Weekly Pulse: Pelosi Champions Public Option

Lindsay Beyerstein

As health care reform moves into the closed-door, intra-party negotiation phase, House Speaker Nancy Pelosi is emerging as a champion of a public option, though she has wavered about how tough that plan should be on payouts to providers.

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

A plan to reform health care that includes a robust public option
would actually cut the deficit, according to preliminary estimates by
the Congressional Budget Office (CBO). For the purposes of this
analysis, a robust public option was defined as one that reimburses
doctors at Medicare rates plus five percent. The latest CBO estimate is
critical for Democrats because President Barack Obama said he wouldn’t
sign a health care bill that adds to the deficit. (There’s a double
standard at work. Health care has to pay for itself or save money. But
as Jo Comerford notes for Democracy Now!, the president has no
compunction about bloating the budget with defense spending.)

As health care reform moves into the closed-door, intra-party
negotiation phase, House of Representatives Speaker Nancy Pelosi is
emerging as a champion of a public option. Pelosi has always said that
she can’t pass a bill without some kind of public plan, though she has
wavered about how tough that plan should be on payouts to providers.
But according to Brian Beutler of TPMDC, yesterday’s “favorable CBO
report seems to have settled all that, and Pelosi’s decided to go all in for a public option.”

And why not? A clear majority of Americans now favor a public option, as John Byrne reports in Raw Story. According to a Washington Post/ABC
News poll published on Tuesday, 57 percent of respondents favor a
public health insurance option to compete with private insurers. That’s
an increase of five percentage points in two months.

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Two bills made it out of committee in the Senate, one with a public
option (the Health Education Labor and Pensions Committee’s effort) and
one without (the Senate Finance bill). So, proponents of the public
option are putting pressure on Senate Majority Leader Harry Reid to
include one in the final bill. The Progressive Change Campaign
Committee is running ads in Reid’s district that ask if he’s strong
enough to back a public option. Reid might be more susceptible than
usual to progressive pressure because he’s up for reelection and facing
dismal poll numbers, according to Alex Koppelman in Salon.

The public option has come back from the abyss several times, thanks
to a combination of popular appeal, political courage and determined
progressive activism. But Mike Lillis of the Colorado Independent
argues that Democrats shot themselves in the foot
by taking single payer off the table early on. Single payer health care
would abolish private health insurance and cover everyone through a
Medicare-like system. It would be an easier and cheaper way to achieve
universal coverage than any of the options Congress is considering now,
but it’s an anathema to the insurance industry.

As Lillis observes, a basic principle of negotiation is to ask for
more than you think you’re going to get and negotiate down from there.
But the White House made a point of shooting down single payer in May
and Congressional Democrats held but one hearing on the prospect. Talk
about lousy business skills.

By choosing the public option — not single payer — as
the left-most negotiating point, Democrats left themselves with few
places to go but toward more conservative proposals for insurance
reform, experts say, including the co-op model and a system of
triggering public plans only if private insurers fail to meet certain
cost and coverage targets. In the blood sport of congressional
negotiating — which dictates that you over-ask, and then move
toward your goal during the subsequent bartering — Democrats were
asking merely for the public plan they wanted in the final bill.

While we’re on the subject of preemptive concessions to unreasonable
political parties, Amanda Marcotte of Rewire describes how
Democrats have bent over backwards to accommodate the anti-choice lobby
on funding abortions under a public plan. Democrats have proposed
elaborate bureaucratic workarounds to make sure that abortions are only
covered by private money. Still, anti-choice militants like Michelle
Bachmann (R-MN) are accusing them of backing abortion fieldtrips
for school kids. Speaking of starting high and negotiating downward,
Democrats should threaten to overturn the Hyde Amendment, which bans
the use of federal funds for most abortions. Let’s see what the
anti-choicers are prepared to give up in exchange.

In a sense, it’s reassuring that legislators are taking the public
option seriously enough to argue about how it might pay for abortions.
If they didn’t think we were going to get a public option, it would be
a moot point.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

Roundups Politics

Campaign Week in Review: Clinton’s ‘Military Families Agenda’ Includes Calls for Family Leave, Child Care

Ally Boguhn

As part of her plan, Clinton would move to “ensure that family leave policies meet the needs of our military families so that, for example, new parents, as practical and consistent with mission, can care for their families at a pivotal moment.”

This week on the campaign trail, Democratic presidential candidate Hillary Clinton released her agenda for helping military families, and anti-choice voters remain ambiguous about Donald Trump’s positions on abortion.

Clinton Releases Plan to Expand Family Leave and Access to Child Care for Military Families

Clinton released her “Military Families Agenda” on Tuesday, detailing the former secretary of state’s plan, if elected, to support military personnel and their families.

“Military families, who serve alongside our service members, are vital to the strength of our military and the health of our nation,” reads Clinton’s plan. “Ensuring our military families have the support they need to balance service to the nation with the demands of family life helps our nation attract and retain the most talented service members.”

As part of her plan, Clinton would move to “ensure that family leave policies meet the needs of our military families so that, for example, new parents, as practical and consistent with mission, can care for their families at a pivotal moment.”

Clinton also vowed to improve access to child care for both active duty and reserve service members “both on- and off-base, including options for drop-in services, part-time child care, and the provision of extended-hours care, especially at Child Development Centers, while streamlining the process for re-registering children following a permanent change of station (PCS).” ​She did not say exactly what these improvements would entail.

“Service members should be able to focus on critical jobs without worrying about the availability and cost of childcare,” continues Clinton’s proposal.

Paid family leave has been a critical issue for Democrats on the campaign trail, and both Clinton and rival Democratic candidate Sen. Bernie Sanders (I-VT) rolled out clarifications and additional details about their proposals on the issue in January. Though the two candidates support similar federal policies, they would pay for them in different ways, with Clinton proposing raising taxes on the wealthy and Sanders pushing a payroll tax on workers and their employers.

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Clinton released a plan in early May to address the rising cost of child care in the United States, proposing that the federal government cap child-care costs at 10 percent of a family’s income, though the candidate’s campaign has yet to release details on how it would be implemented and funded.

Analysis conducted by the Economic Policy Institute (EPI) in 2015 found that increasingly, “child care is out of reach for working families,” and in in 33 states and Washington, D.C., child-care costs were higher than the average cost of in-state tuition at public universities.

Anti-Choice Voters Unsure About Trump’s Stance on Abortion

Recent polling found that the majority of voters who describe themselves as “pro-life” aren’t sure about whether they agree with presumptive Republican nominee Trump’s position on abortion.

The poll, conducted by Gallup during the first week of May, found that 63 percent of anti-choice respondents were unable to say whether they agreed or disagreed with Trump’s stance on abortion. Almost equal shares of anti-choice respondents said they agreed or disagreed with the Republican candidate: 19 percent agreed while 18 percent disagreed.

The majority of overall respondents—56 percent—had “no opinion” on whether they agreed with Trump on abortion or not. Just 13 percent of those polled agreed.

Meanwhile, 38 percent of those polled who considered themselves “pro-choice” said they agreed with Clinton’s position on abortion while 47 percent had “no opinion.” Twenty-two percent of all people surveyed said they agreed with Clinton, while 32 percent disagreed and 46 percent had no opinion.

Gallup’s findings follow months of ambiguity from both Republicans and the anti-choice community about Trump’s position on reproductive rights. Though Trump has consistently pushed his opposition to abortion on the campaign trail, his past statements on “punishing” abortion patients should abortion become illegal, and willingness to change the GOP platform on abortion to include exceptions for cases of rape, incest, and life endangerment have landed him in hot water with some conservatives.

Anti-choice activists, however, are slowly starting to warm to the presumptive Republican nominee. Troy Newman, president of the radical group Operation Rescue, signaled he may be willing to back Trump in a blog post in May instructing the candidate to “earn” the anti-choice vote. Priests for Life and the Susan B. Anthony List officials both backed Trump in statements to the Washington Times, though they had previously spoken out against the Republican.

What Else We’re Reading

Eric Alterman explains in a piece for the Nation that the media’s willingness to provide a false equivalency to both sides of every issue “makes no sense when one side has little regard for the truth.”

“I don’t want to sound too much like a chauvinist, but when I come home and dinner’s not ready, I go through the roof,” said Trump in a 1994 interview with ABC News when discussing his romantic relationships. “I think that putting a wife to work is a very dangerous thing …. If you’re in business for yourself, I really think it’s a bad idea.”

Sanders spotlighted Native American communities while campaigning in California ahead of the state’s primary. “This campaign is listening to a people whose pain is rarely heard—that is the Native American people,” said Sanders at a Sunday campaign rally. “All of you know the Native American people were lied to. They were cheated. Treaties they negotiated were broken from before this country even became a country. And we owe the Native American people a debt of gratitude we can never fully repay.”

Fusion’s Jennifer Gerson Uffalussy questions why Trump has said so little about the the Zika virus.

CNN embedded in a chyron a fact-check on Trump’s false claims about nuclear weapons.

Ohio removed thousands of voters from the state’s voter registration rolls because those voters had not cast ballots since 2008, in a move that could reportedly help Republicans in the state. Though states do occasionally cleanse their rolls, “only a handful [of states] remove voters simply because they don’t vote on a regular basis,” reports Reuters.

Investigations Sexual Health

The Right’s Answer to Gutting Planned Parenthood? Elementary Schools, Homeless Shelters, Jails

Sharona Coutts, Zoe Greenberg & Brie Shea

Most people would consider it unusual to pick a corrections facility if they were in the market for a breast exam. But that’s exactly what is suggested by a new website launched last month by 17 of the nation’s most prominent anti-choice groups.

The receptionist at the clinic at Washington D.C.’s Correctional Treatment Facility seemed baffled to receive a call last week from a reporter asking whether she could schedule a breast exam at the facility.

“This is a jail,” the receptionist said. The reporter asked whether people from the community could nonetheless make appointments at the facility for a breast exam, a Pap smear, or a test for sexually transmitted infections. “Ma’am, this is a jail,” she said again, before suggesting that the reporter contact doctors’ offices nearby.

Indeed, most people would consider it unusual to pick a corrections facility if they were in the market for a breast exam. But that’s exactly what is suggested by a new website launched last month by some of the nation’s most prominent anti-choice groups.

The site, GetYourCare.org, is registered to the Alliance Defense Fund, a deep-pocketed fundamentalist Christian group based in Phoenix, Arizona, now known as the Alliance Defending Freedom. Other sponsors of the site include Concerned Women for America, the Susan B. Anthony List and the Family Research Council. Together, these groups have played leading roles in either promoting or bankrolling some of the most significant anti-choice, anti-LGBTQ campaigns and lawsuits of the last few years.

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The new site was launched on September 28, the day before Cecile Richards, president of Planned Parenthood Federation of America, testified before Congress about the discredited claims that her organization profits from fetal tissue donation. The claims were made in a series of surreptitiously recorded and deceptively edited videos. Though they were the focus of a media frenzy over the summer, no evidence has been found to substantiate them, despite multiple hearings and both state and federal investigations.

Planned Parenthood serves an estimated 2.7 million people throughout the United States per year, many of them students, parents, and low-income individuals reliant on Medicaid for health care. GetYourCare.org is a not-so-subtle effort by anti-choice groups to double down on their repeated claims in Congress and the media that women’s health care would be largely unaffected if federal and state governments stripped Planned Parenthood of public funding. The site features a green map of the United States, covered in a spray of thousands of yellow dots, each of which is supposed to represent a health-care facility that could ostensibly fill the vacuum left by Planned Parenthood’s absence. The site says it draws its information “primarily from two separate lists: Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC).”

“GetYourCare.org was created to show that women have real choices when it comes to health care,” the site says. “All across America, thousands of low-cost health centers offer women and their families high-quality health care.”

A press release from the Alliance Defending Freedom claimed that the facilities listed on the map “typically offer the full range of women’s health services without all the scandal of Planned Parenthood.”

But in an investigation into the facilities, Rewire has found that these “real choices” include hundreds of elementary, middle, and high schools; clinics that provide care for homeless people; nursing homes; pediatrics centers; and even the D.C. jail. Rewire called and emailed hundreds of the facilities listed on the map, and discovered that many of their spokespeople were bewildered by the notion that women would be directed to their facilities for reproductive health services.

School officials, in particular, were confused that they would be asked to provide reproductive and sexual health services to the general population. The GetYourCare site explains that there are over 600 schools listed because they “have been identified as providing girls’ and women’s health care services at ‘school-based health centers’ on location. Thus, the school serves as a very real option for girls and young women in the area who need healthcare.”

In fact, virtually none of the 60 schools Rewire contacted from the list said they provide health care to girls and women in the community.

That includes Wearwood Elementary School, which sits nestled at the foot of the Great Smoky Mountains in Wears Valley, Tennessee. Wearwood, which teaches students from kindergarten through eighth grade, is part of a rural farming community—and not the first place you might think to go for an STI screening.

Instead, the clinic is like many other elementary school nurse’s offices, where a full-time school nurse provides limited care to the 190 students in attendance.

The nurse primarily tends to the school’s one diabetic student, the principal, Jon Manning, told Rewire in a phone interview. She can also treat scrapes, fevers, and headaches, although the district has a telemedicine program for more serious ailments.

Principal Manning described the school as “remote;” the nearest commercial district is nine miles away in Pigeon Forge, Tennessee. If women need to make an appointment for a breast exam or a birth control prescription, Wearwood Elementary is certainly not the place to go.

“We just don’t have the equipment or the staff,” Principal Manning said, when asked if women from the community could make check-up appointments there.  “What we have to offer really wouldn’t be feasible. One thing is, normally, we don’t allow strangers in during the school day for security reasons.”

Of the 60 elementary, middle, and high schools Rewire contacted across six different states, only two said they provided health services to women in the community. Both were based in Sneedville, Tennessee, and are funded by the East Tennessee State University’s college of nursing, according to a receptionist at the clinic. She said the school-based clinics provide care to students during school hours, but are open to the general public after hours and on weekends. They do provide Pap smears, breast exams and STI screenings, and they accept Medicaid patients, she said.

But many respondents at the schools were mystified by the question of providing sexual and reproductive health care.

“You called an elementary school,” a receptionist at the Heritage Hill School in Springdale, Ohio, said.

“To women?” asked a receptionist at the Delhi Charter School in Delhi, Louisiana. “No ma’am, we just do the children here that go to this school.”

“We don’t have a school-based clinic and we never have,” the receptionist at the Abiquiu Elementary School in Abiquiu, New Mexico, told Rewire.

Other types of centers explained that they did not provide services to the general population.

Rewire attempted to contact more than 20 clinics that provide health care for homeless people listed on the map. Many facilities that we contacted did not return calls or emails seeking information about the care they offered. Of those that did answer calls, several said that they did provide some type of primary health care, but in some cases those services were available only to people who met their criteria for homelessness. For a facility in El Paso, Texas, that meant providing a referral letter from a homeless shelter. For the Jessie Trice Community Health Center in Miami, Florida, a receptionist said that treatment consisted mainly of primary care for residential drug treatment patients, and not for the general public.

Similarly, the pediatrics centers we contacted were puzzled by the notion that they could offer comprehensive reproductive and sexual health services to women and girls. For instance, the receptionist at the pediatrics clinic on Marco Island in Florida—the only facility listed by the map in the area of Marco Island—confirmed that they could see girls for general pediatric complaints, but for anything involving reproductive or sexual health issues, they would need to refer patients out. She told us that the closest facility was in Naples, some 30 miles away.

It should come as no surprise that so many of these facilities do not offer comprehensive sexual and reproductive care. The official government document that explains what is included in the list that the anti-choice groups used to populate the map does not specifically mention sexual or reproductive care. Rather, it enumerates some more general forms of care—such as physician services, “other ambulatory services,” and some screening treatments—that could potentially encompass sexual and reproductive care. But the list also explicitly includes services that seem to be unrelated, such as nursing home care and diabetes self-management.

When informed of our findings, the Alliance Defending Freedom was unperturbed.

GetYourCare.org includes clinics serving different populations and demonstrates that Planned Parenthood is very rarely the only option even for the very limited services Planned Parenthood actually provides,” wrote spokesman Bob Trent in an email. “Even if Planned Parenthood were to stop providing these services, it would hardly be a blip.”

The notion that shuttering Planned Parenthood could be done without affecting access to care for those patients has been widely rejected by academics, experts, and the nonpartisan Congressional Budget Office, which concluded that 15 percent of current patients would immediately “face reduced access to care” should Planned Parenthood cease providing family planning services. That conclusion focused on “services that help women avert pregnancies,” and not the many other services, such as cancer screenings and STI testing, that Planned Parenthood provides. The CBO also concluded that the move would result in more births, and therefore greater costs to Medicaid.

But that hasn’t stopped prominent anti-choice politicians and groups from sticking to the claim.

Louisiana Gov. Bobby Jindal, who is running for the Republican presidential nomination, made that argument in court filings over his state’s efforts to strip Planned Parenthood of state reimbursements for services it provides to some 5,200 patients. When the federal judge hearing the case questioned why Jindal and his lawyers had included dentists and ophthalmologists in their list of facilities that could pick up the slack, Jindal’s administration had to back down and acknowledge that a dentist’s office is probably not the right place to go if you’re in need of a Pap smear or other reproductive health service.

The groups backing GetYourCare.org are no small-bit players. The Alliance Defending Freedom is a key architect behind legal strategies to frame anti-LGBTQ laws as protections for religious liberty. It had $35.5 million in assets, according to its 2014 public tax filings. The Family Research Council has been designated as a hate group by the Southern Poverty Law Center for its homophobic vitriol. It reported assets of more than $4 million and revenue of $13.7 million in the fiscal year ending in 2014. Concerned Women for America and the Susan B. Anthony List both clock in with around $4 million in revenue according to their most recent tax filings. Each of these groups actively campaign to end access to safe and legal abortion in the United States, as well as to restrict access to contraception. Another sponsor, Americans United for Life, generates hundreds of the model laws that have been used by state and federal legislators to further the same goal.

Based on efforts to contact hundreds of the roughly 11,000 facilities that appear to be included on the map, Rewire found that many locations did say they could provide the services we requested. Facilities in Arizona and Ohio were more likely than those in Nevada, Oklahoma, northern California, or Oregon to be able to make appointments within the next week. For those other states, wait times were typically until late December or early January. A receptionist at a facility in the northwest quadrant of Washington, D.C., said that since the clinic wasn’t taking any new patients until January, she wasn’t able to schedule appointments at this time. In Kansas and Nevada, receptionists suggested looking to facilities nearby, often more than an hour away, to schedule well-woman visits. Many voicemails and emails simply went without a reply.

Insurance coverage was also patchy. Some facilities said they accepted Medicaid and others said they charged on a sliding scale, depending on ability to pay. However, other facilities said they did not accept the types of insurance that a reporter cited.

Rewire’s reporting, though not a scientific study, strongly supported the conclusions of numerous experts who found that closing or limiting Planned Parenthood services would have a dramatic impact on women and girls—especially those in low-income communities and communities of color.

Writing in the Health Affairs Blog last month, Sara Rosenbaum, a professor and founding chair of the Department of Health Policy at George Washington University School of Public Health and Health Services, argued that defunding Planned Parenthood would be a disaster for women and girls: “Unable to access the contraceptive care they need, women would be left to pay the price, as more unintended pregnancies and abortions result.”

Rosenbaum, who is also a commissioner on the Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission, concluded:

[A] claim that community health centers readily can absorb the loss of Planned Parenthood clinics amounts to a gross misrepresentation of what even the best community health centers in the country would be able to do were Planned Parenthood to lose over 40 percent of its operating revenues overnight as the result of a ban on federal funding.

Based on Rewire’s reporting, not even the nation’s elementary schools, homeless shelters, and nursing homes could fill that gap.

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