News Health Systems

Feds Approve Pennsylvania’s Medicaid ‘Expansion,’ But Concerns Remain (Updated)

Tara Murtha

While pleased that they may no longer have to refer to Pennsylvania as “the island of the uninsured,” advocates still have serious concerns with the Healthy PA plan.

Update and Clarification, September 4, 2014: The initial Healthy PA proposal eliminated podiatry, optometry, and chiropractic services. In April, after facing criticism, state officials suggested those services may not be cut out of the final plan. The approved waiver does not address these specific services, leaving many advocates assuming these services will still be eliminated. With the final details of Healthy PA still under negotiation, it is not entirely clear if these services will be eliminated or modified. A CMS representative referred Rewire to the state Department of Public Welfare, which has not yet responded.

Federal regulators approved “much of” Healthy PA, Pennsylvania Gov. Tom Corbett’s alternative to Medicaid expansion plan. If implemented, the plan will extend health insurance coverage to as many as 600,000 of the state’s working poor by next year.

While pleased that they may no longer have to refer to Pennsylvania as “the island of the uninsured,” advocates still have serious concerns with the plan.

Though people stuck in the gap created by Gov. Corbett’s refusal to expand Medicaid would finally gain coverage, Healthy PA slashes current benefits.

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The federal government and the state are still negotiating the severity of the cuts. So far, of the 24 waivers submitted by Pennsylvania’s Department of Public Welfare, only four were approved. Some of the rejected provisions include a mandatory work-search requirement and punitive lockout periods for neglecting to pay premiums on time.

“[Centers for Medicare & Medicaid Services] told advocates yesterday that they have agreed on a framework for the cuts,” attorney Kristen Dama of Community Legal Services in Philadelphia told Rewire.

The basic “framework” for Healthy PA is to divide enrollees into high-risk and low-risk groups. The high-risk group will cover people with disabilities, seniors, and pregnant people. Everyone else will be rolled into the low-risk group.

The exact standards for how to categorize applicants—for example, what constitutes a disability severe enough to qualify for the high-risk group—is still unclear.

While the high-risk group will theoretically be held to higher standards than the low-risk group, new limitations and eliminations of services will affect everyone on Medicaid.

There will be new caps on lab fees and radiology services such as MRIs, CAT scans, and X-rays. The new plan eliminates chiropractic services, podiatry and optometry visits; these cuts will disproportionately affect diabetics.

Nine percent of Pennsylvania’s adult population has been diagnosed with the disease, which is the 7th leading cause of death in the state. There will also be limits on medical equipment. Subsidies for “durable medical equipment,” for example, could be reduced to $1,000 per year for Medicaid recipients rolled into the low-risk group.

“[We’re] really paring back benefits so that people are going to have to wait until they’re very, very sick [to gain services],” Dama said. “What we’re doing is really deviating from the trend of every other state.”

In addition to these cuts, the plan installs new barriers to coverage.

Healthy PA, in its current form, will charge some enrollees the highest Medicaid premiums of any state in the country, despite evidence “premiums and cost sharing can act as barriers to obtaining, maintaining and accessing health coverage and health care services, particularly for individuals with low-incomes and significant health care needs.”

Pennsylvania Health Access Network, a coalition of organizations advocating for health insurance access in the state, was succinct in their response to the news. Yesterday, the network published a blog post calling on citizens to sign a petition: “As a condition of expanding health care for some, Governor Corbett is trying to take it away from others by pushing through drastic and dangerous cuts in benefits for current enrollees.”

It is not clear if Healthy PA will actually be implemented at all.

Gov. Corbett is facing re-election this fall, and his numbers have been “epically bad.” The latest Franklin & Marshall poll shows Corbett capturing just 24 percent of the vote.

During spring’s primary election, Democratic challenger Tom Wolf promised that if elected, he would expand Medicaid which, at the time, meant the straightforward way, like New Jersey and all other surrounding states—an option advocates believe will be better for the working poor.

However, now that Healthy PA is approved, Wolf’s ability to go this route if elected will depend on when the state signs new contracts with providers under the provisions of Healthy PA.

Pennsylvania remains in an inverse situation where those who need the most financial help obtaining health insurance are the least qualified to obtain it. For example, a Pennsylvania family of four earning $45,000 a year qualifies for a tax subsidy toward health insurance, but a family of four earning $9,000 does not.

As of August, 61 percent of voters believe that Pennsylvania is “off on the wrong track.”

Analysis Politics

Anti-Choice Democrats Employ ‘Dangerous,’ Contradictory Strategies

Ally Boguhn & Christine Grimaldi

Democrats for Life of America leaders, politicians, and rank-and-file supporters often contradict each other, and sometimes themselves, exposing a lack of coherent strategy at a time when the Democratic Party's platform is newly committed to increasing abortion access for all.

The national organization for anti-choice Democrats last month brought a litany of arguments against abortion to the party’s convention. As a few dozen supporters gathered for an event honoring anti-choice Louisiana Gov. John Bel Edwards (D), the group ran into a consistent problem.

Democrats for Life of America (DFLA) leaders, politicians, and rank-and-file supporters often contradicted each other, and sometimes themselves, exposing a lack of coherent strategy at a time when the Democratic Party’s platform is newly committed to increasing access to abortion care for all.

DFLA leaders and politicians attempted to distance themselves from the traditionally Republican anti-choice movement, but repeatedly invoked conservative falsehoods and medically unsupported science to make their arguments against abortion. One state-level lawmaker said she routinely sought guidance from the National Right to Life, while another claimed the Republican-allied group left anti-choice Democrats in his state to fend for themselves.

Over the course of multiple interviews, Rewire discovered that while the organization demanded that Democrats “open the big tent” for anti-choice party members in order to win political office, especially in the South, it lacked a coordinated strategy for making that happen and accomplishing its policy goals.

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Take, for example, 20-week abortion bans, which the organization’s website lists as a key legislative issue. When asked about why the group backed cutting off abortion care at that point in a pregnancy, DFLA Executive Director Kristen Day admitted that she didn’t “know what the rationale was.”

Janet Robert, the president of the group’s executive board, was considerably more forthcoming.

“Well, the group of pro-life people who came up with the 20-week ban felt that at 20 weeks, it’s pretty well established that a child can feel pain,” Robert claimed during an interview with Rewire. Pointing to the U.S. Supreme Court’s ruling in Roe v. Wade, which protected the right to legal abortion care before the point of fetal viability, Rogers suggested that “more and more we’re seeing that children, prenatal children, are viable around 20 to 22 weeks” of pregnancy.

Medical consensus, however, has found it “unlikely” that a fetus can feel pain until the third trimester, which begins around the 28th week of pregnancy. The doctors who testify otherwise in an effort to push through abortion restrictions are often discredited anti-choice activists. A 20-week fetus is “in no way shape or form” viable, according to Dr. Hal Lawrence, executive vice president of the American Congress of Obstetricians and Gynecologists.

When asked about scientific findings that fetuses do not feel pain at 20 weeks of pregnancy, Robert steadfastly claimed that “medical scientists do not agree on that issue.”

“There is clearly disagreement, and unfortunately, science has been manipulated by a lot of people to say one thing or another,” she continued.

While Robert parroted the very same medically unsupported fetal pain and viability lines often pushed by Republicans and anti-choice activists, she seemingly acknowledged that such restrictions were a way to work around the Supreme Court’s decision to make abortion legal.

“Now other legislatures are looking at 24 weeks—anything to get past the Supreme Court cut-off—because everybody know’s it’s a child … it’s all an arbitrary line,” she said, adding that “people use different rationales just to get around the stupid Supreme Court decision.”

Charles C. Camosy, a member of DFLA’s board, wrote in a May op-ed for the LA Times that a federal 20-week ban was “common-sense legislation.” Camosy encouraged Democratic lawmakers to help pass the abortion ban as “a carrot to get moderate Republicans on board” with paid family leave policies.

Robert also relied upon conservative talking points about fake clinics, also known as crisis pregnancy centers, which routinely lie to patients to persuade them not to have an abortion. Robert said DFLA doesn’t often interact with women facing unplanned pregnancies, but the group nonetheless views such organizations as “absolutely fabulous [be]cause they help the women.”

Those who say such fake clinics provide patients with misinformation and falsehoods about abortion care are relying on “propaganda by Planned Parenthood,” Robert claimed, adding that the reproductive health-care provider simply doesn’t want patients seeking care at fake clinics and wants to take away those clinics’ funding.

Politicians echoed similar themes at DFLA’s convention event. Edwards’ award acceptance speech revealed his approach to governing, which, to date, includes support for restrictive abortion laws that disproportionately hurt people with low incomes, even as he has expanded Medicaid in Louisiana.

Also present at the event was Louisiana state Rep. Katrina Jackson (D), responsible for a restrictive admitting privileges law that former Gov. Bobby Jindal (R) signed into law in 2014. Jackson readily admitted to Rewire that she takes her legislative cues from the National Right to Life. She also name-checked Dorinda Bordlee, senior counsel of the Bioethics Defense Fund, an allied organization of the Alliance Defending Freedom.

“They don’t just draft bills for me,” Jackson told Rewire in an interview. “What we do is sit down and talk before every session and see what the pressing issues are in the area of supporting life.”

Despite what Jackson described as a commitment to the constitutionality of her laws, the Supreme Court in March blocked admitting privileges from taking effect in Louisiana. Louisiana’s law is also nearly identical to the Texas version that the Court struck down in June’s Whole Woman’s Health v. Hellerstedt decision.

Jackson did not acknowledge the setback, speaking instead about how such measures protect the health of pregnant people and fetuses. She did not mention any legal strategy—only that she’s “very prayerful” that admitting privileges will remain law in her state.

Jackson said her “rewarding” work with National Right to Life encompasses issues beyond abortion care—in her words, “how you’re going to care for the baby from the time you choose life.”

She claimed she’s not the only Democrat to seek out the group’s guidance.

“I have a lot of Democratic colleagues in my state, in other states, who work closely with [National] Right to Life,” Jackson said. “I think the common misconception is, you see a lot of party leaders saying they’re pro-abortion, pro-choice, and you just generally assume that a lot of the state legislators are. And that’s not true. An overwhelming majority of the Democrat state legislators in our state and others are pro-life. But, we say it like this: We care about them from the womb to the tomb.”

The relationship between anti-choice Democrats and anti-choice groups couldn’t be more different in South Dakota, said state house Rep. Ray Ring (D), a Hillary Clinton supporter at DFLA’s convention event.

Ring said South Dakota is home to a “small, not terribly active” chapter of DFLA. The “very Republican, very conservative” South Dakota Right to Life drives most of the state’s anti-choice activity and doesn’t collaborate with anti-choice Democrats in the legislature, regardless of their voting records on abortion.

Democrats hold a dozen of the 70 seats in South Dakota’s house and eight of the 35 in the state senate. Five of the Democratic legislators had a mixed record on choice and ten had a pro-choice record in the most recent legislative session, according to NARAL Pro-Choice South Dakota Executive Director Samantha Spawn.

As a result, Ring and other anti-choice Democrats devote more of their legislative efforts toward policies such as Medicaid expansion, which they believe will reduce the number of pregnant people who seek abortion care. Ring acknowledged that restrictions on the procedure, such as a 20-week ban, “at best, make a very marginal difference”—a far cry not only from Republicans’ anti-choice playbook, but also DFLA’s position.

Ring and other anti-choice Democrats nevertheless tend to vote for Republican-sponsored abortion restrictions, falling in line with DFLA’s best practices. The group’s report, which it released at the event, implied that Democratic losses since 2008 are somehow tied to their party’s support for abortion rights, even though the turnover in state legislatures and the U.S. Congress can be attributed to a variety of factors, including gerrymandering to favor GOP victories.

Anecdotal evidence provides measured support for the inference.

Republican-leaning anti-choice groups targeted one of their own—Rep. Renee Ellmers (R-NC)—in her June primary for merely expressing concern that a congressional 20-week abortion ban would have required rape victims to formally report their assaults to the police in order to receive exemptions. Ellmers eventually voted last year for the U.S. House of Representatives’ “disgustingly cruel” ban, similarly onerous rape and incest exceptions included.

If anti-choice groups could prevail against such a consistent opponent of abortion rights, they could easily do the same against even vocal “Democrats for Life.”

Former Rep. Kathy Dalhkemper (D-PA) contends that’s what happened to her and other anti-choice Democrats in the 2010 midterm elections, which resulted in Republicans wresting control of the House.

“I believe that pro-life Democrats are the biggest threat to the Republicans, and that’s why we were targeted—and I’ll say harshly targeted—in 2010,” Dahlkemper said in an interview.

She alleged that anti-choice groups, often funded by Republicans, attacked her for supporting the Affordable Care Act. A 2010 Politico story describes how the Susan B. Anthony List funneled millions of dollars into equating the vote with support for abortion access, even though President Obama signed an executive order in the vein of the Hyde Amendment’s prohibition on federal funds for abortion care.

Dalhkemper advocated for perhaps the clearest strategy to counter the narrative that anti-choice Democrats somehow aren’t really opposed to abortion.

“What we need is support from our party at large, and we also need to band together, and we also need to continue to talk about that consistent life message that I think the vast majority of us believe in,” she said.

Self-described pro-choice Georgia House Minority Leader Rep. Stacey Abrams (D) rejected the narratives spun by DFLA to supporters. In an interview with Rewire at the convention, Abrams called the organization’s claim that Democrats should work to elect anti-choice politicians from within their ranks in order to win in places like the South a “dangerous” strategy that assumes “that the South is the same static place it was 50 or 100 years ago.”

“I think what they’re reacting to is … a very strong religious current that runs throughout the South,” that pushes people to discuss their values when it comes to abortion, Abrams said. “But we are capable of complexity. And that’s the problem I have. [Its strategy] assumes and reduces Democrats to a single issue, but more importantly, it reduces the decision to one that is a binary decision—yes or no.”

That strategy also doesn’t take into account the intersectional identities of Southern voters and instead only focuses on appealing to the sensibilities of white men, noted Abrams.

“We are only successful when we acknowledge that I can be a Black woman who may be raised religiously pro-life but believe that other women have the right to make a choice,” she continued. “And the extent to which we think about ourselves only in terms of white men and trying to convince that very and increasingly narrow population to be our saviors in elections, that’s when we face the likelihood of being obsolete.”

Understanding that nuances exist among Southern voters—even those who are opposed to abortion personally—is instead the key to reaching them, Abrams said.

“Most of the women and most of the voters, we are used to having complex conversations about what happens,” she said. “And I do believe that it is both reductive and it’s self-defeating for us to say that you can only win if you’re a pro-life Democrat.”

To Abrams, being pro-choice means allowing people to “decide their path.”

“The use of reproductive choice is endemic to how we as women can be involved in society: how we can go to work, how we can raise families, make choices about who we are. And so while I am sympathetic to the concern that you have to … cut against the national narrative, being pro-choice means exactly that,” Abrams continued. “If their path is pro-life, fine. If their path is to decide to make other choices, to have an abortion, they can do so.”

“I’m a pro-choice woman who has strongly embraced the conversation and the option for women to choose whatever they want to choose,” Abrams said. “That is the best and, I think, most profound path we can take as legislators and as elected officials.”

News Human Rights

Mothers in Family Detention Launch Hunger Strike: ‘We Will Get Out Alive or Dead’

Tina Vasquez

The hunger strikers at the Berks County Residential Center in Pennsylvania are responding to recent comments made by Department of Homeland Security Secretary Jeh Johnson in which he said the average length of stay in family detention is 20 days. The women say they've been in detention with their children between 270 and 365 days.

On Monday, 22 mothers detained inside Pennsylvania’s Berks County Residential Center, one of the two remaining family detention centers in the country, launched a hunger strike in response to recent comments made by Department of Homeland Security (DHS) secretary Jeh Johnson in which he said the average length of stay in family detention is 20 days.

The average length of stay for the 22 hunger strikers has been between 270 and 365 days, they say.

Erika Almiron, director of the immigrant rights organization Juntos and a core member of the Shut Down Berks Coalition, informed the women detained inside Berks of Johnson’s recent comment via email, hoping they would want to release a statement that her organization could help amplify. Instead, the women decided to launch a hunger strike, with recent reports indicating the number of participants has risen to 26.

“When Johnson said [ICE] only detain[s] people for 20 days, he said that thinking that no one would care,” Almiron told Rewire. “Our goal has always been to make people aware of the inhumane nature of detention in general, but also that children are being locked up and moms are being held indefinitely.”

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By definition, “family detention” means the women in Berks are detained alongside their children, who range in age from 2 to 16 years old. In an open letter addressed to Johnson, the women share that their children have routinely expressed suicidal thoughts as a direct result of being imprisoned. The women allege that they are being threatened by psychologists and doctors in the detention center for making this information public, but are choosing to move forward with the hunger strike.

In part, the letter reads:

The teenagers say being here, life makes no sense, that they would like to break the window to jump out and end this nightmare, and on many occasions they ask us if we have the courage to escape. Other kids grab their IDs and tighten them around their necks and say that they are going to kill themselves if they don’t get out of here. The youngest kids (2 years old) cry at night for not being able to express what they feel … We are desperate and we have decided that: we will get out alive or dead. If it is necessary to sacrifice our lives so that our children can have freedom: We will do it!

An August 2015 report about the Berks center by Human Rights First, a human rights advocacy organization, seemed to confirm what women and children detained inside of the facility have been saying since the detention center’s inception in 2001: Detention is no place for families and being imprisoned is detrimental to the health and well-being of children.

According to the Human Rights First report, detained parents in Berks experience depression, which only exacerbates the trauma they experienced in their countries of origin, and their children exhibit symptoms of depression, anxiety, and increased aggression. Frequent room checks that take place at 15-minute intervals each night also result in children experiencing insomnia, fear, and anxiety, the report says.

Families detained inside of Berks have no real means to alleviate these symptoms because the facility does not provide adequate mental health care, according to the report. Human Rights First notes that Berks does not have Spanish-speaking mental health providers, “though the majority of families sent to family detention in the United States are Spanish-speaking and many have suffered high rates of trauma, physical and sexual violence, and exploitation.”

The organization also explains that only 23 of the total staff at Berks (or less than 40 percent) reportedly speak some conversational Spanish, “making it difficult for many staff members to effectively communicate with children and their parents.”

Berks has a history of human rights abuses. A 41-year-old former counselor at Berks was recently sentenced to between six and 23 months of jail time for the repeated sexual assault of a 19-year-old asylum-seeking mother. The young woman, along with her 3-year-old son, fled sexual domestic violence in her native Honduras. The assaults on the young mother at the detention center were witnessed by at least one of the children detained with her.

There have also been health-care issues at Berks, including the failure by the detention center to provide adequate services, according to Human Rights First.

The organization was able to collect some of the letters women detained at Berks wrote to Immigration and Customs Enforcement (ICE), along with ICE’s response to their concerns. One woman, detained at Berks for four months, told ICE that her 5-year-old daughter had diarrhea for three weeks and that the detention center’s doctor failed to provide her child with any medication or other care. The woman asked for “adequate medication” for her daughter and for the opportunity to have her asylum case handled outside of detention. ICE’s response: “Thank you! You may disolve [sic] your case at any time and return to your country. Please use the medical department [at Berks] in reference to health related issues.”

Using family detention as a way to handle migrants, especially those fleeing violence in Central America, has been called inhumane by many, including activists, advocates, mental health specialists, and religious leaders. But the prolonged detainment of women and children at Berks is in violation of ICE’s own standards.

In June of 2015, Johnson announced a series of reforms, including measures aimed at reducing the length of family detention stays for families who had passed a protection screening. But then earlier this month, Johnson defended family detention, saying, “The department has added flexibility consistent with the terms of the [Flores] settlement agreement in times of influx. And we’ve been, by the standard of 1997, at an influx for some time now. And so what we’ve been doing is ensuring the average length of stay at these facilities is 20 days or less. And we’re meeting that standard.”

But all of the 22 mothers on hunger strike at Berks have been in detention for months, according to the letter they sent Johnson.

There’s also the issue that in July, a federal appeals court ordered DHS to end family detention because it violates Flores v. Johnson, which determined that children arriving to the United States with their mothers should not be held in unlicensed detention centers. Soon after, family detention centers scrambled to get licensed as child-care facilities (a battle they’re losing in Texas), but the Pennsylvania Department of Human Services (PA DHS) licensed Berks to operate as a children’s delinquency center. In October 2015, PA DHS decided not to renew the license, which would have expired February 21, 2016, because the facility holds asylum-seeking families as opposed to only children, as the license permitted. Berks appealed the decision to not renew its license, and continues to operate until it receives a ruling on that appeal.

“Our argument from the start has been that we don’t think any of this is legal,” Almiron told Rewire in a phone interview Friday afternoon. “What is happening inside of Berks is illegal. I have no idea how they continue to operate. Right now, Berks does not have a license. It was revoked because the license they did have didn’t fit what they were doing. They also have prolonged detention. Women who are hunger striking have been there 360-something days, but then Jeh Johnson says it’s only 20 days. There is no accountability with DHS or ICE. There are numerous ways [DHS and ICE are] not accountable, but Berks is a prime example. There is no transparency and they can to change the law whenever they like.”

Neither DHS nor Berks responded to requests for comment from Rewire.

Advocates have expressed concerns that the women in Berks will be retaliated against by ICE and detention center employees because of their participation in the hunger strike. As Rewire reported, when women at Texas’ T. Don Hutto Residential Center, a former family detention center, launched a hunger strike in November 2015, participants alleged that ICE used solitary confinement and transferred hunger strikers to different facilities, moving them further from their family in the area and their legal counsel. ICE denied a hunger strike was even taking place.

In December 2015, men detained at the Etowah County Detention Center in Gadsden, Alabama, ended a 14-day hunger strike after a local judge authorized officials to force-feed one of the hunger strikers because of his “deteriorating health” due to dehydration. Advocates told Rewire force-feeding was being used as a form of retaliation.

Almiron said the hunger strikers at Berks have already been threatened by guards, who told the women that if they continue to hunger strike and they get too weak, their children will be taken away from them. The organizer said the letter the women wrote to Johnson shows their bravery, and their understanding that they are willing to take whatever risk necessary to help their children.

“Honestly, I think they’ve been retaliated against the moment they came to this country. The fact that they’re in detention is retaliation against their human survival,” Almiron said. “Retaliation happens in detention centers all the time, women are threatened with deportation for asking for medical care for their children. These women are incredibly strong. In my eyes, they’re heroes and they’re committed to this fight to end family detention, and so are we.”

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