The story of Savita Halappanavar, who died last month as a result of Ireland’s abortion ban, has sparked much debate over Ireland’s abortion laws and, in a broader sense, the issue of access to reproductive health care.
Savita went to a hospital in Ireland while experiencing severe back pain. The medical staff diagnosed her with miscarriage of a fetus with no chance of survival, but refused to perform an abortion because they detected a fetal heartbeat.
Several days passed before the heartbeat ceased and removal was allowed. But by this point, Savita had developed an infection that led to her death.
This is a tragic example, but one that unfortunately is quite predictable when women are unable to obtain legal abortion care. Abortion has been banned in the Republic of Ireland since 1983 by constitutional amendment, but traces back to an 1861 law. According to the Irish Family Planning Association, more than 4,000 women living in Ireland traveled to England and Wales for abortions in 2011, because the service is not legally available in Ireland.
Here are some of the articles and analysis stemming from Savita’s death:
Justice for Savita — Jessica Valenti gets to the bottom line for The Nation: “It’s not just our lives and health that are in danger, but our human dignity.”
Hospital Death in Ireland Renews Fight Over Abortion – Douglas Dalby at The New York Times writes of a state of Irish politics that will not be entirely unfamiliar to U.S. readers: “Given the divisiveness of the abortion issue in Ireland, which has prompted two bitterly fought referendums, successive governments have avoided passing any legislation.”
Several writers have referred to the “X case” in covering this story. This was a controversial 1992 Irish Supreme Court case in which a 14-year-old girl expressed suicidal thoughts after being raped by a neighbor and becoming pregnant as a result. The girl planned to have an abortion elsewhere, but was prevented from doing so. The court eventually ruled that women have the right to seek abortions in life-threatening situations, including possible suicide.
Despite this 20-year-old ruling, Irish legislators have not passed a law to codify this right, leaving women in dangerously uncertain territory.
Today, some twenty years after the X case we find ourselves asking the same question again — if a woman is pregnant, her life in jeopardy, can she even establish whether or not she has a right to a termination here in Ireland? There is still a disturbing lack of clarity around this issue, decades after the tragic events surrounding the X case in 1992.
Ireland’s Deputy Prime Minister Eamon Gilmore has said that the government would act “to bring legal clarity to this issue as quickly as possible.”
See also these additionalcommentaries on the failure to pass relevant laws after the X case to make abortions clearly legal in life-threatening situations.
Emer O’Toole writes at The Guardian about the struggles of pro-choice activists in Ireland, pointing to the culpability of doctors, legislators, journalists, and others in perpetuating the lack of justice in abortion laws. She issues an apology to Savita’s family that is also a call to action to supporters of abortion rights:
To her family, I want to say: I am ashamed, I am culpable, and I am sorry. For every letter to my local politician I didn’t write, for every protest I didn’t join, for keeping quiet about abortion rights in the company of conservative relations and friends, for becoming complacent, for thinking that Ireland was changing, for not working hard enough to secure that change, for failing to create a society in which your wife, your daughter, your sister was able to access the care that she needed: I am sorry. You must think that we are barbarians.
Last night, the War on Women suffered a setback — due largely to women voters who used the ballot to re-elect President Barack Obama and to push back against absurd, insulting and just plain offensive comments about rape and women’s bodies.
Two of the biggest losers last night were the gentlemen who claimed that women have magic wombs that stop pregnancy from occurring during legitimate rape and if it does happen, it was a gift from God. The magic was in our votes, ladies. We’ve had it all along.
Erin Gloria Ryan’s post at Jezebel is succinctly titled “Team Rape Lost Big Last Night.” Read it for a complete look at races around the country.
Some highlights …
Missouri Rep. Todd Akin failed to unseat incumbent Sen. Claire McCaskill, causing Twitter to explode with a new round of Akin-related humor, like “Claire McCaskill legitimately wins and shuts that whole Akin thing down!”
John Koster was defeated by Suzan DelBene in Washington state — Koster famously referred to “the rape thing” and confused one woman’s choice with controlling all women’s choices: “I know a woman who was raped and kept the child, gave it up for adoption and doesn’t regret it.”
hey @RepToddAkin, now maybe you’ll finally have time to get crackin at all those books @oboshealth and @TheLadydrawers dropped off!
We heartily second that recommendation.
Following the defeat of Indiana Senate candidate Richard Mourdock — who recently said, “I think even when life begins in that horrible situation of rape, that it is something that God intended to happen” — Jason Lefkowitz tweeted: ”And in Indiana, Mourdock has officially been buried under a massive pile of hardback copies of ‘Our Bodies, Ourselves.’”
Jason Cherkis also took note of the upsets, tweeting: ”GOP furiously buying ‘Our Bodies, Ourselves’ on Amazon.”
Rep. Tammy Baldwin became the first openly gay senator, and the first woman senator from Wisconsin. Rep. Mazie Hirono became the first woman senator from Hawaii as well as the first Japan-born immigrant to be elected to the Senate and the first Buddhist.
Another big success last night was the passage of ballot measures in Maine and Maryland approving same-sex marriage, the first time it has been made legal through a popular vote. An amendment to ban same-sex marriage was defeated in Minnesota.
We’re still waiting to hear for sure about Washington state, but early returns are promising. Same-sex marriage is now legal in eight states as well as in Washington, D.C.
More good news: Iowa Supreme Court Justice David Wiggins is staying on the bench – he had been targeted for removal because of his role in the legalization of gay marriage in that state.
Mixed results on abortion-related measures …
Abortion-related measures were considered in two states. In Florida, voters defeated Amendment 6, which would have prevented state employees from using their healthcare coverage for most abortions, and would have affected privacy rights in a way that could have led to further restrictions.
And if anyone needs a reminder of the work we still have before us, On the Issues magazine has appropriately titled its fall issue “The Day After.”
From the editor’s note: “On wide-ranging issues — the economy to the environment, reproductive freedom to voting freedom, sexuality to media representation — our writers, artists and thinkers in The Day After remind us to extend our vision beyond the ballot box to where we need to place our energies, build our muscles and put our feet on the ground every day of the year.”
On the state level, personhood amendments that grant fertilized embryos all the rights of a born human didn’t make it onto any ballot, but two states, Florida and Montana, have put restrictive abortion initiatives before voters.
The National Women’s Law Center has published a voter education section with a number of useful links, including fact sheets on issues affecting women and great images to share — like the one on the left by Jen Sorensen.
For more on the election and the importance of women voters, visit Women’s Vote Watch 2012, a project of the Center for American Women and Politics that tracks and analyzes polling data. Here’s a section on the gender gap and voting.
The clerk’s office said Malone’s water had already broken when she made the stop to vote in her first presidential election.
“If only all voters showed such determination to vote,” [Cook County Clerk David] Orr said. “My hat goes off to Galicia for not letting anything get in the way of voting. What a terrific example she is showing for the next generation, especially her new son or daughter.”
(B) A member of Congress believing that thanks to ”modern technology and science, you can’t find one instance” of abortion being necessary to protect the health or save the life of the mother.
3. (A) Fork-Tongued Vampire Kitty
(B) Forcing women to undergo unnecessary and medically unwarranted procedures, such as a transvaginal ultrasound, in order to obtain an abortion [HR 3805]. (If you’re in Pennsylvania and you don’t want to view the images, just close your eyes!)
We’re delivering copies of “Our Bodies, Ourselves” to every senator and representative so they have access to accurate, evidence-based information about reproductive health — and you can be part of this important effort.
Because nothing is more scary than legislators drafting policy that harms women — not even Meow Mix …
Still, there were many subject areas that went left un-touched — immigration, rights of workers and equal pay, environmental regulation, LGBT issues, for starters — and it took quite a while to get to one of the most important issues framing this campaign: women’s access to reproductive health care.
Imani Gandy, who tweets as Angry Black Lady, called it out with this tweet:
You have 23 minutes to start talking about uteri before I cut mine out and send it to Paul Ryan. Seriously. Don’t make me do it. #VPdebates
The question did eventually come, sort of:
Martha Raddatz: We have two Catholic candidates, first time, on a stage such as this. And I would like to ask you both to tell me what role your religion has played in your own personal views on abortion. And, please, this is such an emotional issue for so many people in this country. Please talk personally about this, if you could.
Asking two Catholic men to talk personally about abortion is, well, problematic. The issue begs for a serious discussion around facts and policy, not men’s feelings.
“I really wish she hadn’t framed abortion as a personal issue for a couple of Catholic guys,” Lucinda Marshall wrote today. “Not to mention that we really need to discuss reproductive rights as a whole, not just reduce it to the abortion question.”
Amy Davidson, however, noted the opening it provided: “Making religion the frame meant that the discussion could range well beyond the dilemma of abortion in women’s lives. (Ryan: ‘Look at what they’re doing through Obamacare with respect to assaulting the religious liberties of this country.’)”
Amanda Marcotte wrote that the candidates gave “polished, talking-point heavy answers,” but Ryan bringing up contraception, without prodding and in the context of religion, was notable:
The only remarkable thing about the exchange is that contraception is now such an important target for the anti-choicers that Ryan brought the subject up, even though Raddatz didn’t ask about it, pivoting quickly from abortion to talk about the Catholic Church’s issue with contraception: “Look at what they’re doing through Obamacare with respect to assaulting the religious liberties of this country. They’re infringing upon our first freedom, the freedom of religion, by infringing on Catholic charities, Catholic churches, Catholic hospitals.”
As with abortion, Ryan’s religion teaches that contraception is wrong, though, when pressed, he wasn’t as eager to suggest that what is taught in the pews should be enforced by the law. Instead, he spoke of “religious liberty,” by which he means giving the employer the right to deny an employee insurance benefits she has paid for because he thinks Jesus disapproves of sex for pleasure instead of procreation.
Ryan made the point that his Catholic faith isn’t all that guides his views on abortion. “That’s a factor, of course,” he said. “But it’s also because of reason and science.” Here’s Davidson again:
“Science,” in this case, meant looking at an ultrasound image of his first child with his wife—an experience that is widely shared and rightly regarded with wonder. (The tiny image he saw was the source of his daughter’s nickname, Bean, he said.) And then, “the policy of a Romney administration will be to oppose abortions with the exceptions for rape, incest, and life of the mother”—carefully construed, as even this very restrictive list is more than Ryan, left to his own devices, would allow. Ryan doesn’t think that rape victims should have access to abortion.
We don’t look to personal views on religion to frame debates about when to involve ground troops in global conflicts or how to shape tax policy, but we allow our politicians to fall back on their religion when it comes to women’s health. And that’s a problem.
If we really want to go to religion: Since Italy, which is overwhelmingly Catholic, approved the sale of the emergency contraception Ella (which an Ella representative says wouldn’t have happened if it were considered to induce abortion), why is there still so much debate around the morning-after pill?
And in response to Ryan’s assertion during the debate that the Democratic party supports abortion “without restriction and with taxpayer funding”: Isn’t that, in fact, malarkey?
Raddatz did return to the question of abortion with a different angle: “If the Romney-Ryan ticket is elected, should those who believe that abortion should remain legal be worried?” to which Ryan responded: “We don’t think that unelected judges should make this decision; that people through their elected representatives in reaching a consensus in society through the democratic process should make this determination.”
That led to a brief discussion of Supreme Court nominees, with Biden stating: ”The next president will get one or two Supreme Court nominees. That’s how close Roe v. Wade is. Just ask yourself, with Robert Bork being the chief adviser on the court for — for Mr. Romney, who do you think he’s likely to appoint?”
And shortly thereafter, it was over, leaving many viewers as frustrated as they were before the first question about uteri was asked.
Senators Bob Casey (D-Penn.) and Jeanne Shaheen (D-N.H.) this week introduced the Pregnant Workers Fairness Act to provide pregnant workers with legal protection against discrimination, similar to protections provided by the existing Americans with Disabilities Act (which does not cover pregnancy).
Pregnant workers face discrimination in the workplace every day, which is an inexcusable detriment to women and working families in Pennsylvania and across the country. This legislation will finally extend fairness to pregnant women so that they can continue to contribute to a productive economy while progressing through pregnancy in good health.
The bill was also introduced in the House earlier this summer by Rep. Jerry Nadler (D-N.Y.) and has more than 100 cosponsors. Not much has happened on it, though, except referrals to various committees — prompting RH Reality Check’s Sheila Bapat to remark that the bill was “going nowhere fast.”
Bapat also clarifies why the the Pregnant Workers Fairness Act matters, even though a Pregnancy Discrimination Act has existed since 1978:
There are laws that protect pregnant women from discrimination, but they have not been interpreted to protect women seeking adjustments to their work responsibilities. The Pregnancy Discrimination Act (PDA) was passed over 30 years ago and prevents discrimination “on the basis of pregnancy, childbirth and related medical conditions.” But the PDA is interpreted to only protect women who are pregnant but not hindered in job performance due to pregnancy or women who cannot work at all and need leave.
Los senadores Bob Casey (Demócrata, Pennsylvania) y Jean Shaheen (Demócrata, New Hampshire) presentaron introdujeron la Ley de Equidad para Trabajadoras Embarazadas esta semana para extender protecciones legales a trabajadoras embarazadas contra la discriminación, protecciones a las que provee el Acta de Americanos con Descapacidades (que no cubre el embarazo) .
Muchas mujeres embarazadas necesitan arreglos sencillos en el trabajo: el permiso de trabajar sentadas, o descansos de baño mas frecuentes. Pero estos arreglos no están protegidos bajo las leyes actuales. Como ejemplo, una trabajadora fue despedida después de cargar y beber agua de una botella, ya que el negocio donde trabajaba tenia una regla prohibiendo empleados de comer y beber durante el trabajo.
Trabajadoras embarazadas enfrentan discriminación en el trabajo todo los días, lo que es un detrimento sin excusa a las mujeres y familias trabajadoras de Pennsylvania y por toda la nación. Esta ley finalmente extenderá equidad a las mujeres embarazadas para que puedan continuar a contribuir a una economía productiva mientras que progresan con un embarazo sano.
La ley se presentó en la Cámara de Representantes previamente en este verano por el Rep. Jerry Nadler (Demócrata Nueva York) y tiene más de 100 copatrocinantes. Sin embargo, no ha progresado mucho, menos ser referida a varios comités– provocando el comentario de Sheila Bapat de RH Reality Check, “ la ley no estaba yendo a ningún lugar.”
Bapat también nos clarifica las razones por la cuales la Ley de Equidad para Trabajadoras Embarazadas tiene importancia, aunque una Acta contra Discriminación en el Embarazo ha existido desde 1978:
Ya existen leyes que protegen mujeres embarazadas contra la discriminación, pero no han sido interpretado en términos de proteger mujeres que buscan modificaciones a sus responsabilidades en el trabajo. El Acta contra Discriminación en el Embarazo (PDA) se aprobó hace 20 años, y previene la discriminación “a base de embarazo, parto, y condiciones médicas relacionadas.” Pero esta ley ha sido interpretada a proteger solamente a las mujeres que están embarazadas pero que no necesitan modificaciones en su trabajo para continuar, o mujeres embarazadas que ya no pueden seguir trabajando y que necesitan baja por maternidad.
Defensores Nacionales para Mujeres Embarazadas tiene una guía a las leyes que afectan la discriminación contra las mujeres embarazadas en el trabajo en la red un buen punto de partida para comprender las protecciones que ya existen y los huecos en las leyes actuales, como el Acta de Americanos con Descapacidades y el Acta de Baja Médica y de Familia (“ADA” y “FMLA” en sus siglas ingleses”.
El Centro Nacional de Ley de Mujeres (National Women’s Law Center) está promoviendo la aprobación de la ley, y tiene varias entradas útiles en su blog para profundizar conocimiento sobre el tema. Entradas excelentes incluyen “It Shouldn’t Be A Heavy Lift: Pregnant Workers Fairness Act Introduced in Senate,” y “The Pregnant Workers Fairness Act: What It Means for Low-Wage Working Women.”
Judy Norsigian, OBOS executive director, wrote the lead article today in Cognoscenti, a new public opinion space at WBUR, Boston’s NPR’s station, that aims to foster conversations about issues that matter.
And what matters right now? Women’s access to reproductive health services.
In her column titled “Our Bodies, Our Votes,” Judy discusses the unprecedented level of attacks on women’s access to care. She points to recently enacted laws that restrict abortion and contraception and addresses the importance of defeating attempts to rescind the Affordable Care Act, which benefits millions of women by mandating that insurance companies cover preventive health care, including birth control, without additional co-pays.
For many of us who have been working in women’s health for decades, it is both surreal and discouraging to bear witness to these recent setbacks. What can we do, especially in this critical election year, to reverse these trends and to preserve the gains established in the ACA? We can start by making people, especially young people, aware of the increasing threats to women’s health and family planning.
While we’ve been busily tweeting away with reports on the #akinroadtrip to deliver the most recent “Our Bodies, Ourselves” to Rep. Todd Akin, the story has kept up steam in the media. Here’s some coverage of the overall issue and big picture problem of the GOP’s abortion platform that we liked:
Pretty much everything from the Rachel Maddow Show – she’s been doing a fantastic job covering this all week long, and all the videos are online.
The AHRQ conducts systematic reviews of medical evidence to better inform providers and patients about which treatments seem to work. It does so by evaluating how new treatments stack up to other existing therapies, and by evaluating whether there is good supporting evidence to recommend them. This research, then, helps people make smarter decisions about medical care by analyzing what is known and by making available information about the comparative effectiveness of different treatments.
Sounds like a useful thing, right? So why might Republican lawmakers want to defund an agency that helps us understand more about which medical care is most effective? I have a couple of ideas.
First, it allows Republicans to recycle anti-Obama talking points about both the stimulus bill and the Affordable Care Act. The provision in health care reform that makes preventive services available to insured patients with no copay — such as the many preventive services for women that are now covered — requires that that list of services be based on the U.S. Preventive Services Task Force’s evidence-based recommendations. Although AHRQ and USPSTF aren’t exactly the same thing, it gives opponents a chance to confuse voters by conflating evidence-based reviews to inform care with rationing to limit care.
Likewise, when funding for comparative effectiveness research — primarily conducted through AHRQ — was included in the 2009 stimulus bill, it kicked off conservative outcry about “rationing” of care. A political analyst for Consumers Union called that outcry ”a very clever effort by a bunch of well-paid lobbyists funded by people who don’t want the American people to know some pills work better than others.”
And that brings us to a second reason. Comparative effectiveness research can identify where highly advertised expensive new drugs or treatments aren’t any more effective than less expensive therapies or placebo. For example, a recent AHRQ review concluded that the heavily advertised drugs for urinary incontinence may help less than basic lifestyle changes and may not provide enough benefit compared to placebo to offset the cost and side effects for many patients.
For another example of hostility toward evidence-based reviews, it was a similar process that resulted in the recommendation that women in their 40s who are not at high risk for breast cancer don’t necessarily need regular mammograms – a finding that makes a lot of sense based on the medical evidence, but was controversial both among health care institutions getting paid for doing mammograms and the giant, screening-focused Komen organization.
So the pharmaceutical industry, health care lobbyists, and other associations with vested interests might have a pretty strong interest in minimizing research that could negatively affect industry bottom lines. Both major political parties take a lot of money from pharmaceutical companies, which might be why we haven’t heard as much political opposition to this move as you might expect.
Some expert health professionals, though, have not been so quiet on the proposed elimination. The American Academy of Family Physicians wrote a letter urging Congress not to defund the agency, calling the move, “pennywise and pound foolish,” and pointing out that “this research helps Americans get their money’s worth when it comes health care. We need more of it, not less.” The president of the Association of American Medical Colleges has also spoken out against the provision.
In a recent op-ed in the Philadelphia Inquirer, Jeffrey C. Lerner, president of the ECRI Institute (a center that does evidence-based medicine research for AHRQ), explains the value of AHRQ’s work for patient safety and effective health care and notes that this isn’t the first political attempt to kill the agency. He asks an essential question — “Why is objective information so threatening?” — and goes on to write:
The answer is that objective information shakes up the status quo. Many constituencies think objective information is information that supports their perspective, and are resistant to change, no matter what the evidence shows. So, truly objective information is a very dangerous weapon.
But it is tough to argue publicly that objectivity is bad, so a time bomb is buried in this House bill in an attempt to avoid having to first openly engage the public in a national debate on the best ways to improve quality and reduce unnecessary expenditures.
How will we find out what quality is and how will we find out what unnecessary expenditures are? Without AHRQ, we won’t.
It’s not completely clear what will happen next in the effort to defund AHRQ, as the 2013 spending decisions will be delayed until after the presidential election. It’s worth keeping an eye on, though, and we’ll update as this moves forward.
[Disclosure: some of my work involves systematic reviews/comparative effectiveness research funded by AHRQ.]
The Guttmacher Institute yesterday released a new report detailing the number of new provisions states have enacted this year related to reproductive health and rights.
In the first half of 2012, states enacted 39 new restrictions on access to abortion. Guttmacher notes:
Although this is significantly lower than the record-breaking 80 restrictions that had been enacted by this point in 2011, it is nonetheless a higher number of restrictions than in any year prior to 2011. Most of the 39 new restrictions have been enacted in states that are generally hostile to abortion. For example, 14 of the new restrictions have been enacted in just three states—Arizona, Louisiana and South Dakota—that already had at least five such restrictions on the books. Fully 55% of U.S. women of reproductive age now live in one of the 26 states considered hostile to abortion rights.
On family planning funding, the news is somewhat more encouraging, as fewer states (compared to 2011) seem interested in efforts to defund family planning providers:
In 2011, eight states moved to disqualify at least some family planning providers from receipt of state family planning funds; so far this year, only three states (Arizona, Kansas and North Carolina) have done so. A court has blocked enforcement of the Kansas measure.
In an unequivocal gain for reproductive health, five states have moved to expand eligibility for family planning services under Medicaid.
As for sex education, however, we seem to be sliding back even further into abstinence-only land:
So far this year, Wisconsin and Tennessee have adopted measures promoting abstinence-until-marriage education. In April, Wisconsin rolled back its 2010 law mandating comprehensive sex education and substituted a measure requiring information about the benefits of abstinence until marriage; the 2012 law does not even identify discussion of contraception as a recommended topic.
Below is the text of President Obama’s remarks at Barnard College’s commencement ceremony (as provided by the White House Office of Communications). Let us know what you think!
THE PRESIDENT: Thank you so much. (Applause.) Thank you. Please, please have a seat. Thank you. (Applause.)
Thank you, President Spar, trustees, President Bollinger. Hello, Class of 2012! (Applause.) Congratulations on reaching this day. Thank you for the honor of being able to be a part of it.
There are so many people who are proud of you — your parents, family, faculty, friends — all who share in this achievement. So please give them a big round of applause. (Applause.) To all the moms who are here today, you could not ask for a better Mother’s Day gift than to see all of these folks graduate. (Applause.)
I have to say, though, whenever I come to these things, I start thinking about Malia and Sasha graduating, and I start tearing up and — (laughter) — it’s terrible. I don’t know how you guys are holding it together. (Laughter.)
I will begin by telling a hard truth: I’m a Columbia college graduate. (Laughter and applause.) I know there can be a little bit of a sibling rivalry here. (Laughter.) But I’m honored nevertheless to be your commencement speaker today — although I’ve got to say, you set a pretty high bar given the past three years. (Applause.) Hillary Clinton — (applause) — Meryl Streep — (applause) — Sheryl Sandberg — these are not easy acts to follow. (Applause.)
But I will point out Hillary is doing an extraordinary job as one of the finest Secretaries of State America has ever had. (Applause.) We gave Meryl the Presidential Medal of Arts and Humanities. (Applause.) Sheryl is not just a good friend; she’s also one of our economic advisers. So it’s like the old saying goes — keep your friends close, and your Barnard commencement speakers even closer. (Applause.) There’s wisdom in that. (Laughter.)
Now, the year I graduated — this area looks familiar — (laughter) — the year I graduated was 1983, the first year women were admitted to Columbia. (Applause.) Sally Ride was the first American woman in space. Music was all about Michael and the Moonwalk. (Laughter.)
AUDIENCE MEMBER: Do it! (Laughter.)
THE PRESIDENT: No Moonwalking. (Laughter.) No Moonwalking today. (Laughter.)
We had the Walkman, not iPods. Some of the streets around here were not quite so inviting. (Laughter.) Times Square was not a family destination. (Laughter.) So I know this is all ancient history. Nothing worse than commencement speakers droning on about bygone days. (Laughter.) But for all the differences, the Class of 1983 actually had a lot in common with all of you. For we, too, were heading out into a world at a moment when our country was still recovering from a particularly severe economic recession. It was a time of change. It was a time of uncertainty. It was a time of passionate political debates.
You can relate to this because just as you were starting out finding your way around this campus, an economic crisis struck that would claim more than 5 million jobs before the end of your freshman year. Since then, some of you have probably seen parents put off retirement, friends struggle to find work. And you may be looking toward the future with that same sense of concern that my generation did when we were sitting where you are now.
Of course, as young women, you’re also going to grapple with some unique challenges, like whether you’ll be able to earn equal pay for equal work; whether you’ll be able to balance the demands of your job and your family; whether you’ll be able to fully control decisions about your own health.
And while opportunities for women have grown exponentially over the last 30 years, as young people, in many ways you have it even tougher than we did. This recession has been more brutal, the job losses steeper. Politics seems nastier. Congress more gridlocked than ever. Some folks in the financial world have not exactly been model corporate citizens. (Laughter.)
No wonder that faith in our institutions has never been lower, particularly when good news doesn’t get the same kind of ratings as bad news anymore. Every day you receive a steady stream of sensationalism and scandal and stories with a message that suggest change isn’t possible; that you can’t make a difference; that you won’t be able to close that gap between life as it is and life as you want it to be.
My job today is to tell you don’t believe it. Because as tough as things have been, I am convinced you are tougher. I’ve seen your passion and I’ve seen your service. I’ve seen you engage and I’ve seen you turn out in record numbers. I’ve heard your voices amplified by creativity and a digital fluency that those of us in older generations can barely comprehend. I’ve seen a generation eager, impatient even, to step into the rushing waters of history and change its course.
I think it’s important — because I watched some of the commentary last week — to remind people that this is not an abstract argument. People’s lives are affected by the lack of availability of healthcare, the inaffordability of healthcare, their inability to get healthcare because of preexisting conditions.
The law that’s already in place has already given 2.5 million young people healthcare that wouldn’t otherwise have it. There are tens of thousands of adults with preexisting conditions who have healthcare right now because of this law. Parents don’t have to worry about their children not being able to get healthcare because they can’t be prevented from getting healthcare as a consequence of a preexisting condition. That is part of this law.
And, as of 2014, adults would also be protected. Women could no longer be denied coverage based on pre-existing conditions such as pregnancy or domestic violence. The law would also eliminate gender rating, in which women end up paying more than men for insurance coverage.
Millions of seniors are paying less for prescription drugs because of this law. Americans all across the country have greater rights and protections with respect to the insurance companies, and are getting preventive care because of this law.
So, that’s just the part that’s already been implemented. That doesn’t speak to the 30 million people who stand to gain coverage once it’s fully implemented in 2014.
And I think it’s important, I think the American people understand and I think the justices should understand that in the absence of an individual mandate, you cannot have a mechanism to ensure that people with preexisting conditions can actually get healthcare.
We have to wait until sometime in June to find out if Obama is right, but there’s been no shortage of guess work underway to determine 1.) whether the Supreme Court will uphold the individual mandate requiring almost every American to buy health insurance; and 2.) what will become if health care reform if it does not.
Writing in The New Yorker, Jeffrey Toobin notes that the “heavy burden” of justification for the mandate — which Justice Anthony M. Kennedy asked Donald Verrilli, the solicitor general, to address — should instead be placed on the law’s challengers.
“The involvement of the federal government in the health-care market is not unprecedented; it dates back nearly fifty years, to the passage of Medicare and Medicaid,” writes Toobin. “The forty million uninsured Americans whose chances for coverage are riding on the outcome of the case are already entered ‘into commerce,’ because others are likely to pay their health-care costs.”
“Acts of Congress, like the health-care law, are presumed to be constitutional,” he later adds, “and it is—or should be—a grave and unusual step for unelected, unaccountable, life-tenured judges to overrule the work of the democratically elected branches of government.” Toobin then demonstrates how the justices’ questions reflected a troublesome meddling in policies set by Congress.
The Individual Mandate – A Not-So-Brief History
The individual mandate, as explained in this NPR story, has Republican roots dating back to 1989. Rachel Maddow discussed the party-line history during a recent segment, summed up as: “When Republicans proposed it — great idea, a conservative solution. When a Democrat has the idea, it’s socialism, tyranny and unconstitutional.”
Though Republicans circa 2012 would like Americans to believe the individual mandate is indeed “unprecedented,” Linda Greenhouse, who covered the Supreme Court for The New York Times for 30 years and who now writes a column on legal issues, applies the description to the politics of this debate:
What’s unprecedented is the singular determination of the Republicans both on Capitol Hill and in the statehouses to deprive President Obama of his major domestic achievement. Republican officeholders in all 26 states joined together in the case now known as United States Department of Health and Human Services v. State of Florida. In 22 of those states, the officeholder was the attorney general. In four states with Democratic attorneys general (Nevada, Wyoming, Iowa and Mississippi), Republican governors filed in their own names. If any of them noted any irony in the fact that not so long ago, the individual mandate was an idea cooked up by conservative policy wonks to counter more fundamental reform sought by the Clinton administration, they offer no sign.
The countless unprecedented things that Congress has done over the centuries were not, for that reason, unconstitutional. Social Security, Medicare, the Employee Retirement Income Security Act (Erisa), and the Emergency Medical Treatment and Labor Act, the 1986 law passed to prevent hospitals from refusing to care for uninsured patients in acute distress, all come to mind. (From the perspective of today’s toxic politics, it’s a miracle that any of these laws actually got passed, but that’s a separate issue.) So there must be some problem with the Affordable Care Act other than “never before.”
There are other federal mandates involving health care already on the books, including the Medicare payroll tax on workers and employers, and the 1996 Newborns’ and Mothers’ Health Protection Act, which requires plans offering maternity coverage to pay for at least a 48-hour hospital stay (96 hours following a c-section).
Isn’t It Ironic (Don’t You Think)
Some Republicans who can’t help but fly into an apoplectic rage upon hearing the term “mandate” in the context of health care reform remain surprisingly calm when mandating medical procedures for women.
Yes, I’m referring to government-mandated ultrasounds. Currently, seven states — most recently Virginia — mandate that an abortion provider perform an ultrasound on a woman seeking to have an abortion. These states, along with more than a dozen others, also require the provider to ask the woman if she’d like to view the image.
The Guttmacher Institute notes: “Since routine ultrasound is not considered medically necessary as a component of first-trimester abortion, the requirements appear to be a veiled attempt to personify the fetus and dissuade a woman from obtaining an abortion. Moreover, an ultrasound can add significantly to the cost of the procedure.”
The Road Ahead
The question of whether other parts of the Affordable Care Act can proceed without the individual mandate will continue to be debated until June. If the mandate alone is struck, insurance premiums would likely increase because insurance companies won’t have the built-in benefit of a broader insurance pool.
“Republicans would blame Obama for making health insurance more expensive. Democrats would blame insurers for the higher premiums. In other words: Déjà vu and total gridlock,” writes Jennifer Haberkorn of Politico. Her story explains what’s likely to happen if the Supreme Court strikes just the mandate, or the mandate and insurance reforms, along with the political fall-out if most of the law falls or is upheld.
Josh Gerstein, also of Politico, looks at the effects beyond health care reform: “If the justices knock out key parts of the law or bring down the whole thing, the reverberations could be felt across the legal landscape for generations to come, radically reining in the scope of federal power, according to supporters of the law and others who closely track the high court. And if the justices decide the individual mandate is a constitutional overreach, these observers say, federal labor and environmental laws could be the next on the firing line.”
If you think that seems too dire a prediction, consider Dahlia Lithwick’s reaction to comments made by the court’s conservative justice’s last week: “[A]s the justices pondered whether the individual mandate—that part of the Affordable Care Act that requires most Americans to purchase health insurance or pay a penalty—is constitutional, we got a window into the freedom some of the justices long for. And it is a dark, dark place.”
Those who would welcome the disintegration of health care reform include The Cato Institute’s Michael Cannon. He told NPR that if the entire law were to go away, “we would have just dodged this whole nasty debate over religious freedom and abortion.”
Meaning: There would be no increased access to preventive health care such as contraception, breastfeeding support, and screening for breast and cervical cancers and HIV. But hey, women’s health is so darn offensive when you get down to it, better to just cast it off. Thanks, but we’ve been there.
On the other hand, maybe a defeat at the hands of the Supreme Court will open new doors, for everyone.
Recent coverage of healthcare reform has focused on contraceptive coverage, but another aspect of the Affordable Care Act also deserves our attention as a potential benefit for women everywhere – attention to environmental issues that may contribute to illness.
The healthcare reform legislation included a requirement that a council on prevention be created, and that the council develop a national prevention and health promotion strategy.
The resulting strategy was released last summer, and includes a section on healthy and safe community environments, which recommends attention be paid to pollutants in our air, land, and water, and points out disparities in pollution exposure. Lead exposure, environmental triggers of asthma, safe neighborhoods for walking, and job-related hazards are all noted as environmental hazards that can make people less healthy.
From the report:
Safe air, land, and water are fundamental to a healthy community environment. Implementing and enforcing environmental standards and regulations, monitoring pollution levels and human exposures, and considering the risks of pollution in decision making can all improve health and the quality of the environment. For example, air quality standards, improved fuel efficiency and use of cleaner fuels, and transportation choices that reduce dependency on automobiles all improve air quality and health…Monitoring and research to understand the extent of people’s exposure to environmental hazards, the extent of disparities in exposures and risks from environmental hazards and the impact of these exposures on health, and identifying how to reduce exposures, especially among vulnerable populations, will inform future efforts.
Mary Ann Swissler wrote about the prevention strategy recently for the Fort Worth Weekly, including more detailed discussion and her suggestions for making environmental prevention work.
Because the law requires providers to describe the fetus and play the heartbeat, physicians have indicated that “they almost always must use the transvaginal probe to pick up the heartbeat and describe the fetus in the early stages of pregnancy.”
Trudeau is expected to refer to these non-medical, forced vaginal probes as rape – a sentiment many women have expressed in regard to such bills – and stood up for this position in an interview with The Washington Post:
Texas’s HB-15 isn’t hard to explain: The bill says that in order for a woman to obtain a perfectly legal medical procedure, she is first compelled by law to endure a vaginal probe with a hard, plastic 10-inch wand. The World Health Organization defines rape as “physically forced or otherwise coerced penetration — even if slight — of the vulva or anus, using a penis, other body parts or an object.” You tell me the difference.
Although Doonesbury has a long history of tackling political issues, focusing on abortion was apparently “too much” for some newspapers – the LA Times is moving the strip to the op ed section, and The Oregonian is among the papers that have refused to run it.
The Center for Reproductive Rights is asking supporters to send a quick message of thanks to newspapers who are carrying the abortion-themed installments of the strip, which should run from today through Sunday. The Center has previously filed a lawsuit challenging the Texas requirement.
The strip can be viewed online; today’s installment greets a woman seeking abortion at a Texas clinic, and invites her to wait in the “shaming room,” where “a middle-aged, male state Legislator” will be with her in a moment.
Meanwhile, Texas is expected to lose federal funding to its Medicaid Women’s Health Program which provides family planning and health screening services, because the state has moved to exclude Planned Parenthood from receiving any funding to provide those services.