Our Bodies, Ourselves (165 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
What stunned advocates was not just the
losses, but the perception that abortion had been expendable from the beginning of negotiations on the law. Women could not rely on a vigorous defense from any power bloc. It seemed that reproductive rights and justice had been “thrown under the bus”âleading the Women's Media Center to respond with an online health care campaign called Not Under the Bus.
In part, this was the culmination of years in which advocates and elected officials generally refrained from a full-court defense of reproductive rights. Whether afraid to speak out or bowing to pragmatism, Democrats routinely failed to present a united front in countering attacks on abortion, and they abandoned attempts to win the argument. Instead, they opted for so-called common ground strategies, seeking to prevail by accommodating antiâabortion rights positions and candidates.
As a result, the Patient Protection and Affordable Care Act includes a series of explicit limits on coverage for abortion and contraception including the following.
Limits on federal funding for abortions through the exchanges:
The act requires every enrolleeâfemale or maleâin a health plan offered through the new exchanges that include abortion coverage to make two payments. One of these payments would go to pay the bulk of the premium; the other would go to pay the share of the premium that would ostensibly cover abortion care. The basis for this provision is to ensure that women who receive federal subsidies to help pay for the premium cannot use federal funds for an abortion.
This language was included at the insistence of a bloc of Democratic members of Congress, led by Sen. Ben Nelson of Nebraska, whose votes were needed for passage, since Republicans vowed uniformly to oppose the act. Analysts are concerned that the law will jeopardize coverage for abortion careâeven for policies paid for with private dollarsâbecause the administrative complexities for insurance companies may discourage them from offering abortion coverage.
This provision was underscored by President Obama when he signed an executive order on March 24, 2010, after the act was passed, emphasizing that no federal dollars would be used to pay for abortion through the newly created health insurance exchanges or through community health centers, except in the case of rape, incest, or a threat to the life of the mother. This order codifies in statute the limitations on using federal funds to pay for abortions imposed by the Hyde Amendment, described above, and includes the same exceptions. However, the executive order will outlast any two-year renewal of the Hyde Amendment.
Limits on coverage for abortion through new temporary health insurance programs, known as the Pre-Existing Condition Insurance Plan (PCIP):
The act created the temporary Pre-Existing Condition Insurance Plan (PCIP), which will provide insurance to high-risk pools of citizens. PCIP is a federally authorized, state-administered health insurance plan that must accept any individual who has been uninsured for at least six months and who has a preexisting health condition. Enrollees, who would pay a premium, are usually low income and would benefit from immediate care. Since the women entering PCIP have experienced serious enough medical conditions that insurers have been unwilling to sell them insurance, they're at a heightened risk for needing an abortion for health reasons should they become pregnant. PCIP is set to be disbanded in 2014, when the insurance exchanges become operational.
On July 14, 2010, the Department of Health and Human Services issued an interim final rule stating that abortion would not be covered by PCIP except in the cases of rape or incest, or where the life of the woman would be endangered. This order again codifies in statute the
limitations on using federal funds to pay for abortions that are imposed by the Hyde Amendmentâand it went beyond any expected restrictions on coverage in PCIP. The act itself didn't mandate such restrictions for PCIP, and the Nelson Amendment, described above, applied only to the new health insurance exchanges, which start in 2014.
It was “a whoosh moment” for reproductive rights advocates, said Jill Adams, director of Law Students for Reproductive Justice. The reality sank in that reproductive rights had become truly politically precarious. EQUAL Health Network fellow Keely Monroe and codirector Ellen Shaffer argued that the provisions should be reversed, noting that the administration's decision “would create new restrictions on abortion not already mandated by federal law, and elevate its status as a policy.”
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Shaffer also noted, “We wrote off earlier compromises as part of the price for health care reform, to be fixed down the road. The road has come to our door. A procedure experienced by at least a third of women during our lives, abortion has become stigmatized, a toxic issue. It is not enough to appoint and elect many fine, smart, progressive womenâand pro-choice menâto government. They and we need militant mobilized advocacy for reproductive choice and justice.”
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Prescription contraceptives not covered under preventive health services:
The act calls for preventive services to be covered at no cost to the patient, but the list of covered services is determined by the U.S. Preventive Services Task Force. Bowing to political pressure from the U.S. Conference of Catholic Bishops and others, the Obama administration called for a panel appointed by the Institute of Medicine to determine whether contraceptives are indeed preventive and related to health. Should the panel so decide, women will be able to use the benefit starting in 2012.
In addition, the law includes conscience-clause language that protects only individuals or entities that refuse to pay for or provide coverage for an abortion, or even refer for abortion, removing earlier language that provided balanced nondiscrimination language for those who provide a full range of choices to women in need.
Women's groups saw this as a major loss, and advocates seek to reverse all of these provisions.
After the Republican gains in the 2010 midterm elections, the 112th Congress opened in 2011 with more than forty-five additional antiâabortion rights legislators in the U.S. House of Representatives and five in the Senate. They immediately introduced legislation to further restrict access to and funding for abortion and family planning services, and efforts are likely to include reinstating (and making permanent) the global gag rule.
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Meanwhile, women are facing an increased number of restrictions at the state level. In a 2010 report detailing major trends in anti-abortion legislation and abortion restrictions enacted at the state level, the Center for Reproductive Rights noted that five states had already passed bans on insurance coverage of abortion care, even with premiums paid with private money.
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Other states are considering a similar ban. As of early 2011, thirty-two states have enacted laws subjecting women to mandatory delays and/or biased counseling. Such counseling requires that abortion providers give their patients materials developed by the state, including pictures of fetal development and information about alternatives to abortion. These materials may contain medically inaccurate and misleading information about health risks.
“For women who have unwanted pregnancies
or who have been victims of rape, incest, or abuse, these requirements can also result in unnecessary emotional suffering,” Amie Newman wrote at RH Reality Check. “These bills also interfere with the doctor/patient relationship, forcing physicians to give each woman âone size fits all' treatment, instead of allowing the physician to treat each patient individually according to his or her professional judgment.”
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Related Reading:
For more information on restrictive state and federal legislation and obstacles to access, see
“History of Abortion in the United States,”
; and “Organizing for Change:
reproductive Health and Justice,”.
Another among the numerous trends to limit access to abortionâas well as contraceptionâis the effort to confer “personhood” on fertilized eggs. Ballot initiatives have been attempted in Colorado, Montana, and Nevada, and while they have been defeated, proponents of these laws, who state unequivocally that they aim to ban contraception as well as abortion, continue to push for such measures. As the Center for Reproductive Rights notes, these initiatives to define personhood from the moment of conception would in fact ban many forms of contraception and some reproductive technologies such as in vitro fertilization.
By 2014, when the most sweeping health insurance reforms will take effect, there will be an unprecedented expansion of Medicaid and a new federal tax credit to make health insurance more affordable for low- and moderate-income families. The Congressional Budget Office estimates that by 2019, 32 million people will have secured health insurance coverage under the new law, as long as Congress continues to support and fund health care reform.
As women's health advocates have noted, the PPACA is not a single-payer system and does not even include a public option. However, it opens the door to states that seek to experiment with single-payer plans; broadens policy space to move further toward universal coverage; and takes steps in the right direction by expanding public sector programs such as Medicaid and aiming to reduce administrative waste.
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The Obama administration, elected on a wave of voter mobilization, succeeded in enacting a historic health care reform law, as well as numerous other achievements. But it has yet to generate the momentum for a comprehensive economic and political movement to transform access to and equality of health care and other social services. We must continue to advocate for policies that take into account the needs of all women.
WOMEN'S HEALTH AROUND THE GLOBE
Gender relations of power constitute the root causes of gender inequality and are among the most influential of the social determinants of health.
â
Gita Sen, Piroska Ãstlin, Asha George, Women and Gender Equity Knowledge Network
Women's health is no less contested in other regions of the world than in the United States, but the politics surrounding women's health in the United States, especially related to sexual and reproductive health and rights, have an impact on women beyond our national boundaries. This section discusses some of the major challenges to women's health and rights internationally, focusing particularly on sexual and reproductive health in developing countries.
WHY OUR BODIES OURSELVES ENDORSES SINGLE-PAYER HEALTH CARE
Single-payer models build on systems like Medicare. They are publicly financed, instead of being administered through private insurance plans, and cover everyone. One single payerâthe governmentâreplaces the many private insurance plans that now waste billions on administration. Even more important, it gives the government the authority to negotiate prices with drug companies, hospitals, and other health care providers, the key to controlling costs while protecting care.
Our Bodies Ourselves has supported single-payer proposals since they were first introduced in Congress in the 1970s, including H.R. 3000, sponsored by Representative Barbara Lee (D-Calif.). It remains the only plan that ex
plicitly includes women's reproductive health services, including abortion.
We believe these plans would best address women's needs and improve our health. Coverage would be completely independent from employment and from marriage. The plans would better allocate resources and reduce payment incentives that have been obstacles to investing in training more primary care professionals and that lead to overuse and misuse of drugs and medical procedures.
Other specific advantages of a single-payer system include the following.
It would encourage better care for chronic illnesses:
Women use chronic care services far more than men. Because caring for people with chronic disease now accounts for more than 75 percent of all health care spending, women will benefit substantially from more efficient and effective ways to deal with severe chronic illnesses.
It would eliminate substandard tiers of care:
Women who are unemployed and have functional limitations that exclude them from the private health insurance market would receive health and medical care on a par with women in general.
It would address the cost issues that send women into debt and bankruptcy:
Medical debt is an enormous concern for many women. A 2009 Commonwealth Fund study found that 45 percent of women accrued medical debt or reported problems with medical bills in 2007 compared with 36 percent of men.
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It would reduce the incidence of medical malpractice:
Assuring people they would not have to worry about paying for medical care if they experienced bad medical outcomes would relieve the pressure on medical malpractice premiums.
A single-payer system would enhance the working environment for health care professionals:
There would be less need to spend hours on pointless documentation in order to justify billing for services.
For more information, visit ourbodies ourselves.org/singlepayer.
Women's health status varies greatly depending on socioeconomic status, class, race, ethnicity, and education. The same, of course, can be said of men. However, the intersection of gender inequality with social determinants and race has a profound effect on women's physical and mental health, as well as the health practices women are exposed to and the care they are able to access. Together, these social factors may play a far greater role in a woman's health and life expectancy than innate physical well-being.