Among the accomplishments, HHS Secretary Sebelius lists the development of an Institute of Medicine report on LGBT health, a rule requiring hospitals to accept patients’ wishes for who can visit them “regardless of sexual orientation, gender identity, or any other non-clinical factor,” inclusion for the first time of LGBT health concerns in the nation’s Healthy People goals, anti-bullying efforts, and policies and funds to encourage shelters for homeless young people to be properly equipped to provide services to LGBT youth.

Several items for future action were also listed, including promoting “cultural competence” training for healthcare providers to improve care to LGBT patients, guidance to state child welfare agencies on how to better support LGBT young people, and better data collection on sexual orientation and gender identity in health data collection processes in order to better understand and approach health disparities.

There’s a long way to go – a 2010 report indicated that nearly 1/3 of transgender men and women had avoided getting medical care because of discrimination, and about 1 in 5 had been refused care due to their transgender or gender non-conforming status. Lesbian and bisexual women are thought to be at higher risks of heart disease because of higher rates of obesity, smoking, and stress – which may in turn be related to discrimination faced in healthcare systems and society in general. The IOM report mentioned above reminds us that LGBT folks face “a profound and poorly understood set of additional health risks due largely to social stigma.”

Let us hope that in the coming year, as President Obama stated last night about the nation, the state of our LGBT health will be getting stronger.

For an overview of LGBT human rights and discrimination around the globe, see this United Nations report published last November.

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

Muchas personas que usan cosméticos en los Estados Unidos no se dan cuenta que no se requieren pruebas o aprobación de la FDA para la comercialización de cosméticos.  A su vez, la Agencia Federal no tiene autoridad para requerir que el fabricante retire del mercado productos que no son seguros.  Como los cosméticos no son regulados de la misma manera que los medicamentos, es más difícil para el consumidor hacer una decisión informada, y la FDA tiene menos poder para regular la industria de los cosméticos y para responder a los problemas.

La Ley para Cosméticos Seguros del 2011 (Safe Cosmetics Act of 2011), propuesta por Janic Schakowsky (IL-D) tiene el propósito de ayudar a llenar algunos de estos vacíos en la regulación de los cosméticos.

Esta ley daría poder al gobierno para retirar del mercado los cosméticos no seguros, para requerir mejor información sobre sus ingredientes, establecer estándares de seguridad adicionales y requerir que el fabricante provea información sobre la seguridad del producto.  La ley impone la obligación de informar sobre los efectos adversos para la salud, permite la prohibición de ingredientes que tienen efectos que pueden causar cáncer o problemas con la salud reproductiva, estimula alternativas a las pruebas en animales, aborda la seguridad de los trabajadores, junto a otras medidas.

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.’”

President Obama also went on the offensive today, telling a friendly town hall audience in Portsmouth, N.H., “For all the scare tactics out there, what is truly scary is if we do nothing.”

The New York Times leads off a story on the new website by noting it was created to “fight questionable but potentially damaging charges that President Obama’s proposed overhaul of the nation’s health care system would inevitably lead to ‘socialized medicine,’ ‘rationed care’ and even forced euthanasia for the elderly.”

The Times’ Jim Rutenberg and Jackie Calmes add that White House officials are also “tacitly acknowledging a difficult reality: they are suddenly at risk of losing control of the public debate over a signature issue for Mr. Obama and are now playing defense in a way they have not since last year’s campaign.”

But Media Matters offers another reason — the White House needs to go around the news media, which has been less than helpful in debunking the smears. Matt Gertz writes:

The White House is doing it because they realize that the media is unwilling or unable to call those smears false, instead – just to pull an example out of thin air – referring to misleading-to-ridiculous claims that Democratic proposals “would inevitably lead to ‘socialized medicine,’ ‘rationed care’ and even forced euthanasia for the elderly” as “questionable but potentially damaging charges.”

What makes this particular case even more absurd is that just yesterday, the Times published “A Primer on the Details of Health Care Reform.” Unfortunately, Rutenberg and Calmes don’t seem to have read it.

If they had, they might have written that claims that health care reform would lead to “socialized medicine” “seem overblown” because “[m]ajor versions of the legislation all rely heavily on a continuation of private health plans” and the CBO has found that under the House bill, 3 million more people would have employer-sponsored insurance in 2016 than would be expected under current law. They also might have called the “euthanasia” claims “unfounded” or noted that the AARP says they’re “flat-out lies.”

Plus: Head over to AlterNet to read “Inside Story on Town Hall Riots: Right-Wing Shock Troops Do Corporate America’s Dirty Work.” Adele Stan chronicles ties between the GOP and the extreme-right Web network Grassfire.org, which is organizing town-hall protesters against healthcare reform. Over at sibling site ResistNet.com, comments have included threats of violence and a video racist screed against President Obama.

Get Your Recess Toolkit: The National Women’s Law Center has put together an advocacy toolkit to help those in favor of comprehensive, affordable and accessible health care make their case to lawmakers home for the August recess. No extreme shouting required.

Campaign Costs: The whole healthcare debate has the feeling of a political race — along with the campaign ad costs. More than $52 million has been spent this year on ads, according to the Campaign Media Analysis Group.

“This has the potential to certainly be the biggest [ever] as far as an advocacy advertising campaign goes,” Evan Tracey, CMAG’s chief operating officer, told the Washington Post.

Reform? Insurance Companies Say Bring it On: Business Week writers Chad Terhune and Keith Epstein have written an in-depth piece detailing how UnitedHealth and and other insurance carriers are operating behind the scenes to shape healthcare reform for their own benefit. Their focus is on the more conservative Blue Dog Democrats, who now wield great power in the healthcare debate:

Some Republicans have threatened to make health reform Obama’s “Waterloo,” as Senator Jim DeMint of South Carolina has put it. The President has fired back at what he considers GOP obstructionism. Meanwhile, big insurance companies have quietly focused on what they see as their central challenge: shaping the views of moderate Democrats.

The industry has already accomplished its main goal of at least curbing, and maybe blocking altogether, any new publicly administered insurance program that could grab market share from the corporations that dominate the business. UnitedHealth has distinguished itself by more deftly and aggressively feeding sophisticated pricing and actuarial data to information-starved congressional staff members. With its rivals, the carrier has also achieved a secondary aim of constraining the new benefits that will become available to tens of millions of people who are currently uninsured. That will make the new customers more lucrative to the industry.

In Other News: The American College of Nurse Midwives has endorsed the House bill, HR 3200, saying the legislation will “improve the health status of women and their newborns.” Read the endorsement letter (pdf) to House Speaker Nancy Pelosi.

Plus: For a progressive analysis of HR 3200, which has been marked up by three House committees, check out this analysis by John Gilman and Ellen Shaffer.

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.

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.”

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.

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.”

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.

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.