Daily Pulse: Astroturfing the Public Option

Lindsay Beyerstein

The Senate Finance Committee is slogging through literally hundreds of proposed amendments to the Baucus health care reform bill. The bill still doesn’t have a public option, but there’s a good chance that insurance subsidies will be revised upwards

This article is published in partnership with The Media Consortium, of which Rewire is a member organization.

The Senate Finance Committee is slogging through literally hundreds
of proposed amendments to the Baucus health care reform bill. The bill
still doesn’t have a public option, but there’s a good chance that
insurance subsidies will be revised upwards, as Steve Benen of the Washington Monthly reports.

Last Sunday, President Obama made his pitch for health reform on five national TV talk shows. John Nichols of the Nation criticizes Obama for his uninspired and frankly unappealing depiction of the public option:

Indeed, as Obama describes his notion of a public
option, it is so constrained, under-funded and uninspired in approach
as to be dysfunctional.

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While there is no question that the right reform remains a
single-payer “Medicare for All” system that provides quality care for
all Americans while eliminating insurance company profiteering, if the
best that can be hoped for is a government-supported alternative to the
corporate options, then it should be robust enough to compete.

Obama advocates a public option open to the uninsured only, not to
anyone who wants to buy in. If the goal of the public option is to
reduce costs through competition, a limited public option would be
self-defeating. A public option is supposed to drive down prices
through competition. Obama’s version of a public option couldn’t
compete: It would only take cases the insurers already rejected!

Speaking of insurers, Brian Beutler and Zach Roth
report in Talking Points Memo that insurance company Humana is under
fire for trying to scare senior citizens into resisting health reform,
specifically cuts in Medicare Advantage, a federally subsidized private
insurance plan. If so, Humana is in big trouble. Astroturfing seniors is a violation of the strict rules the government imposes on communications with Advantage beneficiaries.

Public News Service reports that health care activist Joe Szakos goes on trial in Virginia today for allegedly trespassing while protesting insurance rate hikes. Szakos is a member of the Virginia Organizing Project, a non-profit social justice group seeking accountability from insurers.

Obama made his first speech to the United Nations (UN) yesterday at
the UN Summit on Climate Change in New York. Nearly a hundred heads of
state met to iron out differences face-to-face before the official
negotiations on a global climate pact begin on Copenhagen on Dec 18. In
Rewire, Karen Hardee and Kathleen Mogelgaard explain the link
between reproductive freedom and climate change. New research reaffirms that contraception could be a powerful tool to help fight global warming:

So how does reproductive health fit into this picture? A
new study by the UK-based Optimum Population Trust and the London
School of Economics shows the connection between contraceptives and
climate change. The study concludes that universal access to
reproductive health could be one of the most cost effective ways to
reduce greenhouse gas emissions by 2050. A Population Action
International report from May detailed how population dynamics, not
just overall growth, contribute to climate change.

Note that population activists aren’t saying that women in the
developing world ought to have fewer children for the sake of the
planet. They’re saying that societies grow in smarter, healthier, and
ultimately greener ways when women have the power to control their own
fertility.

This post features links to the best independent, progressive reporting about health care and is free to reprint. Visit Healthcare.newsladder.net
for a complete list of articles on health care affordability, health
care laws, and health care controversy. For the best progressive
reporting on the Economy, and Immigration, check out Economy.Newsladder.net and Immigration.Newsladder.net. This is a project of The Media Consortium, a network of 50 leading independent media outlets, and created by NewsLadder.

Roundups Politics

The House Freedom Fund Bankrolls Some of Congress’ Most Anti-Choice Candidates

Ally Boguhn

With the 2016 election cycle underway, the political action committee seems to be working tirelessly to ensure the House Freedom Caucus maintains a radical anti-choice legacy.

In its short existence, the House Freedom Caucus (HFC) has made a name for itself through endless efforts to push Congress further to the right, particularly when it comes to reproductive health. Now with the 2016 election cycle underway, the caucus’ political action committee, the House Freedom Fund, seems to be working just as tirelessly to ensure the caucus maintains a radical anti-choice legacy.

Since its founding by Rep. Jim Jordan (R-OH) in January 2015, the group of ultra-conservative lawmakers that make up the caucus has ballooned from just nine members to at least 36 members, as of October 2015, who have confirmed their own inclusion—though the group keeps its official roster secret. These numbers may seem small, but they pack a punch in the House, where they have enough votes to block major legislation pushed by other parts of the Republican party.

And now, the group is seeking to add to its ranks in order to wield even more power in Congress.

“The goal is to grow it by, and I think it’s realistic, to grow it by 20 to 30 members,” Rep. Matt Salmon (R-AZ), one of HFC’s founding members, told Politico in April. “All new members.”

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While the caucus itself reportedly does not endorse candidates, its unofficial PAC has already thrown money behind defending the seats of some of the group’s most notoriously anti-choice members, as well as a few new faces.

According to OpenSecrets.org, the Center for Responsive Politics’ campaign finance database, thus far in 2016, the House Freedom Fund has invested in seven congressional candidates currently vying to keep a seat in the House of Representatives: Rep. Rod Blum (R-IA), Rep. Dave Brat (R-VA), Rep. Tim Huelskamp (R-KS), Rep. Mark Meadows (R-NC), Rep. Scott Desjarlais (R-TN), Rep. Scott Garrett (R-NJ), and Rep. Paul Gosar (R-AZ). The PAC’s website also highlights two candidates hoping to move from their state legislatures to the House: Republican Indiana state senator Jim Banks and Georgia state Senator Mike Crane. The PAC is also backing the Republican candidate for Florida’s 2nd Congressional District, Mary Thomas; and Republican candidate for North Carolina’s 13th Congressional District, Ted Budd.

Rep. Warren Davidson (R-OH), who won a special election in early June to replace former House speaker John Boehner, also received funding from the PAC. He joined the House Freedom Caucus that same week.

The Republican Party actively works to deny access to virtually all forms of reproductive health care, so it is not surprising that the candidates supported by the House Freedom Fund, whose confirmed members are all members of the GOP, share similarly radical views on reproductive rights and health.

Here are some of the House Freedom Fund’s most alarming candidates:

Rep. Rod Blum

Rep. Blum, a freshman congressman from Iowa, considers his opposition to reproductive choice one of the “cornerstones” of his campaign. “It is unconscionable that government would aid in the taking of innocent life. I strongly oppose any federal funding for abortion and I will vote against any of our tax dollars flowing to groups who perform or advocate abortions on demand,” asserts Blum’s campaign site. The Hyde Amendment already bans most federal funding for abortion care.

Blum spent much of his first year in the House attempting to push through a series of anti-choice bills. The representative co-sponsored the medically unsupported Pain-Capable Unborn Child Protection Act, which would have enacted a federal ban on abortion at or beyond 20 weeks of pregnancy, in January 2015. He signed on as a co-sponsor for the failed Life at Conception Act, a so-called personhood measure that would have granted legal rights to fetuses and zygotes, thus potentially outlawing abortion and many forms of contraception, in March of that year. That July, Blum co-sponsored the Defund Planned Parenthood Act of 2015, which would have stripped the reproductive health organization of all federal funding for one year so that Congress could investigate it in the wake of the Center for Medical Progress’ (CMP) discredited videos smearing the provider. 

Blum’s co-sponsorship of anti-choice legislation was accompanied by a long series of like-minded votes throughout 2015, such as a January vote in favor of the No Taxpayer Funding for Abortion Act and Abortion Insurance Full Disclosure Act of 2015, which, among other things, would have made the Hyde Amendment’s annually renewed ban on most federal funding for abortion care permanent. He also voted to block Washington, D.C.’s Reproductive Health non-discrimination law, and in favor of a measure allowing states to exclude from Medicaid funding any health provider that provided abortions, as well as other anti-choice measures.

Blum’s brief time in Congress has been marked by such extremism that Emily’s List, an organization that works to elect pro-choice women, put Blum on their “On Notice” list in July 2015, signaling their intention to prioritize unseating the Iowa Representative. “In less than five months into the 114th Congress, we have seen Representative Blum lead the crusade to restrict women’s access to healthcare, most notably when he cosponsored a national abortion ban,” explained the organization in a press release on its decision to target Blum. “It’s clear that Congressman Blum is more focused on prioritizing an extreme ideological agenda over enacting policies that benefit more women and families in Iowa’s First Congressional District.”

Rep. Dave Brat

Rep. Dave Brat gained notoriety for his win against incumbent representative and then-House Majority Leader Eric Cantor in 2014, a victory considered one of “the biggest political upset[s] in recent memory.” Like many of his HFC colleagues, Brat has co-sponsored several pieces of anti-choice legislation, including the Pain-Capable Unborn Child Protection Act in 2015 and the Conscience Protection Act of 2016, which claimed to “protect” against “governmental discrimination against providers of health services” who refuse to provide abortion care. Brat’s voting record in Congress earned him a 100 percent rating from the National Right to Life Committee.

In April of this year, the Virginia representative signed on to a letter with Senator Ted Cruz (R-TX) and other anti-choice legislators, such as House Freedom Fund candidate Rep. Meadows expressing “serious concerns” about the Food and Drug Administration’s decision to update the label of abortion drug mifepristone to bring it in line with scientific research and evidence-based medicine. Though medication abortions are safe and result in complications in fewer than 0.4 percent of patients, the lawmakers nonetheless claimed that the regulation change could be dangerous, noting that the drug was originally approved during the Clinton administration and demanding a list of information about it.

In the wake of the deadly shooting at a Colorado Springs Planned Parenthood facility in November, when the alleged shooter parroted the same violent rhetoric about the reproductive health organization popularized by the CMP’s discredited videos, many in Congress called for the panel investigating Planned Parenthood to be disbanded and for lawmakers to distance themselves from the videos. Brat, however, saw no reason the anti-choice violence should affect the conservative crusade to shut down access to reproductive health care. “Principles are principles,” Brat said at the time according to the Huffington Post. “They don’t change on a news cycle.”

Rep. Tim Huelskamp

Kansas Rep. Tim Huelskamp has been an anti-choice advocate since graduate school, when, according to the biography provided on his website, he was “active in assisting women in crisis pregnancies” while working toward a doctoral degree at American University. His advocacy continued as he made his way to Congress, eventually leading him to become the congressional “Pro-Life Caucus” whip.

Though he has cast plenty of anti-choice votes, the congressman’s most notable moment when it comes to reproductive rights may be a 2012 speech on the House floor, in when he compared abortion to slavery and accused Planned Parenthood and the Obama administration of being racist. “Perhaps the biggest war against our liberties is the war that is being waged against those that are not here today, the unborn,” claimed Huelskamp. “Besides slavery, abortion is the other darkest stain on our nation’s character and this president is looking for every way possible to make abortion more available and more frequent. And he wants you to pay for it. Even if you disagree with it.”

Huelskamp went on to falsely accuse Planned Parenthood of targeting people of color. “I am the adoptive father of four children, each of them either Black, Hispanic, Native American, and I am incensed that this president pays money to an entity that was created for the sole purpose of killing children that look like mine; a racist organization and it continues to target minorities for abortion destruction,” said the congressman. “Shame on this president and shame on that party.”

It wouldn’t be the last time Huelskamp exploited race in order to promote his anti-choice agenda. In 2015, the Kansas Representative lashed out at those who accepted awards from Planned Parenthood, tweeting that they were supporting a “racist” agenda.

Rep. Mark Meadows

Rep. Mark Meadows, who has a 100 percent rating from the National Right to Life Committee, co-sponsored anti-choice measures such as the House’s 2015 fetal pain bill, the 2015 Life at Conception Act, and the Prenatal Nondiscrimination Act of 2016 (PRENDA). He also once badgered a pregnant doctor testifying during a House committee hearing about the importance of offering maternity coverage through the Affordable Care Act. However, the congressman’s recent vendetta against Planned Parenthood stands out the most.

In July 2015, in the wake of CMP’s deceptively edited videos, Meadows latched onto the discredited films in order to justify defunding Planned Parenthood. “In addition to cutting funding for abortion providers, I strongly urge Congress to investigate the legality of the practices engaged in by Planned Parenthood,” said Meadows at the time.

In September, as Congress faced the looming threat of a possible government shutdown if they didn’t pass a budget bill, Meadows exploited the opportunity to push for Planned Parenthood to be defunded, no matter the cost. With the South Carolina congressman leading the charge, pressure from conservatives to pull funding for the reproductive health-care provider played a role in prompting then-House Speaker John Boehner to resign his position. Meadows was a co-sponsor of the Defund Planned Parenthood Act of 2015, which passed in the House as part of a compromise to narrowly escape the shutdown. 

But Meadows’ quest to attack Planned Parenthood didn’t end there. In September, the congressman also participated in the House Oversight and Government Reform Committee’s hearing to “examine the use of taxpayer funding” by Planned Parenthood and its affiliates, a sham hearing used by the GOP to repeatedly push misinformation about the organization.

Rep. Scott Desjarlais

Rep. Scott Desjarlais, a medical doctor, is perhaps best known for his attempt to pressure his patient, with whom he was having an affair, into having an abortion when she became pregnant. While the congressman has repeatedly run on his anti-abortion credentials, his divorce papers also revealed he had supported his wife in having two abortions. Politico‘s Chas Sisk labeled DeJarlais  “the biggest hypocrite in Congress.”

Desjarlais made headlines again in 2015 for voting for a later abortion ban. A spokesperson for the Tennessee Republican told the Times Free Press that the vote was in accordance with the congressman’s record:

“Congressman DesJarlais was proud to vote in favor of this legislation,” said his spokesman Robert Jameson, who added that DesJarlais has maintained a “100 percent pro-life voting record” during his five years in Congress and “has always advocated for pro-life values.”

Indiana State Sen. Jim Banks

Indiana state Sen. Jim Banks (R-Columbia City) is one of the few candidates backed by the House Freedom Fund that has yet to win federal office, but his time in the state legislature has given him more than ample opportunity to demonstrate his opposition to reproductive health and rights.

Banks’ campaign website highlights the candidate’s “pro-life” position as a key issue for his race for the House, providing an extensive record of his anti-choice credentials and claiming that he is “running for Congress so that northeast Indiana continues to have a strong voice for innocent lives in Washington, D.C.” That page includes a laundry list of campaign promises, including amending the U.S. Constitution to give a fetus legal human rights, which could outlaw abortion and many forms of contraception; banning federal funding for abortion, though such a ban already exists; eliminating federal funding for any organization that performs abortions domestically or abroad; and opposing any change to the Republican platform on abortion.

The state senator’s site goes on to suggest that “it has been far too long since the Supreme Court discovered that women have a ‘right’ to have an abortion,” lamenting that much of the anti-choice movement’s work to shutter access to abortion in state legislatures hasn’t been replicated on a federal level and promising to address the issue if elected.

Included in his anti-choice resumé is a note that both Banks and his wife have been working in the movement to oppose choice since graduating college, when the two joined Focus on the Family, an organization that has spent millions of dollars promoting its extreme agenda, even devoting $2.5 million to run an anti-abortion ad during the 2010 Super Bowl. The two also worked together on the Allen County Right to Life Board of Directors, and Banks’ wife, Amanda, remains the board’s vice president.

But most extreme of all was the legislation Banks spearheaded while in the state legislature, which included several targeted regulation of abortion providers (TRAP) measures. Most recently the state senator sponsored Indiana’s SB 144, a bill that would modify the state’s 20-week abortion ban to outlaw the procedure once a fetal heartbeat could be detected, typically around six weeks’ gestation. In a statement on the bill, Banks claimed the law was needed because it “would protect unborn Hoosiers’ right to life and also includes important women’s health protections.”

Investigations Abortion

Anti-Choice Groups Use Smartphone Surveillance to Target ‘Abortion-Minded Women’ During Clinic Visits

Sharona Coutts

Women who have visited almost any abortion clinic in the United States have seen anti-choice protesters outside, wielding placards and chanting abuse. A Boston advertiser's technology, when deployed by anti-choice groups, allows those groups to send propaganda directly to a woman’s phone while she is in a clinic waiting room.

Last year, an enterprising advertising executive based in Boston, Massachusetts, had an idea: Instead of using his sophisticated mobile surveillance techniques to figure out which consumers might be interested in buying shoes, cars, or any of the other products typically advertised online, what if he used the same technology to figure out which women were potentially contemplating abortion, and send them ads on behalf of anti-choice organizations?

The executive—John Flynn, CEO of Copley Advertising—set to work. He put together PowerPoint presentations touting his capabilities, and sent them to groups he thought would be interested in reaching “abortion-minded women,” to use anti-choice parlance.

Before long, he’d been hired by RealOptions, a network of crisis pregnancy centers (CPCs) in Northern California, as well as by the evangelical adoption agency Bethany Christian Services.

Flynn’s endeavors quickly won him attention in the anti-choice world. He was invited to speak at the Family Research Council’s ProLifeCon Digital Action Summit in January this year, and he got a few write-ups in anti-choice press.

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In an interview with Live Action News—the website for Live Action, the group run by anti-choice activist Lila Rose that is responsible for bogus attack videos against Planned Parenthood—Flynn gave some details about his strategy. He sends advertisements for his clients to women’s smartphones while they are sitting in Planned Parenthood clinics, using a technology known as “mobile geo-fencing.” He also planned to ping women at methadone clinics and other abortion facilities. His program for Bethany covered five cities: Columbus, Ohio; Pittsburgh, Pennsylvania; Richmond, Virginia; St. Louis, Missouri; and New York City.

“We are very excited to bring our mobile marketing capabilities to the pro-life community,” Flynn told Live Action News.

Anti-choice groups were tantalized by the ability to home in on the women they think will be most susceptible to their message.

“Marketing for pregnancy help centers has always been a needle in a haystack approach—cast a wide net and hope for the best,” said Bethany Regional Marketing Manager Jennie VanHorn, according to the report. “With geo fencing, we can reach women who we know are looking for or in need of someone to talk to.”

Flynn’s targeting of women seeking abortion presents a serious threat to the privacy and safety of women exercising their right to choose, as well as to abortion providers and their staff, a Rewire investigation has found. But due to weak and patchwork laws governing privacy and data collection in the United States, the conduct appears to be perfectly legal.

Women who have visited almost any abortion clinic in the United States have seen anti-choice protesters outside, wielding placards and chanting abuse. This technology, when deployed by anti-choice groups, allows them to send propaganda directly to a woman’s phone while she is in a clinic waiting room. It also has the capability to hand the names and addresses of women seeking abortion care, and those who provide it, over to anti-choice groups.

“It is incredibly unethical and creepy,” Brian Solis, a digital marketing expert, told Rewire, expressing a view that was unanimous among a dozen experts in digital security, privacy law, and online marketing we interviewed for this story.

Solis said this example was the inevitable application of a technology meant for one purpose—mass advertising campaigns that, while considered by many people to be unseemly and intrusive, do not generally amount to a threat—to a very different, and troubling, objective.

“You can grab an uncomfortable amount of information from someone’s device and the apps they use,” said Solis. “It’s unfortunate, but any woman who plans to visit an affected Planned Parenthood, or anyone who works for Planned Parenthood, should be afraid.”

When Ads Follow You Around

By now, most Americans have experienced the following phenomenon: You look at something online—a hotel, a flower delivery service, a course at a local college—and the next thing you know, ads for that thing follow you around the internet for the next week.

A watch you looked at now pops up next to your Facebook feed; an ad for a coffee machine you researched on Amazon now lurks on your favorite news sites. And maybe, after researching cars online, it seems that Toyota knows whenever you visit a lot, and sends ads to your phone as you walk through the dealership’s doors.

This is all part of the new landscape of digital advertising, where marketers can tailor their ads to very specific groups of consumers by compiling “personas” based on the thousands of shards of data we all create as we go about our activities online.

While theoretically anonymous, these marketing personas are surprisingly accurate. Marketers likely know your age, gender, occupation, education level, marital status, and—if you have GPS enabled on your phone and are logged into apps that track you—where you live, work, and travel.

What Flynn realized is that he could use the same technologies to infer that a woman might be seeking an abortion, and to target her for ads from anti-choice groups.

“We can reach every Planned Parenthood in the U.S.,” he wrote in a PowerPoint display sent to potential clients in February. The Powerpoint included a slide titled “Targets for Pro-Life,” in which Flynn said he could also reach abortion clinics, hospitals, doctors’ offices, colleges, and high schools in the United States and Canada, and then “[d]rill down to age and sex.”

“We can gather a tremendous amount of information from the [smartphone] ID,” he wrote. “Some of the break outs include: Gender, age, race, pet owners, Honda owners, online purchases and much more.”

Flynn explained that he would then use that data to send anti-choice ads to women “while they’re at the clinic.”

In his sales PowerPoint, Flynn said that he had already attempted to ping cellphones for RealOptions and Bethany nearly three million times, and had been able to steer thousands of women to their websites. The price tag for one of Copley’s campaigns, he said, was $8,000.

Flynn initially agreed to speak with Rewire for this story, but did not respond to multiple follow-up emails and phone calls. Much of this report is based on materials that he sent to people he believed to be potential clients. Numerous messages seeking comment from management for RealOptions went unanswered; Jennifer Gradnigo, a spokesperson for Bethany Christian Services, confirmed that they have used Copley’s services and “appreciate their ideas,” but declined to discuss specific campaigns.

Not everyone who received Flynn’s pitch emails was impressed. One recipient contacted Rewire after speaking with Flynn, and expressed horror at what Flynn told her he was able to do on behalf of anti-choice clients.

“I felt disgust, and I felt protective of these women who are going to seek sensitive medical services at a time when they’re vulnerable,” said the recipient, who is a social worker at a Northern California adoption agency. Rewire agreed to withhold her identity due to her fears of retaliation from anti-choice activists.

“They’re being spied on by this capitalist vulture who is literally trying to sell their fetuses,” she said. “To do this to women without consent is predatory and it’s an invasion of her privacy, and unethical.”

In emails and PowerPoint presentations sent in early March, Flynn claimed to have reached more than 800,000 18-to-24-year-old women on behalf of RealOptions, and to have sent more than 2,000 of those women to RealOption’s website.

Rewire obtained three examples of the ads that Flynn said he had sent to young women’s phones on RealOptions’ behalf.

The ads are typical of CPCs.

They ask, “Pregnant?” or “Abortion?” and then include statements like “It’s your choice. You have time… Be informed” and “Get the facts first.”

GeoFencing Pregnant Ad

Like most CPCs, the claim that RealOptions provides “facts” about abortion is deceptive. While that language may lead women to believe they could obtain abortion care at RealOptions, in federal tax filings, the organization explains its mission as: “empowering and equipping women and men to choose life for their unborn children through the love of Jesus Christ in accordance with his word regarding the sanctity of human life.”

According to its website, RealOptions has received funding from the radical Christian group Focus on the Family. The organization was founded in 1981 by Marion and Tom Recine, fervent Christians who in a video posted to their website refer to the “many, many, many women who’ve come to Jesus because of the [RealOptions] centers.”

Flynn also says that he has targeted 140 abortion clinics on behalf of Bethany Christian Services over the past few months, and that 10,000 people clicked on the ads for Bethany that he sent to smartphones in those clinics, directing them to a “dedicated resource centers landing page.”

Bethany is the nation’s largest adoption agency, with assets of more than $45 million in 2014, according to the most recent available figures. The chain has faced accusations of pressuring birth moms to continue pregnancies against their will, of abandoning mothers who change their minds and decide not to go through with adoptions, and other abuses.

The social worker who received Flynn’s pitch deck told Rewire she was alarmed that Flynn had succeeded in reaching so many women on behalf of his anti-choice clients.

“He’s doing it and it’s working and it’s probably really impacting human trajectories,” she said. “It changes human lives to be funneled into a system like this.”

Advertising Is Now a System of Surveillance

Although it is now ubiquitous, mobile digital advertising is a relatively new phenomenon, only as old as the sophisticated smartphones on which it relies. As a result, laws and the regulators who enforce them are lagging behind when it comes to the many possible ways that bad actors can abuse smartphone advertising.

In terms of federal laws, many either don’t apply to Flynn’s conduct, or would allow it, according to Chris Hoofnagle, a professor at the University of California, Berkeley’s School of Law, and School of Information.

“Privacy law in the U.S. is technology- and context-dependent,” Hoofnagle said. “As an example, the medical information you relay to your physician is very highly protected, but if you go to a medical website and search for ‘HIV’ or ‘abortion,’ that information is not protected at all.”

In other words, it’s almost certain that the Health Insurance Portability and Accountability Act, known as HIPAA, would not apply.

The other limitations, such as they are, come from two sets of laws. The Federal Trade Commission (FTC) and state attorneys general can prevent advertisers from sending false and misleading ads; they can also stop advertisers from lying about what information they are tracking and what they plan to do with it once collected.

The FTC did not reply to Rewire’s questions in time for the publication of this story. However, the commission does not have jurisdiction over nonprofits, so it is highly unlikely that it could take action in this case.

The second set of laws concern user consent. Companies like Verizon and AT&T, known as carriers, are required to get affirmative consent before using “Customer Proprietary Network Information” gleaned through cellphone towers—including call records and location—for marketing. Apps don’t use network information, but rely instead on the GPS built into phones. They also need to obtain affirmative consent to collect and use information for marketing.

Obtaining that consent is easier than many consumers may think.

“The reality of this stuff is that no one’s asking what marketers will do with their information when they click, ‘I Agree,’ when an app asks if it can use their location,” Hoofnagle said. “If one consents to that tracking, and consents for it to be used for advertising purposes, that’s pretty much the end of the story.”

Certainly, most people wouldn’t imagine that by agreeing that, say, Yelp, Snapchat, Tinder, or the New York Times could use their location, that marketers could then use the same information for the very different purpose of figuring out whether they are seeking sensitive medical services.

Hoofnagle says that such use is perfectly legal, as long as companies don’t lie about what information they’re collecting—even if those disclosures are buried in fine print.

For his part, John Flynn is confident that his campaign is within legal bounds.

“I have worked with pharma, medical recruitment and many others where we mobile geo-fenced medical centers without a problem,” he wrote in an email to a potential client. “Bethany’s campaign targeted just medical centers and there was [sic] no issues. RealOptions in the San Jose area is presently targeting colleges and medical centers without issue.”

In the absence of robust legal limitations in the United States, advertisers have organized into self-regulatory bodies to police themselves, acutely conscious that examples of egregious privacy violations could spark a public backlash, and lead consumers to block ads and to opt out of targeted marketing.

Lindsay Hutter, a spokesperson from the Direct Marketing Association (DMA)—a New York-based group that represents direct marketers—said in an email statement to Rewire:

A key pillar of DMA’s work is to ensure that data-driven marketers conduct their work on an ethical basis, respecting the private information of consumers. This is particularly true for sensitive medical information about particular individuals, the use of which for marketing purposes without permission is against DMA’s Ethical Guidelines. Any location-based marketing should be opt-in, with the consumer notified that marketing offers are being presented due to their location.

Hutter did not provide a direct reply to our questions as to whether targeting women who might be seeking abortion care on behalf of anti-choice groups would be in violation of DMA’s guidelines.

It would, however, violate Facebook’s standards, according to Tom Channick, a company spokesperson.

“Our policies prohibit ads that make implications, directly or indirectly, about a user’s personal characteristics, including medical condition or pregnancy,” Channick said. “Deceptive or misleading advertisements are also prohibited.”

Flynn claims that he has a “relationship” with Facebook that allows him to “place mobile and digital ads in Facebook pages,” but Channick said the company could find no record of Flynn or his company ever using their platform.

Calling Flynn’s campaigns “really objectionable,” Hoofnagle said that these kinds of practices are toxic to the digital advertising industry, as well as the platforms—like Google and Facebook—that depend on advertising dollars.

He said this example drives home the fact that the nature of advertising has fundamentally transformed with the rise of the internet, and as smartphones have become ubiquitous.

“Advertising is a system of surveillance now,” Hoofnagle said. “It used to be billboards and television. Now it’s surveillance.”

Extremists Could Use Women’s Phones to Learn Their Names and Addresses

Surveillance has long played a central—and deadly—role in the efforts of anti-choice activists to intimidate women out of accessing abortion care, and to stop providers from making it available.

In the late 1990s, an anti-choice extremist created a website called the Nuremberg Files—in reference to Nazi Germany—which was a list of the names and addresses of doctors who provided abortions. Operation Rescue maintained a site called “Tiller Watch” that monitored the doctor’s whereabouts until he was murdered in the spring of 2009. Extremists have published “Wanted” signs with photographs of abortion providers. Activists in Texas stalk people entering local clinics, noting their physical appearance and license plates, hoping to determine which women went through with their abortion and whether anyone changed their mind, as well as to identify clinic workers. Many providers around the country report having been followed on their way to and from work.

Sasha Bruce, senior vice president of campaigns and strategy at NARAL Pro-Choice America, says that tagging the cellphones of women who go to abortion clinics falls within the pattern of intimidation.

“Intimidation frankly is the lowest threshold—that quickly turns to violence,” Bruce said. “That’s part of what’s troubling about this. There’s a real incitement that this information can contribute to.”

Bruce said she was alarmed in particular because Flynn was not just collecting information about what women looked at online, but also about their physical locations.

“If you have the smartphone ID, and then you can tie that to a location outside of the clinic, let’s say a home, that’s a real security threat,” Bruce told Rewire. “I worry about the extension of that—the desire of anti-choice activists to know who these staffers are, and who the women are.”

To be clear, there is no evidence to suggest that Flynn or his clients have or want to use geo-fencing to learn the real identities of women seeking abortion. But experts told Rewire that the potential for others to abuse the technology is a cause for alarm. In keeping with the view that transparency fosters security, Rewire has chosen to outline the ways this tracking could be misused.

In theory, when marketers gather information about individual smartphone users through methods like geo-location, that data is anonymized, meaning that it is not attached to a person’s name, but rather to a unique number known as an “advertising ID.” That is the number associated with the particular copy of the operating system that each of us has downloaded onto our smartphone. If you use a Google phone, your operating system is Android; for iPhone users, it’s your copy of iOS. Much of what you do on your phone can be associated with that advertising ID.

In most cases, marketers want to collect data from millions of potential customers, said John Deighton, a professor of marketing at Harvard Business School, in an interview with Rewire. The more data they have, the more ads they can send, which enhances their database.

“What your story is drawing to my attention is that these same surveillance technologies can be used at a much more micro scale,” he said. “You could imagine outright illegal use of geo-targeting: for example, geo-targeting a rich person’s house and getting an alert when they leave home.” That could, say, lead to high-tech burglary.

“Once you start realizing you can target desirable individuals, instead of being a big data function it becomes about tiny data,” Deighton said.

But if all of the data that marketers collect is supposed to be anonymized, how could bad actors—including anti-choice extremists—figure out the actual identities of the people they track?

The dirty secret of digital marketing is that it is in fact relatively easy to find out the real identities that are attached to our online IDs, according to experts who spoke with Rewire.

The most obvious way is simply to ask people for that information.

Both RealOptions and Bethany Christian Services require a person’s name and contact information in order to receive information online. Once a woman enters her name, email, home address, phone number, or ZIP code, that information is tied to her advertising ID, and Flynn could potentially marry that ID to all data associated with it and store it in what he calls his databank.

There are, however, plenty of less aboveboard methods to learn the name attached to an anonymous ID.

Any site or app that uses a profile with your name and any other information—Facebook, dating services, banking apps—can link your device, and your advertising ID, to the real you.

Legitimate services would not hand over personally identifying information willingly, but there are many instances of such information being made widely available. The cyber attack on Ashley Madison, the dating site for married people seeking extramarital partners, resulted in the release by hackers of the personal information of 32 million of the site’s users, revealing the potential for profile-based sites to be targeted.

Even without sophisticated hacks on established sites, bad actors can use techniques known as “social engineering” to learn the personal identities associated with advertising IDs.

For instance, if an anti-choice group wanted to learn the identity of women seeking abortions, instead of sending them ads for CPCs, they could send ads that seemed unrelated to abortion—for a competition to win $500, or for help with student loans—that tricked women into entering their names, email addresses, and any other information required by the form. Any woman who filled out the form would have unwittingly handed her name to anti-choice activists.

That would allow anti-choice groups to literally see women’s whereabouts in real time, said digital marketing experts who spoke with Rewire anonymously because they were not authorized to speak with the press. They described marketing software that allows them to see targeted individuals’ locations, the same way you can see yourself as a blue dot on a smartphone map. If certain people were seen at an abortion clinic regularly—say, during work hours—Flynn or his clients might even be able to infer that they work there.

“That’s what scares me about your story,” said Deighton. “Now we have an incentive to track people that isn’t the usual big data incentive.”

The question naturally arises: What can abortion providers and the women they serve do to fend off these digital affronts?

The simplest measure Planned Parenthood, or any other abortion provider, could take is to tell patients to leave their smartphones at home or in the car. If that isn’t possible or practical, the best advice is to turn off their GPS and log out of all apps before they come to a clinic.

It’s a simple step, but one that many people either won’t or don’t take, said Cooper Quintin, a technologist at the Electronic Frontier Foundation (EFF), a San Francisco-based organization dedicated to preserving fundamental rights in the age of technology.

“The way we need to fight back against this is by blocking these things that are tracking who we are and where we are and what things we’re looking at,” Quintin told Rewire. EFF considers location-based tracking to be a serious threat to privacy.

“Right now, there’s this big ideological debate about ad-blocking. What’s missing from that debate is the idea of blocking things that are tracking you. Tracking people and building up these databases of what they read online, where they go in the real world, linking their online behaviors to their offline purchases and real world behavior—these things can have real-world effects, and this is a horrific example of how this can affect people in a way that’s much more important than seeing some annoying or creepy ads that follow you around.”

Editor’s Note: Watch our video for info on how to avoid location-based tracking.