A new study in the journal Obstetrics and Gynecology, conducted by researchers from the Guttmacher Institute, attempts to quantify the availability of medication abortion (non-surgical abortion via the medication mifepristone/Mifeprex) in the United States, and the overlap between medication and surgical abortion providers. The authors explain that it was hoped that the availability of this non-surgical option might increase abortion accessibility “because it could be delivered more privately and without surgical facilities, [and] offered by a wider range of providers, such as private obstetrician-gynecologists and family practitioners.”

The authors used sales data from the U.S. distributor of mifepristone and abortion surveillance data from the CDC and Guttmacher’s own surveys of abortion providers. Using this data, they attempted to calculate the estimated numbers of mifepristone abortions and providers by year, provider type, and physician specialty, the proportion of all abortions and of eligible (i.e., early enough for the medication option) abortions that used mifepristone, and the number of mifepristone-only providers who were more than 50 miles away from a known surgical provider. [The researchers detail this process and their related assumptions in the methods; statistics geeks will want to get a full copy of the paper for that info and their notes on the limitations.]

Among the findings:

• Not surprisingly, the estimated number of medication abortions increased sharply in the years immediately after the drug became available, from about 55,000 in 2001 (the first full year of availability) to about 158,000 by 2007.
• Based on existing trends, they estimate that mifepristone would represent 7% of eligible abortions performed in 2000, and about 21% in 2007 (an increase in percentage of all abortions from about 4% in 2001 to 10% in 2007).
• Provision of medication abortion tends to follow trends for provision of all abortion, with clinics providing the most, followed by physicians and hospitals. More ob/gyns provide the drug than other physicians (such as family practice or internal medicine) by a wide margin.
• Clinics, which typically provided surgical abortions as well, accounted for 88% of mifepristone abortions, and 96% were in metropolitan areas – “Only 14 mifepristone-only providers were located more than 50 miles away from any surgical provider. Only five mifepristone-only providers of 10 or more abortions were located farther than 50 miles from any surgical provider of 400 or more abortions.” Fewer counties had a mifepristone provider than had any abortion provider generally, and more total abortion providers were estimated than mifepristone providers (meaning that some providers may offer surgical abortion only).

The authors conclude, therefore, that “The large geographic overlap between facilities that provide surgical abortion and those that offer mifepristone means that, in many cases, women are able to choose the type of early abortion procedure they prefer,” but that “mifepristone has not brought a major improvement in the geographic availability of abortion.”

The study did not survey providers as to why they might not offer medication abortion when surgical abortion is offered, why more providers such as family practice physicians don’t seem to provide the drug, or why more providers in areas with few or no surgical providers nearby do not offer the drug as a matter of accessibility. The authors speculate that “One limiting factor may be liability coverage, which has been identified as a barrier to provision of abortion services generally, and mifepristone specifically, in family medicine.” Another unexamined issue is that a small percentage of women (5-8% according to the drug label) using Mifeprex  need a follow-up surgical procedure to complete the abortion or control bleeding; it is not clear what impact this might have on providers who do not provide surgical abortions or in areas where those services are not easily located.

The Senate Finance Committee today began its mark up on the health care overhaul bill put forth by Sen. Max Baucus (D-Mont.). C-SPAN is covering it live; you can watch streaming video here.

Baucus, chair of the committee, seemed to anger all Republicans and Democrats when he released a bill last week that was more conservative than what most Democrats in Congress wanted, yet not conservative enough for any Republican to sign on.

Other committee members have since contributed 534 amendments (here they are, in a 348-page document [pdf]), including three different amendments calling for a public health insurance option to compete with private insurers.

*A recent survey of more than 5,000 doctors by the Robert Woods Johnson Foundation found that the overwhelming majority support expanding health care coverage to include both public and private insurance options. Baucus’s bill shuns the public option in favor of co-ops, which are not considered much of a threat to the insurance industry.

Baucus also faces criticism on funding.

Richard J. Kirsch, national campaign manager of Health Care for America Now, told The New York Times: “The tax credits in the original Baucus plan were so low they would make premiums unaffordable for many moderate- and middle-income people, who could also face high out-of-pocket costs. And if they don’t pay the premiums, they might have to pay a fine.”

Baucus (above left, greeting the committee’s ranking Republican, Sen. Charles Grassley of Iowa) has said he will make some modifications to the bill to provide more assistance to moderate-income Americans who need help buying insurance.

The Amendments

Igor Volsky at Wonk Room breaks down some of the most important amendments into categories for coverage, financing and delivery reforms. View the complete list here.

Volsky’s charts also include some of the more outrageous Republican amendments, such as this gem from Sen. John Kyl (R-Ariz.): “Prohibit the federal government’s takeover of health care.”

Ezra Klein, who previously described the Baucus bill as “a very good platform with some very severe failings,” offers five recommendations to improve it, including phasing in Sen. Ron Weyden’s Free Choice amendment and creating real competition for insurance companies. Klein also prepared a good summary of the amendments Sen. Olympia Snowe (R-Maine) has offered, including a public plan trigger.

About Abortion

Sen. Jay Rockefeller (D-W.V.) has proposed a number of useful amendments, including establishing a public insurance option and limiting out-of-pocket costs. But it’s his amendment #C6 (see page 12) that really intrigues me. A hero last week to progressives for his strong stance against a Senate bill that lacks a public option, Rockefeller disappointed many of those same advocates for denying women enrolled in the public plan access to abortion services:

This amendment would add a strong public health insurance option, the Consumer Choice Health Plan (CCHP), to the exchange to compete directly with private plans. Like private health plans, CCHP would be offered to all individuals and businesses purchasing health insurance through the national health insurance exchange. […] At a minimum, the Consumer Choice Health Plan would be required to follow the same insurance regulations as private plans operating in the exchange. CCHP would also be required to offer the same type of plans as private plans participating in the exchange.

Well, not exactly. The CCHP, according to Rockefeller, “shall not include abortion, except in cases of rape, incest, or the life of the mother. It also prohibits the expenditure of Federal funding for abortion and it requires the segregation of funds to ensure that no Federal dollars pay for abortions.”

Did you get the underlined points? His emphasis, not mine.

The Hyde Amendment, enacted in 1976, already prohibits spending federal dollars to pay for abortions for women on Medicaid. Rockefeller’s amendment would expand the restriction to all women who choose the public option.

The Center for Reproductive Rights is urging supporters to call members of the Senate Finance Committee and ask them to vote against anti-choice amendments. You can also contact your senators and ask them to stop anti-choice amendments from being included in the health care bill.

More good reading on health care reform and the abortion debate:
- Frances Kissling, “Exploiting the Healthcare Debate to Restrict Abortion”
- Molly M. Ginty, “Obama Fuels Battle Over Funds for Abortion”
- Politifact, a project of the St. Petersburg Times, is running a Truth-O-Meter on federal subsidies and abortion
- Rep. Lois Capps, “The Truth About the Capps Amendment”
- David Crary (AP), “Abortion-Rights Forces Vexed by Health Care Debate”

Baucus Bill is “Bunk for Women”

In a post at Raising Women’s Voices outlining five reasons why the Baucus bill is no good for women, Amy Allina writes that the bill “imposes politics and ideology on what should be a purely medical decision — the question about what services an insurance plan will cover. It singles out abortion for special exclusions, rather than treating it like other medical care, by adopting language that was developed by the House Energy and Commerce Committee as a compromise to prevent anti-choice legislators from using the health reform bill as a vehicle to impose sweeping new restrictions on abortion.”

Another reason: Under the Baucus bill, older Americas could pay up to five times as much as younger customers. The bills to come out of the House allowed only a 2:1 ratio.

“Women, who live longer on average than men, are more likely to bear the costs of this age rating,” notes Allina.

Doing away with any niceties, James Ridgeway, in a post titled “How the Baucus Plan Screws Older People,” writes that “the people who stand to get screwed most by the plan are those who aren’t old enough to qualify for Medicare, but are still old enough to be discriminated against by insurance companies.”

Ridgeway quotes Uwe Reinhardt, an economics professor at Princeton University, who estimates that the age rating will enable insurers to cover roughly 70 percent of the added risk they’ll take on by extending insurance coverage to everyone.

“You’re just using age as a proxy for health status,” said Reinhardt.

Maggie Mahar, author of “Money-Driven Medicine: The Real Reason Health Care Costs So Much,” breaks down even further who benefits when health insurance premiums are allowed to vary based only on tobacco use, age, family composition and where you live (allowing for differences in local cost of care).

She writes at HealthBeatBlog.com:

If you smoke, they can charge you 50 percent more; if you have children they can charge you 50% more than they would charge a childless couple, and if you are a single parent, they can charge you 80% more than they would charge a single adult. (Since children’s health care costs are, by and large, significantly lower than adults’ costs, that seems a pretty steep surcharge for the sin of single parenthood.)

I can imagine that some readers would say that it is only fair to charge smokers more. But consider this: the vast majority of adult smokers in the U.S. are poor. Many will qualify for full subsidies; others will be eligible for partial subsidies. So who will pay 50% more for their health care—you, the taxpayer. If he receives a subsidy, the 50% surcharge isn’t likely to induce a smoker to stop smoking. This is simply another way to funnel more taxpayer money to private sector insurers.

Single parents also tend to cling to the lower rungs of the income ladder. Many will qualify for at least a partial, if not a full subsidy. Who pays the extra 80%? That’s right—you and I.

Finally, if insurers can charge 50-somethings five times as much as they charge 20-somethings (who the Baucus plan refers to as “young invincibles”), a great many of them are going to need subsidies. More tax-dollars winging their way to Aetna.

There is, however, an exemption from the mandate for people over 50 if coverage is deemed unaffordable — which makes no sense, really, since this the time they’re likely to need health care more, not less.

As Mahar concludes, “Somehow, this isn’t what I thought they meant by ‘universal coverage.’”

The medical journal The Lancet has an editorial in its current issue that argues that one way to help ward off climate change is to increase family planning services and reduce unintended pregnancies.

The writers of the editorial, Sexual and reproductive health and climate change, believe that family planning proponents might gain more support and funding if they focused on how family planning can reduce climate change. They argue:

With less than 3 months to go, the UN Copenhagen conference on climate change provides an opportunity to draw attention to the centrality of women. The sexual and reproductive health and rights community should challenge the global architecture of climate change, and its technology focus, and shift the discussion to a more human-based, rights-based adaptation approach. Such a strategy would better serve the range of issues pivitol to improving the health of women worldwide.

Astute readers of the full piece will note that the editors seem to be talking about efforts to reduce population in places outside the Lancet’s UK location, given specific reference to efforts in Ethiopia and general mentions of the UN and Millennium Development Goals that seem to suggest work in developing nations.

The SisterSong Women of Color Reproductive Health Collective, however, takes a different stance on this approach. The current issue [PDF] of their Collective Voices newsletter is focused on reproductive and environmental justice, and includes a piece that outlines 10 reasons why population control is not the solution to global warming.

The authors – Betsy Hartmann and Elizabeth Barajas-Roman – argue that “it is not population growth that drives carbon emissions but economic systems of production, distribution and consumption based on the profligate use of fossil fuels,” and state:

Blaming climate change on overpopulation lets wealthy countries, corporations, and consumers off the hook. It is part of a long tradition of eugenic environmentalism in which environmental and economic resource scarcities are attributed to “too many people” – usually meaning too many people of color.

The authors address the issues of reproductive rights, race, and blame raised by this approach, and state that that “This strategy threatens to undermine both climate justice and reproductive justice.” The full piece is well worth a read.

Hartmann and Barajas-Roman write more about this topic at http://popdev.hampshire.edu/.

A bit of catching up to do …

About That Pro-Life Majority …: Amy Sullivan always thought the Gallup poll released in May that showed, for the first time, a majority of Americans describing themselves as “pro-life” rather than “pro-choice,” was a fluke. And she was right:

My skeptical interpretation of the poll didn’t turn out to be terribly popular. The idea that just a few months after the election of a pro-choice president, Americans were racing to embrace the pro-life cause was too tempting a storyline. The poll made headlines everywhere, and we ran an essay on it anyway.

Now along comes a follow-up poll from Gallup and whaddya know, the much ballyhooed pro-life majority seems to have disappeared. The percentages of Americans calling themselves “pro-life” and “pro-choice” are essentially the same (47% for pro-life; 46% for pro-choice). Meanwhile, the positions they hold — a more useful indicator than the labels people choose for themselves — haven’t budged. A solid 78% think abortion should be legal in some or all circumstances.

Think Prescriptions Are Private? Think Again: After buying fertility drugs at a pharmacy in San Diego, a woman started receiving coupons and samples in the mail — for everything from diapers and baby formula to gifts for an elementary school graduate — for a child she did not have. Milt Freudenheim writes that your prescription information — including your and Social Security number — is “a commodity bought and sold in a murky marketplace, often without the patients’ knowledge or permission.”

But protections might be strengthened under federal law:

The federal stimulus law enacted in February prohibits in most cases the sale of personal health information, with a few exceptions for research and public health measures like tracking flu epidemics. It also tightens rules for telling patients when hackers or health care workers have stolen their Social Security numbers or medical information, as happened to Britney Spears, Maria Shriver and Farrah Fawcett before she died in June.

“The new rules will plug some gaping holes in our federal health privacy laws,” said Deven McGraw, a health privacy expert at the nonprofit Center for Democracy and Technology in Washington. “For the first time, pharmacy benefit managers that handle most prescriptions and banks and contractors that process millions of medical claims will be held accountable for complying with federal privacy and security rules.”

The law won’t shut down the medical data mining industry, but there will be more restrictions on using private information without patients’ consent and penalties for civil violations will be increased. Government agencies are still writing new regulations called for in the law.

New Blog: The Global Fund for Women has a new blog: http://globalfundforwomen.wordpress.com. Read about reflections on gender and power; a feminist look at the financial crisis; and tips from Dolores Huerta on keeping activism alive.

Egg-As-Person Crusade Draws Big Money: “In just five short years, the primary movers and shakers in the absolutist anti-abortion/anti-choice movement seeking to promote the ‘personhood’ of zygotes (the single cell that forms after a sperm fertilizes an egg) have amassed nearly $58 million in tax-deductible contributions for their cause,” writes Wendy Norris at RH Reality Check. Norris profiles five organizations that have raised the most money.

Plus: “A Vermont woman whose 6-month-old twin fetuses died after a car crashed into the family van wants them to be legally recognized as children, which is not the case under current state law,” reports the AP.

Why LeRoy Carhart Won’t Stop Doing Abortions: Newsweek profiles Omaha physician LeRoy Carhart, one of three abortion doctors who took turns assisting at the clinic of George Tiller, the Kansas doctor who was murdered in May. Sarah Kliff writes:

Carhart knows there are people who want him dead, too. A few days after Tiller’s murder, Carhart’s daughter received a late-night phone call saying her parents too had been killed. His clinic got suspicious letters, one with white powder. It’s been like this since Carhart started performing abortions in the late 1980s. On the same day Nebraska passed a parental-notification law in 1991, his farm burned down, killing 17 horses, a cat, and a dog (the local fire department was unable to determine the fire’s cause). The next day his clinic received a letter justifying the murder of abortion providers. His clinic’s sidewalks have been smeared with manure. Protesters sometimes stalk him in airports. The threats, the violence, now the assassination of his close friend — all of it has left Carhart undaunted, and the billboard-size sign over his parking garage still reads, in foot-high block letters, ABORTION & CONTRACEPTION CLINIC OF NEBRASKA. “They’re at war with us,” says Carhart of the anti-abortion activist who killed Tiller. “We have to realize this isn’t a difference of opinions. We need to fight back.”

Health Insurance Fail: Sarah Wildman’s daughter cost more than $22,000. Not because of fertility treatments, or adoption. And yes, she and her partner have insurance, which they obtained on the individual market:

Our insurer, CareFirst BlueCross BlueShield, sold us exactly the type of flawed policy— riddled with holes and exceptions — that the health care reform bills in Congress should try to do away with. The “maternity” coverage we purchased didn’t cover my labor, delivery, or hospital stay. It was a sham. And so we spent the first months of her life getting the kind of hospital bills and increasingly aggressive calls from hospital administrators that I once believed were only possible without insurance.

Wildman continues:

Last fall, the National Women’s Law Center issued a report detailing exactly how women who want to bear children are derailed when searching for out-of-pocket health care. Only 14 states require maternity coverage to be included in insurance sold on the individual market, according to the Kaiser Family Foundation. In contrast, the Pregnancy Discrimination Act of 1978 requires employers with more than 15 employees to include maternity benefits in their health insurance packages. “We looked at 3,500 individual insurance policies and only 12 percent included comprehensive maternity coverage,” said Lisa Codispoti, Senior Advisor at the National Women’s Law Center. Another 20 percent offered a rider that was astronomically expensive or skimpy or both. One charged $1,100 a month; others required a two-year waiting period.

Continue reading at Double X.

Gene Mutation That Affects Hair Color Linked to Greater Pain Sensitivity: “A growing body of research shows that people with red hair need larger doses of anesthesia and often are resistant to local pain blockers like Novocaine,” reports The New York Times. The story goes on to note that the mutation in the MC1R gene also occurs in people with brown hair, though it is less common. I think I’m one of ‘em.

Rachel Maddow devoted more than seven minutes of Monday night’s show to the elevated threat against doctors who provide abortions, noting that “perpertrators of violence [against doctors] are not just being turned into martyrs — they’re being turned into leaders.”

The coverage was sparked by a Kansas City Star story on the high number of anti-abortion rights activists who have been visiting and communicating with Scott Roeder, the man accused of killing abortion doctor George Tiller.

The list, writes Judy L. Thomas, “reads like a who’s who of anti-abortion militants”:

Two convicted clinic bombers. The man behind the Army of God Web site. Several activists who once signed a declaration that defended the killing of abortion doctors.

And federal agents have now talked to many of them. [...]

The federal investigation into the possible existence of a conspiracy began after Tiller — one of a handful of doctors in the country who performed late-term abortions — was shot in his Wichita church on May 31 while serving as an usher. Roeder, 51, of Kansas City, was charged with first-degree murder. He has pleaded not guilty, and a trial is scheduled for Sept. 21.

Roeder’s bond was originally set at $5 million, but a judge raised it to $20 million after Roeder called The Associated Press on June 7 and warned that there were “many other similar events planned around the country as long as abortion remains legal.”

Maddow’s guest, Amy Hagstrom Miller, president of Whole Woman’s Health, said that visitors to the county jail where Roeder is being held are parading “in broad daylight, almost in defiance that the government will do anything about it.”

Meanwhile, Jodi Jacobson reports that the U.S. Department of Justice has removed the federal marshals assigned to protect Dr. Leroy Carhart, whose clinic in Nebraska has long been the target of protests. Carhart recently said he intends to open another clinic in Kansas.

Super Fun Health Graphic: Are you an employed single mother? Or maybe you own a small business? Either way, The New York Times explains how bills working their way through Congress might affect you:

A Hot, Hot Summer: By a 31-28 vote, the House Committee on Energy and Commerce on Friday approved a health reform bill that would cover about 95 percent of Americans. It includes the so-called public option, a government insurance plan that would compete with private insurers. The bill allows the federal government to negotiate with drug companies for lower prices under Medicaid and limits how much insurers can increaes premiums. Subsidies would be provided to lower-income families to help cover the cost of insurance.

Two other committees — Ways & Means, and Education & Labor – approved legislation in mid-July. The full House will take up the bill, HR 3200, when it returns from August recess. Now everyone’s waiting on the Senate Finance Committee, chaired by Sen. Max Baucus (D-Mont.), to move its health reform bill out of committee — a move that isn’t likely to happen until after summer recess. Lawmakers and experts weigh in on what’s slowing everything down.

The Energy and Commerce committee vote was largely along party lines, with five Democrats joining all 23 Republicans opposed to the bill. In a story about how the White House might be ready to move forward without building broader bipartisan support, The New York Times notes that lobbying efforts are going to be “unusually heavy” this month. Indeed, House Republican leader, Rep. John Boehner of Ohio, has promised a “hot summer” for Democrats.

How much hotter than health reform = death can it get? Opposition to health reform already has become increasingly vocal, what with conservative talk radio fueling fear among senior citizens that healthcare reform will lead to end-of-life “rationing” and “euthanasia.” Ceci Connolly of the Washington Post writes:

Not since 2003, when Congress and President George W. Bush became involved in the case of Terri Schiavo, who lay in a vegetative state in a hospice in Florida, have lawmakers waded into the highly charged subject, said Howard Brody, director of an ethics institute at the University of Texas Medical Branch at Galveston.

The attacks on talk radio began when Betsy McCaughey, who helped defeat President Bill Clinton’s health-care overhaul 16 years ago, told former senator Fred D. Thompson (R-Tenn.) that mandatory counseling sessions with Medicare beneficiaries would “tell them how to end their life sooner” and would teach the elderly how to “decline nutrition . . . and cut your life short.”

House Minority Leader John A. Boehner (R-Ohio) and Republican Policy Committee Chairman Thaddeus McCotter (Mich.) said they object to the idea because it “may start us down a treacherous path toward government-encouraged euthanasia.”

Lawmaker, Protect Thyself: House Speaker Nancy Pelosi (D-Calif.), according to the NYT, “distributed cards outlining key points of the House’s health care approach” to all 256 Democrats heading to their home districts for August recess. She might want to send them home with their own personal armor.

Politico reports on growing incivility at town hall meetings led by Democratic representatives: “Screaming constituents, protesters dragged out by the cops, congressmen fearful for their safety — welcome to the new town-hall-style meeting, the once-staid forum that is rapidly turning into a house of horrors for members of Congress.”

Think Progress notes that “much of these protests are coordinated by public relations firms and lobbyists who have a stake in opposing President Obama’s reforms.”

The lobbyist-run groups Americans for Prosperity and FreedomWorks, which orchestrated the anti-Obama tea parties earlier this year, are now pursuing an aggressive strategy to create an image of mass public opposition to health care and clean energy reform. A leaked memo from Bob MacGuffie, a volunteer with the FreedomWorks website Tea Party Patriots, details how members should be infiltrating town halls and harassing Democratic members of Congress.

Visit Think Progress for the memo, which Lee Fang says “resembles the talking points being distributed by FreedomWorks for pushing an anti-health reform assault all summer.”

All this makes the 1994 version of Harry & Louise look like the nicest, most honest couple you’d ever meet (funny how life repeats itself, with a twist).

Center of Debate: Back to the legislation approved by the Energy & Commerce committee … By a vote of 30 to 28, the committee approved an amendment (pdf) that states abortion would not be included in the “essential benefits package” to be defined by the government.

Dan Gilgoff at U.S. News & World Report explains the details:

The amendment, proposed by Democratic Rep. Lois Capps, prohibits the federal government from compelling private providers participating in the federal healthcare exchange to cover abortion. But it also bars the government from prohibiting those plans from offering such coverage. And it requires that at least one of the private plans participating in the exchange cover abortion—and at least one of the plans to not. [...]

Democratic defenders of the Capps amendment say it applies the Hyde Amendment, which for more than three decades has prohibited Medicaid from funding abortions except in very limited circumstances, to the new government-controlled healthcare. Private healthcare providers are free to cover abortion, but not with federal funds. The public plan would cover abortion, but not with federal funds; a Capitol Hill aide tells me money for abortions would come from what participants pay into the public plan.

Abortion has been the political football since the debate over healthcare commenced this year.

“One of the very real dangers in the debate on how to fix American healthcare is that women’s health will become a bargaining chip, with the GOP and anti-abortion forces trying to frame healthcare reform as an endrun to government ‘interference’ in our lives by ‘mandating’ abortion and gasp, contraception,” writes Lucinda Marshall.

And over at RH Reality Check, Amanda Marcotte looks at how the media has been reinforcing unexamined arguments against public funding for abortion, and she explains the true story:

Here’s the unvarnished truth: There is no way that any kind of public health care plan will have elective abortion coverage. Nor is there any real chance of abortion becoming mandated coverage. It’s more likely that breast implants will be paid for by tax money. It’s more likely that a public insurance option will provide everyone wth an iPod Touch. Believe me; even most pro-choicers gave up a long time ago on hoping that we could overturn the Hyde Amendment that bans women who are on federally funded insurance programs from getting elective abortions covered, and there’s no way that this will change if the number of women on federally funded health insurance grows. And even though it would only be fair and cost-effective to mandate coverage for elective abortion, in this country that’s sadly a pipe dream.

Plus: For more on fact vs. fiction, read this AP story on distortions in the health care debate. Meanwhile, Princeton economics professor Uwe E. Reinhardt offers a glimpse of what a health reform bill would look like if it conformed with the American public’s idea of “common sense” in health care. And Bill Moyers on Friday re-aired a must-see interview with former insurance industry executive Wendell Potter. Watch it or read the transcript. You may come away mad, but you won’t be disappointed.

Want to Cut Costs? Over Here, Mr. President: Also at RH Reality Check, Jennifer Block, author of “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” writes about where healthcare cost savings can be found:

A new economic analysis forecasts savings of $9.1 billion per year if 10 percent of women planned to deliver out of hospital with midwives. (Right now, just one percent do). If America is serious about reform, midwifery advocates are saying, “Hey, how about us?”

Childbirth, in fact, costs the United States more in hospital charges than any other health condition — $86 billion in 2006, almost half paid for by taxpayers. This high price tag — twice as high as what most European countries spend — buys us one of the most medicalized maternity care systems in the industrialized world. Yet we have among the worst outcomes: high rates of preterm birth, infant mortality, and maternal mortality, with huge disparities by race.

Tell Me: What’s Wrong With Single-Payer Again?: David Brooks and Gail Collins try to figure it out. Collins starts with this set-up:

Since something like a third of the cost of health care is in administration, and the problem with reorganizing health care has to do with all the multitudinous plans and policies, a single-payer system would be far and away the most cost effective answer. We don’t talk much about it because it isn’t politically possible. But it isn’t politically possible because we don’t talk about it. The opponents of a public plan are afraid that people would all gradually migrate toward it, causing the insurance industry as we know it to wither away. Wouldn’t that be a good thing?

In Other News, Senate Committee Grasps Reality: It seems that funding for abstinence-only sex education is losing its luster. The Senate Appropriations Committee on Thursday approved its fiscal year 2010 spending bill (HR 3293) for health, education and labor programs, minus funding for the controversial program. The $730 billion bill, approved by a vote of 29-1, includes $104.5 million for a comprehensive “Teen Pregnancy Prevention” program and no funding for abstinence-only sex ed. Abstinence-only advocate Sen. Sam Brownback (R-Kan.) cast the only “no” vote.

“After more than a decade, Congress has finally begun to put teenagers’ health above politics and ideology,” Michael Macleod-Ball, acting Director of the ACLU Washington Legislative Office, said in a statement. “The Committee’s actions represent a looming victory for young people, parents and advocates of science-based approaches.”

The same statement notes that the measure must still go to the full Senate for a vote, “where misguided efforts to reinsert funding for abstinence-only programs are possible.”

Take Action
From the Big Push for Midwives, sign the “I pushed for out-of-hospital maternity care” petition in support of  including out-of-hospital maternity care and Certified Professional Midwives, who are specially trained to provide it, in federal healthcare reform legislation.

Before I start a week-long vacation Aug. 3, I’m attempting to clear out my bookmarks by posting several theme round-ups this week.

An Abortion Battle, Fought to the Death: The New York Times takes an in-depth look at the life and work of Dr. George Tiller, and the longstanding battle against him and his abortion clinic that ended with Tiller’s murder in May.

David Barstow writes about Tiller’s committed stance — quoting the doctor as having said: “If a stake has to be driven through the heart of the anti-abortion movement,” he said, “I want to have my hand on the hammer” — and what his death has meant to the abortion debate:

Scott Roeder, an abortion foe with the e-mail name “ServantofMessiah,” awaits trial in the murder. In a jailhouse interview, Mr. Roeder did not admit guilt but told a reporter that if he is convicted, his motive was to protect the unborn, a goal seemingly advanced when the Tiller family closed the clinic. But in the weeks since the killing, supporters and opponents of Dr. Tiller have been measuring the larger ramifications. Implacably divided for so long, they now agree on a fundamental point: Dr. Tiller’s death represents an enormous loss for each side.

Plus: IAmDrTiller.com is still collecting stories. Visit the site or follow on Twitter.

Also, here’s another New York Times story, “The Deadly Toll of Abortion by Amateurs,” which presents these startling statistics:

Worldwide, there are 19 million unsafe abortions a year, and they kill 70,000 women (accounting for 13 percent of maternal deaths), mostly in poor countries like Tanzania where abortion is illegal, according to the World Health Organization. More than two million women a year suffer serious complications. According to Unicef, unsafe abortions cause 4 percent of deaths among pregnant women in Africa, 6 percent in Asia and 12 percent in Latin America and the Caribbean.

Born Too Soon: Vicki Forman, author of “This Lovely Life: A Memoir of Premature Motherhood,” writes in her new book: “My husband and I had tried for two long years to conceive these twins, had lived through miscarriages and fertility treatments to bear them. When I learned they were coming so early and so fragile, I had only one wish: to let them go.”

Salon interviews Forman about her reaction to delivering twins at 23 weeks, how her wishes conflicted with hospital policy, and the joy and heartache that resulted. Read her story.

Surrogate Pregnancies, the Update: “Much has changed in surrogacy in the two decades since the high-profile Baby M case, in which the surrogate was the baby’s biological mother and unsuccessfully sought custody after the birth,” writes Jane Brody in The New York Times.

“The legal proceedings in that case markedly changed the conversation about the validity of surrogacy contracts. Some states have laws that protect the commissioning parents in surrogate pregnancies. And in a vast majority of surrogate pregnancies today, the surrogate has no genetic link to the baby.”

A Victory, of Sorts: National Advocates for Pregnant Women reports on a New Jersey case involving a question of consent for pregnant women:

Last week, a mid-level court of appeals in NJ avoided deciding the question of whether or not a pregnant woman’s decision-making during labor and childbirth may be the basis for a finding, under state civil child welfare laws, of abuse and neglect. While the decision is a victory of sorts, it nevertheless reveals how extraordinarily unsettled and contested pregnant women’s rights are.

In this case, called New Jersey Division of Youth and Family Services v. V.M. and B.G., In the Matter of J.M.G., (view a pdf of the decision) a woman’s refusal to sign a consent form for cesarean surgery led to hospital interventions and a report of abuse to child welfare authorities. This resulted in a child welfare investigation, the state’s decision to remove the child from her parent’s custody at birth, and a court finding that both parents had committed medical neglect. Ms. M., by the way, would have consented to cesarean surgery when and if it became necessary, never in fact needed cesarean surgery and delivered a health baby, vaginally.

Repeat C-Section, or Vaginal Birth?: Amie Newman reports on the safety and costs of having a vaginal birth after a previous c-section, instead of having a repeat c-section.

“What we know is that, making allowances for the overuse of medical interventions during childbirth, vaginal birth in the United States carries inherently less risk to the mother than c-sections do and can lay the foundation for more choices for future childbirth options as well,” writes Newman. “Now, with this new study, the evidence also suggests that babies born via c-section have poorer health outcomes than do newborns born vaginally.”

Protect Pregnant Prisoners: In May, the New York State Legislature passed an anti-shackling measure prohibiting correctional authorities from using restraints on a pregnant inmate who is in labor and is being transported to the hospital. It’s time for Gov. David Patterson to sign the bill into law.

Here’s one woman’s story, as reported in The New York Times earlier this month:

One day last November, the first shudders of childbirth woke Venita Pinckney before dawn. She was well into her ninth month of pregnancy. She was also incarcerated at Bedford Hills Correctional Facility, a state prison.

Before she left for the hospital, Ms. Pinckney said, a corrections officer wrapped a chain twice around her waist and handcuffed her to it. Then he covered the handcuffs with a locked black box to further limit her range of motion. Finally, her ankles were shackled.

“You can’t walk like a normal human being,” said Ms. Pinckney, 37. “When you’re pregnant, you have a hard time keeping your balance to begin with.”

At least once a week, somewhere in one of New York’s prisons or jails, a pregnant women goes into labor. Nearly all of them, including Ms. Pinckney, are behind bars for drug offenses. Even so, they are often as severely restrained in the final hours of pregnancy as the most nimble and dangerous of criminals. While their bodies heave toward childbirth, they become walking, clanking jail cells.

Continue reading …

Later in Life: This Detroit Free Press story about fertility problems and increased health risks for children born to older mothers and fathers quotes Dr. Kristen Wuckert, an ob-gyn at Mission Obstetrics and Gynecology in Warren, Mich., who has seen an increase in the number of older mothers over the years:

“It makes sense that women are waiting longer to start families — college, careers, not meeting the right person earlier in life [...] Another reason women wait is because they can. We have a lot more options, albeit expensive ones, to help in getting pregnant. It has also become more the norm than the exception.

“We see celebrities in their 40s and older doing it — why not us?” she adds.

Why not, indeed — the story presents a sidebar feature on at least seven celebrity “mature mommas.”

In what’s being touted as a legitimate display of common ground, two Democratic representatives, pro-life Tim Ryan of Ohio and pro-choice Rosa DeLauro of Connecticut, are introducing legislation today aimed at reducing the number of abortions by expanding prengnancy prevention programs while also increasing goverment support for mothers.

Steven Waldman has a good summary of the bill’s provisions. Here are statements in support of the bill (pdf), gathered by Third Way, a D.C. think tank that helped to broker the compromise.

The bill, “Preventing Unintended Pregnancies, Reducing the Need for Abortion and Supporting Parents Act,” was first introduced in 2007, but as Amy Sullivan writes at Time, Ryan and DeLauro “could persuade only one religious organization — and not a single abortion-rights group — to support them.”

Compare that with today, when “leaders from Planned Parenthood and NARAL will be crowded elbow to elbow with Catholics and conservative Evangelicals to stand behind Ryan and DeLauro. It may not be an end to the culture war, but it looks a lot like a cease-fire.”

Sullivan continues:

Aside from its support for contraception, none of the new or expanded initiatives it contains are terribly controversial: a national campaign to teach parents how to talk to their kids about sex, efforts to educate the public about adoption, home nurse visits for low-income mothers, expanded postpartum Medicaid coverage.

Interestingly, the arduous work of getting traditional adversaries on the abortion issue to endorse the Ryan-DeLauro effort had relatively little to do with concerns about the substance of specific provisions. Instead, the bill’s backers found they needed to give people on both sides time to learn to let down their guard a little after decades of skirmishes. “We had to reach a level of trust,” says DeLauro. “Because so often this issue has been one about which there was nothing other than trying to score political points.”

One way to encourage trust was to make changes that Rachel Laser, director of the culture program of the think tank Third Way, says were designed to “turn down the heat.” Laser began her career in the pro-choice community and agreed four years ago to help Ryan craft a common-ground bill. She shouldered the task of patiently hearing out each group’s concerns and turning them into a final product that could garner broad support without being uselessly watered down or split into two. When abortion-rights advocates, for example, objected to a provision to have abortion providers obtain what is called “informed consent” from patients (a requirement already mandated in all 50 states), Laser removed it. And she did the same when some of the bill’s pro-life supporters complained that a section requiring homes for pregnant women to provide family-planning counseling would take funding away from Catholic group homes that don’t support contraception.

Of course, not everyone is convinced. Democrats for Life kicked Ryan off its national advisory board for supporting the bill. Why is it so hard for some folks to see that contraception is the easiest way to prevent abortion? Maybe because it’s really not about life; it’s about control.

Meanwhile, the debate over insurance coverage for reproductive health services continues. Yes, it’s frustrating work — making sure health reform addresses the needs of a mere 51 percent of the population. But as Jodi Jacobson writes at RH Reality Check, if women want coverage for reproductive health services, or simply want to keep the coverage they have now for reproductive health care, contraception and abortion services, they have to demand it.

Last week, at the 2009 Planned Parenthood Organizing and Policy Summit, Tina Tchen, director of the White House Office of Public Engagement — on a panel with Rep. Jan Schakowsky (D-Ill.) and PPFA President Cecile Richards — told participants it’s time to “bring it” and get back into campaign mode.

Jacobson explains what we’re up against:

Some of the opposition comes from likely suspects and is based on misinformation campaigns that belie their true purpose. Republicans in Congress, like Senator Orrin Hatch and Representative Mike Pence — who introduced an amendment today to the House appropriations bills to defund Planned Parenthood — just can’t seem to get the connection between increased access to prevention services, improved health and reduced need for abortions, the women’s right they love to hate.

And it is no surprise that groups like Family Research Council and the National Right to Life Committee are against not only funding for abortion services, but also for contraception. FRC, for example, continues to perpetuate myths about an amendment to the Senate Health, Education, Labor and Pension (HELP) Committee health reform bill originally sponsored by Senator Barbara Mikulski (D-MD). This amendment, which was passed, would ensure coverage of well-woman care, HIV prevention and testing, pap smears, pregnancy care, and contraceptive supplies. FRC continues to claim it forces taxpayers to pay for abortions for the first time in 30 years.

It does not address abortion coverage. At all.

But then there are Democrats who may either “cut a deal” on coverage of abortion services or who oppose it outright.

For example: while the House and Senate HELP Committees have passed their bills, and neither of those includes any restrictions on coverage of reproductive health care, Tchen noted:

This was not easy to achieve in committee and won’t be easy to hold on to the Senate floor or on the House floor. And the President can not do it alone. His efforts alone will not be enough. It will take each of you to raise your voices when you go home and here in DC and to spread the word.

We’ve been posting action alerts from groups such as National Women’s Law Center and National Partnership for Women and Families. Visit their websites and the sites of PPFA and NARAL Pro-Choice America, all of which are mobilizing efforts to protect reproductive health coverage. Raising Women’s Voices blog has also been keeping tabs on the debate.

With President Obama less than an hour away from addressing the nation to allay the concerns of skeptics and build public support for health care reform, we’ve been reading some troubling accounts of whether coverage for abortion services will be included in the proposed public insurance option, which is prefered by Obama and many who say it’s necessary for reform.

In a wide-ranging health care discussion Tuesday night with Katie Couric, Obama discussed abortion coverage:

Katie Couric: Do you favor a government option that would cover abortions?

President Obama: What I think is important, at this stage, is not trying to micromanage what benefits are covered. Because I think we’re still trying to get a framework. And my main focus is making sure that people have the options of high quality care at the lowest possible price.

As you know, I’m pro choice. But I think we also have a tradition of, in this town, historically, of not financing abortions as part of government funded health care. Rather than wade into that issue at this point, I think that it’s appropriate for us to figure out how to just deliver on the cost savings, and not get distracted by the abortion debate at this station.

Over at The American Prospect, Dana Goldstein writes in response that Obama is referencing the Hyde Amendment, which Obama said he opposed when he was a presidential candidate.

“[W]hile none of the health reform bills in Congress threaten Hyde, reproductive health advocates have been trying for decades to repeal the ban,” writes Goldstein. “By deferring to this ‘tradition,’ Obama seems to be signaling that he could support a public plan that excludes abortion coverage.”

Under the current Hyde provisions, federal funding under Medicaid is allowed under some circumstances: rape, incest and to save the life of the mother. (The National Abortion Federation has a good fact sheet on the history of Medicaid and the Hyde Amendment, and how states have responded with their own funding.)

The Washington Post, meanwhile, reports that centrist House Democrats have proposed a “compromise” over federal funding for abortions.

Saying they are “increasingly concerned about potential roadblocks around the issue of abortion” in Congress’ health-care debate, abortion opponent Rep. Tim Ryan (D-Ohio) and four other Democrats propose “a common-ground solution” that would neither require nor ban private insurers from covering the procedure as long as federal funds are not used, according to a letter obtained by The Washington Post.

The letter to House Speaker Nancy Pelosi (D-Calif.) was also signed by Reps. Dale Kildee (Mich.), James Langevin (R.I.), Artur Davis (Ala.) and Kendrick Meek (Fla.).

The lawmakers say that their proposal “maintains the current status quo in the private market” and would not “preempt constitutionally permissible state laws” governing notification requirements and other restrictions on obtaining an abortion.

“Now it is imperative that we reach some consensus on the issue of abortion in health care reform, so that we can move this critical legislation forward,” the lawmakers wrote.

And in a separate story published this afternoon, WaPo’s Dan Eggens and Rob Stein explain more about the conflict and how it may affect bipartisan legislation that’s expected to be introduced this week aimed at  encouraging pregnancy prevention along with improved government support for young mothers.

The measure from Ryan, who opposes abortion, and Rep. Rosa DeLauro (D-Conn.), who supports abortion rights, has attracted an unusual array of supporters ranging from Planned Parenthood to evangelical leaders such as the Rev. Joel Hunter of Orlando. [...]

The prevention bill being proposed by Ryan and DeLauro would establish a series of new and expanded initiatives focused on contraceptives and other prevention measures, including expansion of Medicaid coverage for family planning services. The bill, which was drafted by the centrist advocacy group Third Way, also includes a series of grants and policies aimed at helping young mothers, including expanded maternity care options and more financial assistance for adoptions.

Backers say the Ryan-DeLauro bill has been carefully scrubbed for months to remove policies that might alienate either side, such as financial support for the morning-after pill. Hunter, senior pastor of Orlando’s Northland megachurch, said the proposal “isn’t going to end the disagreement or the alarm that comes up on both sides. But I think it is the first of its kind to take such an incendiary culture-war issue and really make progress. It’s a start.”

“The Ryan approach represents the politics of the future on abortion,” said Rachel Laser, Third Way’s culture program director.

Update: Here’s a this-just-in action alert from National Women’s Health Network:

There are reports that compromise discussions are taking place right now in the House Energy and Commerce Committee that would single out abortion services for onerous restrictions. This could result not only in extending existing abortion restrictions, but also in taking abortion coverage away from women who currently have it. Now is a critical time to speak out and let Congress know that reproductive health care is basic health care for women and must be treated like any other type of health care.

We must tell House members that women want health care reform that includes the comprehensive care that we need throughout our lives. Tell them also that politicians shouldn’t be making the decisions about what’s included in a health benefits package. If your Representative is a member of the Energy and Commerce Committee, it’s especially important that you take action immediately! (Click here to see a list of Energy and Commerce Committee members, and here to find the name and contact information for your Representative.) Please cc nwhn@nwhn.org so that we know how many of you have taken action for quality, affordable health care that meets women’s health needs.

Plus: And for the latest in health care statistics … a new Gallup poll says 1 in 6 adults are now without health insurance: “The current percentage of uninsured Americans (16.0%) represents a small, but measurable increase over last year. Hispanic Americans, at a rate approaching triple the national average, are the most likely subset of the population to be uninsured. Those making less than $36,000 per year are the second-most-likely group to be uninsured, with 18- to 29-year-olds following closely behind.”

Road to the Supreme Court: It may not have been great theater, but the confirmation hearing of Judge Sonia Sotomayor did offer fire(fighters) without brimstone; a lesson on the dangers of nunchucks; the theory of neutral man’s burden; and many, many words.

Through it all, Sotomayor displayed nothing but “intelligence, grace and patience.” Melissa Harris-Lacewell describes the public humiliation Sotomayor endured as an Elizabeth Eckford moment.

It appears that  Sotomayor will be confirmed — with at least some Republican support — as the third woman and the first Latina on the Supreme Court. But as Frank Rich notes, Republicans still have some ’splainin’ to do:

Southern senators who relate every question to race, ethnicity and gender just assumed that their unreconstructed obsessions are America’s and that the country would find them riveting. Instead the country yawned. The Sotomayor questioners also assumed a Hispanic woman, simply for being a Hispanic woman, could be portrayed as The Other and patronized like a greenhorn unfamiliar with How We Do Things Around Here.  [...]

It’s the American way that we judge people as individuals, not as groups. And by that standard we can say unequivocally that this particular wise Latina, with the richness of her experiences, would far more often than not reach a better conclusion than the individual white males she faced in that Senate hearing room. Even those viewers who watched the Sotomayor show for only a few minutes could see that her America is our future and theirs is the rapidly receding past.

Plus: How many words, you ask? Politico crunched the numbers and determined that between the start of the confirmation hearing on Monday and the end of the senators’ primary questioning and comments on Thursday, senators out-talked Sotomayor by about a third.

“And Republicans – clearly more leery of the Democratic-nominated Sotomayor than those on the other side of the aisle — spent the most time with Sotomayor. The average Republican had 5,908 words to the Democrats 4,217,” writes Patrick Gavin.

Millions More Like Her: Regina Benjamin, the new surgeon general nominee, attended a Catholic elementary school and attends mass regulary. Her numerous honors include an award from Pope Benedict XVI and another inspired by Mother Teresa. But — and here’s the shocking part — Benjamin, a family physician who has spent her life providing health care to the rural poor, supports abortion rights.

Not so shocked? Neither is this Catholic school grad. But this Washington Post story plays it up, noting that Benjamin’s position on reproductive health services “potentially could put her at odds with the Catholic Church.”

The story goes on to note:

Those who know Benjamin said her beliefs will not interfere with her role as surgeon general, which would include acting as the country’s chief health educator. If confirmed, she would lead the 6,000-member uniformed Public Health Service Commissioned Corps, issue public health messages and advise the president and health and human services secretary.

“We all have our religions, but when you speak as the surgeon general to the American people, it’s not about your religion,” said David Satcher, a former surgeon general under President Bill Clinton. Satcher taught community health to Benjamin at the Morehouse School of Medicine in Atlanta. “I don’t see why the surgeon general has to get involved in a discussion about abortion.”

Asylum for Battered Women: The pathway is a narrow corridor with strict conditions, but the Obama administration, reversing a Bush administration stance, has “opened the way for foreign women who are victims of severe domestic beatings and sexual abuse to receive asylum in the United States,” reports The New York Times. Julia Preston writes:

In addition to meeting other strict conditions for asylum, abused women will need to show that they are treated by their abuser as subordinates and little better than property, according to an immigration court filing by the administration, and that domestic abuse is widely tolerated in their country. They must show that they could not find protection from institutions at home or by moving to another place within their own country.

The administration laid out its position in an immigration appeals court filing in the case of a woman from Mexico who requested asylum, saying she feared she would be murdered by her common-law husband there.

According to court documents filed in San Francisco, the man repeatedly raped her at gunpoint, held her captive, stole from her and at one point tried to burn her alive when he learned she was pregnant.

No super fun healthcare graphic this week. Instead, we present a tongue-in-cheek video that gives new meaning to “friends with benefits.”

Full Court Press: “With skepticism about the president’s health-care reform effort mounting on Capitol Hill — even within his own party — the White House has launched a new phase of its strategy designed to dramatically increase public pressure on Congress: all Obama, all the time,” reports the Washington Post.

That includes a primetime news conference on Wednesday, internet video and direct appeals to supporters.

Moving Along, Alone: The Senate’s Health, Education, Labor and Pensions (HELP) Committee speeded up health reform last week with the passage of the Affordable Health Choices Act (pdf), which aims to make health insurance available to all Americans.

Though approved without any Republican votes, Democrats were quick to point out that the bill includes more than 160 Republican amendments; it’s therefore legit to call it “bipartisan.”

Ellen Shaffer, co-director of the Center for Policy Analysis, blogs about the Senate developments in “The Good, the Bad and the Murky.” On discussion of a single-payer amendment to the Senate bill:

Bernie Sanders’ state single payer amendment elicits shining and shameful moments: Strong statements of support from Senators Tom Harkin (“We have a dysfunctional system”), Jeff Merkley, and Sherrod Brown. Listen To Your Staff Demerit for Barbara Mikulski (“Can’t states enact single payer anyway?” [She is reminded that states need waivers for ERISA, and transfers of federal funds.] “Oh.” She still voted No.

On Friday, two House committees — Ways & Means, and Education & Labor – approved the reform legislation (HR 3200). The Education & Labor panel rejected two amendments offered by Rep. Mark Souder (R-Ind.) “that would have precluded plans participating in the health insurance exchange — including the proposed public insurance plan — from covering abortion services,” according to Daily Women’s Health Policy Report.

By a 25-19 vote, the Education & Labor committee did approve an amendment allowing states to create single-payer health care systems if they so choose. Calling it a victory for single-payer advocates, John Nichols of The Nation writes about the importance of regional initiatives.

Meanwhile, the House Energy and Commerce Committee continues its deliberation. All eyes are on “tenacious dealmaker” Rep. Henry A. Waxman (D-Calif.).

On the Senate side, everyone’s waiting for the Finance Committee to release details of its proposal. Considering the importance of Finance Chair Sen. Sen. Max Baucus (D-Mont.), the Sunlight Foundation thoughtfully decided to take a look at the circle of lobbyists surrounding both Baucus and other committee members.

Abortion Debate Heats Up: Appearing on Fox News on Sunday, Peter R. Orszag, the White House budget director, was asked whether he was prepared to say that “no taxpayer money will go to pay for abortions.” His response: “I am not prepared to say explicitly that right now. It’s obviously a controversial issue, and it’s one of the questions that is playing out in this debate.”

Here’s the full transcript. Dana Goldstein has more.

In a New York Times story on the role of abortion in the healthcare debate, Robert Pear and Adam Liptak write:

Abortion has been simmering behind the scenes as an issue in legislation to guarantee access to health insurance for all Americans. The debate affects not only the public health insurance plan that Democrats want to create, but also private insurers, who would receive tens of billions of dollars of federal subsidies to cover people with low and moderate incomes.

Under the House bill, for example, most insurers would have to provide an “essential benefits package” specified by the health and human services secretary, who would receive recommendations from a federal advisory committee. Opponents of abortion want Congress to prohibit inclusion of abortion in that benefits package, while advocates of abortion rights say the package should be left to medical professionals to determine.

Budget Bummer: The Congressional Budget Office concluded that the bills under consideration do not accomplish Obama’s goal of slowing long term the rate of growth in health care. Is it accurate/relevant? Experts weigh in. Other experts weigh in.

Orszag on Sunday called the House bill “deficit neutral.” One undisputed outcome: the CBO assessment won’t make negotiations easy this week.

Missing Kennedy: “As a divided Senate tangles over health care legislation, there is bipartisan consensus on one point: Ted Kennedy could make a big difference, if only he were here,” writes Mark Leibovich.

Kennedy is battling brain cancer, and his presence on Capitol Hill has been missed. In an essay published in Newsweek last week, Kennedy wrote that universal, affordable health care is the “cause of my life.”

Supreme Court Decisions and You: The National Women’s Law Center has released an analysis of 2008-2009 Supreme Court decisions that have a direct effect on women’s lives. Here’s the report (pdf); more discussion at the NWLC blog, Womenstake:

In Fitzgerald v. Barnstable School Committee, the Supreme Court safeguarded women’s and girls’ rights by allowing them to pursue remedies for gender discrimination in schools under both Title IX and the Constitution. In Crawford v. Metropolitan Government of Nashville and Davidson County, Tennessee, the Court ruled that employees are protected from being subject to retaliation for cooperating with an employer’s internal investigation of discrimination. “The Court’s decisions in these two cases kept hard-won protections in place,” [NWLC Co-President Marcia] Greenberger said.

But not all outcomes were positive:

“In AT&T Corp. v. Hulteen, the Supreme Court ignored the realities of the workplace and the intent of Congress and ruled against female workers,” Greenberger said. As Justice Ginsburg noted in a strong dissent in the case, the Court’s decision permitted AT&T to pay women lower pension benefits for the rest of their lives.

Gag on Global Gag Rule: Ever since President Ronald Reagan instituted the “global gag rule” in 1984, its existence has been dependent on which party is in the White House. If it’s a Democrat, it’s revoked; if it’s Republican, it’s reinstated. On Thursday, the Senate Appropriations Committee voted 17-10 to approve an amendment to a Department of State and foreign affairs appropriations bill that would make permanent President Obama’s reversal of the global gag rule. Emily Douglas has more.

The global gag rule, also known as the Mexico City policy (the site of the United Nations International Conference on Population where it was first announced), prohibits international family planning groups that receive U.S. aid from offering abortion services or providing information about safe abortion, even if they use other funding. It would be great to see it gone, for good.

New NIH Director: President Obama has nominated Francis Collins, best known for leading the public effort to sequence the human genome, to be director of the National Institutes of Health. Chris Wilson at Slate looks at how Collins, an evangelical Christian, has combined his faith in God with his faith in science.

New Violence Against Women Advisor: “Vice President Joe Biden’s June 26 announcement of a White House Advisor on Violence Against Women stirred some public grumbling about President Barack Obama’s recent ‘czar frenzy,’” writes Kayla Hutzler at Women’s eNews.

“But at a time of rising pressure on domestic violence shelters, representatives of two of the largest advocacy groups for ending domestic violence were far more enthusiastic about the creation of the post. They were also excited at the naming of Lynn Rosenthal, a former executive director at the New Mexico Coalition against Domestic Violence in Albuquerque, with a substantial resume of safety advocacy and working ties to Biden.”

Here’s the White House announcement, and a New York Times editorial in favor of the appointment.

The Last Word on Sarah Palin (Fingers Crossed): Go read “Palin’s Long March to a Short-Notice Resignation,” then head over to Slate for Dahlia Lithwick’s parting shot: “[Wh]en the dust settles, the lesson may be that she was simply a woman who made no sense.”

Looking Ahead to 2012: Jill Miller Zimon wonders, “Could we see a female-female GOP ticket for president and vice president in 2012?”

Update on Conscience Clause: Kay Steiger has written a good round-up of efforts at the state level to pass legislation that allows medical professionals to refuse to provide services that violate their religious or moral beliefs.

Speaking of conscience clauses, anyone remember the federal rule instituted in the final days of the Bush administration? It cut off federal funding for state and local governments, hospitals, health plans and clinics that did not fully accommodate doctors, nurses, pharmacists or other employees who refuse to provide care they feel violates their beliefs. Aimed at abortion and family planning services, it went beyond laws that already provide for healthcare workers and threatened access to many health services, including infertility treatment, end-of-life care, blood transfusions and mental health counseling.

President Obama moved to rescind the rule, as expected, but the process has been very slow. The 3o-day public comment period on rule changes ended in April; Health and Human Services Department is still reviewing the hundreds of thousands of comments received.

Administration officials acknowledged early on that they were looking for a compromise, but we haven’t heard much more on the subject until President Obama told a group of religion reporters earlier this month that the new policy would “certainly not be weaker” than what existed before President Bush’s expansion:

We will be coming out with I think more specific guidelines.  But I can assure all of your readers that when this review is complete there will be a robust conscience clause in place.  It may not meet the criteria of every possible critic of our approach, but it certainly will not be weaker than what existed before the changes were made.

David Brody has the full transcript of Obama’s remarks.

Judge Sonia Sotomayor’s Supreme Court confirmation hearing begins today at 10 a.m. (EST). C-SPAN will have live television coverage. Streaming video will be available at newshour.pbs.org.

Viewers and listeners can expect statements today from each of the Senate Judiciary Committee members (reminder: 17 men, two women) and possibly Sotomayor’s opening statement.

For a look at some of the issues sure to arise, head over to SCOTUSblog, where Kristina Moore provides a detailed look at Sotomayor’s judicial record, neatly organized by subject matter.

The AP reports on the mock hearings Sotomayor has gone through and, in a separate story, on the restrained support offered by some women’s groups.

Sotomayor is expected to be confirmed, but as Michael D. Shear points out, there are other issues and agendas to look for this week:

Democrats are betting that an overly zealous assault on Sotomayor by Republican senators could anger Latinos and accelerate the shift of Hispanic voters away from the Republican Party, particularly in the South and West.

Conservatives are hoping to use the Sotomayor hearings as a way to motivate their base if they can successfully portray her as an activist judge whose “empathy” for certain groups guides her rulings more than court precedent or the written law.

And activist groups on both sides have already prepared press releases and statements to argue that the Sotomayor outcome says something about where the country’s population is on the issues of guns, abortion, affirmative action, race and gender. Liberals hope an overwhelming vote for her confirmation will encourage Obama to consider even more progressive nominees in the future.

Dahlia Lithwick has kindly put together everything you need to know about the hearing, including who will say what (yes, she can predict these things):

For those brave souls choosing to watch this spectacle on live television all week, it’s useful to point out that most of her interlocutors will not be addressing themselves to Judge Sotomayor at all, although they will frequently use her name. Instead, they will be talking aloud to their constituents back home, with Judge Sotomayor serving as a sort of constitutional blackboard on which to sketch out their legal views: Senators will talk at length about their pet projects and concerns, then turn to ask Judge Sotomayor what she thinks of their pet projects and concerns. She will say she is for them. [...]

Other senators, such as Arlen Specter, will attempt to tap into Judge Sotomayor’s judicial subconscious; asking trick questions about whether she thinks precedent is important (she’ll say it is) and what she thinks of specific cases (she will take a page from Chief Justice John Roberts’ book and summarize cases, without opining on them). She will make blurry-yet-bold pronouncements about the right to privacy, personal autonomy, and bodily integrity—none of which will clarify her stand on abortion.

Both sides will ask how it’s possible that she has ruled in a handful of abortion cases over the years without ever addressing the rightness of abortion itself. She will reply that she is a careful minimalist who answers only the question before her. Both sides will grind their teeth in frustration at this marked absence of judicial activism, which makes it very hard to tell whether she will be a judicial activist once confirmed. Jeff Sessions will rail that Sotomayor should have been more of a judicial activist (he will say “zealous constitutional watchdog”) where gun rights were concerned. Everyone will thus agree that judicial activism is bad except insofar as it’s good.

There’s more. Actually, if you’ve got nothing else going on this week, Lithwick’s predictions may be the basis of a supreme drinking game.

Remembering what it took to get to this moment, the Women’s Media Center has documented racist and sexist comments made about Sotomayor in various media outlets. A video, “Media Justice for Sotomayor,” ties it all together:

A continuation of the latest in health reform politics and discussions …

Speaking of reducing bureaucratic interference, Lois Uttley of Merger Watch wrote the definitive get-your-act-together letter to Congress warning against drafting healthcare legislation that shortchanges women.

Referring to numerous Senate amendments, such as no funding for abortion, that “would deny health care to women, gays and lesbians, people with HIV and anybody else conservatives don’t like,” Uttley offers the following advice:

Apparently, you conservative Republicans have forgotten the advice GOP consultant Frank Luntz gave you just two months ago about how to talk about health reform: “What Americans are looking for in health reform is more access to treatments and more doctors … with less interference from insurance companies and Washington politicians and special interests.” That means we don’t want any more interference in our health care from you, or any of the right-wing groups urging you to use health reform to restore the rejected Bush “moral values” agenda.

There’s enough blame to go around. Indeed, Uttley lashes out with a masterful bipartisan critique:

Now, let’s turn to you Democrats who are supposedly running Congress. You are spending far too much time trying to win over colleagues who are never going to vote for health reform, no matter if you offer them abortion exclusions or new provider “conscience” laws or other provisions that would hobble health reform. You need to get over your worries that if you support inclusion of a strong public plan in health reform, somebody is going to call you a socialist.

Don’t forget that women are among the strongest supporters of moving quickly on health reform this year. Why? Women are grassroots experts on what is broken in the current health system.

Insurance plans try to squirm out of covering us when we are having babies by declaring our pregnancies to be “pre-existing conditions.” In a lot of states, insurance companies charge us more than men for health coverage, largely because of the costs of having children. They call this “gender rating.” We call it discrimination.

Read on for more about what makes us (frustrated) experts.

As the Senate Health, Education, Labor and Pensions (HELP) Committee marked up the long-term care part of a health care change bill Tuesday, Health and Humans Services Secretary Kathleen Sebelius sent a letter to committee Chairman Ted Kennedy with an endorsement. She signaled the Obama administration’s support for something called the Community Living Assistance Services and Supports Act (CLASS Act).

That legislation, which is part of the committee’s health bill, would let workers choose to have government deduct money from their paychecks — maybe $65 to $100 a month — and put it in a savings account. When they get old or disabled and need care, they could then use that money.

There’s opposition from Republicans, but they’re not the only ones voicing concerns:

Bob Kafka, of the disability civil rights group ADAPT, said not enough is done for poor people who can’t afford to have the money deducted from their weekly paychecks — or who, because of their illness or disability, may not be able to work at all. “Secretary Sebelius’ letter adds insult to injury,” said Kafka. “This administration has totally said to low income people with disabilities, ‘You do not count.’ ”

Kafka’s group endorsed the CLASS Act but wants it paired with passage of another bill called the Community Choice Act. That would allow people who get long-term care services through Medicaid to use that money for help to stay at home. Now, the only thing they are guaranteed is that Medicaid will pay for them to live in a nursing home — and home services are limited, require being on yearlong waiting lists, or are unavailable.

Want to Reduce Healthcare Costs? Support Midwives: Writing at The American Prospect, Miriam Perez reports on advocacy efforts to get all states to recognize and license certified professional midwives. Unlike certified nurse midwives, who are allowed to practice in all 50 states and generally work in hospital settings alongside obstetricians, CPMs practice outside of hospitals, mostly in homes or birth centers. How is this related to health care reform? Perez explains:

Childbirth is among the top five causes for hospitalization, and the No. 1 cause for women. According to Childbirth Connection, Cesarean section is the most common operating-room procedure, and in 2009 the C-section rate hit an all-time high according to the Centers for Disease Control and Prevention, at 31.8 percent of all births. These rates account, in part, for the increasing cost of maternity care in the U.S. Maternal and newborn charges totaled $86 billion in 2006, 45 percent of which was paid for by Medicaid. The federal government is already footing a huge portion of the U.S.’ maternity-care bill, and these midwives think they can help reduce costs significantly, and not just for low-income women. [...]

David Anderson, economics professor at Centre College in Kentucky, has run the numbers and says that midwifery care could save us billions of dollars annually, without affecting quality of care (maybe even improving it). Anderson posits that if we increase the percentage of women giving birth out of hospital by 10 percent (currently at only 1 percent nationally) we could save close to $9 billion per year. He points to the difference in baseline costs for out-of-hospital birth — a difference of more than $6,000 when comparing the average cost of a home birth to an in-hospital one. Another main cost reducer, according to Anderson, is the significantly lower rate of C-sections for out-of-hospital births.

It’s not just the costs that are lower, according to these advocates. The outcomes are better too, which in turn, further lowers cost by reducing additional care needed by sick babies and mothers. Anderson adds that if CPMs are allowed to practice in all 50 states, competition will drive down prices for maternity care, since more women will have access to a low-cost alternative to hospital births.

Visit The Big Push for Midwives for more information.

How To Fund Health Care Reform: House Democrats are expected to add details today to a proposed healthcare bill. The bill will include a tax increase on wealthy couples.  House Ways and Means Committee Chairman Charles Rangel (D-N.Y.) predicted the plan could generate as much as $540 billion over 10 years. From the Chicago Tribune:

Married taxpayers earning more than $350,000 a year in adjusted gross income and single filers making more than $280,000 a year would pay a surtax of at least 1%. Rates would rise on higher incomes, with families earning more than $1 million paying about 3%.

The tax plan faces an uncertain fate in the House and the Senate, where Democrats and Republicans are working on their own proposals to offset the costs of helping tens of millions of people get health insurance. Senate leaders have shown much less interest in a new income tax. President Obama, meanwhile, has proposed raising more than $300 billion over 10 years by limiting the deductions that wealthy Americans take on their income taxes.

News Analysis: Another site to add to your healthcare reform reading list — The New England Journal of Medicine has a useful section featuring the latest news and articles on costs and coverage.

Excess Pounds, Longer Life?: It wasn’t so long ago that we heard calorie restriction was linked to longevity. Now it seems the scales have shifted: A new report, published online in the journal Obesity, found that people who are moderately overweight live longer.

“[W]hy is it so hard to believe, even in the face of such evidence, that being fat’s not exactly a death sentence?” asks Washington Post columnist Jennifer LaRue Huget.

On another note, looking at the journal’s website, I wish access wasn’t restricted to an article touted on the homepage as an “important review” of weight discrimination and the stigma of obesity.  The “comprehensive update” features “sections on stigma-reduction research and legal initiatives to combat weight discrimination”; alas, only the citation is available without charge.

Plus: Also see Huget’s column on locally grown food. Miriam at Feministing has more on food politics.

Google AdWords Won’t Advertise Abortion: Lori Adelman of the International Women’s Health Coalition writes that as a result of policy changes, Google AdWords, the search engines’s advertising network, now prohibits ads for abortion services in more than a dozen countries, including Brazil, France, Mexico, Poland, and Taiwan.

“Google’s rationale behind disallowing ads in these particular countries, whose abortion laws range from conservative (Argentina, Brazil ) to more liberal by comparison (France, Italy), is shrouded in mystery: the spokeswoman deftly avoided answering my question about how the countries were chosen,” writes Adelman at Feministing. She includes an email exchange she had with a Google representative.

IWHC has an action alert over at its blog that encourages emailing Google.

Plus: Frances Kissling, a visiting scholar at the Center for Bioethics at the University of Pennsylvania and the former president of Catholics for a Free Choice, wrote a provocative piece at Salon last month that asks whether it’s ever appropriate to say “no” to a woman seeking an abortion.

Nurse Stereotypes Are Bad for Health: Theresa Brown, an oncology nurse, writes about how popular culture misrepresents nurses and the work that they do. She recommends a new book — “Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk,” by Sandy Summers and Harry Jacobs Summers.

“Saving Lives” is an important book because it so clearly delineates how ubiquitous negative portrayals of nursing are in today’s media, particularly three common stereotypes of nurses — the “Naughty Nurse,” the “Angel” and the “Battle Axe.” They argue that these images of nursing degrade the profession by portraying nurses as either vixens, saints or harridans, not college-educated health care workers with life and death responsibilities.

There’s a media advocacy website connected with the book: TruthAboutNursing.org.

Sex, Kids & Reality: Amy Richards and Jennifer Baumgardner’s new book-in-progress — “The Family Bed: Is There Sex After Kids?” — focuses on the sex lives of parents after having children. As research for the book, they’re looking for folks to complete this survey on sex and parenthood.

When Wives Don’t Know: The New York Times Room for Debate Club brought together an all-female panel to discuss modern marriage. The central issue? Political wives who said they didn’t know about their spouses’ infidelities and Ruth Madoff, who said she didn’t know her husband of 50 years was practicing massive fraud.

Sales Outpace Data in Rush for Natural Remedies: “In 2002, when the initial findings of a National Institutes of Health study — known as the Women’s Health Initiative project — suggested that women on conventional hormone therapy were at greater risk for heart disease, cancer, stroke and blood clotting, the market for alternative treatments soared,” writes Camille Sweeney at The New York Times.

“There are now more than 500 products that purport to relieve symptoms associated with menopause, including capsules, tablets, teas, gels and creams. In the United States, the dietary supplement market associated with menopause has grown to $337 million in 2007 (the last year tabulated) from $211 million in 1999, according to the Nutrition Business Journal, a trade publication.”

“Beauty” Aces Talent at Wimbledon: Anyone else watch women’s tennis at Wimbledon last week? Read how looks came under consideration in determining which matches were played in the premiere Centre Court. Slender white women with long hair clearly had the advantage.

What Would Buffy Do?: See what happens when our favorite heroine takes on Edward from “Twilight” in a mash-up not to be missed.

“My re-imagined story was specifically constructed as a response to Edward, and what his behavior represents in our larger social context for both men and women,” creator Jonathan McIntosh explains in a blog post at Women in Media & News. He continues:

More than just a showdown between The Slayer and the Sparkly Vampire, it’s also a humorous visualization of the metaphorical battle between two opposing visions of gender roles in the 21ist century. [...]

In the end the only reasonable response was to have Buffy stake Edward — not because she didn’t find him sexy, not because he was too sensitive or too eager to share his feelings — but simply because he was possessive, manipulative, and stalkery.