Top Pharmaceutical Lobbyist Quits; Crafted Deal with White House on Health Reform

Jodi Jacobson

Billy Tauzin is resigning as president of the drug industry trade group Pharmaceutical Research and Manufacturers of America amid internal disputes over its pact with the White House to trade political support for favorable terms in health reform.

Politico and the New York Times report tonight that Billy Tauzin, former Congressman from Louisiana and now one of Washington’s highest-paid lobbyists, is resigning
as president of the drug industry trade group Pharmaceutical Research
and Manufacturers of America amid internal disputes over its pact with
the White House to trade political support for favorable terms in the
proposed health care overhaul.

As the industry’s top lobbyist, according to the New York Times, "Mr. Tauzin brokered the deal with the
White House and Max Baucus, chairman of the Senate finance committee,
last summer to limit the drug industry’s total costs under the proposed
health care overhaul to $80 billion over 10 years."

Mr. Tauzin’s departure is the latest unexpected fallout of the
Republican upset in the Massachusetts Senate race, which abruptly
transformed the health care overhaul from a near-inevitability to a
daunting cause.

Like almost every other seasoned Washington player, Mr. Tauzin, who
makes $2 million a year, bet on health care reform early –  only to
watch it come to a screeching halt.

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Under his direction — and amid some protests from its board — the
organization had backed up its end of the deal by spending more than
$100 million on television advertising to promote the plan.

But after the health care overhaul stalled when Democrats lost the
Massachusetts Senate seat, some industry leaders felt the trade group
had gone too far giving concessions and could lose on some important
legislative issues without gaining the protection it had sought.

While both the White House and Tauzin initially refused to disclose terms of the deal, their hands were forced when Congressional supporters of  allowing importation of
cheaper drugs from Canada or permitting Medicare to bargain for lower
drug prices, and "Tauzin publicly accused the White House of failing to
stand for its end of a quid pro quo."

The arrangement — confirmed by White House officials and later in Congress — became a source of controversy among liberals who faulted
the administration for giving away too much and Republicans who had
traditionally been supported by the pharmaceutical industry. It
contributed to the perception that the Democrats were negotiating the
terms of the health care overhaul in secret meetings.

But the deal was also controversial within the drug industry, people
familiar with the group’s deliberations said, because some on its board
questioned whether the agreement would pay off for them. And when the
Republican victory in the Massachusetts Senate seat put the brakes on
the health care process, many in the trade group known as PhRMA
grumbled that it had all been for naught, these people said.

News Contraception

White House Openly Considers Caving to Bishops on Birth Control Coverage

Jodi Jacobson

According to a New York Times article today, the White House has now publicly confirmed that President Obama is considering caving to demands by the United States Conference of Catholic Bishops (USCCB) and other far right religious groups on the requirement that insurance plans under health reform cover birth control without a co-pay.

See all our coverage of the Birth Control Mandate 2011 here

According to a New York Times article today by Robert Pear, the White House has now publicly confirmed that President Obama is considering caving to demands by the United States Conference of Catholic Bishops (USCCB) and other far right religious groups that he “expand the exemptions” from the requirement that insurance plans under health reform cover birth control without a co-pay.

If he does so, the President will be trading the health, welfare, autonomy, and economic prospects of millions of women and the opinion of the entire medical and public health communities to curry favor with a very small minority of male-dominated religious right groups such as the USCCB which has found that it can not, on its own, force women to become and remain pregnant.

And as far as I am concerned, if the President does this, he will also forfeit the right to call himself “pro-choice” under any definition of the term as I understand it.

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What’s the problem here? Even the Times basically has it wrong, because the article continues to mis-characterize both the nature of contraceptive coverage (it is not “free of charge”) and of the current exemption, which not only “may” (as the Times suggest) but does exempt Churches from the requirement.

The basic problem here is this: The vast majority of women of reproductive age in the United States–99 percent–uses at least one modern form of birth control at some point in their lives. This includes Catholic women, Jewish women, Muslim women, Protestant women and the majority of women of every other religious persuasion and those who are not religiously identified, are atheists, agnostic or any other category I may be inadvertently failing to mention.

That women–Catholic women and other women–actually do control their fertility drives the Bishops and the rest of the religio-political patriarchy up a wall.  And, this summer, the Administration drove them over the top of that wall.

In August, the Department of Health and Human Services (HHS) adopted the recommendations of the Institute of Medicine to include as part of the basic package of services an array of preventive health care services for women.

Expanding access to preventive care without cost-sharing (co-pays) was ostensibly a core principal of health reform. As HHS notes:

The Affordable Care Act – the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 – helps make prevention affordable and accessible for all Americans by requiring health plans to cover recommended preventive services without cost sharing.

“Before health reform,” states an HHS press advisory, “too many Americans didn’t get the preventive health care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs.  Often because of cost, Americans used preventive services at about half the recommended rate.”

Yet chronic diseases – which are responsible for 7 of 10 deaths among Americans each year and account for 75% of the nation’s health spending – often are preventable. Cost sharing (including copayments, co-insurance, and deductibles) reduces the likelihood that preventive services will be used. Especially concerning for women are studies showing that even moderate copays for preventive services such as mammograms or pap smears deter patients from receiving services. [Emphasis added.]

The preventive care services to be covered without co-pay include well-woman visits, support for breastfeeding equipment, screening and counseling for gestational diabetes, cervical cancer, sexually transmitted infections, and domestic violence, and support and supplies for breastfeeding.

And, of course, IOM strongly recommended and HHS included coverage without co-pays of contraceptive counseling and supplies. The reasons why have been extensively documented in numerous articles including one here, here, here, and here.

The HHS mandate states:

Women will have access to all Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling. These recommendations do not include abortifacient drugs. Most workers in employer-sponsored plans are currently covered for contraceptives. Family planning services are an essential preventive service for women and critical to appropriately spacing and ensuring intended pregnancies, which results in improved maternal health and better birth outcomes. [Emphasis added].

HHS exempted from this mandate certain religious employers including those that define the inculcation of religious values as their primary purpose; that primarily employ persons who share its religious tenets; that primarily serve persons who share the organization’s religious tenets; and are non-profit organizations.  Contrary to the Times story that churches may be exempt,” HHS made clear that their exemption absolutely includes churches, their integrated auxiliaries, and conventions or associations of churches, as well as exclusively religious activities of any religious order.

As HHS stated, the “interim final rule… is modeled on the most common exemption available in the 28 states that already require insurance companies to cover contraception.”

HHS, as is common practice, provided an ample comment period, during which religious right organizations went to work, claiming that their religious liberty would be infringed if they had to include in their employer-based health plans coverage of contraception for women, whether they be Catholic, Jewish, Hindu, Protestant, atheistic, agnostic or otherwise. In other words, as I have pointed out elsewhere, the only means through which the religious right can experience religious liberty is to rob everyone else of theirs.

This is not a trivial matter. Cost plays a major role in consistent access to and use fo contraception, most especially for low-income and middle class women.  Access to birth control is a major factor in preventing unintended pregnancies, ostensibly a goal of this Administration.  Moreover, it is the right of every woman to decide whether and when to bear a child and under what conditions.  No religious figure has the right to “override” the fertility and health decisions of any woman.

Now, however, HHS is punting. I called the White House last week for comment on their policy, and two days later received a call back from someone at HHS who’d been asked by White House staff to call me.  I was told by the HHS spokesperson that no decision had been made on when to finalize the policy and that technically the department could take until next summer to decide since the final rule does not go into effect until August.  When I asked what more, on top of the weight of evidence already made public, was left to consider, I was told that the department was hearing from “all stakeholders.”  Apparently, HHS considers the USCCB, the Family Research Council, Focus on the Family and other religious right organizations to be a stakeholders of your womb, because they are weighing heavily on this decision.

My question to you is this: How far do we allow an Administration to go on simply trading away the basic health and economic needs of millions of women before we call this a political foul?

_____________________________________

These groups urge you to take action:

Catholics for Choice

National Women’s Law Center

Physicians for Reproductive Choice and Health

Feminist Majority Foundation

Emily’s List

Planned Parenthood Federation of America

NARAL Pro-Choice America

Physicians for Reproductive Choice and Health

_____________________________

Follow Jodi Jacobson on Twitter: @jljacobson

News Contraception

Obama and the Bishops: Is the White House Caving on Birth Control Coverage?

Jodi Jacobson

The Bishops are lobbying hard for the Obama Administration to effectively excuse any and all "religious" entities from covering contraceptives without a co-pay. Last week Archbishop Dolan paid a private visit to President Obama and word on the street is that the White House may cave. This would be a grave mistake.

See all our coverage of the Birth Control Mandate 2011 here

This week, the United States Conference of Catholic Bishops (USCCB) threw itself a pity party in Baltimore. According to the bishops, their “religious liberty” is threatened unless they are able to ensure that every single person in the United States (well, actually the world) is made to follow Catholic canon law to the letter. According to the New York Times, the bishops are “recasting their opposition” to same-sex marriage, birth control, and other fundamental aspects of public health and human rights, because they view both government and culture as infringing on the church’s rights.

“We see in our culture a drive to neuter religion,” Archbishop Timothy M. Dolan of New York, president of the bishops conference, said in a news conference Monday at the bishops’ annual meeting in Baltimore. He added that “well-financed, well-oiled sectors” were trying “to push religion back into the sacristy.”

But the sacristy is where the vast majority of Catholics appear to believe the bishops should be focusing their efforts. The Times notes that in light of the ongoing evidence of massive cover-ups by the Vatican and the USCCB of the priest pedophilia scandal, the bishops’ “pronouncements on politics and morality have been met with indifference even by many of their own flock.”

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The bishops issue guidelines for Catholic voters every election season, a document known as “Forming Consciences for Faithful Citizenship,” which is distributed in many parishes. But the bishops were informed at their meeting on Monday that a recent study commissioned by Fordham University in New York found that only 16 percent of Catholics had heard of the document, and only 3 percent had read it.

Nonetheless, the Bishops believe their own right to practice their religion is threatened by your right to practice yours or to act as a moral agent in your own life. Their freedom of religion is threatened unless they can ensure that all LGBT persons are denied the right to marry or adopt children. It is threatened unless all women are denied the rights to decide whether and when to have children. It is threatened unless a Catholic hospital can let a woman die from complications of pregnancy rather than provide her with or even refer her on an emergency basis for a life-saving abortion. It is threatened unless a two-celled fertilized egg has more rights than the living, breathing woman in whose body it floats.

They are not “free” until you are not free.

And they certainly are not “free” unless women are denied access to affordable birth control. 

An integral part of the Affordable Care Act is the new benefit requiring health plans to cover preventive health care, including cancer screenings, immunizations, and birth control, with no co-pays.  Inclusion of these benefits came about through dogged efforts by female legislators, including an amendment authored by Senator Barbara Mikulski (D-MD), known as the Women’s Health Amendment. The Department of Health and Human Services, tasked with implementing health reform through regulations and oversight, took the advice of an expert panel of the Institute of Medicine (IOM) and recommended birth control be covered as a women’s preventive service because it is basic health care, and because it improves health outcomes for women and their families. Research shows that improved access to birth control is directly linked to declines in maternal and infant mortality among other health benefits. The IOM recommendations are supported by a vast amount of research and affirmed by the World Health Organization, the International College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists and the American Public Health Association among many other medical and public health bodies.

Regulations promulgated by HHS this summer mandate coverage in all employee-based health plans of contraceptive methods without a co-pay. The current provision includes what many already consider to be a sweeping refusal clause, exempting certain religious organizations for which religious values are their primary purpose; that primarily employ persons who share the religious tenets of the organization; that primarily serve persons who share the religious tenets of the organization; and that are nonprofit organizations. The regulations would still require institutions such as Catholic hospitals–for which one assumes the primary purpose is evidence-based health care–and universities (primary purpose, education?) to offer insurance that covers contraception without a co-pay. Nothing (repeat: NOTHING) in this new benefit requires an organization to dispense birth control, or an individual to take it. This is simply a matter of ensuring women have access to affordable preventive care by providing it with no co-pays. For an excellent and thorough review of this issue, read the testimony of Catholics for Choice President Jon O’Brien.

Still, this has so riled the USCCB that Archbishop Timothy Dolan took his lobbying straight to President Obama, with whom he met privately at the White House last week. In what I take to be a somewhat ominous comment, Dolan stated at a news conference that he “found the president of the United States to be very open to the sensitivities of the Catholic community.”

“I left there feeling a bit more at peace about this issue than when I entered.”

By “Catholic community,” Dolan clearly means the USCCB, the Vatican and the male hierarchy, certainly not the community constituted by the people–or the women–of the church.

Word on the street now–through off-the-record conversations with health groups–is that the White House is considering caving on the exemptions for contraceptive coverage.

This would be a grave mistake on Obama’s part.

For women, birth control is about as controversial as toothpaste and as widely used. According to the Centers for Disease Control, between 2006–2008, 99 percent of ALL women who had ever had sexual intercourse had used at least one method of birth control.  This includes, as O’Brien of Catholics for Choice pointed out, the 98 percent of sexually active Catholic women in the US who have used a form of contraception banned by the Vatican.

Moreover, while the most common reason U.S. women use oral contraceptive pills is to prevent pregnancy, 14 percent of pill users—1.5 million women—rely on them exclusively for non-contraceptive purposes, according to a study by the Guttmacher Institute called “Beyond Birth Control: The Overlooked Benefits of Oral Contraceptive Pills,” by Rachel K. Jones. More than half (58 percent) of all pill users rely on the method, at least in part, for purposes other than pregnancy prevention–such as reducing cramps or menstrual pain, to help prevent migraines, for treatment of endometriosis—meaning that only 42 percent use the pill exclusively for contraceptive purposes.

The contraceptive coverage provision under health reform is widely-supported by female voters, a critical constituency in the 2012 election. Public polling shows seventy-one percent of American voters, including 77 percent of Catholic women voters, support covering birth control at no cost.

So caving to the USCCB on something as fundamental to women’s health, lives and pocketbooks as contraception will not sit well with women, as a recent poll by NARAL Pro-Choice America notes.

“There is a group of women who voted for President Obama in 2008 but are not currently supporting him, and these data suggest many of them should be in his camp,” according to Al Quinlan, president of Greenberg Quinlan Rosner Research, a firm that conducted a recent survey for NARAL Pro-Choice America.

“Choice provides an opening for President Obama and other Democrats to create a sharp contrast with anti-choice Republicans,” he continued. The “women defectors” are defined as having voted for President Obama in 2008 but are currently not voting for him, weakly supporting him, or holding back from turning out in 2012.

“While the economy is the dominant issue, this survey shows that choice is a stronger, more persuasive issue for bringing key women voters back to President Obama’s camp,” said Nancy Keenan, president of NARAL Pro-Choice America.

Contraceptive coverage also is an equity issue. As many state contraceptive equity laws make clear and as the Equal Employment Opportunity Commission has ruled, failing to provide women with coverage for contraception in health plans that otherwise cover prescription drugs and devices is sex discrimination.

State supreme courts in California and New York have both found that contraceptive-equity laws with narrower employer exclusions such as the one put forth by HHS, do not substantially burden a religious belief or practice. In a majority opinion in one of the cases, the justices write:

“[W]hen a religious organization chooses to hire nonbelievers it must, at least to some degree, be prepared to accept neutral regulations imposed to protect those employees’ legitimate interests in doing what their own beliefs permit.”  [Catholic Charities of Albany v. Serio, 859 N.E.2d 459, 468 (N.Y. 2006)].

If the requirement for coverage of birth control is weakened, nearly one million people (and their dependents) who work at Catholic hospitals would lose benefits they already have. In addition, the approximately two million students and workers now attending universities that have a religious affiliation would also lose this important benefit.  It would mean a further weakening of women’s health and one more step toward theocracy. And it would raise health care costs and result in more unintended pregnancies.

What the Bishops really want is to strong-arm government into imposing restrictions on people’s choices and lives that they can’t even get Catholics to follow. They want to be able to receive federal funding, federal grants and contracts, get tax breaks and special treatment over other groups for building Catholic hospitals, maintain tax-exempt status while flouting lobbying rules, and play the victim card whenever they can’t avoid laws meant to advance health and human rights.  And they are aided and abetted in their efforts by other far-right my-way-or-the-highway-on-religion organizations like Focus on the Family and the Family Research Council, as well as a considerable number of GOP and Tea Party members of Congress. New efforts by conservatives to pass the Regulatory Accountability Act, for example, also threaten women’s health.  Nothing drives the patriarchy more batty than the notion of women being anything other than breeding cows.

So it takes some imagination–and I have not mustered anywhere nearly enough–to understand why the Obama Administration would EVEN. THINK. TWICE. about caving to the Bishops. Obama needs women to come out for him in the 2012 election, he campaigned on and promised adherence to science and evidence in the creation of policy, and he promised that under health reform people would not lose benefits they already had, a promise he has already broken once–big time–when it came to women’s health coverage on abortion care.

There is nothing more fundamental to women’s choices than choosing whether, when and with what partner to become pregnant. There is nothing more fundamental to ensuring the best prospects for all children than to work to ensure every child is a wanted child. And there is nothing less controversial for women than birth control.

If the White House does cave to fundamentalist organizations like the USCCB, (led, it should be underscored, by men), it would appear to have an even more fundamental problem with re-electing this President.

[Several calls to the White House on this issue were not returned by time of publication.]

_____________________________________

These groups urge you to take action:

Catholics for Choice

National Women’s Law Center

Physicians for Reproductive Choice and Health

Feminist Majority Foundation

Emily’s List

Planned Parenthood Federation of America

NARAL Pro-Choice America

Physicians for Reproductive Choice and Health

************

Follow Jodi Jacobson on Twitter: @jljacobson