietly being deported and not heard from again.

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