The Irony of Ironies via Republican Poison Pills

H.R. 2577 is a conglomeration of a number of bills (Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017) that  the Senate needs to take action on failed a super-majority vote (60 votes) for cloture (the ability to be considered and voted for/against on the Senate floor).  One version of that bill was passed by the House and a different version of that/those bills passed the Senate.  Thus, it’s now gone to conference committee to work out the wrinkles between the two versions.

This conference agreement now includes the Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2017, the Zika Response and Preparedness Appropriations Act, 2016, the Zika Vector Control Act, and an unacceptable ‘division’ on funds to be rescinded from programs the Republicans don’t particularly like.  That’s what came to the floor for a cloture vote, and it failed miserably — 52-48.

Really, Senator McConnell?  It’s too difficult for the general public to understand?  I don’t think so.

It’s one thing for Republicans to short-change President Obama’s funding request.  It’s another thing to start attaching ‘poison pills’ to the proposed legislation that limit or outright prohibit women’s choices.  When you introduce a funding proposal that limits the distribution of contraceptives and that prevents family planning organizations like Planned Parenthood from participating in the effort to help women in Zika-affected areas delay pregnancy, from a disease that not just contracted from a mosquito bite, but from sexual activity with an infected male partner, did you really think that Senate Democrats would just roll over and vote for that?

When you start gutting provisions of the Federal Water Pollution Control Act, did you honestly believe that Democrats would just roll over and just vote for that?

SEC. 2. MOSQUITO CONTROL WAIVER.
Notwithstanding section 402 of the Federal Water Pollution Control Act (33 U.S.C. 1342), during the 180 day period following the date of enactment of this Act the Administrator of the United States Environmental Protection Agency (or a State, in the case of a permit program approved under subsection (b)) shall not require a permit for a discharge from the application by an entity authorized under State or local law, such as a vector control district, of a pesticide in compliance with all relevant requirements of the Federal Insecticide, Fungicide, and Rodenticide Act (7 U.S.C. 136 et seq.) to control mosquitos or mosquito larvae for the prevention or control of the Zika virus.

When you start stripping funding for the Patient Protection and Affordable Care Act (Obamacare), did you really expect Democrats to just roll over, see the light and vote your way?  Or, when you decide to fund your bill by stripping balances  from the Departments of Labor, Health and Human Services, and Education, did you really expect Democrats to go “oh yeah, that’s a great idea” and vote in favor of your bill?  Or better yet, given that we already know that you stripped a bunch of funding from the State Department for Embassy security that might have made the outcome in Benghazi drastically different, did you really expect the Senate Democrats to let you strip even more funding for the State Department and other Foreign Operations?

Are you nuts?  They certainly weren’t and neither am I.  It took me hours to sort through all the links on Congress.gov, but here’s what I found:

DIVISION D–RESCISSIONS OF FUNDS

Sec. 101.
(a) $543,000,000 of the unobligated amounts made available under section 1323(c)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18043(c)(1)) is rescinded immediately upon enactment of this Act.

Sec. 1323. Community health insurance option. Requires the Secretary to offer a Community Health Insurance Option as a qualified health plan through Exchanges. Allows States to enact a law to opt out of offering the option. Requires the option to cover only essential health benefits; States may require additional benefits, but must defray their cost. Requires the Secretary to set geographically adjusted premium rates that cover expected costs. Requires the Secretary to negotiate provider reimbursement rates, but they must not be higher than average rates paid by private qualified health plans. Subjects the option to State and Federal solvency standards and to State consumer protection laws. Establishes a Start-Up Fund to provide loans for initial operations, to be repaid with interest within 10 years. Authorizes the Secretary to contract with nonprofits for the administration of the option.

(b) $100,000,000 of the unobligated balances available in the Nonrecurring expenses fund established in section 223 of division G of Public Law 110-161 (42 U.S.C. 3514a) from any fiscal year is rescinded immediately upon enactment of this Act.

DIVISION G–DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2008
Title I–Department of Labor
Title II–Department of Health and Human Services
Title III–Department of Education
Title IV–Related Agencies
Title V–General Provisions
Title VI–National Commission on Children and Disasters

(c) $107,000,000 of the unobligated balances of appropriations made available under the heading Bilateral Economic Assistance, Funds Appropriated to the President, Economic Support Fund in title IX of the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2015 (division J of Public Law 113-235) is rescinded immediately upon enactment of this Act: Provided, That such amounts are designated by the Congress as an emergency requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control Act of 1985.

Personally, I side with Senate Minority Leader Harry Reid who declared, “It is unbelievable that somebody would have the audacity to come to the floor and say it’s Democrats’ fault. A significant amount of American women, especially young women, go to Planned Parenthood, and the Republicans want to say, ‘you can’t do that.’” Why indeed would Democrats not just prohibit Planned Parenthood from providing any services, but gut the EPA’s ability to assure clean water and harm HHS’s ability to manage health insurance options for not just Puerto Ricans, but millions of American families across our nation?  Apparently Sen. McConnell completely missed the irony of claiming to improve women’s health by prohibiting and defunding health opportunities for women altogether.


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A Bishop In The Exam Room: When Faith Dictates Health Care Instead Of Science

A number of folks in Humboldt County have expressed complaints about our local hospital, but they should be thankful for the secular hospital we have available to serve our population. Given the merger-mania in corporate America, we could be facing, like so many other communities, a takeover of our hospital by Catholic Hospitals of America and the imposition of OBGYN-lite policies, restricting the availability of reproductive healthcare services to women throughout the hospital’s service area.

Here’s a post an article from ThinkProgress that will walk you through how religious institutions are imposing their religious beliefs on women through the limited care they’re willing to provide, essentially elevating their religious rights at the expense of any patient’s rights.


CREDIT: DYLAN PETROHILOS
CREDIT: DYLAN PETROHILOS

— by Erica Helerstein and Josh Israel

When Rita, a Michigan-based OB-GYN, learned that the hospital where she worked would be switching hands, she was dismayed.

The secular community hospital, Crittenton, had plans to join with Ascension Health, a prominent Catholic nonprofit hospital chain. Rita, who asked that her real name be withheld to protect her identity, knew the transition would profoundly impact her ability to do her job the way she saw fit. The OB-GYN specifically wanted to work at a place where she could practice the full scope of reproductive care, from preventing pregnancy to delivering babies. But now, with the hospital merger looming in the not-so-distant future, that possibility seemed increasingly unlikely.

Rita also understood the change in leadership meant that her patients’ medical options would be limited. That’s because Catholic hospitals follow a set of rules written by the U.S. Conference of Catholic Bishops, which often prohibit doctors from performing basic reproductive services — like contraception, sterilization, in vitro fertilization, abortion — and end-of-life care.

Although Rita knew certain services at the hospital would soon be banned, many of her patients had no idea. They also may not have known that mergers like Crittenton’s are becoming increasingly common.

As hospitals throughout the country struggle with financial woes, many have begun to merge with Catholic systems in order to stay in business. This means a growing number of patients are winding up in institutions guided by religious doctrine. Between 2001 and 2016, the number of hospitals affiliated with the Catholic Church increased by 22 percent. Today, one in six patients in the U.S. is cared for at a Catholic hospital — a troubling trend for health care providers like Rita, who worry that patients are increasingly being placed in centers that provide services based on faith rather than medical necessity.

“I do think as more places are being purchased by Catholic systems it’s going to become more of a problem,” she told ThinkProgress. “To take away the ability to provide services that people need or desire… I think it’s very upsetting both for an OB-GYN and also for a woman. Having those choices gives you the ability to participate in society.”

Rita found another job before the Catholic system moved in. Although she says her decision to leave Crittenton was based on other factors, she admits she probably would have sought employment elsewhere even if those reasons hadn’t come up. Before Rita departed from the hospital, though, she warned her patients about what was to come — and encouraged them to get their tubes tied before it was too late.

As Rita was advising her patients to move forward with their procedures, organizers with the American Civil Liberties Union of Michigan were trying to gin up support for a campaign opposing the Crittenton merger. In June, they arranged an event at a public library in a nearby town to talk about what the shift in leadership would mean for community members. But only six people showed up. “It was so hard for us to connect to anyone who cared,” said Merissa Kovach, a field organizer in charge of the campaign.

The struggle to engage people who could be directly impacted by Crittenton’s transition might not be entirely surprising given the demographic makeup of Rochester, which is predominantly white, conservative-leaning, and upper-middle class. But it suggests another problem that Kovach and others have been struggling to address: A widespread lack of awareness about a conflict that’s quietly brewing in the health care industry. It’s a trend that has managed to accelerate rapidly and yet evade public scrutiny. Because Catholic hospitals aren’t required to disclose their religious affiliation or talk about the limited medical services they may offer, many patients wind up in the dark — and don’t think about the hierarchies that govern their care until it’s too late.

In Rochester, for example, the two systems merged without much of a fuss. But just a few days after Ascension took over the hospital in October 2015, its official website changed ever so slightly. “Tubal ligations” were removed from the list of available services.

CatholicHospitalData-before-after6

The role of Catholics in health care is nothing new — indeed, throughout the Middle Ages, it was the Catholic Church that created hospitals and hospices for the old and ill in an attempt to follow Jesus’ teachings about healing the sick. Many of the earliest hospitals in America were set up by Ursuline sisters and other Catholic orders dedicated to serving the poor. About 75 Catholic hospitals had been established in the U.S. by 1875.

But there has been a particular boom in the number of Catholic hospitals since the beginning of the 21st century, according to a groundbreaking 2013 report on the growth of Catholic hospitals and health systems by MergerWatch, a patients’ rights organization that tracks hospital mergers, and the American Civil Liberties Union (ACLU). In 2001, about 8.2 percent of the nation’s acute care hospitals were Catholic nonprofits. By 2011, that number had jumped to 10.1 percent. This increase coincided with notable drops in the numbers of other nonprofit hospitals and public hospitals.

This trend is accelerating among all hospital chains, too, and not just nonprofits. A recently released 2016 update found that 14.5 percent of all acute care hospitals are now Catholic-owned or affiliated (up from 11.2 percent in 2001) and that four of the nation’s 10 largest hospital systems are Catholic-sponsored. Some of the growth is the result of new Catholic hospitals opening their doors — but many were the result of secular hospitals merging with Catholic systems, bringing them under the Catholic hospitals umbrella.

But while Lois Uttley, MergerWatch’s director, believes Catholic hospitals do deliver “excellent care” in many treatment areas, she and her group are working to shine a light on a major exception. They believe Catholic hospitals prevent many women from getting the reproductive health care they need — even procedures that are medically necessary — ultimately putting them in an untenable situation once they walk through the doors of one of these religious facilities.

Once a hospital elects to merge with the Catholic system, it agrees to obey a set of directives issued by the U.S. Conference of Catholic Bishops. Called the “Ethical and Religious Directives for Catholic Health Care Services” (ERDs), these rules include instructions that Catholic care “should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination: the poor; the uninsured and the underinsured; children and the unborn; single parents; the elderly; those with incurable diseases and chemical dependencies; racial minorities; immigrants and refugees.”

Although these large Catholic hospital systems operate in accordance with religious values and doctrine, they aren’t directly funded or controlled by the Catholic Church. As Uttley put it, “they are not being funded by the envelope my mother used to put in the collection basket every Sunday.”

Instead, as tax-exempt nonprofit corporations, they are funded through a combination of private insurance reimbursement, Medicare and Medicaid payments, and sometimes government grants, according to Uttley.

By bringing many hospitals together into large Catholic health systems, they can cut costs through shared administration and joint purchasing, offering protection to hospitals in rural states where isolated health care facilities often struggle. “It’s to their credit, they’ve kept these hospitals operating in very challenging times,” she said.

CatholicHospitalData-01v4
CREDIT: DYLAN PETROHILOS

But the directives also include prohibitions on abortion, even when a woman’s health is at risk; assistance with surrogacy; egg and sperm donation; contraception; and temporary or permanent sterilization, with few — if any — exceptions. And the condoning of or participation in euthanasia or assisted suicide “in any way” is expressly verboten for all who work at a Catholic health care institution. MergerWatch, the ACLU, and the handful of other organizations that track this issue believe these directives often mean even procedures needed to mitigate serious health risk to the patient are unavailable at a Catholic hospital.

The groups also pointed to a troubling lack of transparency: Because Catholic hospitals often choose not to disclose which services are not offered, patients don’t always realize they operate any differently from a secular institution.

Proponents of the Catholic hospital system say the distinction should already be obvious to patients given the facilities’ religious presentation. As the attorney for one Catholic hospital in California that refuses to perform tubal ligation argued in a lawsuit earlier this year, “no one is lacking for understanding that this is a Catholic hospital, from the crucifix in the front entrance to everything about it.”

But that’s not necessarily how providers see it. Nancy, a physician who provided services at Rochester’s Crittenton before the merger and continues to do so today, said the now-Catholic hospital is presented to the public as a secular institution with no disclosure of its restrictions. “I think it is incredibly difficult to understand what limits we have available,” said Nancy, who asked that her real name be withheld because she is still practicing in the field, noting that the names of Catholic hospitals don’t always reveal their religious affiliation. “It’s not Saint Crittenton. It’s not Mary of Christ Crittenton. It’s just Crittenton.”

Ascension and Crittenton did not respond to a ThinkProgress inquiry about their practices. A spokesperson for the Catholic Health Association, which represents hundreds of Catholic hospitals and facilities nationwide, said his group “encourages transparency from Catholic hospitals regarding the services they do and do not offer.”

But Brigitte Amiri, senior staff attorney for the ACLU’s Reproductive Freedom Project, says in practice, that transparency is often absent — putting patients in potentially perilous situations when they’re in urgent need of care.

“The hospital closest to you might be Catholic, you might not know it, you might not think to ask these questions until [you’re facing] an emergency situation or far along in a pregnancy,” she said.

Rachel Miller found herself in that exact situation when she was a patient at Mercy hospital in Redding, California in 2015. Miller, who was pregnant with her second child, was certain she didn’t want to have more kids: In 2013, she had an emergency C-section for her first daughter, and knew she would have to repeat the procedure for the birth of her second child. After she discussed her options with her OB-GYN, she decided a tubal ligation made the most sense — she could get it right after delivering her baby and it wouldn’t require an additional hospitalization.

Miller sent a request to Mercy for the procedure, and assumed it would be approved. Instead, she received a letter back stating Mercy would be unable to accommodate her, citing the Catholic bishops’ directives.

Miller had never heard of the directives before — in fact, she had no idea that the standard of care at Mercy would be any different than what was available at a secular hospital. “I guess if someone had asked me at the time, ‘is this a Catholic hospital?’ I would have said yes, because it’s Mercy, normally a Mercy hospital is Catholic,” she told ThinkProgress. “But I had never thought about it. And as far as Catholic hospitals in general and having ERDs, I had never thought about that either.”

Miller was sure she wanted to get her tubes tied, but after Mercy’s rejection, she found that her options were limited. Redding has only one hospital with a labor and delivery department and the nearest hospital Miller could find that took her insurance was some 160 miles away. That was out of the question — Miller knew she would have to stay at the hospital for several days, and she didn’t want to be away from her toddler for that long. Mercy — the largest hospital provider in California — was her only option, and they just wouldn’t budge.

That was especially concerning to Elizabeth Gill, an attorney at the ACLU of Northern California who later took up Miller’s case. “It’s troubling that your access to health care in such a significant degree in a state like California is dictated by the moral code that corporations subscribe to, especially given that these are entities that are largely state and federally funded,” she said.

The predicament Miller found herself in is becoming increasingly common.

For many patients, Catholic hospitals are now so ubiquitous they may be the closest or only option for care. According to MergerWatch’s most recent report, more than 40 percent of the acute care beds in Alaska, Iowa, Wisconsin, Washington, and South Dakota are in Catholic-owned or affiliated hospitals, and more than 45 Catholic hospitals in the country provide the only acute care in their geographic region. Naturally, this impacts the services available to patients. As Miller experienced, the bishops’ guidelines often prevent doctors from performing tubal ligations after patients deliver, which is the safest time for the procedure.

Moreover, as the National Women’s Law Center noted in a complaint to the Centers for Medicare and Medicaid Services, many Catholic hospitals don’t follow the medical standards of care for what’s known as “miscarriage management,” often by denying services to women experiencing pregnancy complications before viability or in the middle of a miscarriage.

Tamesha Means was 18 weeks pregnant when she showed up at a Mercy hospital in Michigan in December 2010. Her water had broken prematurely. Hospital staff examined Means, but neglected to tell her that the fetus she was carrying had virtually no chance of survival — and in fact posed a risk to her health if she continued to carry it. Means was sent home, but she returned the next day as her bleeding and cramps intensified. Again, she was instructed to go home. Means returned for a third time that night — visibly in pain and showing signs of an infection. The hospital prepared to send her home once again, but stopped when she started delivering. The baby died shortly thereafter, and the hospital staff told Means to prepare funeral arrangements.

The ACLU took on the case, arguing that the directives prevented hospital staff from informing Means of the risk of the pregnancy and directly placed her in harm’s way. “Because of the Directives, MHP did not inform Ms. Means that, due to her condition, the fetus she was carrying had virtually no chance of surviving, and continuing her pregnancy would pose a serious risk to her health,” the lawsuit claimed. As a result, “Ms. Means suffered severe, unnecessary, and foreseeable physical and emotional pain.”
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CatholicHospitalData-02v2
CREDIT: DYLAN PETROHILOS/SHUTTERSTOCK

The restrictions on care don’t present a burden for patients alone — working within the system can also weigh heavily on providers who are prevented from performing the full range of medical care they expected to practice as an OB-GYN. According to a 2012 national survey, more than 50 percent of OB-GYNs who work at Catholic hospitals said they’ve run into conflicts with their institutions over the directives. Dr. Didi Saint Louis, a physician in the Southeast who completed her medical residency at a Catholic hospital, is familiar with that tension herself. She remembered seeing a patient who fell extremely ill at an early stage in a nonviable pregnancy. Saint Louis was prohibited from terminating the pregnancy — even though the fetus would not survive — and ended up transferring the patient to another hospital.

“I remember our director riding in the ambulance with the patient, she went straight to the operating room, they terminated the pregnancy, and she was fine,” she recalled. “But it could have gone so many different ways. And while the Catholic hospitals strive to give the best standard of care, this is one area where I think they fall short.”

The impact of a hospital merger can be much more profound for people living in geographically isolated regions without easily accessible alternatives. According to MergerWatch, there are 46 hospitals nationally that provide the only short-term acute care for people in their region, leaving people who lack transportation and travel resources with few alternative options.

Nancy, the physician from Michigan who works with Ascension, says she’s fortunate to be in a region with more than one hospital. “I’m in an area in which my patients can commute or get to a different location, so people in more remote areas are stuck without that,” she said. “Which is a really disturbing trend.”

About 2,000 miles west of Rochester, a Catholic hospital merger brought a very different outcome. In Washington, a battle was waged over the fate of Vashon Island’s only health clinic. Vashon, a quirky island community near Seattle, is home to about 11,000 people, 45 miles of shoreline, and an unofficial mayor who was re-elected in 2015 over a goat named Bandit. It is a Democratic bastion: Mitt Romney received a mere 18.6 percent of the vote in the 2012 elections, to Barack Obama’s 77.6 percent.

In 2012, Mark Benedum, the CEO of the island’s health clinic, announced the board had decided that, due to financial struggles, the time had come “to explore the benefits of joining a larger system.” It reached an agreement to become an affiliate of Franciscan Health System, a chain of Catholic health facilities and part of the behemoth Catholic Health Initiatives.

Benedum initially claimed patients’ options would be unaffected by this union, insisting, “it’s not going to change a thing.”

Vashon’s residents weren’t so sure. A group of skeptics, calling itself Vashon HealthWatch, worried that the island’s sole clinic would now be forced to adhere to the bishops’ directives — and that their care would be limited as a result. After consulting with MergerWatch, they organized a massive town hall meeting where members of the community could question Franciscan and Highline leadership.

On April 25, 2013, weeks after the Franciscan’s purchase of the clinic was complete, about two hundred people packed the multipurpose room at one of the the island’s schools, according to Kate Hunter, who helped organized the event. It was a far cry from the sparsely attended event that took place in Michigan. And not only did people show up, but they’d read the directives and were prepared with specific questions.

Benedum and executives from Franciscan Health Services were peppered with two hours of anxious inquiries from community members about the merger’s impact on available reproductive health and end-of-life services.

Margaret Chen, a staff attorney with the ACLU of Washington Foundation, said this level of civic engagement is atypical. “The visibility of concerned citizens was large in the Vashon Island community, maybe in part because of the unique situation [of being so separated from other options].” This response, she suggested, might have been part of the reason the new ownership agreed to continue offering birth control, family planning, and contraception to patients on the island — though a company spokesperson said the directives are “consistently applied” across all of its facilities.

While the executives sought to assure residents that “nothing is going to change at the Vashon medical clinic,” Hunter wasn’t convinced. She recalled one particularly concerning exchange toward the end of the forum: “Does your contract with your doctors specify that they will follow the directives?” a resident asked. “Yes, they do,” the Franciscan representative answered. “Our employment contract does.”

John Jenkel, who is part of the Vashon-Maury Health Collaborative, a community group that works to improve emergency care options on the island, said the relationship between the new ownership and residents was scarred by that early tension. “[T]hose directives and the manner in which the Franciscans communicated with the community caused a rift that never really made for a comfortable working relationship on our small island,” he said. “The initial discussion that the Franciscans had with the community was a rocky one, and the relationship of the directives to the type of care the Franciscans would be providing was never too clear.”

Hunter stopped going to the Vashon clinic. “I just feel so strongly that no one’s religious beliefs should interfere with my health care and I had no confidence that that would not be the case at the clinic anymore,” she said. Instead, she travels to a secular nonprofit facility in Seattle, via ferry and bus — a 60- to 90-minute trip each way.

When ThinkProgress reached out to Franciscan for comment, spokesperson Scott Thompson said that “none of the practice’s women’s reproductive services changed at the clinic after Highline’s affiliation with CHI Franciscan Health.” However, he added that the Vashon Island clinic would be closing in August. The company attributed the decision to the cost of operating the clinic and the fact that visits had declined from about 1,000 a month when they took it over to between 750 and 850 a month today.

Kate Hunter laments that with the closing, “there will be no health care clinic on Vashon Island. We’re back to ground zero.”

The bishops’ directives were last updated in 2009 and, according to observers, are due to be revised again in the near future. Reproductive rights advocates say a revision could loosen restrictions on how hospitals that become Catholic through mergers may deal with reproductive decisions — or could put the kibosh on the limited flexibility that Catholic chains have shown in places like Vashon Island.

Sara Hutchinson Ratcliffe, domestic program director for Catholics for Choice, fears it will be the latter. “I think the upcoming regulations are going to close those avenues for alternative provision for those health care services, to make the partnership agreements even more strict on who must/must not do this or that,” she said. “I think it will make it worse.”

MergerWatch’s Lois Uttley is a bit more optimistic. “We hope that they will be realistic about the fact that, in this day and age, Catholic hospitals are serving everyone in the community, not just Catholics. And they are employing doctors and staff that come from a wide background of religious affiliation,” she said. “We hope there will be a recognition that all hospitals, including Catholic ones, are licensed to serve the whole community.”

The press office for the U.S. Conference of Catholic Bishops did not respond to a ThinkProgress inquiry about their timetable for an update. But when and if the directives are updated, they could make a huge difference in terms of whether doctors at hospitals that merge with Catholic hospital system.

In the meantime, several approaches have been contemplated for how to address the topic.

The Center for Inquiry, which advocates for a secular society, thinks that the Medicare and Medicaid funding Catholic hospitals receive could be used as leverage to force Catholic hospitals to provide a full range of reproductive health and end-of-life care. Michael De Dora, who heads the Center’s Office of Public Policy, explained that while he does not believe all individual doctors should be forced to engage in all health care services, all hospitals should. “The responsibility should be with the hospital in any case [if] they’re receiving public funds,” he said. “That is the ideal.”

The ACLU’s Brigitte Amiri noted that some — though not many — states have considered legislation that would shield doctors from punishment, should they choose to provide services forbidden under the directives. After non-discrimination laws and same-sex marriage equality were enacted, several Catholic Charities organizations shelved adoption services rather than serve same-sex couples.

Thus far, the ACLU has concentrated its efforts on the judicial system, threatening and bringing lawsuits under the federal Emergency Medical Treatment and Active Labor Act and state medical laws. Two suits were dismissed at the trial court level, though both are being appealed, and others are still working their way through the courts. In April, for the first time, the 41,000 doctors of the California Medical Association announced they would join an ACLU of Northern California case against a Catholic hospital system that bars its doctors from performing tubal ligation.

Since these and other attempts to force Catholic hospitals to provide services have not yet been met with much success, some activists have focused on making the rules more transparent.

Washington state enacted a requirement that hospitals generally disclose what services they refuse to provide to the state government — which would become public record — but MergerWatch’s advocacy coordinator, Christine Khaikin, observed even that “leaves a lot of room for interpretation to the hospital system,” and few hospitals have reported much of anything.

model-patiens
CREDIT: AMERICAN ATHEISTS

The American Atheists, a group that advocates for a strict separation of government and religion, have circulated a piece of model state legislation called the Patient’s Right to Know Act. The organization’s national legal and public policy director Amanda Knief said it would simply require that providers “inform their patients up front of all services they’re not going to provide, according to their religious, philosophical beliefs.” This “sunshine law” would not require hospitals to provide an explanation or a referral, she added, but simply a disclosure of which services are not provided there “because we’re Catholic affiliated, or we’re Pastafarian affiliated, or we don’t believe in modern medicine.”

The bill has been introduced in Arizona, and Knief is hopeful other states will soon follow. But, she acknowledges, it may have trouble gaining momentum — some progressive groups have been reluctant to back the measure because it lacks a requirement that the hospital refer the patient to a place that performs procedures prohibited by the directives.

In some communities, MergerWatch has partnered with local advocates to utilize state hospital merger laws and galvanize public actions to force accommodations or block the mergers entirely. “Frankly, totally stopping the merger is our fallback position,” Lois Uttley explained. “What we try to do, from the outset, is make sure that community access to needed reproductive health care services is preserved in some way.” She pointed to one case in which a separately funded and staffed reproductive health care center was opened on the second floor of a newly Catholic hospital that could no longer provide all services under the directives. In another, the community got a local hospital to call off its plans to affiliate with a Catholic system.

But, like with Crittenton Hospital in Michigan, these mergers often fly under the radar. Because the hospitals themselves do not highlight that they are going to begin restricting services, MergerWatch, the ACLU, and a small number of other organizations are often the only early-warning system for communities. And, as Sara Hutchison Ratcliffe of Catholics for Choice pointed out, until more people understand what these mergers mean, it can be an uphill battle for them to galvanize community resistance.

“Awareness isn’t the only solution, but it is the first step,” she said. “Until they are aware, the likelihood of something happening is small… The first step is getting those who have the power to change it involved.”

The fate that awaits Rochester, Vashon, and the numerous other communities that have recently experienced hospital mergers is uncertain. Indeed, some may choose to go the path of resistance favored by Washington’s quirky island community, organizing themselves and arranging well-attended town hall meetings. But, as Merissa Kovach and her coworkers at the ACLU of Michigan experienced while organizing their campaign, getting that community buy-in is often an uphill battle.

“One of the biggest issues with this is that it’s just not well-known at all and nobody understands what these hospitals are doing,” Kovach said. “We’re in such a public education step with this, and it’s such an unknown issue. People don’t know why they should care.”

But why did they seem to know and care in the Washington island? At least some portion of the differences between the two community responses can likely be drawn along political lines — Vashon overwhelmingly leans left, Rochester tilts right. But what took place in the Michigan city might be the more standard course of events: A merger takes place in a community that isn’t predisposed to fight it — or isn’t even aware that it might impact the care they expect to receive — and, as was the case with Rochester, a new merger quietly goes into effect. And the cumulative impact of these mergers, critics say, is an overall reduction in available reproductive services.

CatholicHospitalData-03
CREDIT: DYLAN PETROHILOS

So what are the alternatives to Catholic medical care? In some rural communities, there aren’t any — it’s a Catholic system or nothing at all. That’s a sobering reality for people on all sides of the debate, including reproductive health advocates. They recognize that a singular focus on the expansion of the Catholic health care system ignores the forces that often propelled them to step in in the first place. Public hospitals are struggling, and their Catholic counterparts can provide much-needed care. According to the most recent MergerWatch report, the number of public short-term acute care hospitals in the U.S. dropped an astonishing 34 percent between 2001 and 2016. The number of secular nonprofit hospitals, too, shrunk by 11 percent, while for-profit systems shot up by more than 50 percent. In rural areas, where it is harder to turn a profit, these trends have left tremendous disparities in health care access.

Catholic hospitals help fill some of that gap — but at what cost? The ACLU’s Brigitte Amiri worries that hospitals’ fealty to the directives over the standard of care means that for some, the delta between the services they seek and those that are available is becoming a gulf.

“We don’t want to take away health care services from a community that desperately needs them,” she acknowledged. “But I don’t think we can be so timid about our work that we don’t push them to provide health and lifesaving care to women.”

Kiley Kroh and Tara Culp-Ressler edited this piece. Cory Herro provided research assistance. Videos by Victoria Fleischer, graphics by Dylan Petrohilos, and illustrations by Laurel Raymond.


This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe. ‘Like’ CAP Action on Facebook and ‘follow’ us on Twitter

With Women and Doctors in Danger, House GOP Called upon to End Their ‘Witch Hunt’

‘We disgrace ourselves by allowing this misconduct to continue,’ 178 House Democrats say in letter to Speaker Paul Ryan

by Deirdre Fulton, staff writer

24abortionweb-master675_0
The Democrats’ letter says the panel’s chair, Rep. Marsha Blackburn (R-Tx.) “has used her unilateral subpoena power to intimidate scientific researchers, doctors, clinics, health care providers, universities, and other entities.” (Photo: Manuel Balce Ceneta/Associated Press)

Backed by key women’s health and civil liberties groups, 178 House Democrats on Tuesday sent a letter to Republican Speaker Paul Ryan demanding he disband an anti-choice investigative panel that has been issuing subpoenas to abortion providers and medical researchers around the country.

The so-called “Select Investigative Panel on Infant Lives” was created to look into fetal tissue research in the wake of last summer’s video smear campaign by anti-abortion activists that purported to show Planned Parenthood officials admitting to selling fetal body parts. In January, a grand jury empaneled to investigate those charges indicted the anti-abortion activists for fraud instead.

Women’s health and academic freedom advocates have long warned that the panel could have a chilling effect on both the provision of healthcare and university research.

But the panel’s “pattern of reckless disregard” has only escalated, according to House Democrats, with Republican members sending 36 subpoenas to researchers and healthcare providers, including a physician who was recently identified by name.

“From the beginning, Chair Marsha Blackburn has used her unilateral subpoena power to intimidate scientific researchers, doctors, clinics, health care providers, universities, and other entities,” reads the letter, which asks Ryan to respond in writing no later than June 6, 2016.

“On May 11, 2016, the majority reached a new low when it posted a press release identifying a doctor and his clinic by name,” the letter continues. “The press release’s hyperbolic rhetoric and misleading allegations pose a real danger to the doctor, the staff at the clinic, and the patients of the named clinic. These recent steps are completely outside the bounds of acceptable Congressional behavior. We disgrace ourselves by allowing this misconduct to continue.”

Indeed, the signatories—who include Reps. Keith Ellison (MN), Donna Edwards (MD), Ruben Gallego (AZ), Eddie Bernice Johnson (TX), Barbara Lee (CA), and Maxine Waters (CA)—declare:

The most recent subpoenas are only the latest in a series of aggressive tactics that constitute a virtually unprecedented abuse of Congressional power, perhaps only matched by the McCarthy hearings of the 1950s. To this day, the Panel still lacks credible evidence to support its case that any federal laws were broken. Yet the Chair and majority staff continue to harass individuals, researchers, clinics, and health care facilities, issuing a total of 36 subpoenas so far, often without reaching out to the subject of the subpoena to ask for voluntary compliance first or without giving subjects sufficient time to comply. Congress simply has no business “prosecuting” these unfounded allegations.

The danger posed by the Panel is real and serious. There is a long and undeniable history of violence against women’s health care clinics, physicians, and patients. As recently as November 27, 2015, a gunman murdered three people and injured nine others at a Planned Parenthood clinic in Colorado Springs, repeating the “baby parts” rhetoric pushed by the very members of Congress leading this investigation. Despite this horrific event, the same inflammatory language has been used repeatedly during Panel hearings, in communications with the press, and in other documents. The majority has also refused to take necessary steps to protect the names and privacy of those subject to the investigation. Indeed, some names and targets have already been publicly disclosed. We are deeply disappointed by the majority’s decision to continue down this road despite these well-known risks.

In a statement on Tuesday, the ACLU expressed support for the Democrats’ call.

“By issuing broad and baseless subpoenas,” said Louise Melling, the ACLU’s deputy legal director, “the Select Investigative Panel is not only wasting time and taxpayer money, but also violating the civil liberties of health care providers, medical researchers, and staff. This panel’s actions are clearly meant to harass and intimidate healthcare providers to prevent them from providing constitutionally protected care women need.”

And there are even more insidious goals in play, said Ilyse Hogue, president of NARAL Pro-Choice America.

“By promoting falsehoods in order to close clinics, the Select Panel has been endangering women, students, researchers, and health care providers since it was formed,” Hogue said in a statement on Tuesday. “House Democrats are right to call on Speaker Ryan to disband this committee and put a stop to its taxpayer-funded witch hunt.”

The panel and its actions, she said, offer “one more example of the anti-choice GOP’s reckless disregard for safety of women and the priorities of most Americans.”


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How Anti-Choice Groups Push Message “Directly Into Women’s Phones”

New investigation by Rewire finds that ‘pregnancy crisis centers’ use geofencing to target women seeking abortions

by Nadia Prupis, staff writer

phones_1
It’s a tactic that presents serious threats to women’s safety and privacy, as well as that of abortion providers and their staff, experts say. (Photo: Toshihiro Gamo/flickr/cc)

Anti-choice groups are using smartphone location tracking technology known as geofencing to target women seeking abortions with advertisements intended to mislead and intimidate, a new investigation by Rewire has revealed.

It’s a tactic that presents serious threats to women’s safety and privacy, as well as that of abortion providers and their staff—particularly as the technology allows anti-choice activists to target those they think will be most susceptible to their message.

“Far too many women already know the fear and intimidation of walking past protesters who are shouting and holding graphic posters outside an abortion clinic,” said Rewire‘s vice president of investigations and research Sharona Coutts, who authored the piece.

“This technology could provide those same protesters the opportunity to push their messages directly into women’s phones. It could even represent a physical threat, as once anti-choice organizations have a woman’s unique phone information, they can sell it to others, or use it to learn her name and address,” Coutts said.

The pioneer of the technology is marketing executive John Flynn, CEO of Copley Advertising, who developed the idea of using geofencing to target abortion seekers with anti-choice propaganda and pitched the plan to the pregnancy crisis center network RealOptions and the country’s largest evangelical adoption group, Bethany Christian Services.

Both organizations now use the technology, which allows them to send propaganda to women’s phones while they are in clinic waiting rooms.

Due to inadequate privacy laws in the U.S., these methods are legal. Rewire reports:

In terms of federal laws, many either don’t apply to Flynn’s conduct, or would allow it, according to Chris Hoofnagle, a professor at the University of California, Berkeley’s School of Law, and School of Information.

“Privacy law in the U.S. is technology- and context-dependent,” Hoofnagle said. “As an example, the medical information you relay to your physician is very highly protected, but if you go to a medical website and search for ‘HIV’ or ‘abortion,’ that information is not protected at all.”

In other words, it’s almost certain that the Health Insurance Portability and Accountability Act, known as HIPAA, would not apply.

Meanwhile, agencies like the Federal Trade Commission (FTC) have no jurisdiction over nonprofits, while laws concerning user consent for apps that want to access their data and location are not enough to protect consumers. The only rule is that companies don’t lie about what information they are collecting—even if the truth is buried in the fine print,Rewire writes.

Cooper Quintin, a technologist at the digital rights group Electronic Frontier Foundation, told Rewire that “the way we need to fight back against this is by blocking these things that are tracking who we are and where we are and what we’re looking at.”

“Tracking people and building up these databases of what they read online, where they go in the real world, linking their online behaviors to their offline purchases and real world behavior—these things can have real-world effects,” Quintin said, “and this is a horrific example of how this can affect people in a way that’s much more important than seeing some annoying or creepy ads that follow you around.”


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New ‘Pro-Life’ Law Could Literally Kill Utah Women Who Attempt To Obtain An Abortion

— by Ian Millhiser  

CREDIT: AP PHOTO/ALEX WASHBURN
CREDIT: AP PHOTO/ALEX WASHBURN

A new Utah law will subject women to medically unnecessary risk in order to ward off a problem that almost certainly does not exist. It makes a significant new incursion on what remains of Roe v. Wade — at a time when the Supreme Court is signaling that anti-abortion state lawmakers have moved too far. And it will likely either drive up the cost of abortions or cause many clinics to stop performing certain kinds of abortion because they will need to recruit new specialist physicians in order to continue serving all women.

The law, colorfully labeled the “Protecting Unborn Children Amendments,” requires abortion providers who perform “an abortion of an unborn child who is at least 20 weeks gestational age” to administer an anesthetic or analgesic to eliminate or alleviate organic pain to the unborn child.” The law’s supporters claim that human fetuses are capable of feeling pain around the twentieth week of pregnancy, and that this bill will help eliminate that pain.

This claim about fetal pain, however, is scientifically dubious at best. According to a paper published by the Journal of the American Medical Association, scans for electrical activity in fetal brains suggest that “the capacity for functional pain perception in preterm neonates probably does not exist before 29 or 30 weeks.” As the same paper explains, fetal pain awareness “requires functional thalamocortical connections,” yet the brain fibers necessary to allow such connections do not start appearing until “23 to 30 weeks’ gestational age.”

Nevertheless, anti-abortion lawmakers frequently cite the idea that fetuses can feel pain at 20 weeks to justify restrictions on reproductive choice.

Utah law typically prohibits abortions around 22 weeks into a pregnancy, when the fetus is deemed viable. Thus, that state’s new law will primarily impact women who seek abortions during a narrow two-week period.

Yet the new law will subject those women to considerable risk. According to the Associated Press, the law will require doctors to either administer general anesthesia or “a heavy does of narcotics”to women impacted by the law. In rare cases, that could lead to a woman’s death. Though anesthesia-related deaths are in decline, approximately 34 patients per million died from anesthetics in the 1990s and 2000s.

And, while deaths are rare, serious complications ranging from nerve damage to “malignant hyperthermia” can result from anesthesia. Anesthesia can also cause long-lasting mental defects. According to Scientific American, studies “suggest that a high enough dose of anesthesia can in fact raise the risk of delirium after surgery,” and that “even if the confusion dissipates, attention and memory can languish for months and, in some cases, years.” (Though it should be noted that these mental side effects are especially likely to occur in elderly patients that are past childbearing age.)

As one doctor told the AP, “you never give those medicines if you don’t have to.” Now, however, thanks to this Utah law, doctors will have to.

That is, of course, unless the courts strike down the Utah law. Under Roe, states gain greater authority to regulate — or even ban — abortions as a pregnancy progresses. Yet, even in the latest stages of pregnancy, the health of a woman seeking an abortion has primacy. Abortion is always permitted “where it is necessary, in appropriate medical judgment, for the preservation of the life or health of the mother.”

Since Roe, however, the Supreme Court has carved away much of the right protected by that decision. Most notably, in Gonzales v. Carhardt, the Court upheld a ban on a method of abortion that was viewed by many doctors and medical associations as the safest method “for women with certain pregnancy-related conditions, such as placenta previa and accreta, and for women carrying fetuses with certain abnormalities, such as severe hydrocephalus.” Thus, in effect, the Court held that lawmakers could potentially make abortion less safe for many women who seek it.

Even after Gonzales, however, the Utah law is a significant escalation in the war against Roe. AfterGonzales, a woman who sought an abortion was still likely to receive a procedure that, in their doctor’s medical opinion, was the safest legal option — even if the single safest procedure was no longer legal. The majority opinion in Gonzales also claimed that “there is medical and scientific uncertainty” regarding whether to procedure at issue in that case was ever the safest medical option.

The Utah law, by contrast, imposes additional risk on women seeking abortions, despite the fact that there does not appear to be any medical benefits to subjecting a woman to unnecessary
anesthesia or narcotics. It is as if Utah required women to consume a small dose of strychnine before they can receive an abortion. If the dose is small enough, it probably won’t kill the woman, but the state would still be exposing women to a very dangerous chemical without any health-related reason to do so.


This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe. ‘Like’ CAP Action on Facebook and ‘follow’ us on Twitter

What the GOP’s Supreme Obstruction Means for Women

Senate Republicans are leaving women in limbo on several crucial issues.

— by Martha Burk, OtherWords.org author
Martha BurkSenators, constitutional scholars may tell you, must “advise and consent” on the president’s Supreme Court nominees. But apparently the official GOP policy is to “refuse and obstruct.” They’ve vowed not even to give President Obama’s nominees a vote.

These Republicans claim that leaving the Supreme Court understaffed is no big deal. Well, it’s certainly a big deal for women. Pending cases on abortion, birth control, education, and public employee unions are all sitting before a divided court.

The scariest case is Whole Woman’s Health v. Cole.

It’s a challenge to a Texas law that would close all but about 10 abortion clinics in the state — down from more than 40 — by requiring them to essentially become mini-hospitals. They’d have to employ only doctors with admitting privileges at nearby hospitals, a regulation almost unheard of for safe and common procedures like abortion.

LaDawna Howard / Flickr
LaDawna Howard / Flickr

Since an appeals court upheld the requirements, a 4-4 deadlock on the Supreme Court would give Texas the green light to enforce them. And it would almost certainly encourage other states to enact similar laws.

On the birth control front, the court will consider Zubik v. Burwell. A successor to the Hobby Lobby case, it’s an argument over whether religiously affiliated institutions have to observe the Affordable Care Act’s requirement that employer-provided health plans cover birth control.

These groups are allowed to avoid the requirement by filling out a form, in which case the government will arrange with their insurer to cover their employees. A few of these groups are claiming that still makes them complicit in sinful conduct.

A 4-4 tie at the Supreme Court would be a mixed bag, since most — but not all — appeals court decisions have upheld the accommodation as not burdensome to religious practice.

Meanwhile, established labor law is on the line in Friedrichs v. California Teachers Association, where the court will consider whether public employees who choose not to join unions can still be required to pay fees for collective bargaining activities. A decision against the unions could mortally wound them.

According to the National Women’s Law Center, women are the majority of the public sector workforce, and the wage gap with their male counterparts is smaller for public union women than non-union women. The lower court favored the unions, so a tie would stave off a major blow to their viability. But that’s still a lot to risk.

Women are now also the majority of college students, and women of color could be greatly affected by a decision in Fisher v. University of Texas. In that case, the court will decide whether the school’s race‑conscious admissions program violates the Constitution’s equal protection principles.

Justice Elena Kagan has recused herself. So if the Senate leaves Scalia’s seat unfilled, the case will be decided by seven justices — which means there can be no tie. Three judges — John Roberts, Clarence Thomas, and Samuel Alito — oppose affirmative action, and a fourth, Anthony Kennedy, has previously expressed doubts about the University of Texas policy.

So what’s the score?

In four cases affecting women the most, two could go in women’s favor with tie votes. A third tie vote would go against women, and a 4-3 conservative majority would hurt them in the final case as well.

However you score it, Senate Republicans are leaving women in limbo until a new justice is chosen and new cases can be brought. That could take years. Women — and the country — deserve better.


Martha Burk is the director of the Corporate Accountability Project for the National Council of Women’s Organizations (NCWO) and the author of the book Your Voice, Your Vote: The Savvy Woman’s Guide to Power, Politics, and the Change We Need. Follow Martha on Twitter @MarthaBurk.

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The Supreme Court Shamed The Most Anti-Abortion Court In The Country With Just 14 Words

— by Ian Millhiser

Credit: AP photo/Michael Dwyer

Friday afternoon, the Supreme Court handed down a very brief order allowing several Louisiana abortion clinics to reopen after a conservative federal appeals court forced them to shut down. Yet, while the Supreme Court’s order was very short — only slightly more than a paragraph long — it contained 14 more words than such an order normally would. And those 14 words appear to be a direct swipe at the appeals court that shut down Louisiana’s clinics in the first place.

To explain, the conservative United States Court of Appeals for the Fifth Circuit has handed down a series of decisions that appear calculated to dismantle nearly all of Roe v. Wade within the three states (Louisiana, Mississippi and Texas) overseen by that court. In 2015, for example, the Fifth Circuit’s decision in Whole Woman’s Health v. Cole gave states sweeping power to restrict abortion, so long as the restriction is dressed up as a health regulation. Among other things, this opinion blessed a provision of Texas law requiring abortion clinics to undergo expensive renovations in order to comply with regulations governing “ambulatory surgical centers,” even if the clinic does not actually perform any surgeries. Many Texas abortion clinics only offer medication abortions, which are induced by pills the woman takes orally.

An appeal of this Whole Woman’s Health decision is currently pending before the justices, and a majority of the Court appeared skeptical of the Fifth Circuit’s decision at oral arguments last Wednesday.

Just one week before the Supreme Court heard these arguments, however, the Fifth Circuit handed down another anti-abortion decision. In June Medical Services v. Gee, the Fifth Circuit granted an “emergency” motion reinstating a Louisiana law that was expected to shut down all but one of that state’s abortion clinics. The Louisiana law at issue in June Medical Services closely resembles a provision of the Texas law at issue in Whole Woman’s Health.

The Fifth Circuit’s order in June Medical Services was surprising, largely because the Supreme Court had already dropped some pretty big clues that a majority of the justices disapprove of the Fifth Circuit’s decisions forcing abortion clinics to close. Among other things, the justices stayed the Fifth Circuit’s Whole Woman’s Health decision pending the Supreme Court’s own resolution of the case — effectively enabling many Texas abortion clinics to remain open that would be closed if the Fifth Circuit’s order were still in effect.

Nevertheless, the Fifth Circuit decided not to take the hint that Texas-style attempts to shut down clinics should be placed on hold. Instead, the Fifth Circuit claimed in June Medical Services that it was free ignore this hint because, when the Supreme Court stayed Whole Woman’s Health, it did so in a brief order without explaining its reasoning. “No guidance can be gleaned from the Supreme Court’s vacating portions of the stay without explanation,” according to the lower court, “as we cannot discern the underlying reasoning from the one-paragraph order.”

Which brings us back to the 14 significant words in the Supreme Court’s most recent order. “Consistent with the Court’s action granting a stay in Whole Woman’s Health v. Cole,” that order begins, the Fifth Circuit’s order reinstating the Louisiana law is vacated.

These 14 words are a subtle spanking, but they are a spanking nonetheless. They directly contradict the Fifth Circuit’s claim that it can ignore the Supreme Court’s previous stay orders if the lower court “cannot discern the underlying reasoning” behind those orders. And they rebut the Fifth Circuit’s logic on its own terms. Why shouldn’t lower courts allow Texas-style abortion restrictions to go into effect in the future? Because halting these laws is “consistent with the Court’s action granting a stay in Whole Woman’s Health v. Cole.”

To be clear, it is normally a dangerous practice to read too much into a one-paragraph order like the one the Supreme Court handed down Friday. This order provides only a limited window into the Court’s thinking, and it deals only with a preliminary issue facing the Fifth Circuit in June Medical Services. The conservative appeals court will have another opportunity to hear this case, and that will give it another opportunity to make mischief for abortion providers.

But the Supreme Court is now signalling very loudly that a majority of the Court is not pleased with the Fifth Circuit’s efforts to pare Roe v. Wade down to near nothingness. If the lower court’s judges do decide to make more mischief, they will probably wind up on the receiving end of yet another judicial spanking.


This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe. ‘Like’ CAP Action on Facebook and ‘follow’ us on Twitter

An Historic Attempt To Kill Roe v. Wade May Backfire Spectacularly On The Anti-Choice Right

CREDIT: DOUG MILLS/THE NEW YORK TIMES VIA AP, POOL

It was supposed to be an epic battle over the fate of Roe v. Wade.

Next week, the Supreme Court hears oral arguments in Whole Woman’s Health v. Hellerstedt, a challenge to Texas’s ambitious anti-abortion law HB2. If this law is upheld — a very real possibility in a conservative Supreme Court — Roe v. Wade would have most likely remained alive in name only. States would gain sweeping new power to shut down abortion clinics, so long as they dressed up the laws they enacted to end access to abortion as health regulations.

Except that opponents of abortion no longer have the fifth vote they need to gut Roe. Justice Antonin Scalia’s death means that Roe shall live at least another year. Whether it survives past next year, however, could very well be decided by whoever gets to fill Scalia’s seat.

The Masterminds

HB2 is the brainchild of the sophisticated anti-abortion group Americans United for Life (AUL). The law imposes expensive architectural and other requirements on abortion clinics, as well as often-difficult-to-obtain credentialing requirements on abortion providers. If the Supreme Court allows the law to take full effect, at least 32 of the 40 abortion clinics that existed in Texas before it was enacted are expected to shut down.

AUL, moreover, does not hide its goal in pushing such legislation — as ThinkProgress’ Erica Hellerstein reported, AUL functions as a “legislation mill” producing anti-abortion bills that can be copied and enacted in many states. The anti-abortion group brags on their website that they work “through the law and legislative process to one end: Achieving comprehensive legal protection for human life from conception to natural death.” Overruling Roe v. Wade, according to AUL, “can be accomplished through deliberate, legal strategies that accumulate victories, build momentum, and restore a culture of life.”

Just over one week ago, Whole Woman’s Health appeared poised to become AUL’s crowning achievement. Under the Supreme Court’s 1992 decision in Planned Parenthood v. Casey, states may not enact laws that place an “undue burden” a woman’s right to choose abortion — a vague standard that’s proved quite malleable in the hands of abortion opponents. At the same time, states may legitimately regulate all medical clinics, including those that provide abortions, to protect the health of individuals who seek treatment from those clinics. Whole Woman’s Health asks what happens when a state enacts abortion restrictions disguised as health regulations.

The clinic regulations and credentialing requirements at issue in this case will do little, if anything, to advance women’s health. But they make it a whole lot harder to obtain an abortion. Thus, a decision upholding HB2 could potentially return women to a world much like the one that existed prior to Roe. States may not actually be allowed to openly ban abortion after such a decision, but they’d have broad authority to restrict abortion just so long as they are clever enough to devise anti-abortion laws that look like health laws. And if state lawmakers proved inept at this task, groups like AUL would be more than happy to give them a hand.

Now, however, with Scalia’s seat vacant and the Court evenly divided between Democratic and Republican appointees, the likelihood HB2 will be upheld outright is vanishingly small.

No Longer The Man in the Middle

Before Scalia’s unexpected death, all eyes were on Justice Anthony Kennedy, the closest thing the Roberts Court has to a swing vote on abortion. As a general rule, if your plan of attack against an abortion restriction depends on winning Kennedy’s approval, you need a better plan. Prior to HB2, Justice Kennedy considered 21 abortion restrictions as a member of the Supreme Court andallowed 20 of them to take effect. In one case, Kennedy justified an abortion restriction in part because he thought that “it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained.”

(It also seems unexceptionable to conclude that some people come to regret their choice to bring a dangerous firearm into their home, yet this insight has not animated Kennedy’s votes in Second Amendment cases.)

Yet, while Kennedy’s opinions reveal an almost visceral revulsion towards abortion, he’s also proved unwilling to overrule Roe outright. Kennedy co-authored the Casey opinion, which limited abortion rights, but which also purported to hold that “the essential holding of Roe v. Wade should be retained and once again reaffirmed.”

Thus, before conservatives lost their majority on the Supreme Court, the most important question in Whole Woman’s Health was likely to be which Justice Kennedy shows up to work next week — the one that consistently upholds abortion restrictions or the one that is unwilling to invalidate Roe in its entirety. Kennedy, moreover, gave hope to Team Choice when he cast the fifth vote to stay a lower court order upholding nearly all of HB2.

Uncertain Process

Now that the Court is evenly divided between liberals and conservatives, Kennedy no longer has the power to drive a nail in Roe‘s coffin, but he could still have the power to do considerable damage to the right to choose. The ordinary rule when the Court splits 4-4 is that the lower court’s decision is affirmed and the justices’ decision does not have any precedential value. Because the court of appeals largely upheld HB2, a 4-4 decision in Whole Woman’s Health would allow the Texas law to almost entirely remain in effect — at least until a fifth justice is confirmed to the Court and another abortion case reaches the justices.

Thus, as Cosmopolitan’s Jill Filipovic notes, Scalia’s death may actually make it more likely that Justice Kennedy votes to uphold HB2. “If Scalia were still alive, Kennedy might be choosing between overturning Roe and invalidating the Texas law,” Filipovic writes. Now, however, he doesn’t have to choose between two options that he’s likely to view as undesirable. Rather, if he sides with the conservatives he will leave lower court’s opinion in place without creating a precedent he may later come to regret. “For this particular justice, who seems to find abortion troubling but may not want to see it outlawed wholesale,” Filipovic notes, “that may be a desirable outcome.”

There is, however, some uncertainty about whether Kennedy will have this option. As SCOTUSBlog’s Tom Goldstein notes, the Court’s past practice when a vacancy opened in the middle of a term was to hold cases where the justices split over until the next term, when the open seat presumably would be filled. Given the extraordinary obstructionism Senate Majority Leader Mitch McConnell (R-KY) has already planned against anyone President Obama sends up to fill this seat, it remains to be seen whether the justices will decide to hold over split decisions until next term or simply affirm the case by an evenly divided vote and be done with it.

Which process they choose could matter a great deal in Whole Woman’s Health. Recall that Kennedy provided the fifth vote to stay the lower court’s decision upholding HB2. That order provides that the stay shall last until “the issuance of the judgment of this Court.” Thus, if the Court holds the case over for reargument next term, the stay remains in effect until the Court decides the case, and HB2 does not go into effect. If the Court affirms the lower court by an evenly divided vote, by contrast, that counts as a “judgment” of the Supreme Court, so the clinics most impacted by HB2 will close.

The choice whether to hold the case over could also matter for an entirely different reason. If President Obama (or a similarly minded president) manages to fill Justice Scalia’s seat, one of the first matters taken up by the Court’s new liberal majority would be a major abortion case. That would not only give them the opportunity to strike down HB2, it would also give them the chance to expand a right to choose that has been gradually chipped away after decades of conservative decisions. The vague “undue burden” standard that now controls abortion cases was pushed by abortion opponents including the Reagan Justice Department and AUL itself before it was ultimately adopted by the Supreme Court. A more liberal Court could scrap this standard altogether or, at the very least, clarify it in a way that does not permit anti-abortion judges to take advantage of its vagueness.

Rather than becoming AUL’s crowning achievement, in other words, Whole Woman’s Health could be their most demoralizing defeat.

Yet that outcome depends entirely on who gets to fill Justice Scalia’s seat. If the next justice is more like Scalia, Whole Woman’s Health could still become AUL’s greatest triumph.


This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe. ‘Like’ CAP Action on Facebook and ‘follow’ us on Twitter

The Abortion Case That Could Overturn Roe v. Wade Has A Lot Of Opponents

— by Alex Zielinski, a health reporter at Think Progress

CREDIT: AP PHOTO, PABLO MARTINEZ MONSIVAIS

US Capitol police officers line-up in front of pro-abortion rights demonstrators on Thursday, Jan. 22, 2015, at the Supreme Court in Washington.

A looming Supreme Court case that could severely undermine the right to an abortion has attracted an unprecedented amount of opposition from across the country.

A slew of organizations and individuals filed 45 legal briefs in the Supreme Court on Tuesday, each brief examining the case through a unique lens and each coming to the same conclusion: State laws that restrict abortion access are unconstitutional.

The case will examine the validity of a Texas law, known as HB2, that places burdensome, unnecessary guidelines on the state’s dwindling abortion clinics. These regulations, while framed as improvements to safeguard “women’s health,” ultimately have nothing to do with patient safety — and were instead created by anti-abortion legislators to impose additional, costly red tape on clinic staff. So far, it’s been successful. HB2 has already forced half of the state’s clinics to close, thus cutting Texas’ abortion providers in half.

The Supreme Court case, Whole Women’s Health v. Cole, won’t only decide if Texas’ law is constitutional. Depending how the court rules, the decision could also give legal cover to all states seeking to enact laws that appear to function as health regulations, but that actually exist to restrict access to abortion. The oral arguments for the case begin in March.

Reproductive rights advocates have been outspoken since HB2 passed in 2013, but since the Supreme Court’s  November decision to hear the case, the diversity of opponents has grown. The 45 briefs were filed by a variety of petitioners, including physicians, historians, religious leaders, military officers, scientists, members of Congress, civil rights advocates, law scholars, entire cities, and the United States federal government itself.

“Never before has such a diverse array of organizations and leaders…stepped forward to condemn abortion restrictions at the U.S. Supreme Court,” said Nancy Northup, president and CEO of the Center for Reproductive Rights, in a statement.

Among the briefs were voices of actual women who’ve been affected by the lack of abortion access in the past — a voice some say is forgotten in the high-level case.

“The Supreme Court justices need to hear the real effects of restrictive abortion laws on women like this one in Texas,” said Debra Hauser, the president of Advocates for Youth, a group helping young people access comprehensive sexual health education. Hauser shared her personal experience with abortion in her organization’s brief.

“What is missing from this issue are our personal stories. The reality is that one in three women will have an abortion in her lifetime.”

Many of those women shared their stories in another brief submitted Tuesday, representing 110 law professionals who’ve had abortions. Some noted how they would have never had the chance to become a lawyer if they hadn’t had an abortion when they did.

“[Our] experiences demonstrate the real world effects of abortion access on the lives and careers of women attorneys, and underscore the truth of the court’s observation that reproductive choice facilitates women’s ability ‘to participate in the economic and social life of the nation,’” the brief reads.

According to Northup, the briefs represent the largest coalition of faith leaders and faith organizations ever to oppose anti-choice laws at the Supreme Court level. In the legal brief filed by a large collection of different religious leaders, the petitioners stress their support of abortion access — despite efforts from more radical religious organizations to say otherwise.

“As religious leaders and pastoral counselors, [we] provide spiritual guidance to women facing this decision and believe that this complex decision is ultimately a moral one,” the brief reads. “While various religious groups in this country hold differing views on abortion, there is substantial agreement that women have a moral right to make their own decisions on the issue.”

A group of 40 prominent scientists also submitted a brief Tuesday, hoping to overrule the “flawed pseudoscience” that will be used in testimony to support the case.

“We hope the court is able to put abortion politics aside and focus on the illegitimacy of the medical claims propping up the restrictions,” said Robyn Blumner, president and CEO of the Richard Dawkins Foundation for Reason & Science. “When science claims are used to infringe a constitutional right they had better be valid, but that’s not the case here.”

A Tuesday press call drew a variety of opponents together, including Wendy Davis, the former Texas state senator who led an 11-hour filibuster in an attempt to defeat HB2, and Planned Parenthood CEO Cecile Richards, to further illustrate the severity of this case. Jessica González-Rojas, the executive director of the National Latina Institute for Reproductive Health, also spoke on the call, representing the women already harmed the most by the current Texas law.

“For immigrants, mothers, low-wage workers, and Latinas who are all three, securing an abortion means navigating a state-created obstacle course,” she said. “Those unable to jump through these hoops will be forced to carry an unwanted pregnancy to term or take matters into their own hands.”

Since HB2 was enacted, at least 100,000 Texan women have tried to induce their own abortion, due to the cost driving to a distant abortion clinic, taking time off work to do so, and other frustrating roadblocks to make it difficult for them to legally end a pregnancy.

The legal briefs filed, which represent more than 1,000 opponents in total, may shine more light on the broader impact the pending case could have on women across the country — an impact that has already left Texas in a health crisis.

“These briefs present a thorough record of the undeniable damage Texas’ sham law has,” concluded Northup. “It will continue to cause, and an indisputable legal argument for why it must be struck down.”


This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe. ‘Like’ CAP Action on Facebook and ‘follow’ them on Twitter

Republican Presidential Candidates Want You To Know They Are Against LGBT Rights

— by Zack Ford Dec 8, 2015 4:20 PM

Marco Rubio, Ben Carson, and Ted Cruz at the Presidential Family Forum in Iowa last month.

Over the past few weeks, several Republican presidential candidates have served up attacks on LGBT people, recommitting themselves to persecution by rolling back gains for equality and enshrining the right to discriminate into law. The comments all seem to be popping up as the candidates have stayed relatively mum on issues like abortion, gun control violence, and Islamophobia, despite recent tragedies spotlighting those issues in the media.

Here are some of the recent anti-LGBT highlights from the Republican primary.

Marco Rubio
In an interview this weekend with David Brody of the Christian Broadcasting Network, Marco Rubio outlined outlined extensive plans for enabling discrimination against LGBT people in the name of religious liberty. As president, Rubio said he would do the following:

  • Rescind President Obama’s executive order protecting the LGBT employees of federal contractors.
  • Only appoint Supreme Court Justices committed to undoing marriage equality and a woman’s right to an abortion.
  • Protect religious organizations that wish to refuse service to same-sex couples.

Rubio seemed to imply that employing and serving LGBT people were themselves sinful actions. “There are many government contractors and small companies who provide services to the government who are faith-based people, and they are being compelled to sin by government in their business conduct,” he said. “That is not something we should be supporting.”

Ted Cruz
Ted Cruz recently sat down with National Organization for Marriage founder Robert George for an interview on EWTN, a Catholic television network. In one segment, Cruz agreed with George that the Supreme Court’s marriage equality decision was “profoundly wrong,” “fundamentally illegitimate,” “lawless,” and “not based on the Constitution.”

Cruz then referenced Justice Anthony Kennedy’s recent comments that a public official that can not follow the decision, like Kim Davis, should resign. During his remarks, Kennedy alluded to the fact that very few judges resigned from the Nazi German government. Thus, Cruz claimed, he was comparing the Supreme Court to Nazis. “This isn’t me calling them the Nazis,” Cruz explained, “this is Justice Kennedy calling the court on which he serves, calling the opinion that he wrote — analogizing that to the Nazi decrees that we must obey. That is an arrogance, it is an elitism, it is being out of touch with our nation.”

In another segment, Cruz fielded a question about accommodations for transgender students in public schools. He condemned such policies as “ridiculous” decisions made by “zealots.” “I don’t want my daughters taking showers with little boys; I don’t want them when they’re in junior high or high school. And it’s absurd. No parents do.”

Cruz pledged to end Common Core and abolish the Department of Education entirely, so there would be no federal agency to enforce Title IX to protect transgender students.

Mike Huckabee
Mike Huckabee also talked to Robert George for an hour late last month and offered his own renditions on many of the same points. Huckabee would “absolutely decline” to enforce the marriage equality decision, because “it’s a matter of saving our republic.” He’d also ensure that he had an attorney general who “would protect in every way the rights of those citizens who joined in disagreeing.”

As such, Huckabee would pass the First Amendment Defense Act (FADA) in his first 100 days. The bill would prohibit the federal government from acting against any organization that discriminates against same-sex couples, creating a widespread license to discriminate. Citing examples of wedding vendors who would refuse to serve same-sex couples or schools that would refuse to recognize their marriages, he pledged the federal government under his leadership would side with them if a state is trying to enforce a nondiscrimination law.

Huckabee also chimed in on transgender school protections, calling it a “ludicrous notion” that someone “can just wake up one day and say, ‘You know, I know I have the biological makeup of a male and I have the gene — I’m genetically male, but I kind of feel feminine today,’ or ‘I’m going to feel feminine for the next year or the rest of my life.’”

He described it as “most baffling” than anyone could thoughtfully “defend the notion that it is normal — that it is perfectly legitimate — for a person just to declare oneself to be a different gender. It borders on laughable, and I know to say it’s laughable would bring great contempt because people would say you’re being insensitive. I’m not being insensitive. I’m exercising just a little bit of common sense.”

Huckabee similarly exercised his little bit of common sense earlier this year when he joked that he wished transgender protections existed when he was a kid, because he would’ve found his “feminine side” so he could “shower with the girls.”

Ben Carson
Over the weekend, Ben Carson said at a town hall event that he misses “Don’t Ask, Don’t Tell,” the policy that discriminated against lesbian, gay, and bisexual people in the military. “Why do you have to go around flaunting your sexuality?” he asked. “It’s not necessary. You don’t need to talk about that. We need to talk about how we eliminate the enemy.”

He also opposed allowing transgender people to serve, worrying that the military is being used as “a laboratory for social experimentation.” “Deal with the transgender thing somewhere else,” he said. Last month, Carson similarly said that trans people don’t deserve “extra rights,” like equal access to safely use the bathroom. The ban on transgender military service will be lifted this spring.

At a recent debate, Carson took umbrage at the notion that he might be described as a “homophobe” for his frequent anti-LGBT comments. When he apologized earlier this year for suggesting that homosexuality is a choice because prison turns people gay, he announced that he wasn’t going to talk about “gay rights” issues anymore.

That hasn’t proven to be the case for him or any of his fellow candidates.


This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe. ‘Like’ CAP Action on Facebook and ‘follow’ us on Twitter