Analysis Law and Policy

Philadelphia Becomes Third City to Pass Resolution Supporting Reproductive Health Care

Annamarya Scaccia

As of last week, the Philadelphia Board of Health has avowed it will firmly stand behind the right to comprehensive reproductive health and abortion care.

See our coverage of the resolution strategy here.

See our coverage of New York Resolution 1635-A here.

As of last week, the Philadelphia Board of Health has avowed it will firmly stand behind the right to comprehensive reproductive health and abortion care.

The proclamation came in the form of a resolution adopted last week calling on the federal government, Pennsylvania Governor Tom Corbett, and the state’s General Assembly to uphold public funding for reproductive health care and reinstate insurance coverage for abortion care for all women regardless of income level and insurance type. Specifically, the resolution states:

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“Be it therefore resolved, that the Board of Health of the Philadelphia Department of Public Health calls upon President Obama, the US Congress, Governor Corbett, and the Pennsylvania General Assembly to support public funding for comprehensive family planning services; to reinstate coverage for abortion services for women enrolled in public insurance programs, including women enrolled in Medicaid and Medicare, women in the military, federal employees, Native American Women, women in federal prison, women in the Peace Corps, and women who live in the District of Columbia; and to ensure that the Commonwealth of Pennsylvania does not withhold insurance coverage for abortion for women purchasing plans on a state insurance exchange.”

With this resolution, Philadelphia becomes the third city to stand behind women’s access to reproductive health care. It comes on the heels of similar resolutions adopted by the New York City Council Committee and the Travis County Commissioners Court in Austin, Texas in late January.

“If state and federal government were to provide comprehensive pregnancy-related coverage then it would be good for women and families of Philadelphia,” says Dr. Susan Schewel, executive director of Women’s Medical Fund (WMF) and Board of Health member. “The lack of pregnancy-related coverage is a public health issue and that’s what the Board of Health deals with. We know that when women can’t control their fertility and make their own decision about how many children they want to have and when and if they want to have them, then there are public health consequences for that, for women and for their children.”

A draft of the resolution was first brought to the Board of Health by Dr. Schewel a couple of months ago after gaining interest through her work with WMF. Initially, Dr. Schewel’s pledge only included the issue of abortion coverage but, she says, “They were so outraged about threats to public family planning services that they wanted to expand to include that issue.”

“We had no conversations about personal feelings about abortion and family planning because we’re here as servants of public health and so our personal beliefs are irrelevant, so they embraced it,” she told me after a press event on the resolution held Friday afternoon. “Cities are where we see the impact of state and federal policies. We see them here on the ground, the frontline. We see the impact on our city streets, in our city health centers, in our day care centers, everywhere.”

Ultimately, what the resolution signifies is the acknowledgment of rights for “women everywhere…on behalf of the Board of Health and the citizens that it represents,” says Brenda Shelton-Dunston, MPH, executive director of the Philadelphia Black Women’s Health Alliance.

“Those women that fall within those cracks and do not have an income level, should they be discriminated against with not being provided access to this service? No,” says Shelton-Dunston, who attended the Friday conference. “The same thing as far as those individuals who have no insurance, the essence of what is occurring is that they will be impacted by that. That’s why we’re here. That’s why we’re standing up.”

The resolution’s passing couldn’t come at a more appropriate time for women in the Commonwealth. The Pennsylvania General Assembly is presently considering Senate Bill 3 (SB 3) and House Bill 742 (HB 742), which would prohibit qualified health care plans offered in the Keystone state’s American Health Benefits Exchange from including certain abortion coverage once the Patient Protection and Affordable Care Act (ACA) is implemented.

“It’s a political statement from the Philadelphia Board of Health and it hopefully will reflect on the General Assembly and help them to make an informed decision as they consider that legislation,” says Jen Horwitz, director of Public Policy at Women’s Way and coordinator of Raising Women’s Voices of Southern Pennsylvania, also at the press event.

The legislation would, however, allow for publicly-funded coverage in the cases of rape, incest, and life endangerment, as permitted under the Hyde Amendment.

“That, in itself, is extremely restrictive because of other legislative issues that ring throughout the federal level,” says Horwitz, referring to ACA’s Nelson provision. “The challenge that we really see is, if this passes, there isn’t even exceptions for women facing serious complication issues. It doesn’t offer a type of health care coverage that woman actually need.”

As written, the Nelson provision requires insurances plans offering abortion coverage in state exchanges to create two separate accounts for premium payments. Insurers would deposit private premium monies for abortion care into one account (which cannot include any federal dollars), and process payments for all other covered benefits into the other. If implemented in its strictest interpretation, women would have to dole out two separate checks just to pay for their insurance, asserts NARAL Pro-Choice America.

Unsurprisingly, 25 of the 26 senators who’ve sponsored SB 3 are Republican, 24 of them men. Additionally, none of the senators actually serve Philadelphia County; rather, only six of the men represent the city’s outlining counties including Chester, Bucks, Delaware, and Montgomery. The bill’s prime sponsor, Republican Senator Donald White, represents District 41 in Western Pennsylvania.

“This requirement to purchase abortion coverage outside of the exchange imposes new, unnecessary burdens on consumers who purchase coverage in the exchange,” says Dr. Schewel. “Currently, 80 percent of private insurance companies cover abortion, so a woman who has coverage now would find this coverage withheld if her employer chooses to take part in the exchange. These restrictions could cause serious constraints on women’s ability to access abortion coverage in the exchange, even a woman with a serious health condition such as cancer.  As well, this potentially creates unnecessary administrative burdens on the private insurance market at large.”

It would also add insult to injury. Unlike New York, Pennsylvania has not earmarked state funding to cover abortion care through its Medicaid program in order to fill the void left by Hyde; nor does it offer abortion coverage for government and military employees. That means 83,373 women ages 18 to 44 on Medicaid, and 87,039 women in the same age bracket with public insurance living in Philadelphia proper remain without access to comprehensive reproductive health care. And there are 84,900 Philadelphia women ages 18 to 44 who have no health insurance at all.

“We know that low-income women are often harmed first and worst by restrictions on reproductive healthcare access,” wrote Catholics for Choice’s Domestic Policy Director Sara Hutchinson in an email. She considers the resolution’s passage “one of the most sensible public policy statements…seen in a long time.” “As Catholics, we believe that each individual, no matter their circumstances, has a right and responsibility to follow his or her own conscience when making moral decisions.”

The implication of this resolution extends beyond the topic of family planning. It is also a rallying cry for all-inclusive reproductive health care services, including screenings for sexually-transmitted infections (STIs).

To illustrate the significance, Deputy Mayor for Health and Opportunity and Philadelphia’s Health Commissioner Dr. Donald F. Schwarz, who serves as the Board of Health’s president, presented statistics on current STI trends, specifically among the city’s youth, at Friday’s event, according to Horwitz. According to the Philadelphia Department of Health’s 2011 Philadelphia Youth in Crisis: Adolescents and Sexually Transmitted Infections report, over 45 percent of Philadelphia high school students are currently sexually active, nearly 20 percent more than youth in New York (over 10 percent of those students first had intercourse before 13 years of age, as opposed to about five percent of New York youth.) During their last sexual encounter, 37 percent of those Philadelphia students did not use a condom. And a little over 60 percent of the city’s high school students use condoms, about 10 percent less than those in New York.

The report also states that 10- to 14-year-olds are 5.3 times as likely to contract Chlamydia as American teens overall, with the rate of the disease at 3.5 times the national rate among 15- to 19-year-olds. Among this same age group, the gonorrhea rate in Philadelphia is three times the national rate, with four times the national among ages 10 to 14. Black and Hispanic youth ages 15-19 are more likely to contract these two diseases than White youth.

More telling, youth ages 13 to 24 make up 25 percent of all newly-diagnosed HIV cases, with African-Americans making up 70 percent of those cases. In Philadelphia’s STD clinic, 47 percent of those found to have the disease had a previous history of Chlamydia, gonorrhea and/or syphilis. Additionally, syphilis cases are also rising among 15- to 19-years-old, increasing from 1 percent in 2004 to 7 percent in 2010.

“That’s a key point to pay attention to,” says Horwitz. “It really paint[s] the picture of why this is particularly important for Philadelphia.” 

“What Philadelphia has done is part of a growing national trend,” says Horwitz. “Other states are starting to say, ‘We want to make sure that we are supporting women, offering them comprehensive reproductive health choice.’”

While only three cities have passed a resolution of this type, the National Institute for Reproductive Health’s Urban Initiative for Reproductive Health is working with and connecting advocates, policymakers and public health officials on the city and county levels to bolster mass support for comprehensive reproductive health and abortion care coverage. According to a National Institute press release, additional cities will introduce similar resolutions and initiatives supporting insurance coverage for abortion in the coming months.

“The more you have a ground swell, a focus on the issues, hopefully from the legislature perspective, there will be less movement to repeal, less movement to bring in conservative legislation,” says Shelton-Dunston.

Analysis Economic Justice

New Pennsylvania Bill Is Just One Step Toward Helping Survivors of Economic Abuse

Annamarya Scaccia

The legislation would allow victims of domestic violence, sexual assault, and stalking to terminate their lease early or request locks be changed if they have "a reasonable fear" that they will continue to be harmed while living in their unit.

Domestic violence survivors often face a number of barriers that prevent them from leaving abusive situations. But a new bill awaiting action in the Pennsylvania legislature would let survivors in the state break their rental lease without financial repercussions—potentially allowing them to avoid penalties to their credit and rental history that could make getting back on their feet more challenging. Still, the bill is just one of several policy improvements necessary to help survivors escape abusive situations.

Right now in Pennsylvania, landlords can take action against survivors who break their lease as a means of escape. That could mean a lien against the survivor or an eviction on their credit report. The legislation, HB 1051, introduced by Rep. Madeleine Dean (D-Montgomery County), would allow victims of domestic violence, sexual assault, and stalking to terminate their lease early or request locks be changed if they have “a reasonable fear” that they will continue to be harmed while living in their unit. The bipartisan bill, which would amend the state’s Landlord and Tenant Act, requires survivors to give at least 30 days’ notice of their intent to be released from the lease.

Research shows survivors often return to or delay leaving abusive relationships because they either can’t afford to live independently or have little to no access to financial resources. In fact, a significant portion of homeless women have cited domestic violence as the leading cause of homelessness.

“As a society, we get mad at survivors when they don’t leave,” Kim Pentico, economic justice program director of the National Network to End Domestic Violence (NNEDV), told Rewire. “You know what, her name’s on this lease … That’s going to impact her ability to get and stay safe elsewhere.”

“This is one less thing that’s going to follow her in a negative way,” she added.

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Pennsylvania landlords have raised concerns about the law over liability and rights of other tenants, said Ellen Kramer, deputy director of program services at the Pennsylvania Coalition Against Domestic Violence, which submitted a letter in support of the bill to the state House of Representatives. Lawmakers have considered amendments to the bill—like requiring “proof of abuse” from the courts or a victim’s advocate—that would heed landlord demands while still attempting to protect survivors.

But when you ask a survivor to go to the police or hospital to obtain proof of abuse, “it may put her in a more dangerous position,” Kramer told Rewire, noting that concessions that benefit landlords shift the bill from being victim-centered.

“It’s a delicate balancing act,” she said.

The Urban Affairs Committee voted HB 1051 out of committee on May 17. The legislation was laid on the table on June 23, but has yet to come up for a floor vote. Whether the bill will move forward is uncertain, but proponents say that they have support at the highest levels of government in Pennsylvania.

“We have a strong advocate in Governor Wolf,” Kramer told Rewire.

Financial Abuse in Its Many Forms

Economic violence is a significant characteristic of domestic violence, advocates say. An abuser will often control finances in the home, forcing their victim to hand over their paycheck and not allow them access to bank accounts, credit cards, and other pecuniary resources. Many abusers will also forbid their partner from going to school or having a job. If the victim does work or is a student, the abuser may then harass them on campus or at their place of employment until they withdraw or quit—if they’re not fired.

Abusers may also rack up debt, ruin their partner’s credit score, and cancel lines of credit and insurance policies in order to exact power and control over their victim. Most offenders will also take money or property away from their partner without permission.

“Financial abuse is so multifaceted,” Pentico told Rewire.

Pentico relayed the story of one survivor whose abuser smashed her cell phone because it would put her in financial dire straits. As Pentico told it, the abuser stole her mobile phone, which was under a two-year contract, and broke it knowing that the victim could not afford a new handset. The survivor was then left with a choice of paying for a bill on a phone she could no longer use or not paying the bill at all and being turned into collections, which would jeopardize her ability to rent her own apartment or switch to a new carrier. “Things she can’t do because he smashed her smartphone,” Pentico said.

“Now the general public [could] see that as, ‘It’s a phone, get over it,'” she told Rewire. “Smashing that phone in a two-year contract has such ripple effects on her financial world and on her ability to get and stay safe.”

In fact, members of the public who have not experienced domestic abuse may overlook financial abuse or minimize it. A 2009 national poll from the Allstate Foundation—the philanthropic arm of the Illinois-based insurance company—revealed that nearly 70 percent of Americans do not associate financial abuse with domestic violence, even though it’s an all-too-common tactic among abusers: Economic violence happens in 98 percent of abusive relationships, according to the NNEDV.

Why people fail to make this connection can be attributed, in part, to the lack of legal remedy for financial abuse, said Carol Tracy, executive director of the Women’s Law Project, a public interest law center in Pennsylvania. A survivor can press criminal charges or seek a civil protection order when there’s physical abuse, but the country’s legal justice system has no equivalent for economic or emotional violence, whether the victim is married to their abuser or not, she said.

Some advocates, in lieu of recourse through the courts, have teamed up with foundations to give survivors individual tools to use in economically abusive situations. In 2005, the NNEDV partnered with the Allstate Foundation to develop a curriculum that would teach survivors about financial abuse and financial safety. Through the program, survivors are taught about financial safety planning including individual development accounts, IRA, microlending credit repair, and credit building services.

State coalitions can receive grant funding to develop or improve economic justice programs for survivors, as well as conduct economic empowerment and curriculum trainings with local domestic violence groups. In 2013—the most recent year for which data is available—the foundation awarded $1 million to state domestic violence coalitions in grants that ranged from $50,000 to $100,000 to help support their economic justice work.

So far, according to Pentico, the curriculum has performed “really great” among domestic violence coalitions and its clients. Survivors say they are better informed about economic justice and feel more empowered about their own skills and abilities, which has allowed them to make sounder financial decisions.

This, in turn, has allowed them to escape abuse and stay safe, she said.

“We for a long time chose to see money and finances as sort of this frivolous piece of the safety puzzle,” Pentico told Rewire. “It really is, for many, the piece of the puzzle.”

Public Policy as a Means of Economic Justice

Still, advocates say that public policy, particularly disparate workplace conditions, plays an enormous role in furthering financial abuse. The populations who are more likely to be victims of domestic violence—women, especially trans women and those of color—are also the groups more likely to be underemployed or unemployed. A 2015 LGBT Health & Human Services Network survey, for example, found that 28 percent of working-age transgender women were unemployed and out of school.

“That’s where [economic abuse] gets complicated,” Tracy told Rewire. “Some of it is the fault of the abuser, and some of it is the public policy failures that just don’t value women’s participation in the workforce.”

Victims working low-wage jobs often cannot save enough to leave an abusive situation, advocates say. What they do make goes toward paying bills, basic living needs, and their share of housing expenses—plus child-care costs if they have kids. In the end, they’re not left with much to live on—that is, if their abuser hasn’t taken away access to their own earnings.

“The ability to plan your future, the ability to get away from [abuse], that takes financial resources,” Tracy told Rewire. “It’s just so much harder when you don’t have them and when you’re frightened, and you’re frightened for yourself and your kids.”

Public labor policy can also inhibit a survivor’s ability to escape. This year, five states, Washington, D.C., and 24 jurisdictions will have passed or enacted paid sick leave legislation, according to A Better Balance, a family and work legal center in New York City. As of April, only one of those states—California—also passed a state paid family leave insurance law, which guarantees employees receive pay while on leave due to pregnancy, disability, or serious health issues. (New Jersey, Rhode Island, Washington, and New York have passed similar laws.) Without access to paid leave, Tracy said, survivors often cannot “exercise one’s rights” to file a civil protection order, attend court hearings, or access housing services or any other resource needed to escape violence.

Furthermore, only a handful of state laws protect workers from discrimination based on sex, sexual orientation, gender identity, and pregnancy or familial status (North Carolina, on the other hand, recently passed a draconian state law that permits wide-sweeping bias in public and the workplace). There is no specific federal law that protects LGBTQ workers, but the U.S. Employment Opportunity Commission has clarified that the Civil Rights Act of 1964 does prohibit discrimination based on gender identity and sexual orientation.

Still, that doesn’t necessarily translate into practice. For example, the National Center for Transgender Equality found that 26 percent of transgender people were let go or fired because of anti-trans bias, while 50 percent of transgender workers reported on-the-job harassment. Research shows transgender people are at a higher risk of being fired because of their trans identity, which would make it harder for them to leave an abusive relationship.

“When issues like that intersect with domestic violence, it’s devastating,” Tracy told Rewire. “Frequently it makes it harder, if not impossible, for [victims] to leave battering situations.”

For many survivors, their freedom from abuse also depends on access to public benefits. Programs like Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), the child and dependent care credit, and earned income tax credit give low-income survivors access to the money and resources needed to be on stable economic ground. One example: According to the Center on Budget and Policy Priorities, where a family of three has one full-time nonsalary worker earning $10 an hour, SNAP can increase their take-home income by up to 20 percent.

These programs are “hugely important” in helping lift survivors and their families out of poverty and offset the financial inequality they face, Pentico said.

“When we can put cash in their pocket, then they may have the ability to then put a deposit someplace or to buy a bus ticket to get to family,” she told Rewire.

But these programs are under constant attack by conservative lawmakers. In March, the House Republicans approved a 2017 budget plan that would all but gut SNAP by more than $150 million over the next ten years. (Steep cuts already imposed on the food assistance program have led to as many as one million unemployed adults losing their benefits over the course of this year.) The House GOP budget would also strip nearly $500 billion from other social safety net programs including TANF, child-care assistance, and the earned income tax credit.

By slashing spending and imposing severe restrictions on public benefits, politicians are guaranteeing domestic violence survivors will remain stuck in a cycle of poverty, advocates say. They will stay tethered to their abuser because they will be unable to have enough money to live independently.

“When women leave in the middle of the night with the clothes on their back, kids tucked under their arms, come into shelter, and have no access to finances or resources, I can almost guarantee you she’s going to return,” Pentico told Rewire. “She has to return because she can’t afford not to.”

By contrast, advocates say that improving a survivor’s economic security largely depends on a state’s willingness to remedy what they see as public policy failures. Raising the minimum wage, mandating equal pay, enacting paid leave laws, and prohibiting employment discrimination—laws that benefit the entire working class—will make it much less likely that a survivor will have to choose between homelessness and abuse.

States can also pass proactive policies like the bill proposed in Pennsylvania, to make it easier for survivors to leave abusive situations in the first place. Last year, California enacted a law that similarly allows abuse survivors to terminate their lease without getting a restraining order or filing a police report permanent. Virginia also put in place an early lease-termination law for domestic violence survivors in 2013.

A “more equitable distribution of wealth is what we need, what we’re talking about,” Tracy told Rewire.

As Pentico put it, “When we can give [a survivor] access to finances that help her get and stay safe for longer, her ability to protect herself and her children significantly increases.”

News Politics

Congresswoman Pushes Intersectionality at Democratic National Convention

Christine Grimaldi

Rep. Bonnie Watson Coleman (D-NJ) charges that reproductive health-care restrictions have a disproportionate impact on the poor, the urban, the rural, and people of color.

The members of Congress who flocked to the Democratic National Convention in Philadelphia this week included a vocal advocate for the intersection of racial and reproductive justice: Rep. Bonnie Watson Coleman (D-NJ).

Watson Coleman’s longstanding work in these areas “represented the intersection of who I am,” she said during a discussion in Philadelphia sponsored by the Center for Reproductive Rights and Cosmopolitan. Reproductive health-care restrictions, she stressed, have a disproportionate effect on the poor, the urban, the rural, and people of color.

“These decisions impact these communities even more so [than others],” she told Rewire in an interview. “We don’t have the alternatives that middle-class, suburban, white women have. And we’d rather they have them.”

Watson Coleman has brought that context to her work in Congress. In less than two years on Capitol Hill, she co-founded the Congressional Caucus on Black Women and Girls and serves on the so-called Select Investigative Panel on Infant Lives, a GOP-led, $1.2 million investigation that she and her fellow Democrats have called an anti-choice “witch hunt.”

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Coleman said she’s largely found support and encouragement among her fellow lawmakers during her first term as a woman of color and outspoken advocate for reproductive rights.

“What I’ve gotten from my Republican colleagues who are so adamantly against a woman’s right to choose—I don’t think it has anything to do with my being a woman or an African American, it has to do with the issue,” she said.

House Republicans have increasingly pushed anti-choice policies in advance of the ongoing August recess and November’s presidential election. The House this month passed the Conscience Protection Act, which would give health-care providers a private right of action to seek civil damages in court, should they face supposed coercion to provide abortion care or discrimination stemming from their refusal to assist in such care.

Speaker Paul Ryan (R-WI) lauded passage of the bill and the House’s thus-far unsuccessful effort to prove that Planned Parenthood profited from fetal tissue donations—allegations based on widely discredited videos published by the Center for Medical Progress, an anti-choice front group that has worked closely with GOP legislators to attack funding for Planned Parenthood.

On the other side of the aisle, Watson Coleman joined 118 other House Democrats to co-sponsor the Equal Access to Abortion Coverage in Health Insurance Act (HR 2972). Known as the EACH Woman Act, the legislation would overturn the Hyde Amendment and ensure that every woman has access to insurance coverage of abortion care.

The Hyde Amendment’s restriction of federal funding for abortion care represents a particularly significant barrier for people with low incomes and people of color.

The Democratic Party platform, for the first time, calls for repealing the Hyde Amendment, though the process for undoing a yearly federal appropriations rider remains unclear.

For Watson Coleman, the path forward on getting rid of the Hyde Amendment is clear on at least one point: The next president can’t go it alone.

“The president will have to have a willing Congress,” she said. She called on the electorate to “recognize that this is not a personality contest” and “remove some of those people who have just been obstructionists without having the proper evidence.”

In the meantime, what does a “willing Congress” look like for legislation with anti-choice roadblocks? A majority voting bloc helps, Watson Coleman said. But that’s not everything.

“There are lots of bills that Republicans will vote for if their leadership would simply bring them up,” she said.