The Wonk Room

Obama Supports Condoms: Plans To Overturn Global Gag Rule»

Advisers to President-elect Barack Obama are indicating that “Obama will reverse U.S. family planning and AIDS prevention strategies that have long linked global funding to anti-abortion and abstinence education.”

The Obama reversal is a return to an approach that is based on solid evidence and public health rather than ideology, and a recognition of needs on the ground rather than the need to please domestic political constituencies.

On January 21 2001, President Bush reinstated the Mexico City Policy (the global gag rule), requiring NGOs receiving federal funding to refrain from using their own money to perform or promote abortion services in other countries.

While the policy was “purportedly designed to reduce abortion by limiting a woman’s access to abortion services, and to ensure that U.S. funding for family planning services overseas is completely separate from abortion activities,” in actuality the rule has denied “many NGOs access to in-kind donations of the very contraceptives that can prevent recourse to abortions“:

- Desperately needed USAID-supplied contraceptives are no longer being shipped to 16 developing countries in Africa, Asia and the Middle East.

- The leading providers of family planning in 13 other developing nations are also no longer receiving USAID contraceptives.

- By 2002, the Global Gag Rule had resulted in the loss of USAID-donated contraceptives including condoms (purchased with family planning funds), to NGOs in 29 countries

Placing ideology ahead of science or reason, Bush fundamentally misunderstood the root of the problem. The rise of HIV infections in girls is attributed not to women’s individual choices and behavior, but to gender inequalities and sexual violence, including the widespread practice and acceptance of child marriage of young girls to older men, forced marriage and polygamy, male promiscuity, “marital rape, domestic violence, wife inheritance, widow cleansing, and female genital mutilation.”

Obama seems to understand a reality that Bush chose to ignore, if only selectively, for the Bush administration admits to the effectiveness of condoms domestically but limits their provision in countries battling HIV/AIDS epidemics. Just today, for instance, the Bush FDA acknowledged in a new rule amending the classification regulation for condoms:

That evidence supports the conclusions that correct and consistent use of latex condoms reduces the risk of transmission of HIV/AIDS and other STIs such as gonorrhea that are sexually transmitted solely by contact with the head of the penis (via genital fluids).

Palin Ignores Gender Discrimination: Women Would Benefit From Individual Health Care Plans»

Two days after new data from insurance companies and online brokers suggested that women buying health insurance in the individual market pay more for coverage, Sarah Palin argued that Sen. McCain’s plan to push more Americans into the individual heath insurance market would benefit women:

Of course we want and deserve equal pay for equal work. But we also want to be able to afford good health care for our families. John McCain’s plan for the $5,000 tax credit will allow us to make our own decisions, to be able to afford health care, to erase these state lines that prohibit a competitive environment to purchase a good health-care package. . . . That’s an issue that is important to women.”

Palin’s pro-market rhetoric obscures the consequences of exposing health care to a “competitive environment.” In fact, despite Palin’s pro-choice assertions, allowing insurance companies to sell policies across state lines would eliminate existing consumer protections and increase the costs of insurance.

Insurance companies are already charging women more than men for identical coverage. As the New York Times reported last week, “women pay much more than men of the same age for individual insurance policies providing identical coverage.” A 30-year-old woman pays “31 percent more than a man of the same age in Denver or Chicago” and in Iowa, “a 30-year-old woman pays $49 a month more than a man of the same age.”

Women pay more because they are more likely to have certain chronic diseases and are expected — as people who bare children — to need more care.

McCain’s plan would give insurance companies even more incentive to discriminate against women. Under his proposal, in order to attract the healthiest risk pool and maximize profits, insurance companies would market bare-bones policies from states that don’t require insurers to finance maternity care or cervical cancer screenings. But an exodus of non-insurance users into bare-bones policies would further fragment the health insurance pool, divide those who don’t use insurance from those who do and force women who require pregnancy check-ups or other health care services to pay more for identical coverage.

The only “choice” McCain’s health care plan would provide women, is the “choice” of paying more for health care. And that’s certainly “an issue that is important to women.”

For more on how McCain’s health care plan would effect women, click here and here.

How McCain’s Health Care Plan Fails Women»

Under Sen. John McCain’s (R-AZ) proposal to tax employee health benefits and encourage more Americans to buy health insurance in the individual market, individuals who actually need and use care will shoulder higher out-of-pocket expenses, prohibitive deductibles and expensive premiums. This is because McCain is more interested in keeping costs down than increasing access to affordable coverage. He believes that if Americans had more ’skin in the game,’ if the cost and risk of insurance were shifted from the employer to the individual, health care prices would come down.

And while lowering health care cost should be part of any comprehensive health care reform, over-relying on a deregulated individual market fails the 56 million Americans with pre-existing conditions who currently receive insurance through their employer. An unregulated individual insurance market seeks to maximize profit by insuring only the healthiest applicants; individuals who actually use their insurance, drain profits.

For this reason, women — who are more frequent users of health care, “in part because they experience chronic illness more often than men and because they are more likely than men to require prescription drugs, such as oral contraceptives” — “face too many obstacles obtaining comprehensive, affordable health coverage in the individual market — simply because they are women.”

A new report about women in the individual health insurance market, found the following:

- “Under a practice known as gender rating, insurance companies are permitted in most states to charge men and women different premiums.” Among insurers who gender rate, “the majority charge women more than men until they reach around age 55, and then some (though not all) charge men more.”

- The “majority of individual market health insurance policies,” don’t provide maternity coverage. “In the capital cities of Hawaii, New Mexico, North Dakota and South Dakota, the center couldn’t find “an offer of maternity coverage at any price.”

- In nine states and D.C., it is legal “for insurers to reject applicants who are survivors of domestic violence. Insurers can also reject women for coverage simply for having previously had a cesarean section (C-section).

For women, McCain’s plan would only exacerbate the failures of the individual market. In fact, by creating a deregulated national marketplace in which insurers no longer have to comply with rules that require they provide cancer screenings, maternity care, mammograms, and emergency services, or abide by rules that “limit the rates that can be charged to higher-cost consumers and that limit who can be excluded for a health plan,” insurance companies could sell plans across the country that lack even the most basic consumer protections.

Women will be more vulnerable to “cost barriers to care and coverage because they earn less than men on average, work more for small businesses that do not offer coverage, and are more vulnerable to losing health insurance due to job or relationship changes.”

Medical Professionals: ‘Thanks, But No Thanks’ For Deceptive HHS Rule»

Medical professions are saying “thanks, but no thanks” to the Bush administration’s proposed regulations allowing health care workers to opt-out of providing abortion and contraceptive services.

Health and Human Services Secretary Michael Leavitt has argued that the new rule is necessary to protect the “freedom of expression and action” of medical professionals, but medical professionals disagree. The American Psychiatric Association and the American Academy of Pediatrics say that “doctors and nurses are already not required to perform abortions or sterilizations.”

Indeed, the proposed regulation would be redundant if it weren’t so expansive. By using an “opinion put forth several months ago by the American College of Obstetricians and Gynecologists” as pretext to issue new regulations, Leavitt is potentially expanding the existing conscience exemption. Medical professionals have expressed concern about the consequences of the new rule:

Implementation of this regulation would effectively allow health care providers’ personal beliefs to override patients’ right to full disclosure of accurate information and available health care resources.

Similarly, in a separate letter to the HHS, 13 attorneys general have also complained that “the rule was too vague about what health care procedures may be withheld”:

The proposed regulation completely obliterates the rights of patients to legal and medically necessary health care services in favor of a single-minded focus on protecting a health care provider’s right to claim a personal moral or religious belief.

Thus, for the Bush administration, the new regulation are a bridge to limiting women’s access to reproductive services.The purpose of the regulation is to muddy the waters and allows conservatives to threaten “both the diversity of beliefs in our pluralistic society and the health and well-being of patients seeking care.”

UPDATE: Time is running out but there’s still a chance to act. You can submit comments on the regulation here or by emailing your comments to consciencecomment@hhs.gov by 11:59 pm EDT Thursday, September 25th.

‘Pro‐Life As Any Candidate’ Palin Picketed Abortion Doctor»

For pro-choice activists, Gov. Sarah Palin’s (R-AK) short time in public office is characterized by her strong opposition to reproductive rights and sensible sex-education.

As mayor of Wasilla, the Palin administration “cut funds that had previously paid” for rape kits “and began charging victims or their health insurers the $500 to $1200 fee.” Palin expressed support for a constitutional amendment outlawing abortion, opposed abortion in cases of rape or incest, strongly supported failed abstinence-only initiatives, and generally described herself as “pro‐life as any candidate can be.”

In her exclusive interview with ABC’s Charlie Gibson, Palin moderated her rhetoric, saying that she respected the views of the pro-choice community:

I am pro-life. I do respect other people’s opinion on this also, and I think that a culture of life is best for America. What I want to do when elected vice president with John McCain, hopefully be able to reach out and work with those who are on the other side of this issue…I do understand McCain’s position on this, I understand others who are very passionate about this issue who have a differing view.

Watch it:

But Palin’s wasn’t alway so understanding. In fact, according to at least one report, Palin may have physically prevented or intimidated women from exercising their right to have an abortion.

Salon reports that in 1996, as “evangelical churches [in Alaska] mounted a vigorous campaign to take over the local hospital’s community board and ban abortion,” Palin participated in a “boisterous picket line” against an OB-GYN who opposed activists’ efforts to “take over the local hospital’s community board and ban abortion”:

At one point during the hospital battle, passions ran so hot that local antiabortion activists organized a boisterous picket line outside Dr. [Susan] Lemagie’s office, in an unassuming professional building across from Palmer’s Little League field. According to Bess [a priest who often clashed with Palin and the evangelical community] and another community activist, among the protesters trying to disrupt the physician’s practice that day was Sarah Palin.

The protest came two years after President Clinton signed the Freedom of Access to Clinics Entrances Act (FACE), “legislation that makes it a Federal crime to attack or blockade abortion clinics, their operators or their patrons.” Not surprisingly, Sen. John McCain (R-AZ), who has consistantly received a score of zero from NARAL, voted against the bill.

Digg It!

UPDATE: Dr. Susan Lemagtie’s 16-year-old daughter reflected on anti-abortion protests in a 1998 essay:

Picketers began protesting at the hospital across the street from my mom’s clinic. In late ‘94, when the national papers carried stories about bombed abortion clinics and murdered doctors, they moved to the sidewalk outside the clinic. My mother no longer talked about managed care and AIDS; she talked about buying a bulletproof vest.

The McCain-Palin Contraception Gap»

While running for governor in 2006, Gov. Sarah Palin (R-AK) portrayed herself as a pro-life feminist who opposed abortion but supported contraception. From Anchorage Daily News:

Palin said last month that no woman should have to choose between her career, education and her child. She is pro-contraception and said she’s a member of a pro-woman but anti-abortion group called Feminists for Life.

“I believe in the strength and the power of women, and the potential of every human life,” she said.

But Palin’s support for contraception clashes with McCain’s ignorant record of voting against expanding access to affordable birth control.

As the Wonk Room previously pointed out, in 2007, McCain admitted to reporters that he was “not informed” about “whether I support government funding for them [contraceptives] or not,” and expressed doubts about the effectiveness of condoms.

McCain also voted against requiring insurance companies to cover prescription contraception in both 2003 and 2005, consistantly opposed funding health care services for women, and even supported abstinence-only programs that censored “information about birth control.”

Despite their differences on contraception, however, McCain and Palin would both deny women around the world the right of choice. During her campaign for governor, Palin made it clear that “she is opposed to abortion, even in cases of rape or incest.”

Thus, even with Palin, McCain is still not what women want.

Digg It!

Leavitt Pushes New Abortion Regulation As Backdoor Effort To Restrict Contraception»

Before officially announcing new regulations to protect “federally funded health care providers’ right of conscience” by allowing them to opt-out of providing abortion and contraceptive services, Health and Human Services Secretary Michael Levitt argued that the new rule was necessary to protect the “freedom of expression and action” of medical professionals:

I want to reiterate. If the Department of Health and Human Services issues a regulation on this matter, it will aim at one thing, protecting the right of conscience of those who practice medicine. From what I’ve read the last few days, there’s a serious need for it.

But Leavitt’s claim is sensationalistic. On his own blog and in the press release announcing the regulation, Levitt undermines the necessity of the regulation by admitting that there are “clear provisions in three separate laws protecting federally-funded health care providers’ right of conscience.” These provisions already protect “freedom of expression”:

- The Church Amendment of 1976: “prevents the government (as a condition of a federal grant) from requiring health care providers or institutions to perform or assist in abortion or sterilization procedures against their moral or religious convictions. It also prevents institutions receiving certain federal funds from taking action against personnel because of their participation, nonparticipation or beliefs about abortion or sterilization.”

- The Coats Amendment of 1996: prohibits the government from “discriminating” against medical residency programs or other entities that lose accreditation because they fail to provide or require training in abortion services.

- Hyde/Weldon Conscience Protection Amendment of 2004: “forbids federal, state and local governments from requiring any individual or institutional provider or payer to perform, provide, refer for, or pay for an abortion. This goes well beyond the Church Amendment.”

Leavitt’s rule would be redundant if it weren’t so expansive. By using an “opinion put forth several months ago by the American College of Obstetricians and Gynecologists” as pretext to issue new regulations, Leavitt is potentially expanding the existing conscience exemption. As Jessica Arons points out, by failing to provide a clear, medically-accepted definition of abortion and leaving the door open for refusers to self-define “abortion,” the new rules enable individuals to “deny women access to oral contraceptives, emergency contraception, and the IUD, among other commonly used methods of birth control.”

In short, the purpose of the regulation — which violates White House Chief of Staff’s Josh Bolten’s requirement that new regulations be proposed by June 1, 2008 — is to muddy the waters and allow opponents of abortion and contraceptive services to obstruct women’s access to reproductive health care.

UPDATE: On Friday, during an interview with NARAL’s Mary Alice Carr about the new regulation, Laura Ingraham falsely claimed that “pro life doctors who refuse to provide abortions may finally get some help from the federal government”:

Proposed HHS Regulation Could Still Be Used to Block Access to Contraception, Other Health Services»

Our guest blogger is Jessica Arons, the Director of the Women’s Health and Rights Program at the Center for American Progress Action Fund.

HHS has released its proposed regulation to “help protect health care providers from [religious] discrimination.” The good news is it no longer attempts to re-define abortion to include birth control. But don’t breathe a sigh of relief just yet.The regulation no longer defines pregnancy or abortion at all. But in a telephone news conference, Sec. Mike Leavitt left open the possibility that individuals might be able to define those terms for themselves in determining what they find morally objectionable, which means they still may be able to deny women access to oral contraceptives, emergency contraception, and the IUD, among other commonly used methods of birth control.

And that’s just the beginning.

While most of the regulation limits the scope of allowable moral objections to training, performing, counseling, or referring for abortion and sterilization, some sections are not so restricted.

Entities to whom this subsection 88.4(d) applies shall not require any individual to perform or assist in the performance of any part of a health service program or research activity funded by the Department if such service or activity would be contrary to his religious beliefs or moral convictions.

That seems to be an exception you could drive a truck through.

Also note the objections can be based not only on religious beliefs but on any personal moral convictions. This is much broader than the traditional conscience clauses, including those that allowed for conscientious objectors during the Vietnam War.

Finally, the proposed regulation would extend protection from doctors and nurses to just about anyone who might come into contact with a patient, and even some who might not.

[A]n employee whose task it is to clean the instruments used in a particular procedure would be considered to assist in the performance of the particular procedure.

By that logic, an ambulance driver, a receptionist, and even the person who processes health insurance forms might be able to refuse to perform their jobs if related to a health care service they find morally objectionable. Volunteers are explicitly protected too.

The public may submit comments on the regulation during the next 30 days to http://www.Regulations.gov or via email to consciencecomment@hhs.gov.

UPDATE: NFPRHA has more.

McCain’s Opposition To Medicare Compromise Could Have Jeopardized Women’s Health»

Today, Sen. John McCain (R-AZ) will hold a women-only forum in Hudson, Wisconsin “to bolster his support among women.” But McCain’s repudiation of the Senate’s recent compromise to halt the cut in Medicare physician reimbursement rates undermines women’s access to affordable health care.

While the senator said he supported providing “proper reimbursements to Medicare physicians,” he opposed the compromise because it tried to eliminate the government’s overpayments to Medicare Advantage plans. Thus, when given the choice between protecting womens’ access to physicians and continuing to subsidize private insurance companies, McCain agreed with President Bush and chose the latter.

But low Medicare reimbursement rates have already led many OBGYNs to stop accepting Medicare patients. In 2002, for instance, The Los Angeles Times reported that some Medicare patients “had a hard time finding a gynecologist and an ophthalmologist”:

Three or four OB/GYN offices told her they were not accepting new Medicare patients. Finally, she persuaded a friend’s doctor to take her. But now the 75-year-old is afraid her new doctors will drop her. “You’ve got to be careful not to step on your doctor’s toes,” Bowers said. “They don’t want to mess” with Medicare because of the low payments.

Similarly, in 2003, OB-GYN News reported that “Ob.gyn. practices are being affected as physicians nationwide are rethinking treating Medicare patients” and have “begun limiting the number of Medicare patients they take on…or–in some cases–have stopped caring for Medicare patients entirely.”

McCain’s choice to side with the insurance companies would have further restricted women’s access to doctors who simply couldn’t afford the lower payments:

- “Steven Polansky, who’s been an obstetrician and gynecologist in Sacramento, Calif., since 1977, said he couldn’t afford a 10.6 percent pay cut from Congress…”We haven’t gotten a raise from anybody in centuries,” Polansky said in an interview. “And it is becoming more and more difficult to run a private practice.”

- “There’s a threshold out there beyond which people can’t keep their doors open,” added Jerry McLaughlin, a Hobbs obstetrician and gynecologist who is the former president of the New Mexico Medical Society.”

- “‘We can’t compete with other cities,’ said local OB/GYN Dr. Paul Kocay. Some doctors already are moving towards cash-only practices. These ’boutique medicine’ clinics are going to increase if these cuts are enacted. Local doctors are between the 10th and 20th percentile in national salary averages. This could become a crisis situation in Kerrville.”

As the Wonk Room has pointed out again and again, McCain is not what women want.

UPDATE: Steve Benen points out that “the key thing to remember here is that McCain’s record on reproductive rights and sexual health is utterly miserable. His rhetoric is awful, but his record is worse.”

FLASHBACK: McCain In 1999 — ‘I Would Not Support Repeal Of Roe V. Wade’»»

Today, CNN’s Late Edition re-broadcasted an August 22, 1999 interview with Sen. John McCain (R-AZ), in which McCain expressed support for overturning Roe v. Wade, while also noting that the action “would condemn young women to dangerous and illegal operations”:

Ultimately, I would like to see the repeal of Roe v. Wade, but to do it immediately, I think, would condemn young women to dangerous and illegal operations.

Watch It:

I’d love to see a point where [Roe v. Wade] is irrelevant, and could be repealed because abortion is no longer necessary. But certainly in the short term, or even in the long term, I would not support repeal of Roe vs. Wade.

Unfortunately, now that he is the presumptive nominee of the Republican party, McCain is no longer concerned for the “young women” who will undergo “dangerous and illegal operations” if Roe v. Wade is repealed. In fact, on his campaign website McCain argues that the decision “must be overturned” to restore “constitutional balance”:

John McCain believes Roe v. Wade is a flawed decision that must be overturned, and as president he will nominate judges who understand that courts should not be in the business of legislating from the bench. Constitutional balance would be restored by the reversal of Roe v. Wade, returning the abortion question to the individual states. The difficult issue of abortion should not be decided by judicial fiat.

While his rhetoric has waffled back and forth, McCain’s voting record throughout his entire public career has been consistently anti-choice. That’s why McCain gets a zero from women.

Cross-posted at ThinkProgress

UPDATE: On January 26, 2000, a reporter asked McCain, “If his 15-year-old daughter became pregnant and believed that she wasn’t ready to bear a child, would McCain block her from getting an abortion?” McCain answered “No,” he would not:

McCain first said that the ”final decision” on ending a pregnancy would be made by his daughter, 15. An hour later, he contacted reporters with a clarification: ”I misspoke,” he said. ”The family decision will be made by the family, not by” his daughter alone, he added. [AP, 1/26/2000]