Aborting Health Care Reform

Dana Goldstein

The president and his staff have been reluctant to take on reproductive rights in health reform. But that has not prevented anti-choicers from using the issue to activate their base against reform.

This article was first published by The American Prospect.

In September 1993, as Hillary Clinton lobbied Congress to pass her
health-reform bill, she plainly addressed the looming controversy over
reproductive care. "It will include pregnancy-related services, and
that will include abortion, as insurance policies currently do," she
told the Senate Finance Committee. Conservatives were incensed. But as
the history books record, it was industry pressure and legislative
malaise that killed Hillarycare, not debate over women’s rights.

On the campaign trail, Barack Obama did not shy away from the issue
of abortion, pledging, "On this fundamental issue, I will not yield."
In the context of health reform, though, the president and his staff
have been reluctant to directly address reproductive rights. In a March
interview with the Christian Broadcasting Network’s David Brody, the
White House’s chief domestic policy adviser, Melody Barnes — who once
sat on the board of Planned Parenthood — claimed she had never spoken
to the president about whether abortion services should be covered
under a universal health-care system. "We haven’t proposed a specific
benefits package or a particular health-care proposal, so we’re going
to be engaging with Congress to have this conversation," she said. When
Office of Management and Budget Director Peter Orszag was asked by Fox
News in July whether the public insurance plan should cover abortion,
he was vague. "I’m not prepared to rule it out," he said. The president
finally addressed the issue himself in a July 21 interview with Katie
Couric, in which he bucked reproductive rights groups by saying he
would consider deferring to the "tradition" of "not financing abortions
as part of government-funded health care."

Perhaps in response to the failure of the Clintons’ highly detailed
plan, Obama’s strategy has been to leave the nuts and bolts of health
reform up to the legislative branch, saying only that the resulting
bill must fulfill three goals: lower costs, provide Americans with more
health choices, and assure quality. That lack of detail has shoved
Congress deep into the weeds. Predictably, the president’s vagueness
hasn’t prevented anti-choicers from seizing upon the possible inclusion
of reproductive-health services as a vehicle to activate their base
against reform. "A vote for this legislation, as drafted, is a vote for
tax-subsidized abortion on demand," wrote Douglas Johnson, the National
Right to Life Committee legislative director, in a letter to Congress.
That message penetrated. At a July 14 press conference, Rep. Joe Pitts,
a Republican from Pennsylvania, claimed health reform undermined
Americans’ "right to life. Let’s make it explicit that no American
should be forced to finance abortions." As the health-care debate
reached a fever pitch in the weeks before Congress’ summer recess, Fox
News featured daily segments on the threat of "subsidized abortion."

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Meanwhile, Obama declared in his July 18 radio address that he would
not sign any reform bill that did not include a public health-insurance
program. A public plan is central to progressives’ goals of lowering
costs by giving private insurers real, high-quality competition. A
government-funded insurance option might, eventually, serve as the
shell for a single-payer health-care system similar to those of Western
Europe. But if Congress acquiesces to abortion opponents and passes a
public plan that does not provide reproductive-health services
comparable to what Americans can purchase in the private market or
obtain through their employer, it will be a weaker plan with a smaller
constituency. After all, the typical woman spends five years of her
life pregnant, or trying to become so, but a full 30 years avoiding
pregnancy. Without good reproductive-health coverage and strong buy-in
from women — who use more health care than men — it is difficult to
see how a public plan would gain strength over time.

Contrary to conservative hand-wringing, reproductive rights have
been under constant assault in the health-reform debate. At stake is
not only whether a potential public plan covers contraception or
abortion but also whether existing private health insurers, 87 percent
of which currently offer some abortion access, will be able to continue
to do so once they are operating within the new health-insurance
exchanges. The exchanges will house both public and private plans after
reform and will be regulated by the federal government.

This increased government intervention in the health sector both
excites and terrifies advocates for better reproductive care. The
potential upside is that through a public plan, an expansion of
Medicaid, and more competition among private insurers, many more women
will be able to afford good reproductive health care. But the potential
downside is stark: A politicization of which reproductive-health
services insurers can cover, meaning that under anti-choice
administrations, abortion and even contraceptive limitations or bans
could become the norm.

For millions of American women, insurance-subsidized abortion is already off limits. After Roe v. Wade
legalized abortion in 1973, one of the religious right’s first
successes in limiting access to the procedure was the passage of the
Hyde Amendment. Since 1976, Hyde has banned Medicaid — the federal
health-insurance program for poor women and children — from paying for
abortions, except in the most extreme cases when a woman’s physical
health or life is in danger. Medicaid covers 7 million American women
of reproductive age, or 12 percent of women in that cohort. Federal
employees, members of the U.S. military, Peace Corps volunteers, and
prisoners are also barred from using their government health coverage
to access abortion.

During a July 14 interview on MSNBC, Sen. Chuck Grassley, the
ranking Republican on the Senate Finance Committee, contended that when
it comes to abortion and health reform, "what we’re trying to do is
maintain current policy." Yet because any potential public health plan
would be funded by the federal government, what anti-choicers would
really like to ensure is that Hyde would also apply to any new public
insurance programs.

That isn’t likely to sit well with the public. Though past polls
have shown Americans are resistant to the concept of "taxpayer-funded
abortions," the public seems to see health reform under a different
light. According to a poll by the Mellman Group on behalf of the
National Women’s Law Center, 71 percent of Americans support coverage
for reproductive health, including contraception, under a public plan.
Sixty-six percent support coverage for abortion in a public plan.

None of the health-reform proposals being considered by Congress
explicitly threaten Hyde or the other existing federal bans on abortion
funding. In fact, reproductive-health-care advocates reluctantly admit
that the repeal of Hyde, although a long-term priority, is not on their
current agenda. After all, some Democrats, including Vice President Joe
Biden, have a history of support for the ban. "Hyde is discriminatory
against poor women, and we’d like to see it overturned," says Adam
Sonfield, a senior policy associate at the Guttmacher Institute. "But
it does not seem to be a political priority right now."

To protect against disruptions in American women’s access to
reproductive medicine, advocacy groups are recommending that an
independent council of medical experts — not a political appointee —
define which services will be covered by insurance plans participating
in the exchanges. Such a commission would likely argue for the
inclusion of abortion and contraceptive services. Though politically
volatile, family planning is rather uncontroversial in the insurance
industry and among public-health experts. For every $1 spent on public
family-planning services, the government saves $4.02. The public sector
alone saves $4.3 billion in medical costs each year thanks to the
family-planning coverage the federal government already provides poor
women through Medicaid and Title X. That’s because birth control and
abortion are simply much less costly than pregnancy.

The final health-reform bill will likely establish a council of
experts to advise the health and human services secretary on what
benefits should be covered. But in both the House and Senate proposals,
the council’s power is limited; it is still the HHS secretary who makes
the final call. This means that under anti-choice administrations,
abortion and contraceptive access could be threatened within the
health-insurance exchanges. "The potential there is that many, many
women could lose the coverage they presently have," said NARAL
Pro-Choice America President Nancy Keenan in July, as hundreds of
Senate amendments were being filed on health reform, many of them
seeking to prevent abortion coverage.

Another risk is that even if abortion services are covered, health
clinics that provide abortion — such as the Planned Parenthood network
— could be barred from participating in the exchange, meaning they
would not be able to offer insured services to patients in either
public or private plans. An amendment to the Senate Health, Education,
Labor, and Pensions (HELP) bill from Barbara Mikulski, a Democrat from
Maryland, would protect the status of clinics, but it attracted
opposition even from some Democrats, such as Sen. Bob Casey of
Pennsylvania, who identifies as pro-life.

For many congressional Republicans — and some of the 19 moderate
House Democrats who joined their cause — fanning the flames of the
abortion debate is, at least in part, a tactic for delaying reform. To
be fair, some family planning opponents do support the broader goal of
universal health care — the Catholic Church chief among them. But
according to Marilyn Keefe, director of reproductive-health programs at
the National Partnership for Women and Families, "The pressure [on
reproductive rights] largely comes from people who don’t support the
larger health-reform effort."

Advocates were able to ensure that both the House tri-committee
bill and the Senate HELP bill made it through committee without any
amendments limiting access to reproductive care. But as Tina Tchen,
director of the White House Office of Public Engagement, told a July 15
Planned Parenthood conference — perhaps in an effort to tamp down
expectations — "That was not easy. It was not easy in committee. It
won’t be easy to hold on the House floor. It won’t be easy to hold on
the Senate floor."

Women’s organizations find themselves in the strange position of
playing defense, even as a pro-choice president sits in the White House
and both houses of Congress have pro-choice majorities. "Depending on
some of the things that are being proposed, we could be worse off"
after health reform than before it, Planned Parenthood President Cecile
Richards said at the conference. "That is untenable. Those are some of
the tough conversations we’re having, frankly, with the White House and
Congress. We can’t be worse off."

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 Law and Policy

Pastors Fight Illinois’ Ban on ‘Gay Conversion Therapy’

Imani Gandy

Illinois is one of a handful of states that ban so-called gay conversion therapy. Lawmakers in four states—California, Oregon, Vermont, and New Jersey—along with Washington, D.C. have passed such bans.

A group of pastors filed a lawsuit last week arguing an Illinois law that bans mental health providers from engaging in so-called gay conversion therapy unconstitutionally infringes on rights to free speech and freedom of religion.

The Illinois legislature passed the Youth Mental Health Protection Act, which went into effect on January 1. The measure bans mental health providers from engaging in sexual orientation change efforts or so-called conversion therapy with a minor.

The pastors in their lawsuit argue the enactment of the law means they are “deprived of the right to further minister to those who seek their help.”

While the pastors do not qualify as mental health providers since they are neither licensed counselors nor social workers, the pastors allege that they may be liable for consumer fraud under Section 25 of the law, which states that “no person or entity” may advertise or otherwise offer “conversion therapy” services “in a manner that represents homosexuality as a mental disease, disorder, or illness.”

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The pastors’ lawsuit seeks an order from a federal court in Illinois exempting pastoral counseling from the law. The pastors believe that “the law should not apply to pastoral counseling which informs counselees that homosexuality conduct is a sin and disorder from God’s plan for humanity,” according to a press release issued by the pastors’ attorneys.

Illinois is one of a handful of states that ban gay “conversion therapy.” Lawmakers in four states—California, Oregon, Vermont, and New Jersey—along with Washington, D.C. have passed such bans. None have been struck down as unconstitutional. The Supreme Court this year declined to take up a case challenging New Jersey’s “gay conversion therapy” ban on First Amendment grounds.

The pastors say the Illinois law is different. The complaint alleges that the Illinois statute is broader than those like it in other states because the prohibitions in the law is not limited to licensed counselors, but also apply to “any person or entity in the conduct of any trade or commerce,” which they claim affects clergy.

The pastors allege that the law is not limited to counseling minors but “prohibits offering such counseling services to any person, regardless of age.”

Aside from demanding protection for their own rights, the group of pastors asked the court for an order “protecting the rights of counselees in their congregations and others to receive pastoral counseling and teaching on the matters of homosexuality.”

“We are most concerned about young people who are seeking the right to choose their own identity,” the pastors’ attorney, John W. Mauck, said in a statement.

“This is an essential human right. However, this law undermines the dignity and integrity of those who choose a different path for their lives than politicians and activists prefer,” he continued.

“Gay conversion therapy” bans have gained traction after Leelah Alcorn, a transgender teenager, committed suicide following her experience with so-called conversion therapy.

Before taking her own life, Alcorn posted on Reddit that her parents had refused her request to transition to a woman.

“The[y] would only let me see biased Christian therapists, who instead of listening to my feelings would try to change me into a straight male who loved God, and I would cry after every session because I felt like it was hopeless and there was no way I would ever become a girl,” she wrote of her experience with conversion therapy.

The American Psychological Association, along with a coalition of health advocacy groups including the American Academy of Pediatrics, the American Counseling Association, and the National Association of Social Workers, have condemned “gay conversion therapy” as potentially harmful to young people “because they present the view that the sexual orientation of lesbian, gay and bisexual youth is a mental illness or disorder, and they often frame the inability to change one’s sexual orientation as a personal and moral failure.”

The White House in 2015 took a stance against so-called conversion therapy for LGBTQ youth.

Attorneys for the State of Illinois have not yet responded to the pastors’ lawsuit.

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