Commentary Media

Point-Counter-Point: Is a Royal-Wedding-Watch Fun or Harmful to Little Girls?

Martha Kempner & Patrick Malone

Should a 4-year-old girl bombarded with princess mania watch the royal wedding? Two of our writers debate. 

A point-counterpoint discussion between Patrick Malone of SIECUS and Martha Kempner, Rewire.

Patrick’s Point: You Can Control Your Daughter’s Pretty Princess Exposure

In case you have been living under a rock on Mars and haven’t heard, the royal wedding is upon us and, with it, one of the largest media circuses to surround a non-event in a generation.  The last royal wedding, which took place 30 years ago, resulted in divorce, heartbreak, controversy, and more TV movies than you can shake a stick at.  But, come hell or high water, the American public is committed once again to following every detail of the upcoming nuptials, despite the fact that opposition to monarchical rule, specifically rule by this monarchy, is one of the founding ideals of our nation.

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Fine.  Whatever.  There are a lot stupider things that people watch on television, and adults are allowed to pitter away their time on such frivolities as the Kardashian sisters, giant inedible cakes, or even this wedding.  Adults are going to do what adults are going to do.  But, I ask you this, Martha: are you really going to watch this with your four-year-old daughter? 

Over the many years that I have known you, Martha, I have often heard you talk about the challenge of trying not to force Charlie (your daughter) into traditional gender roles and stereotypes, and even listened to the ongoing lament you expressed when, despite your best efforts, she entered into the dreaded “princess phase” that seems to be so common among little girls right now.  But despite your conscientious efforts to keep too much pink out of your house, well-meaning family members, friends, and gift bags from birthday parties have created a glut of tiaras that could choke a mouse turned into a horse.

But here, finally, is something you can control.  You and I both know that the narrative of this wedding is going to focus on how magical the day is and what a fairy tale story it is that this prince picked a commoner to be his princess.  This sends all sorts of wrong message to little girls about what fate holds in store for them, that their value is determined by a man “picking” them, and that being a preening, puffy, perfect, princess is the ideal for girls.  Pardon my ineloquence, but barf.  Little girls are so exposed to these potentially harmful messages outside the walls of their homes that they don’t need more of it inside.

If you are truly committed to helping your daughter shape her own identity in these critical years, as I know you are, take this opportunity to take control of your own fate, and watch the wedding on your TiVo after Charlie goes to sleep.  She’ll be able to catch reruns of it when the divorce happens.

Martha’s Counter-Point:  A Little Princess-time With Mommy Can’t Hurt

What can I say Patrick, you’re right.  The media frenzy around this wedding is ridiculous.  It absolutely perpetuates every stereotype that I have tried to keep away from Charlie and may usher in a princess phase that is far worse than the Disney-mandated one that she seems finally to be growing out of.  And yet, not only am I going to watch it with her, I’m keeping her home from school and making a special day of it.  (Nobody yell, it’s preschool, also known as daycare, she won’t be missing any SAT prep.) 

Here’s the thing; I think it’s going to be fun.   There’s pomp.  There’s circumstance.  There’s a gold stage coach, a palace, a big sapphire ring, funny hats, and really, really fancy dresses.  And I think she’s going to love it.  We talk about weddings a lot in this house.  (The current plan by the way is for her to marry Juliette, her baby sister, so we can all live together forever.) 

So I’m going to put my ideology aside for the day and have some fun with it.  Her friend Molly and her mother are coming over.  My mother is going to sleep over so she’ll be here first thing in the morning.  Maybe we will eat scones with clotted cream.  Perhaps we’ll drink tea out of dainty china cups and hold our pinkies up.

Will it have any educational value?  No.  Will watching it help impart the values that I ultimately want Charlie to have?  No.  Will it hurt?  I don’t think so.

I remember watching Charles and Diana get married.  I was 8.  It was before we had cable.  The only TV in the house was a 13-inch Sony Trinitron with a dial and rabbit ears in my parent’s room.  They were away, and my aunt, my sister, and I camped out on their bed early in the morning to see the big event.  I remember the dress, I remember the horse-drawn carriage, and I remember waiting for them to come out and kiss on the balcony. (I also remember, years later, sitting in a doctor’s waiting room reading one of the first articles about discontent in their marriage and feeling sad for them, but that’s another story.) 

My point here is this: I remember it and it didn’t ruin me.  I did not come away thinking that the most important thing I could be was pretty.  I did not come away thinking that the most important thing I could do was to marry well.  I did not spend my adolescence and young adulthood waiting around for a prince to find me.  And I did not come away with the belief that my wedding day was going to be the most important day of my life. Sure I invested too much money on Silver City Pink lipstick, wasted too much time on trying to get my feathered bangs to stand up just right (it was the 80’s), and spent too many nights waiting by the phone for some boy to call– but that’s just part of growing up.  I also did well in school, got into a good college, graduate Phi Beta Kappa, and carved out a pretty interesting career.  And, when it came time for my own wedding, Woodie and I looked at it as a good excuse to get all of the people we loved together for a whole weekend and have a lot of fun.  

Patrick, you’re right that I am in complete control of whether or not Charlie knows anything about this wedding.  She is not even of the age yet where she would have heard about it and asked to watch it.  I could keep this media spectacle away from her (and trust me if there were a Kardashian involved I would).  

I realize that having opened this particular can of worms, I may have to redouble my efforts to undo themes of princess-hood and wedding spectaculars.  I might point out that this particular prince and princess met in college where they were both getting a good education.  Maybe I will note that they dated for over eight years before they decided to get married (which just might counter some of Disney’s penchant for love-at-first-sight, wedding two-frames later).  I may even say that she had a career before getting married (I know, I know it was in fashion) and that after she becomes the princess she will likely work with many charities and call light to important issues much like Princess Diana did.   Or not.

Mostly I will just have to trust that the last 4 and the next 14 years of living in my house and learning my values will be enough to counter one day of pomp, circumstance, and media silliness.  

Analysis LGBTQ

Medicaid Coverage for Transition-Related Care ‘Is Really a Life-or-Death Issue’

Annamarya Scaccia

Medicaid's exclusionary regulations deny many low-income transgender people access to medically necessary health care, advocates say, and cause physical, mental, and economic harm.

Pennsylvania’s ban on Medicaid coverage for transition-related care is discriminatory and unreasonable, says a transgender man who filed a federal court lawsuit against the state’s Department of Human Services Secretary Theodore Dallas in February.

The plaintiff, John Doe of Delaware County, says Medicaid denied him coverage in 2015 for an abdominal hysterectomy his doctor deemed medically necessary to treat his gender dysphoria diagnosis, according to the complaint. Doe’s complaint notes that “Medicaid coverage in Pennsylvania includes payments for medically necessary hysterectomies,” but that it bans those for individuals diagnosed with gender dysphoria. He claims state regulations banning transition-related care, which led to the coverage denial, violate federal and constitutional law. The courts granted Doe’s request for anonymity shortly after he filed his complaint.

Pennsylvania is one of 16 states that prohibit Medicaid coverage of transition-related care, including hysterectomies, gender confirmation surgeries, and hormone therapy. These exclusionary regulations deny many low-income transgender people access to medically necessary health care, advocates say, and cause physical, mental, and economic harm.

“Medicaid is supposed to be a safety net for people who can’t otherwise access health care,” said Harper Jean Tobin, director of policy at the National Center for Transgender Equality, in an interview with Rewire. “That puts people who need care and can’t afford it and can’t get covered under Medicaid in a very bad situation.”

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According to the complaint, Keystone First Health Plan, which administers Medicaid in southeastern Pennsylvania, denied Doe’s doctor’s insurance request for Medicaid coverage in July 2015. Doe appealed, but an administrative law judge upheld the decision in October 2015, stating that Keystone is bound to “clear and express regulations,” which do not “permit the approval of the requested hysterectomy.”

Doe is seeking an injunction to order DHS to immediately cover Doe for all transition-related care, as well as eliminate Pennsylvania’s exclusionary regulation. He also asked for a declaratory judgment ruling that Pennsylvania’s Medicaid exclusion regulations are discriminatory and a violation of the 14th Amendment’s Equal Protection Clause.

“We hope that that declaration will enable thousands of the neediest among us to be provided with Medicaid for their gender dysphoria,” said Doe’s attorney Julie Chovanes, who runs the Trans Resource Foundation.

The state responded to the complaint on March 31, denying allegations that its policy is discriminatory and unconstitutional. The state also believes that Doe is not entitled to any relief. At press time, no hearing or trial date had been set in Doe’s case.

“This Is Really Life or Death”

Exclusionary policies like Pennsylvania’s, advocates say, have a twofold effect: They deny necessary health care to transgender Americans and, in turn, threaten their economic stability and safety. Transgender people are disproportionately more likely to be poor and more likely to rely on needs-based state-run programs such as Medicaid, and research shows that they benefit from the very transition-related care for which Medicaid is denying them coverage.

A 2015 joint report by the Center for American Progress and the Movement Advancement Project found that transgender Americans are four times more likely to live on less than $10,000 a year per household than the cisgender population. Rates are even higher for transgender people of color—Asian and Pacific Islander (API) and Latino transgender Americans, for example, are nearly six times more likely to live in extreme poverty than cisgender API or Latino Americans, respectively.

“If you think about Medicaid as a policy that’s not just to protect people’s health but to potentially make it possible for people to climb out of poverty,” said Tobin, “then having broad exclusions on important health needs is something that helps keep them stuck in poverty.”

Research has shown the benefits of transition-related care. A 2015 Journal of Urban Health report found that when trans women have access to and utilize transition-related care, they are at significantly lower risk of suicidal thoughts and substance abuse. But remove that access, and transgender Medicaid enrollees are left in a precarious position, says Joanne Carroll, president of TransCentralPA, an advocacy group based in Harrisburg, Pennsylvania. They may forgo care, leading to emotional, mental, and physical distress; they may find risky ways to pay for care or plunge deeper into poverty; or they may use illegal methods to get the care they need.

To that last point, Carroll said transgender people will sometimes buy hormones offshore without medical supervision or go to illegal silicone pumping parties because they can’t afford augmentation.

And it’s costing lives, she said. Last January, a 40-year-old transgender woman died after being injected with silicone at a party in Santa Ana, California. Another trans woman died on New Year’s Day 2014 after two months in a coma from illegal silicone injections. Trans Road Map has a list of further incidents from 2003 through 2011 on silicone-related deaths.

“Denying people health care is causing them to seek stuff off the radar,” Carroll told Rewire, “which is ultimately killing off a lot of people.”

Advocates note that Medicaid coverage alone won’t stop these off-the-radar methods, as intolerant doctors, inadequate medical services, and other systemic barriers cause trans people to seek out that care. But, they say, eliminating transgender health-care exclusions in Medicaid is a necessary step toward addressing these safety concerns, though not a complete solution.

Leading health organizations have affirmed the medical necessity of providing coverage for transition-related care throughout the years. In 2008, the American Medical Association and American Psychological Association both passed resolutions supporting transgender health-care inclusion in public and private health insurance. Similar declarations have been made by the American Congress of Obstetricians and Gynecologists in 2011, the American Academy of Family Physicians in 2012, and the American College of Physicians in 2015, to name a few.

“The evidence is there around the effectiveness and medical necessity of this type of care,” said M. Dru Levasseur, director of the Transgender Rights Project at Lambda Legal, in an interview with Rewire. “This is really a life-or-death issue for transgender people.”

“Actionable Under the Law”

In September, the U.S. Department of Health and Human Services (HHS) released proposed regulations clarifying that civil rights protections afforded in Section 1557 of the Affordable Care Act also apply to Medicaid. The proposed HHS rule states that, under Section 1557’s sex discrimination ban, many health insurance plans—which include state-run Medicaid programs—cannot discriminate on the basis of gender identity. HHS already made this explicit for Medicare, which serves older Americans and people with disabilities, two years ago.

The proposed federal rule, then, upholds that Medicaid exclusions nationwide are discriminatory on their face, advocates say. “That basically sets out that this is actionable under the law,” said Levasseur.

HHS is expected to release its final rule this summer.

There’s case law to support HHS’s clarification. In March 2015, a federal court ruled in Rumble v. Fairview Health Services that anti-trans discrimination is prohibited under the ACA for providers and hospitals accepting federal Medicaid or Medicare funds. The federal lawsuit was brought on behalf of a young trans man in Minnesota who alleged health-care providers at a nonprofit hospital were intolerant and provided substandard care because of his gender identity.

But while federal law prohibits health-care discrimination by providers on the basis of gender identity, how it applies to Medicaid coverage varies state-to-state. Such spotty interpretation has led to a patchwork of policies protecting against transgender health-care discrimination.

Only 11 states plus the District of Columbia have Medicaid policies inclusive of transition-related care coverage, according to data from the Movement Advancement Project. Pennsylvania and 15 other states have explicit regulations denying such coverage of care. Twenty-three states have no clear rule on the matter. Nearly two-thirds of the LGBTQ population live in states that either have exclusionary policies or have no explicit policy at all.

lgbtmaFurthermore, 12 states plus the District of Columbia—nine of which have laws prohibiting health insurance discrimination based on sexual orientation and gender identity—have also banned transgender health-care exclusions from private insurance. (Although Minnesota mandates protections for transgender health care in private insurance, its state Medicaid program specifically excludes transition-related care, according to MAP.)

Advocates say that efforts to abolish state-sponsored exclusionary policies are already happening at the local, grassroots level. New York state announced in late 2014 that its Medicaid program would cover transgender health care after 12 years of campaigning by the Sylvia Rivera Law Project, a collective providing legal services to New York City’s transgender population. Advocates hope more states will roll back their prohibitory regulations as they wait for HHS to release its final rule.

“It’s a matter of time and multiple strategies for states to fall in line with where they should,” said Levasseur, “which is the medical consensus that you cannot have exclusions for certain people’s health care.”

The cost to states for inclusive transition-related Medicaid coverage would be negligible, advocates say. According to Tobin, states would only have to cover the health-care needs of “a relatively small part of the population” on Medicaid. In fact, when Oregon added transition-related care to its Medicaid program in 2014, the state’s Health Evidence Review Commission estimated it would cost the state less than $150,000 of its total annual Medicaid budget and impact about 175 enrollees per year, reported the Advocate.

“In that sense, it’s a drop in the bucket,” said Tobin. “But you’re also talking about spending a little bit of money now to prevent treating complications later.”

And, she continued, providing transition-related care would also cost states far less than covering later symptoms from untreated gender dysphoria, such as depression and substance abuse.

Pennsylvania Gov. Tom Wolf (D) has spoken out against the state’s Medicaid exclusion in response to the John Doe case. He said through his spokesperson that precluding coverage for transition-related care is “wrong” and that the state shouldn’t discriminate “based on sexual orientation and gender identity and expression,” according to Philadelphia Magazine.

“The governor hopes to have a robust conversation with the legislature, community and all other parties regarding this issue to move the commonwealth forward,” the spokesperson said last month.

“It’s great that Gov. Wolf agrees that the exclusions are wrong and should be eliminated,” said Thomas W. Ude Jr., legal and policy director at the Mazzoni Center in Philadelphia. The Mazzoni Center provides health and wellness care, in addition to legal assistance, to Philadelphia’s LGBTQ population.

“The only question is what his approach would be to actually make that happen,” he said in an interview with Rewire.

Eliminating exclusionary policies would, in no small measure, open the door to fundamental health care for transgender people and save the states money. But that’s only one piece of the puzzle regarding “health-care delivery all-in-all,” said Carroll. The other: ensuring physicians actually treat transgender patients.

Carroll says she’s fortunate to not have faced many barriers to care. But she acknowledges she’s the exception and not the rule; more often, transgender people are denied treatment for something as common as walking pneumonia on the basis of their gender identity alone. And in many states, including Pennsylvania, there is no law broadly protecting the transgender population from discrimination in health care, employment, or public life. (Despite bipartisan support, the so-called PA Fairness Act has languished in a Republican-controlled general assembly that’s had trouble even passing its budget bill, said Carroll.)

“Right now we’re almost captive to these individual physicians whether or not they’ll even agree to treat somebody,” she said.

In a way, John Doe’s case is bigger than itself. While the complaint addresses a specific systemic barrier, it also underscores the discrimination transgender people face in health care across the board. Whether it’s hormone therapy or a yearly physical, advocates say, transgender people should have uninhibited access to care, period.

“Medicine is medicine,” said Carroll.

Culture & Conversation Sexual Health

Pornography Is Not a ‘Public Health Crisis,’ No Matter What Utah Lawmakers Think

Martha Kempner

The resolution introduced to declare pornography an epidemic is pretty toothless. But the resolution still carries harmful implications: It allows the moral musings of one misguided lawmaker, backed up by nothing more than pseudoscience, to be presented as fact in the legal code.

A Utah lawmaker would like us all to know just how dangerous pornography really is. State Sen. Todd Weiler (R-Woods Cross) filed a concurrent resolution (SCR 9) at the end of January asking his colleagues to declare pornography a “public health crisis.” Weiler apparently believes that pornography is addictive and that exposure to X-rated material has led to sex trafficking, infidelity, and a whole generation of young men who don’t want to get married.

After detailing the hazards of pornography, SCR 9 requests that “the Legislature and the Governor recognize the need for education, prevention, research, and policy change at the community and societal level in order to address the pornography epidemic that is harming the people of our state and nation.”

The resolution unanimously cleared committee last Friday and is now headed to the senate floor. Even if it passes, though, the resolution itself is pretty toothless—it’s not a bill outlawing pornography in Utah or a law designed to limit access to some websites. It’s just another politician ranting against vice. But the resolution still carries harmful implications: It allows the moral musings of one misguided lawmaker, backed up by nothing more than pseudoscience, to be presented as fact in the legal code.

Anti-porn crusaders have been around for centuries. The most famous is Anthony Comstock, whose 1873 law banned sending “obscene” material through the U.S. Postal Service, which, in the world before the Internet, adult stores, and UPS, was pretty much the only way to get material of any kind. Of course, Comstock’s law, and the state-level legislation it inspired, included contraception in their definition of obscene materials, making it a criminal offense to distribute birth control or information about birth control through the mail or across state lines.

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Comstock began his crusade because he was personally offended by the prostitution and pornography he perceived to be on the streets of New York when he moved to the city after fighting in the Civil War. He was also offended by explicit ads for contraception and believed that access to birth control promoted lust and lewdness. This single man’s sense of what was and was not appropriate for other adults to see led to the effective banning of birth control for decades. Given our history, it would be shortsighted of us to just dismiss actions of lone lawmakers with agendas like Sen. Weiler.

And it wouldn’t be too much of an exaggeration to say that Sen. Weiler has started his own anti-porn crusade. SCR 9, after all, is not his first resolution. In 2013, he authored one that warned parents of the dangers of “gateway pornography,” which he described as “sexualized images found in advertising and the media.” That resolution passed, though like SCR 9, it did not seem to have any real-life ramifications. 

Similar to Comstock, Weiler seems to have a personal objection to porn. The senator told the New York Daily News that he wished he’d never been exposed to pornography as he grew up in the 1970s. He compared pornography to cigarettes: a vice that was once considered acceptable but has been proven by science to be harmful and thus shunned by health experts, lawmakers, and much of the general public. And, he insisted that the problems with pornography, which are clearly detailed in his resolutions, are “scientific facts, just like global warming.”

But here’s the problem with his analogy and assertions—the science just isn’t there. The resolution asks Utah legislators to declare that porn is a public health epidemic and accept 18 other points of “fact” that have no grounding in existing research. To take on just a few of those points: Porn is not a public health crisis, nor is it an epidemic. In fact, viewing pornography alone is one of the few sexual behaviors that does not carry any risk of unintended pregnancy or disease transmission.

According to researchers, porn is not biologically addictive, exposure to it does not lead to lower self-esteem and increased sexual risk in teens, the availability of porn does not increase rape and sexual violence, and porn is not creating a generation of men who aren’t going to marry.

The basic myth of porn addiction goes like this—a young boy (and it’s always a boy in these stories, because people ignore that young women might enjoy porn as well) watches porn and likes it, so he watches more porn, and soon he can’t stop. Not just is he watching porn all the time, he has to watch kinkier and kinkier porn in order to get the same thrill he used to. It’s as if he were doing cocaine: He’s a porn addict. Depending on which brand of pseudoscience you subscribe to, either he can’t stop watching porn without experiencing withdrawal symptoms and starts acting out sexually and violently, or he can’t even get an erection in real life because it’s too boring compared to what he’s seen on screen.

David Ley, a clinical psychologist, told Rewire in an email, “Saying that porn is bad … is a sad example of very poor thinking and worse, an attempt to manipulate through fear.”

Nicole Prause, a researcher at University of California, Los Angeles, told Rewire in an email: “Scientists, including myself, have demonstrated that porn activates reward processes in the brain. This is like cocaine. It is also like viewing chocolate, cheese, and puppies playing.” But the parallels with drug addiction end there. Prause explained: “Sex film viewing does not lead to loss of control, erectile dysfunction, enhanced cue (sex image) reactivity, or withdrawal. Missing any of these would mean sex films are not addicting.”

Ley said simply: “Porn isn’t addictive. It isn’t even harmful for the overwhelming majority of users. Fewer than one percent of porn users experience negative effects from their porn use. But ten percent of people are afraid of their porn use. The message here is that porn isn’t addictive—but fear might be.”

Science has found that porn also generally does not lead to lower self-esteem in adolescents or cause them to engage in risky sexual behavior, as Weiler’s resolution claims. In a recent article in Psychology Today, Ley pointed to a British review of more than 40,000 studies that found that although there were links between such adverse behaviors among young people and watching porn, there was no proof that one directly led to the other. He also noted that a longitudinal study in the Netherlands found that exposure to pornography explained a very small percentage of sexual behaviors, including risky sexual behaviors, among teens. As Ley argued in the article, blaming porn for the serious issues facing some of our young people takes the focus away from the real roots of these problems, such as poverty, mental health issues, and a lack of education (including sexuality education).

There is, in addition, a large body of research that suggests pornography does not broadly increase rape or sexual violence. Research in countries as diverse as the Czech Republic, Japan, and Hong Kong have compared periods of time when there were strict laws against pornography to later periods when those laws were relaxed. Each study found that as access to pornography goes up, rape and sexual violence goes down. Research in the United States that compares the time before the Internet made porn readily available, to more recent years when it is just a mouse-click away, also shows that as access to porn increased, rates of sexual assault decreased. Though these studies do not prove that access to porn directly causes rates of violence to decrease—there could certainly be a host of other factors at play—the fact that this correlation is consistently found suggests that access to porn does not cause violence to increase either.

My favorite statement of “fact” in Weiler’s resolution is the one that suggests that porn is creating a generation of men who are not interested in marriage. I can’t quite figure out the logic behind this one. Perhaps it’s a bastardization of the old “Why buy the cow if you can get the milk for free” trope. Something like, “Why buy a cow at all if you can watch one have sex on the Internet?” Maybe he thinks these men are so obsessed with watching porn that they don’t want to bring a wife into the house who might make them turn off the computer.

Or maybe he’s making it up, because there’s no proof that there even is such a generation of men. One poll last year found that two-thirds of adults under 30 felt that marriage was still relevant and led to a happier, healthier, and more secure life. Millennials are marrying later in life than those who came before them, but porn doesn’t seem to play a role in that decision. Instead, surveys have found that they are less religious, more accepting of alternative relationship structures such as living together, and feel it is important to have economic security before you marry.

The irony of Weiler suggesting that the science on pornography’s harms is just like the science on global warming is not lost on me. If anything, the two situations are opposite. Climate change has legitimate science that politicians often ignore, whereas the suggestion that porn is harmful is based on phony science that is being held up as true by at least one politician.

Pornography has been a relatively accepted outlet for sexual pleasure for millennia and it should remain that way in Utah and everywhere else. This is not to say it’s a perfect art form: A lot of pornography objectifies and demeans women; much of it is not appropriate for young people; and it is certainly not a realistic way for adolescents and teens to learn about sex. Still, it’s not an epidemic, it’s not inevitably harmful to the viewer, and it won’t be the downfall of our society.

What might be our downfall, however, is allowing politicians to impose their own morality and use pseudoscience and misinformation to scare us all into buying their beliefs or at least living by their rules. We’ve been there before under the Comstock laws, which made even educating women about contraception through the mail a federal offense. We should not allow ourselves to be guided back to that kind of ignorance and censorship.