There’s More To Women’s Health Than Contraception
If you have been listening to the contraception debate in Washington (sort of hard to avoid, isn’t it?), you may be under the impression that preventive health for women equals contraception. Or contraception equals women’s preventive health. (We’re putting aside, for the purpose of this post, the debate about religion, conscience and the role of government).
The Senate has defeated one bid to overturn the administration rule requiring employers to provide an insurance plan with first-dollar coverage of birth control, and it’s not clear what the House will do. But the issue is likely to percolate in Washington, state legislatures and the courts for some time to come.
The health reform law, and the regulations being developed to implement it, has a far more expansive definition of prevention and what it means for women’s health. Here are more details on the new regulations and a tutorial from Kaiser.edu. According to the new women’s preventive health rule, new health plans must cover, without cost-sharing, a lot more than the pill:
- well-woman visits;
- screening for gestational diabetes;
- human papillomavirus (HPV) DNA testing for women 30 years and older;
- sexually-transmitted infection counseling;
- human immunodeficiency virus (HIV) screening and counseling;
- FDA-approved contraception methods and contraceptive counseling;
- breastfeeding support, supplies, and counseling; and
- domestic violence screening and counseling.
These requirements will go into effect in August (with another year allowed to finalize how the religious exemptions will work). Grandfathered plans won’t have to follow the new rule, while they maintain their “grandfather” status. Over time, many health plans will go through changes that will mean that they will no longer be “grandfathered.” Then they too will have to follow the new regulations.
Of course, more women will get these benefits, simply because more women will be insured. Approximately one in five women of reproductive age is currently uninsured. Most of them will get coverage, including preventive services, starting in 2014 whether through Medicaid, through subsidized coverage in the exchanges or by buying coverage. Right now, coverage of maternity benefits is spotty on the individual insurance market, but the plans in the health exchanges will cover it.
The law also requires many other preventive services – some free – for men, women and children. They have not gotten much attention in the polarized birth control debate.
The conversation (and press coverage) about the contraceptive rules have included lots of misinformation about abortion. Politicians who misstate policy don’t help, but reporters need to know what the law does and does not do.
The health law does not mandate abortion coverage and this preventive health rule does not change that. In fact, states under health reform have the explicit ability to limit abortion coverage in policies sold in state exchanges and several have already taken action to do precisely that. Plans that do cover abortion in the exchange will have to wall that off in a way to keep it apart from the federal subsidies.
A few more stray but relevant facts:
According to the Kaiser.edu materials, about two-thirds of women aged 15 to 44 use contraception – and do so for about 30 years.
Most employer-based insurance plans do cover contraception, though there are often co-pays. Among large employers, more than 80 percent cover contraception.
Federal Medicaid dollars do not cover abortion under the Hyde Amendment (except for rape, incest or when the life of the mother is in danger) – although some states use their own money to cover abortion in some circumstances. But Medicaid does cover contraception. In fact, Medicaid pays for more than 70 percent of publicly financed family planning services.
And Title X funds family planning clinics (created in 1970 under the Nixon presidency). According to HHS, about 5 million women and men get family planning services through more than 4,500 community-based clinics. Someone with religious objections to providing contraceptives for employees is indirectly paying for Medicaid birth control coverage – and indirectly for the tax subsidies of employer-sponsored insurance – just as we all pay taxes that fund some things we agree with and some we don’t.
By: Joanne Kenen, Association of Health Care Journalists, March 1, 2012
“Republican Standard Bearer?: No Really, Rick Santorum Can’t Beat Barack Obama
I gave into temptation and checked out the comments page for my piece on the GOP’s “Ricksanity” that was published last week. The comments were so overwhelmingly negative toward my criticism of former Sen. Rick Santorum that I actually paused and considered that maybe I was wrong, and Rick Santorum does have the support needed to become the nominee.
Then, Rick Santorum did me a favor and made my case for me.
First, there was the wide coverage of his comments about “Satan” and subsequent refusal to back away from them. Voters want to hear what a candidate is going to do to solve the soaring gas prices, high unemployment, and the deficit. Rick Santorum chooses to talk about Satan engulfing the United States of America because of issues such as Title X allowing the federal government to fund contraception. That is the exact type of useless social rhetoric that hurts the Republican Party’s image with the electorate and its chances of being successful in the November elections.
Then we got to see what front-runner Rick Santorum looks like at the debate on Wednesday night. It is now clear that while former Senator Santorum is able to deliver passionate speeches and portray himself as the unyielding conservative, under scrutiny he is about as consistent as Sen. John Kerry’s stance on the Iraq war.
The Title X that former Santorum loathes so much? Turns out he voted for it. His excuse—he proposed a second federal spending program called Title XX to counteract Title X. So much for being a deficit hawk.
The federal takeover of education in No Child Left Behind? Turns out Rick Santorum voted for that as well in order to be a “team player.” So much for being a small government conservative.
Santorum’s stance on former Gov. Mitt Romney? He endorsed Romney in 2008 calling him a “true conservative.”
Throughout the debate Rick Santorum appeared angry, dismissive of the other candidates (especially Rep. Ron Paul who was hitting him the hardest), and not ready for the limelight of being the front-runner.
Bottom line: The debate was a nightmare for Rick Santorum. It provided another window into the reasons behind his double digit loss in Pennsylvania in 2006. It was also a useful preview of what an Obama-Santorum debate would be like—not a pretty picture for the GOP.
I have absolutely no personal ill will against former Senator Santorum; I think he is a good man, husband, and father. However, I am also convinced that he should not be the Republican standard bearer in November.
By: Boris Epshteyn, U. S. News and World Report, February 25, 2012
Mitt Romney And The GOP’s War On Birth Control
The night of the Florida Republican primary, Hotline National editor Josh Kraushaar (@HotlineJosh) Tweeted, “Romney line about religious liberty CLEAR reference to Obama health law on contraceptives. Sleeper issue in general.”
With the Colorado Republican caucuses on Tuesday, I can only respond, “Oh please oh please oh please.”
Here’s the real question: How much will former Gov. Mitt Romney and the Republican Party’s hostility to birth control cost them with voters, especially women voters, in the fall?
This is not about religion. This is about a Republican party actively campaigning against contraception, something that is enormously popular with the electorate. I would love nothing more than Mitt Romney going around the country telling voters he wants to take their birth control away, which he’s pretty much doing already. Seriously dude, bring it.
According to the Center for Disease Control, 99 percent of American women use birth control during their reproductive lifetime. According to a Reuters report on a Guttmacher Institute study, 98 percent of sexually active Catholic women use some form of birth control banned by the church. And a NPR/Thompson Reuters poll found that 77 percent of Americans favor insurance coverage for the birth control pill.
In swing state Colorado, there are approximately 114,000 more women voters than men, and they vote in higher percentages than men do. Personhood measures that would ban birth control have failed repeatedly by landslide margins, and the 2010 version probably cost Ken Buck a Senate seat. Personhood even failed in Mississippi, the most religious-conservative state in the country.
Meanwhile all the Republican candidates are actively campaigning against Title X and family planning funding. A plank in the Republican platform upholds the “life begins at conception” foundation of “personhood”, which would ban the most commonly-used forms of contraception such as the Pill and IUDs. Mitt Romney has repeatedly embraced “personhood”, most notably in 2005 when he vetoed a bill expanding access to emergency contraception for rape survivors “because it would terminate a living embryo after conception”.
For those of you, like Mitt Romney, unsure how birth control works and why “personhood” would ban it Rachel Maddow goes into the Man Cave to explain it all to you.
As for the Obama administration’s decision that Catholic institutions have a year to figure out how to include birth control in their insurance coverage under the Affordable Care Act, Rep. Xavier Becerra, a Catholic, explained it beautifully on Meet the Press: Religious employers, like any other business that offers insurance, can’t discriminate against women by excluding reproductive healthcare.
Anyone who doubts the power of contraception and women’s healthcare as an issue need only see the blowback against the Komen foundation by supporters of Planned Parenthood. I’ve been in politics for 20 years, and I’ve never seen a public fusillade like this one. Komen badly underestimated not only how many Americans have used Planned Parenthood’s services—1 in 5—but how many people support Planned Parenthood because they provide healthcare, including birth control, without judgment.
The pundit class piled on George Stephanopoulos for asking a question about contraception at the January ABC News debate. Apparently since it didn’t fit within the Cool Kids Acceptable Topics list, it wasn’t worth asking. And Romney fumbled the question badly, just as badly as he did the question on releasing his taxes. It was the rhetorical equivalent of strapping the dog kennel to the top of his car.
But it’s entirely worth asking for the millions of average American working families who get by on $50,000 a year and can’t afford to have another kid. It’s entirely relevant to millions of American women whose economic and physical well-being is dictated by when and if they get pregnant. Self-determining the size of your family is a baseline economic issue.
Mitt Romney and the Republicans are welcome to campaign against contraception all they want, because they are on the wrong side of that issue with voters by a landslide.
By: Laura Chapin, U. S. News and World Report, February 6, 2012
Government Shutdown Over Pap Smears: GOP Culture War Is Alive And Well
Last night Ryan Grim reported that the GOP may force a government shutdown largely over funding for Planned Parenthood under Title X:
At a late-night White House meeting between the president and key congressional leaders, House Speaker John Boehner (R-Ohio) made clear that his conference would not approve funding for the government if any money were allowed to flow to Planned Parenthood through legislation known as Title X. “This comes down to women’s health issues related to Title X,” a person in the meeting told HuffPost.
The negotiations are dominated by men: All of the principal negotiators in both parties are male, as are most of the senior staff involved. (House Democrats, led by Minority Leader Nancy Pelosi (Calif.), have largely been left out of key talks.)
House Republicans have been insisting the roadblock to cutting a new budget deal is not just the culture-war riders attached to the spending plan, but a source familiar with a top-level White House meeting earlier Thursday said most of the discussion in fact was about the riders.
The Hyde Amendment already prevents government funding for abortions, and abortions are a tiny part of the services Planned Parenthood provides.
The government is on the verge of being shut down because Republicans want to inset a provision into the budget that would prevent millions of women from getting contraception or cancer screening. This could be brinkmanship:Because the Republican base sees a shutdown as an end unto itself, the Republican leadership has a really strong political incentive to stretch this out as long as possible and cut a deal at the last minute. If this is the case, then culture war rhetoric serves as political cover for Republican leaders who want to cut a deal that might be hard to sell to the base.
In the past few weeks, we’ve been treated to a bevy of coverage insisting that Republicans have abandoned the culture war and are focusing on fiscal issues. Republicans like these stories because they make them look less extreme. But as Greg noted earlier today: “In its current form, at least, the budget debate is not meaningfully about fiscal matters. It’s over abortion, women’s health, and whether our environmental policies should be premised on climate science.”
What’s more, it’s not like pursuing the culture war and trying to defund the federal social safety net for women are mutually exclusive goals. In this case, they’re complimenting each other — when you’re trying to appease the Republican base, there isn’t a much better sweet spot intersection between the culture war and fiscal conservatism than women’s reproductive health.
By: Adam Serwer, The Washington Post, April 8, 2011
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