Over the past 10 days, the White House has postponed two scheduled conference calls on the IOM recommendations regarding preventive care for women. The deadline originally set by HHS for releasing its final recommendations is the same as the deadline for an agreement on the debt ceiling. Are the two connected?
See all of our coverage of the IOM report and HHS guidelines here.
Will women’s health insurance be held hostage to the debt ceiling fiasco?
On July 19th, an expert panel convened by the Institutes of Medicine (IOM) released a set of evidence-based recommendations on the range of basic preventive care services for women that should be covered by insurance plans without a co-pay under health reform. The recommendations were requested by the Department of Health and Human Services (HHS) to guide its final decision-making on these issues, and to put the imprimatur of peer-reviewed public health and medical science as well as evidence from clinical practice behind the final guidelines.
Services recommended by IOM for coverage without a co-pay include an annual well-woman visit as well as contraception, sterilization, gestational diabetes screenings, cervical cancer screenings, HIV/STI annual testing, domestic violence counseling, and breastfeeding support. The Administration could have included these same services–including those on family planning services and contraceptive supplies–as part of its initial guidelines based on existing evidence. But the IOM process was seen by some as necessary not because these findings were not already self-evident to clinicians and public health experts, but because it is widely known that fanatical anti-choice groups and legislators would object to and fight against anything that improves the reproductive and sexual health of women or enables them to exercise their right to self-determination.
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The problem always was that the IOM recommendations were scheduled to be delivered in late July 2011, and that HHS set a date of August 1, 2011 for issuing its final guildelines. Those dates, we already knew, would fall squarely at the beginning of the 2012 Presidential campaign. And, given that the Obama Administration has not exactly shown itself to be a strong voice on women’s health and rights when there is any political cost involved, delaying this decision until now has always been a political gamble.
Now that problem is compounded by the fact that the deadline also comes at the same time as the possible default of the United States on its debt for the first time in history. Eschewing leadership from the beginning for a sickeningly-long process of “compromise” with Tea Party fanatics that was likely never possible nor going to be achieved, the White House finds itself at the brink of this disaster with no real solution.
Meanwhile, over the past week, the White House has twice “postponed” a conference call on the IOM guidelines with HHS Secretary Kathleen Sebelius and various other experts in and outside of the Administration. Now the tension appears to be rising among women’s health advocates: Press releases and calls on HHS to do the right thing for women based on evidence have been flooding my in-box and Monday 80 Democratic House members sent a letter to Sebelius calling on her to “adopt each of the recommendations in full.”
This may be business as usual and good advocacy strategy… gather your troops to make known your position and take nothing for granted. Postponements of phone calls and silence from HHS may mean nothing at all. Perhaps the White House has decided that adopting the recommendations in full next week will generate enough press on its own and that tamping down on other outreach during a politically-charged financial crisis is just smart politics, especially because the media keeps repeating the falsehood that this means “free” contraception. That may be the case, but it further suggests that there is something controversial about contraceptive coverage; it “hides” rather than “changes the debate” on what should be a non-issue. It strengthens rather than weakens the claims of fanatical anti-choicers over time because they exploit any and every weakness and we need a leader who is willing to stand up once and for all and silence this nonsense.
Or perhaps, feeling uneasy as I do, the letters, press releases and petitions suggest a growing anxiety that, having left this issue to be decided in the middle of a political season, one that has become even more fraught than perhaps anyone could have imagined, the recommendations on preventive care for women will be ditched or pushed off because the anti-science, anti-choice heat is just too much for this White House. Perhaps it reflects lack of trust and fear that the Administration may not have our backs after all, even on contraception.
Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.
Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.
Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.
Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.
This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.
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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.
Where Funding Comes From
The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.
This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.
As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.
Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.
“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”
Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.
According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.
Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.
Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazettereported in April that at least some of the money appears to have been designated for programs outside the state.
Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.
“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”
“Every Other Baby … Starts With Women’s Care Center”
Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.
Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.
In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.
The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.
“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.
Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.
Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.
“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.
Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”
In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.
Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”
Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.
Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.
“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.
There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.
Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.
“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”
“Life Is Winning in Indiana”
Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.
These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.
Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.
A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”
Hunsberger denies any deceit on the part of Women’s Care Center.
“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”
Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”
“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.
Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.
“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.
If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.
In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.
Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.
Read more of our articles on Justice Antonin Scalia’s potential successor here.
Over the last two days, both Sen. Chuck Schumer (D-NY) and Vice President Joe Biden have weighed in on the kind of nominee they think President Obama should recommend to replace deceased Supreme Court Justice Antonin Scalia.
And as things go, it is no accident that these two men, leaders in the Democratic Party with direct access to the president, said basically the same thing within a couple of days of each other. They are either floating trial balloons—testing public reaction—for the White House or trying to influence the president’s decision. Either way, they are using their positions and their access to the media as a way of sending a message.
And either way, I call foul.
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Both Schumer and Biden seem to agree that what we need now is a “mainstream” nominee for the Court.
In an interview on ABC News’ This Week with George Stephanopoulos last Sunday, Schumer, who sits on the Senate Judiciary Committee, said he expects President Obama to nominate a “mainstream” justice, citing the potential to win support of “mainstream Republicans.”
“I think the president, past is prologue, will nominate someone who is mainstream,” Schumer stated. As the New York Timesreported:
“When you go right off the bat and say, I don’t care who he nominates, I am going to oppose him — that’s not going to fly,” he said, criticizing the majority leader Mitch McConnell for pledging to block any nominee. “A lot of the mainstream Republicans are going to say, I may not follow this.”
According to the Washington Post, Biden echoed Schumer’s statement in an interview aboard Air Force Two:
“This is a potential gigantic game changer” for the philosophical makeup of the court, Biden said in an interview with The Washington Post and Politico. “And my advice is, the only way we get someone on the court, now or even later, is to do what we’ve done in the past…we have to pick somebody, as the president will, who is intellectually competent, is a person of high moral character, is a person who is demonstrated to have an open mind, and is a person who doesn’t come with a specific agenda.
These comments are so full of potentially meaningless and yet potentially profound code and buzzwords, I don’t know where to start.
First of all, what exactly these days is a “mainstream Republican” and where do they live? Is Biden referring to the senators who joined a party-line vote to overturn the Affordable Care Act? Is he talking about the “moderate” GOP party-line vote to impose a 20-week abortion ban? Which of the Republicans that voted against Obama’s nominees to the Consumer Financial Protection Bureau are the moderate ones? Which of the ones that have held up judicial nominees for over two years are “mainstream”? How is opposing all attempts by the White House and Democrats to pass paid family leave a “mainstream” position, especially in light of the fact that this policy is supported by a wide majority of Americans? Are the mainstream the ones that continue to block the Paycheck Fairness Act?
Second, does Vice President Biden mean to suggest that a justice who perhaps believes that women have rights to their own bodies cannot be “intellectually competent … a person of high moral character … a person who is demonstrated to have an open mind … a person who doesn’t come with a specific agenda”? Is promoting public health an agenda? Are basic human rights a specific political agenda?
Is Biden suggesting, no matter how subtly and in meaningless Beltway-speak, that a jurist who pays heed to overwhelmingmedical and public health evidence on the role that both contraception and abortion play in improving public health, women’s health, and infant and child health is not “mainstream” and otherwise has an agenda?
Does a jurist with roots in a specific community and with an understanding of the law’s differential impact on people of different races, classes, and privileges come with an agenda?
Given that the white population will soon be the minority, who is “mainstream,” the white guy or the person of color?
Let’s face facts: What is considered “mainstream” for both of these men is not necessarily based on the needs and priorities of the average American. Schumer is only “mainstream” in that he is a white male senator in a legislative body that is dominated by white male senators (the Senate is 80 percent male and 94 percent white) and in that he takes huge amounts of funding from Wall Street. “Mainstream” for Schumer might well be translated to mean someone who won’t seek to curb the influence of big money in politics.
Likewise, Joe Biden is only “mainstream” on many issues insofar as they can be comfortably navigated within the Old Boys Clubs of which he is a longstanding member, one of which is the Senate and the other of which is the group of Catholic Democrats that remain beholden at some level to the most-conservative U.S. Conference of Catholic Bishops. It was Biden, who as a Catholic is highly ambivalent about reproductive health care, played leading roles in the Obama administration’s decisions on the Stupak Amendment in the ACA, and in the “contraceptive accommodations” made to religious groups, among many other things.
The carve-outs never satisfied the rabidly right-wing bishops and led to continuing lawsuits and ever greater demands of exemptions. This is not a “mainstream” position, especially if you consider that 98 percent of Catholic women (and 99 percent of all women) who have ever had sex have used modern forms of birth control. The only mainstream position on birth control and abortion is the one that recognizes both the public health and social science evidence, the rights of women as people, and the fact that an overwhelming majority of women use birth control and one third of women in the United States have abortions. There is nothing mainstream about white, religious men ignoring that fact or pretending that they know better.
The only reason they suggest that someone who does not have any record of supporting evidence or rights might (and it’s a highly questionable assumption) get approved by the GOP-led Senate is because the Republicans themselves are not mainstream by any stretch of the imagination, and are only interested in someone with an agenda to protect their interests.
In my definition, someone who, as Biden suggests, “is intellectually competent, is a person of high moral character, is a person who is demonstrated to have an open mind, and is a person who doesn’t come with a specific agenda,” is a person who recognizes that human rights, evidence, and justice should be of central concern to the Supreme Court. When I hear Biden use these words, I hear echoes of his 2007 statement that Barack Obama was the first “mainstream African-American who is articulate and bright and clean and a nice-looking guy.” It sounds to me that “mainstream” is someone comfortable to the white men in power.
The word “mainstream” is now meaningless. The media won’t challenge it because most of the reporters are stuck in a white male corporate bubble and spend their time at parties at the vice president’s residence. You can’t depend on them to challenge the very notion of what it means.
When you hear a white male senator or a white male vice president—both of whom have vested interests in agendas that do not represent either the interests of the greater number of people in this country, and/or also ignore solid scientific evidence—use terms like “mainstream,” know one thing: They are not swimming in the same stream as the rest of us.