Commentary Contraception

Pain and Shame: What Real Life Looks Like in a Religiously-Affiliated Non-Profit Without the Birth Control Mandate

ACLU

An employee at a religiously-affiliated nonprofit writes about the challenges of getting her workplace to cover contraception to treat conditions like polycystic fibrosis and dysmenorrhea.

By “Dara:”  Due to concerns about job security the author of this post has chosen to write under a pseudonym.

See all our coverage of the 2012 Contraceptive Mandate here.

Lately the water cooler conversations at my religiously-affiliated nonprofit social service agency have been focused on trying to understand the new HHS contraceptive mandate. My younger, female coworkers and enlightened male coworkers are giddy with anticipation. For as long as any of us have been working here, we haven’t been able to get coverage for our birth control and have even had to struggle to get our employer to cover contraception prescribed for conditions like polycystic fibrosis and dysmenorrhea.

When a coworker with a cancer-causing condition needed contraception, she didn’t know what to do. She couldn’t afford the medication out-of-pocket with her meager nonprofit salary. I called our HR Director on her behalf. It took weeks to get an answer. Meanwhile my coworker couldn’t fill her prescription and her condition got worse. Recently I found out that another coworker has been paying $90 a month out-of-pocket for the contraception she needs to treat her polycystic fibrosis.

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HR then told us that we would have to ask permission of the agency’s CEO on a case-by-case basis. It reminded me of when I first got my period at age 12. My cramps were so bad that my pediatrician recommended low-dose contraception. My non-Catholic mother said that my very Catholic father might not allow it and that I would need to ask him for permission. The only difference here is that we are not young girls and the CEO is not our father.

I pursued my coworker’s issue with our agency’s lawyer. She acknowledged that the agency had to cover the contraception in this situation, and she finally intervened and informed HR that they needed to cover it. A year later, I too needed to get contraception for dysmenorrhea, so when I asked for coverage I ended up in battle with a male HR employee that knew nothing about the earlier situation. It was embarrassing to have to reveal my medical condition to him. The ground I thought I covered last year had been lost it seemed, making it a continuously frustrating battle.

When I finally got a clear answer, I requested that the agency develop a protocol and send it out to our thousands of staff throughout the city. They refused.

We’re relieved that with today’s announcement from President Obama, by this time next year, the HHS mandate will allow us to make our own decisions about whether or not to take birth control. We will consult our own consciences, informed by our own health needs, and our own religious and moral convictions, not the religious beliefs of a distant religious figure. As U.S. Sen. Kirsten Gillibrand recently said, “whether or not to take birth control is the woman’s choice, not her boss’s.”

 

News Politics

Sen. Tim Kaine Focuses on Reproductive Rights Amid Clinton’s Looming Decision on Vice President

Ally Boguhn

Last week, the senator and former Virginia governor argued in favor of giving Planned Parenthood access to funding in order to fight Zika. "The uniform focus for members of Congress should be, 'Let's solve the problem,'" Kaine reportedly said at a meeting in Richmond, according to Roll Call.

Sen. Tim Kaine (D-VA) appears to be rebranding himself as a more staunch pro-choice advocate after news that the senator was one of at least three potential candidates being vetted by presumptive Democratic nominee Hillary Clinton’s campaign to join her presidential ticket.

Last week, the senator and former Virginia governor argued in favor of giving Planned Parenthood access to funding in order to fight the Zika virus. “The uniform focus for members of Congress should be, ‘Let’s solve the problem,'” Kaine reportedly said at a meeting in Richmond, according to Roll Call. “That is [the] challenge right now between the Senate and House.”

Kaine went on to add that “Planned Parenthood is a primary health provider. This is really at the core of dealing with the population that has been most at risk of Zika,” he continued.

As Laura Bassett and Ryan Grim reported for the Huffington Post Tuesday, “now that Clinton … is vetting him for vice president, Kaine needs to bring his record more in line with hers” when it comes to reproductive rights. While on the campaign trail this election cycle, Clinton has repeatedly spoken out against restrictions on abortion access and funding—though she has stated that she still supports some restrictions, such as a ban on later abortions, as long as they have exceptions.

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In what is seemingly an effort to address the issue, as Bassett and Grim suggested, Kaine signed on last week as a co-sponsor of the Women’s Health Protection Act, which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services. As previously reported by Rewire, the measure would effectively stop “TRAP (targeted regulation of abortion provider) laws, forced ultrasounds, waiting periods, or restrictions on medication abortion.” TRAP laws have led to unprecedented barriers in access to abortion care.

Just one day before endorsing the legislation, Kaine issued a statement explicitly expressing his support for abortion rights after the Supreme Court struck down two provisions of Texas’ omnibus anti-choice law HB 2.

“I applaud the Supreme Court for seeing the Texas law for what it is—an attempt to effectively ban abortion and undermine a woman’s right to make her own health care choices,” said Kaine in the press release. “This ruling is a major win for women and families across the country, as well as the fight to expand reproductive freedom for all.”

The Virginia senator went on to use the opportunity to frame himself as a defender of those rights during his tenure as governor of his state. “The Texas law is quite similar to arbitrary and unnecessary rules that were imposed on Virginia women after I left office as Governor,” said Kaine. “I’m proud that we were able to successfully fight off such ‘TRAP’ regulations during my time in state office. I have always believed these sort of rules are an unwarranted effort to deprive women of their constitutionally protected right to terminate a pregnancy.”

Kaine also spoke out during his run for the Senate in 2012 when then-Gov. Bob McDonnell (R) signed a law requiring those who seek abortions to undergo an ultrasound prior to receiving care, calling the law “bad for Virginia’s image, bad for Virginia’s businesses and bad for Virginia’s women.”

Kaine’s record on abortion has of late been a hot topic among those speculating he could be a contender for vice president on the Clinton ticket. While Kaine’s website says that he “support[s] the right of women to make their own health and reproductive decisions” and that he opposes efforts to overturn Roe v. Wade, the senator recently spoke out about his personal opposition to abortion.

When host Chuck Todd asked Kaine during a recent interview on NBC’s Meet the Press about Kaine previously being “classified as a pro-life Democrat” while lieutenant governor of Virginia, Kaine described himself as a “traditional Catholic” who is “opposed to abortion.”

Kaine went on to affirm that he nonetheless still believed that the government should not intrude on the matter. “I deeply believe, and not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm,” Kaine continued. “They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As the Hill noted in a profile on Kaine’s abortion stance, as a senator Kaine has “a 100 percent rating from Planned Parenthood’s scorecard, and has consistently voted against measures like defunding Planned Parenthood and a ban on abortions after the 20th week of pregnancy.”

While running for governor of Virginia in 2005, however, Kaine promised that if elected he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

After taking office, Kaine supported some existing restrictions on abortion, such as Virginia’s parental consent law and a so-called informed consent law, which in 2008 he claimed gave “women information about a whole series of things, the health consequences, et cetera, and information about adoption.” In truth, the information such laws mandate giving out is often “irrelevant or misleading,” according to the the Guttmacher Institute.

In 2009 he also signed a measure that allowed the state to create “Choose Life” license plates and give a percentage of the proceeds to a crisis pregnancy network, though such organizations routinely lie to women to persuade them not to have an abortion.

Analysis Politics

Advocates: Bill to Address Gaps in Mental Health Care Would Do More Harm Than Good

Katie Klabusich

Advocates say that U.S. Rep. Tim Murphy's "Helping Families in Mental Health Crisis Act," purported to help address gaps in care, is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.

The need for reform of the mental health-care system is well documented; those of us who have spent time trying to access often costly, out-of-reach treatment will attest to how time-consuming and expensive care can be—if you can get the necessary time off work to pursue that care. Advocates say, however, that U.S. Rep. Tim Murphy’s (R-PA) “Helping Families in Mental Health Crisis Act” (HR 2646), purported to help address gaps in care, is not the answer. Instead, they say, it is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.

“We believe that this legislation will result in outdated, biased, and inappropriate treatment of people with a mental health diagnosis,” wrote the political action committee Leadership Conference on Civil and Human Rights in a March letter to House Committee on Energy and Commerce Chairman Rep. Fred Upton (R-MI) and ranking member Rep. Frank Pallone (D-NJ) on behalf of more than 100 social justice organizations. “The current formulation of H.R. 2646 will function to eliminate basic civil and human rights protections for those with mental illness.”

Despite the pushback, Murphy continues to draw on the bill’s mental health industry support; groups like the American Psychiatric Association (APA) and the National Alliance on Mental Illness (NAMI) back the bill.

Murphy and Rep. Eddie Bernice Johnson (D-TX) reintroduced HR 2646 earlier this month, continuing to call it “groundbreaking” legislation that “breaks down federal barriers to care, clarifies privacy standards for families and caregivers; reforms outdated programs; expands parity accountability; and invests in services for the most difficult to treat cases while driving evidence-based care.”

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Some of the stated goals of HR 2646 are important: Yes, more inpatient care beds are needed; yes, smoother transitions from inpatient to outpatient care would help many; yes, prisons house too many people with mental illness. However, many of its objectives, such as “alternatives to institutionalization” potentially allow outpatient care to be mandated by judges with no medical training and pushed for by “concerned” family members. Even the “focus on suicide prevention” can lead to forced hospitalization and disempowerment of the person the system or family member is supposedly trying to help.

All in all, advocates say, HR 2646—which passed out of committee earlier this month—marks a danger to the autonomy of those with mental illness.

Victoria M. Rodríguez-Roldán, JD, director of the Trans/GNC Justice Project at the National LGBTQ Task Force, explained that the bill would usurp the Health Insurance Portability and Accountability Act (HIPAA), “making it easier for a mental health provider to give information about diagnosis and treatment … to any ‘caregiver’-family members, partners or spouses, children that may be caring for the person, and so forth.”

For the communities she serves, this is more than just a privacy violation: It could put clients at risk if family members use their diagnosis or treatment against them.

“When we consider the stigma around mental illness from an LGBT perspective, an intersectional perspective, 57 percent of trans people have experienced significant family rejection [and] 19 percent have experienced domestic violence as a result of their being trans,” said Rodríguez-Roldán, citing the National Transgender Discrimination Survey. “We can see here how the idea of ‘Let’s give access to the poor loved ones who want to help!’ is not that great an idea.”

“It’s really about taking away voice and choice and agency from people, which is a trend that’s very disturbing to me,” said Leah Harris, an organizer with the Campaign For Real Change in Mental Health Policy, also known as Real MH Change. “Mostly [H.R. 2646] is driven by families of these people, not the people themselves. It’s pitting families against people who are living this. There are a fair number of these family members that are well-meaning, but they’re pushing this very authoritarian [policy].”

Rodríguez-Roldán also pointed out that if a patient’s gender identity or sexual orientation is a contributing factor to their depression or suicide risk—because of discrimination, direct targeting, or fear of bigoted family, friends, or coworkers—then that identity or orientation would be pertinent to their diagnosis and possible need for treatment. Though Murphy’s office claims that psychotherapy notes are excluded from the increased access caregivers would be given under HR 2646, Rodríguez-Roldán isn’t buying it; she fears individuals could be inadvertently outed to their caregivers.

Rodríguez-Roldán echoed concern that while disability advocacy organizations largely oppose the bill, groups that represent either medical institutions or families of those with mental illnesses, or medical institutions—such as NAMI, Mental Health America, and the APA—seem to be driving this legislation.

“In disability rights, if the doc starts about talking about the plight and families of the people of the disabilities, it’s not going to go over well,” she said. “That’s basically what [HR 2646] does.”

Rodríguez-Roldán’s concerns extend beyond the potential harm of allowing families and caregivers easier access to individuals’ sensitive medical information; she also points out that the act itself is rooted in stigma. Rep. Murphy created the Helping Families in Mental Health Crisis Act in response to the Sandy Hook school shooting in 2012. Despite being a clinical psychologist for 30 years before joining Congress and being co-chair of the Mental Health Caucus, he continues to perpetuate the well-debunked myth that people with mental illness are violent. In fact, according to the Department of Health and Human Services, “only 3%-5% of violent acts can be attributed to individuals living with a serious mental illness” and “people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population.”

The act “is trying to prevent gun violence by ignoring gun control and going after the the rights of mentally ill people,” Rodríguez-Roldán noted.

In addition, advocates note, HR 2646 would make it easier to access assisted outpatient treatment, but would also give courts around the country the authority to mandate specific medications and treatments. In states where the courts already have that authority, Rodríguez-Roldán says, people of color are disproportionately mandated into treatment. When she has tried to point out these statistics to Murphy and his staff, she says, she has been shut down, being told that the disparity is due to a disproportionate number of people of color living in poverty.

Harris also expressed frustration at the hostility she and others have received attempting to take the lived experiences of those who would be affected by the bill to Murphy and his staff.

“I’ve talked to thousands of families … he’s actively opposed to talking to us,” she said. “Everyone has tried to engage with [Murphy and his staff]. I had one of the staffers in the room say, ‘You must have been misdiagnosed.’ I couldn’t have been that way,” meaning mentally ill. “It’s an ongoing struggle to maintain our mental and physical health, but they think we can’t get well.”

Multiple attempts to reach Murphy’s office by Rewire were unsuccessful.

LGBTQ people—transgender, nonbinary, and genderqueer people especially—are particularly susceptible to mistreatment in an institutional setting, where even the thoughts and experiences of patients with significant privilege are typically viewed with skepticism and disbelief. They’re also more likely to experience circumstances that already come with required hospitalization. This, as Rodríguez-Roldán explained, makes it even more vital that individuals not be made more susceptible to unnecessary treatment programs at the hands of judges or relatives with limited or no medical backgrounds.
Forty-one percent of all trans people have attempted suicide at some point in their lives,” said Rodríguez-Roldán. “Once you have attempted suicide—assuming you’re caught—standard procedure is you’ll end up in the hospital for five days [or] a week [on] average.”

In turn, that leaves people open to potential abuse. Rodríguez-Roldán said there isn’t much data yet on exactly how mistreated transgender people are specific to psychiatry, but considering the discrimination and mistreatment in health care in general, it’s safe to assume mental health care would be additionally hostile. A full 50 percent of transgender people report having to teach their physicians about transgender care and 19 percent were refused care—a statistic that spikes even higher for transgender people of color.

“What happens to the people who are already being mistreated, who are already being misgendered, harassed, retraumatized? After you’ve had a suicide attempt, let’s treat you like garbage even more than we treat most people,” said Rodríguez-Roldán, pointing out that with HR 2646, “there would be even less legal recourse” for those who wanted to shape their own treatment. “Those who face abusive families, who don’t have support and so on—more likely when you’re queer—are going to face a heightened risk of losing their privacy.”

Or, for example, individuals may face the conflation of transgender or gender-nonconforming status with mental illness. Rodríguez-Roldán has experienced the conflation herself.

“I had one psychiatrist in Arlington insist, ‘You’re not bipolar; it’s just that you have unresolved issues from your transition,'” she said.

While her abusive household and other life factors certainly added to her depression—the first symptom people with Bipolar II typically suffer from—Rodríguez-Roldán knew she was transgender at age 15 and began the process of transitioning at age 17. Bipolar disorder, meanwhile, is most often diagnosed in a person’s early 20s, making the conflation rather obvious. She acknowledges the privilege of having good insurance and not being low-income, which meant she could choose a different doctor.

“It was also in an outpatient setting, so I was able to nod along, pay the copay, get out of there and never come back,” she said. “It was not inside a hospital where they can use that as an excuse to keep me.”

The fear of having freedom and other rights stripped away came up repeatedly in a Twitter chat last month led by the Task Force to spread the word about HR 2646. More than 350 people participated, sharing their experiences and asking people to oppose Murphy’s bill.

In the meantime, Sen. Lamar Alexander (R-TN) has introduced the “Mental Health Reform Act of 2016” (SB 2680) which some supporters of HR 2646 are calling a companion bill. It has yet to be voted on.

Alexander’s bill has more real reform embedded in its language, shifting the focus from empowering families and medical personnel to funding prevention and community-based support services and programs. The U.S. Secretary of Health and Human Services would be tasked with evaluating existing programs for their effectiveness in handling co-current disorders (e.g., substance abuse and mental illness); reducing homelessness and incarceration of people with substance abuse and/or mental disorders; and providing recommendations on improving current community-based care.

Harris, with Real MH Change, considers Alexander’s bill an imperfect improvement over the Murphy legislation.

“Both of [the bills] have far too much emphasis on rolling back the clock, promoting institutionalization, and not enough of a preventive approach or a trauma-informed approach,” Harris said. “What they share in common is this trope of ‘comprehensive mental health reform.’ Of course the system is completely messed up. Comprehensive reform is needed, but for those of us who have lived through it, it’s not just ‘any change is good.'”

Harris and Rodríguez-Roldán both acknowledged that many of the HR 2646 co-sponsors and supporters in Congress have good intentions; those legislators are trusting Murphy’s professional background and are eager to make some kind of change. In doing so, the voices of those who are affected by the laws—those asking for more funding toward community-based and patient-centric care—are being sidelined.

“What is driving the change is going to influence what the change looks like. Right now, change is driven by fear and paternalism,” said Harris. “It’s not change at any cost.”