Roe v. Wade 40 Years Later: How Far Have We Come?*

By Kate Michelman and Carol Tracy

January 22nd marks the fortieth anniversary of landmark Supreme Court decision Roe v. Wade.

Roe v. Wade was a historic milestone for women in America, because this right to control our capacity to reproduce – including our right to use contraception – significantly enhances our ability to participate fully in society. It helps ensure our personal privacy, our dignity, and our health.

Roe v. Wade promised to protect our ability to make decisions about our bodies without unwarranted interference, and recognized the essential importance of equality and freedom for women in our society.

On this fortieth anniversary, it is appropriate to ask if the promise of Roe v. Wade has been fulfilled.  Has women’s liberty and equality progressed as far as we hoped it would since January 22, 1973?

Clearly there have been some great strides forward. During the 2012 elections, women turned out in droves to make their voices heard. In almost every instance where women’s reproductive rights were challenged, freedom of choice prevailed. Earlier this month, a record number of women were sworn into the 113th Congress. Indeed, some may view the successes of 2012 as a sign of continually emerging equality and solid and lasting protection against discrimination and political harassment. Sadly, they would be wrong.

In 2012, forty-two states and the District of Columbia enacted 122 reproductive health-related measures. The primary purpose of at least 43 of those was to limit access to abortion.  This was in addition to the 92 abortion restrictions enacted in 2011. Twenty states restricted abortion coverage through the state health insurance exchanges mandated by the Affordable Health Care Act. Crucial family planning funds were slashed from many state budgets.  Funding for reproductive health services in non-state operated clinics such as Planned Parenthood came under attack at both the state and federal levels. Currently, contraception can be barred from employer-based insurance coverage in eight states, and abstinence-only education remains the norm in the majority of our country.

This fight against contraception reveals the true hypocrisy of the anti-abortion groups: their concern isn’t protecting the unborn fetus; it’s about controlling which choices women are, and are not, allowed to make.

Forty years later, women still do not have equal pay in the workplace and are discriminated against due to pregnancy and familial responsibilities.

And despite the record-breaking number of women in Congress this year, and despite women voting at higher rates than men, women remain vastly underrepresented in the political landscape, let alone the corporate world. Those who do beat the tremendous odds are subjected to double standards of behavior, gender-based rhetoric, and vicious vitriol directed at times towards their femininity rather than their capability.

Negative attitudes towards women do not end there. The continued occurrences and reactions to instances of rape and sexual assault are indicative of the negative attitudes towards women that permeate society today. The gang rape on a bus in India sparked a global furor. The rape in Steubenville, Ohio, our own backyard, sparked a similar wave of repudiation. However, the blaming, shaming, and judgment directed toward the victims of these horrific crimes remains a key component of the dialogue surrounding even these high-profile instances of sexual assault. While the sheer volume of sexual assault and rape speaks to the prevalence of violent and negative attitudes towards women, the victim-blaming and judgment that occurs paints an even more disturbing picture revealing how subversive and long-lasting these negative perspectives of women are.

Technically, the core protections guaranteed by Roe v. Wade remain intact. However, those protections are eroding due to the constant onslaught by radical conservatives bent on undermining the rights of women. The goal of Roe v. Wade was to ensure a woman’s right to control the most intimate aspect of her life. Without this right, simply put, women are unable to participate equally with men in the social, political and economic life of the nation.

The road ahead remains difficult. Our health, financial security, and personal safety are constantly challenged, compromised, and limited. So while we reflect on these past forty years, let us acknowledge and celebrate the extraordinary steps we have taken to move our country towards equality.

But let us also understand that hard work and vigilance is needed now, more than ever, in the fight for women’s equality and justice.  The goal of Roe v. Wade has not been achieved, but on this anniversary it is essential that it also not be forgotten.

Kate Michelman is president emerita of NARAL Pro-Choice America, author of “With Liberty and Justice for All: A Life Spent Protecting the Right to Choose,” and co-chair of WomenVote PA.

Carol E. Tracy is Executive Director of the Women’s Law Project and co-chair of WomenVote PA, an initiative of the Women’s Law Project.

*NOTE: This post so far has appeared in the following newspapers and/or online: the Huffington Post, the Main Line News, the Harrisburg Patriot-News, and USA Today.

Court Ruling: Hobby Lobby Cannot Deny Contraceptive Coverage to its Employees

By Amal Bass, WLP Staff Attorney

On November 19, 2012, an Oklahoma federal court denied Hobby Lobby’s motion for a preliminary injunction, telling the business and its co-plaintiff (Mardel, another business owned by the same family trust) that they would be unlikely to succeed in their legal challenge to the contraceptive coverage rule under the Affordable Care Act (ACA).  This rule makes contraception more affordable for women by requiring new or renewed insurance to cover the cost without co-pays or deductibles as of August 1, 2012.

Religious organizations, like houses of worships, are exempt from providing such coverage, and the Obama Administration has proposed an “accommodation” for other religious organizations under certain circumstances.  Just yesterday, November 27, 2012, a Pennsylvania federal court dismissed a lawsuit by the Catholic Diocese of Pittsburgh, Catholic Charities, and Catholic Cemeteries Association as premature because, unlike Hobby Lobby, several exceptions to the contraceptive coverage rule apply to them at the present time either because they are religious organizations or have grandfathered plans.  Most v. Sebelius, No. 12-cv-00676, 2012 U.S. Dist. LEXIS 167737 (W.D. Pa. 2012).  Hobby Lobby, as a private, for-profit business, is in a different situation; it does not fit within the accommodation or exemptions.

In its lawsuit, Hobby Lobby and Mardel claimed that requiring contraceptive coverage in the health plans they offer to their employees violates their rights under the First Amendment of the U.S. Constitution and the Religious Freedom Restoration Act of 1993 (RFRA).  In particular, Hobby Lobby protested coverage for contraceptive methods that it wrongly believed to be abortifacients, such as Emergency Contraception (EC), which does not cause abortions because it works by preventing the ovary from releasing an egg, not by disturbing a fertilized egg implanted in the uterus.

The United States District Court for the Western District of Oklahoma ruled against Hobby Lobby and Mardel, concluding that the companies were not entitled to a preliminary injunction because:

Hobby Lobby and Mardel, [being] secular, for- profit corporations, do not have free exercise rights. The [owners] do have such rights, but are unlikely to prevail as to their constitutional claims because the preventive care coverage regulations they challenge are neutral laws of general applicability which are rationally related to a legitimate governmental objective.

Plaintiffs also have failed to demonstrate a probability of success on their Religious Freedom Restoration Act claims. Hobby Lobby and Mardel are not ‘persons’ for purposes of the RFRA and the Greens have not established that compliance with the preventive care coverage regulations would ‘substantially burden’ their religious exercise[.]

Essentially, the court concluded that, for the purposes of free exercise of religion, corporations are not people and do not have such rights.  Their owners have religious freedom rights, but broadly applicable, neutral laws like the ACA do not infringe on these constitutional or statutory rights.  Legal challenges waged by secular, for-profit businesses against the contraceptive coverage rule in other lower federal courts, however, have resulted in mixed results.

It is important that our federal courts protect the contraceptive coverage rule from attacks like the one at the heart of Hobby Lobby v. Sebelius.  Business owners should not be able to impose their personal religious beliefs on their employees, who come from a wide range of backgrounds.  Depending on the method used, contraception can cost between $15 and $1,000 up front, and the contraceptive coverage rule ensures that fewer women will pay out-of-pocket for birth control, which is not only important for family planning but also to address other health concerns, such as polycystic ovarian syndrome.

To learn more about the Affordable Care Act and reproductive health care, see our report, Through the Lens of EQUALITY: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women.

PA Lawmakers Should Care More about the Health of the Commonwealth’s Residents

By Amal Bass, WLP Staff Attorney

With the uncertainty of the 2012 elections behind us, we know that the Affordable Care Act (ACA) — known to many friends and foes alike as “Obamacare” — is here to stay, with most of its provisions having passed constitutional muster under U.S. Supreme Court review.  Nevertheless, Pennsylvania has stalled on the implementation of this important law, despite having already accepted millions of dollars in federal funding to prepare for it.  To protect the health and well-being of Pennsylvania’s residents, the Corbett Administration and the Pennsylvania General Assembly must act now to determine how the Commonwealth will handle key features of the ACA, including the establishment of an insurance exchange and the expansion of Medicaid eligibility.

The ACA will create state-based marketplaces for private insurance that will make affordable coverage available to small businesses to purchase for their employees and to individuals who do not qualify for Medicaid and who do not receive health insurance through their employers.  These exchanges are scheduled to open for enrollment on October 1, 2013, with coverage beginning on January 1, 2014.  States have three options: set up their own exchanges, partner with the federal government, or have the federal government set up and run the state’s exchange.  Although Pennsylvania had announced its intention to build a state-run exchange a year ago, it did not submit a Declaration Letter to the U.S. Department of Health and Human Services (HHS) by November 16, 2012, as required.  Last week, the Obama Administration extended the deadline to December 14, 2012 for states to submit blueprints for such exchanges for approval by HHS.  The states that intend to partner with the federal government have until February 15, 2013 to submit their plans to HHS.

The Corbett Administration has not indicated what it intends to do about the establishment of an insurance exchange.  Bills are pending in the General Assembly, but there has been no action on them.  The Commonwealth is thus far behind several other states that are taking the necessary steps to set up these exchanges on time.  Without clear direction from the governor and without appropriate legislation, it is likely that Pennsylvania will not set up a state-run exchange in a timely manner, resulting in either a federally-run or partnership exchange.  Federal involvement in the Commonwealth’s exchange may be in the best interests of Pennsylvanians, or it may not be — but it is certainly not in Pennsylvania’s best interests for the Governor and the General Assembly to ignore one of the most important issues in years.

The Corbett Administration has also remained silent on whether the Commonwealth intends to expand Medicaid eligibility to 138 percent of the federal poverty level, with the federal government paying a large portion of the costs as part of the Affordable Care Act.  In National Federation of Independent Business v. Sebelius, the Supreme Court upheld most of the Affordable Care Act, but weakened the Medicaid expansion provision by making it so that states that refuse to comply do not lose all of their Medicaid funding.  Medicaid expansion would provide health coverage to working families that cannot otherwise afford private insurance and would bring more than $17 billion in federal dollars into Pennsylvania’s economy.  Representative Dan Frankel (D-Allegheny) has introduced legislation, H.B. 2557, to enable Medicaid expansion, but the bill has not yet passed.  If Pennsylvania declines to participate in Medicaid expansion, many poor individuals, many of whom are women, will be left without health coverage.

Pennsylvania’s refusal to engage in ACA implementation, including its silence on the establishment of an exchange and the expansion of Medicaid, shows its disregard for the health of the women, men, and children who live in the Commonwealth.  It is time for the Corbett Administration to take Pennsylvania residents’ health and well-being seriously.

For more information on the ACA and WLP’s work on access to health care, see WLP Health Care Reform and WLP’s Report, Through the Lens of Equality: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women.

Women have the power – why aren’t more of them using it?

Co-chairs of WomenVote PA, Carol Tracy, Executive Director of the Women’s Law Project, and Kate Michelman, President Emeritus of NARAL Pro-Choice America

AT A RECENT meeting a colleague of ours presented us with a challenge and posed the following questions:  Imagine if every woman of voting age participated in this upcoming presidential election? How would that determine the outcome of the election and the legislation and policy coming out of Washington?  What would happen – would anything really change?

The implications of such a reality are staggering.

For one, you would never hear any politician utter the phrase “legitimate rape” nor would a “transvaginal ultrasound” be prescribed by anyone other than a woman’s doctor; equal pay for equal work would be obvious; our reproductive rights would be championed by politicians, not jeopardized; support for efforts to end violence against women would be expanded; Social Security and Medicare would be stabilized and strengthened, not privatized and minimized.

Sadly, the question is hypothetical and the reality is quite the opposite – but we believe it doesn’t have to be. And we believe we can start by increasing the political participation of women here in Pennsylvania. In 2004, the Women’s Law Project, based in Philadelphia and Pittsburgh, began an initiative called WomenVote PA. The goal was and is straightforward: Increase the participation of women in the electoral process. We are focused on making WomenVote PA a resource for voters to learn more about legislative and policy initiatives and, equally important, a community both in the real world and the digital world, a place that uses education, collaboration and information-sharing to mobilize women voters.

The focus on the November election all but guarantees more Americans will vote this November than in any election since 2008 (assuming voter-ID requirements don’t deprive them of their right to vote). In 2008, 6 million Pennsylvanians voted in the presidential race and yet just two years later, 4 million voted in the U.S. Senate race – a staggering 2 million Pennsylvanians who voted in 2008 failed to do so in 2010. That is likely over 1 million women not voting in off-year elections – and each of these off-year elections determine who sits in the Pennsylvania General Assembly as well as the U.S. House of Representatives and Senate. Increasing that off-year participation number even slightly has real policy implications and real-world effects on women.

A reason behind WomenVote PA’s re-emergence has been what we will generously describe as politicians simply “not getting it.” Whether it is using the phrase “legitimate rape,” attempting to define rape only as “forcible rape,” blocking legislation in support of equal pay for equal work, rolling back our reproductive rights or limiting protections for victims of domestic and sexual violence, WomenVote PA is active in educating our network on the federal, state and local legislation that affects their lives. We believe in assisting our elected officials and policy makers in “getting it.”

And we have the data to back it up. WomenVote PA is an initiative of the Women’s Law Project, which has just published a remarkable study titled Through the Lens of Equality: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women, which will inform our education and outreach efforts. The study provides important research and data about how ongoing bias against women – in the home, in the workplace, in the classroom, and in the community – negatively impacts women’s health. We see it as a necessity that women’s voices are informed and are heard on issues that are essential to their health and well-being and that of their families.

The question “What if all women voted?” really does set the mind reeling – but in Pennsylvania WomenVote PA will focus our efforts on seeing what happens when more women vote. We believe much will.

This opinion piece appeared in many newspapers throughout Pennsylvania.  Please share this with your friends and remember to vote!

The Affordable Care Act Extends No-Cost Preventive Care to Women

Nikki Ditto, WLP Intern

Wednesday, August 1^st  is an important day for women’s health. After this date, all new insurance plans must cover certain women’s preventive health services, including contraceptives, without co-pays or deductibles. This represents an essential change in access to health care for women. Women, who have long been subjected to denial of access to insurance coverage for essential health services are more likely than men to forgo needed health care due to cost.  The number of women who can access these benefits will continue to expand as older plans lose their “grandfathered” status and become subject to the ACA’s preventive health services requirements.  For now, many college and university students will benefit if they receive health insurance through their schools, as those plans usually begin their health plan years around the start of the school year.  Other insurance policies that are renewed with substantially different content (usually on January 1^st) will also comply with the new law.

Women whose insurance plans fall under the new guidelines will now have access to a number of services that will “keep them healthier and…catch potentially serious conditions at an earlier, more treatable stage,” according to Secretary of Health and Human Services, Kathleen Sebelius. This includes annual well-woman visits, as well as screening and counseling for HPV, HIV, and STIs. Insurance policies will also have to cover testing for gestational diabetes, breastfeeding support, and domestic violence screening and counseling. Perhaps most significantly, women will also have access to birth control and other forms of contraception without a co-pay, though exceptions have been made for religious institutions and self-funded plans. These services add to the no-cost coverage that has already been implemented for pap smears and mammograms.

The Department of Health and Human Services reports that 20.4 million women have been and will be affected by this expansion in coverage. A startling 52% of women “report delaying needed medical care because of cost,” a number that will be decreased under the ACA. The Women’s Law Project (WLP) explained in its report Through the Lens of EQUALITY: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women that “lack of access to the full range of women’s health care has many adverse health consequences.”  Many women are unable to afford contraceptives, which range from $15 to more than $1,000 up front depending on the method.  The contraceptive coverage rule will increase women’s access to these methods of contraception, which will help them plan pregnancies and address other health concerns, such as polycystic ovarian syndrome, for which birth control pills are a common treatment.

Controversy continues over the provision requiring employer-provided insurance plans to cover birth control and other forms of contraception, including sterilization. As WLP blogged about today, twenty-four legal challenges are still pending in courts. The ACA already provides exceptions for religious institutions, and allows religiously affiliated businesses to push cost and administration on to the insurance companies. These accommodations, however, have not stopped the debate. WLP has blogged before about lawsuits that challenge the constitutionality of the provision on the basis of the First Amendment. As Terry Fromson, WLP’s Managing Attorney, explained, “the First Amendment does not give church leaders any right to impose their beliefs about contraception on women.”

Overall, the implementation of this provision of the ACA represents an important and necessary change to the way we view women and women’s health. Reproductive and sexual health must be seen as central to ensuring the health and well-being of all women, and not as a secondary concern. America will be healthier if women are given better access to the services necessary to care for themselves and their families, and increasing access to contraception is a step in the right direction.

Courts Come to Different Decisions on the ACA’s Provision Requiring Some Employers to Cover Contraception

Mary Pat Dwyer, WLP Law Intern

Two federal district court judges ruled recently on claims regarding the Affordable Care Act (ACA) provision which requires that employers providing health insurance to their employees cover reproductive health services, including birth control, emergency contraception, and other procedures.

On Tuesday, July 17, Judge Warren Urbom of the District of Nebraska dismissed a suit brought by several states, Catholic groups, and individual plaintiffs challenging the constitutionality of the provision.  The groups argued that the First Amendment’s protection of freedom of association gave them the right to deny their employees coverage for these essential services.  The states claimed that the groups and others like them would cease to provide insurance for their employees rather than comply with the law, which in turn would increase the number of Medicaid applicants and adversely affect state budgets.

Judge Urbom found that the plaintiffs did not have standing to pursue their claim that the mandate violated the first amendment for two reasons.  First, the federal government has delayed enforcement of the provision until August 2013.  Because of this, the groups are not facing any imminent requirement to comply with the law, and thus cannot show the “direct and immediate harm” that plaintiffs must show in order to have the courts consider their claims. Second, the states claims that they would face increases in Medicaid costs were based purely on “layers of conjecture,” and had no factual grounding. Furthermore, Judge Urbom pointed out that the Department of Health and Human Services is currently considering revising the definition of religious employers under the ACA. Because of the potential for revision, none of the plaintiffs could show that they would ever be impacted by the provision.

On Friday, July 27, Judge John Kane of the District of Colorado reached a drastically different conclusion when he granted an injunction prohibiting the federal government from enforcing the provision against Hercules Industries Inc., a private corporation. Judge Kane found that for the Catholic plaintiffs, who serve as co-owners and board of directors of a company that manufactures HVAC equipment, the obligation to comply with the law threatened their right to exercise their religious beliefs under the Religious Freedom Restoration Act (RFRA). Katherine Sebelius, Secretary of the Department of Health and Human Services, expressed disappointment with Judge Kane’s decision, but also stated that she is “confident that as this case moves through the courts, the policy that most health insurance plans cover contraception will be upheld.” Sebelius also reaffirmed the administration’s position that “health decisions should be between women and their doctors, not their employers.”

Twenty-four similar lawsuits claiming that the requirement violates the First Amendment are still pending in courts across the country. These suits undermine the security of women’s health care, and it is crucial that the courts recognize the grave importance of comprehensive health care access. As WLP highlighted in Through the Lens of Equality: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women, women who face restricted access to contraceptive care suffer serious health risks as a result. Women who are unable to effectively and safely plan their pregnancies are more likely to experience pregnancy complications. For women who have preexisting conditions, such as diabetes, coronary artery disease, or arthritis, unintended pregnancies can be life threatening. Additionally, children born of unplanned pregnancies, face increased risks of premature birth, low birth, poor nutrition, and infant mortality.

Neither judge ruled on the constitutionality of the provision. However, as we have previously explained, the federal contraceptive coverage rule does not violate the First Amendment because it is a neutral law that does not target a particular faith and applies to everyone equally.  It is constitutional.

Abington Memorial Hospital and Holy Redeemer: Putting Women’s Health at Risk by Imposing Religious Doctrine on Patients

Amal Bass, WLP Staff Attorney

UPDATE: On Wednesday, July 18, 2012, Abington Health and Holy Redeemer Health Systems announced that they have abandoned their plan to merge.

In late June 2012, Lawrence Merlis, president and CEO of Abington Health System, and Michael Laign, president and CEO of Holy Redeemer Health System announced a joint venture between the two suburban Philadelphia systems with the goal of creating a regional health system by the spring of 2013.  The result will be a partnership between a secular hospital system and a Catholic system, a partnership that will dilute the quality of care women across the region have come to expect from Abington Health’s facilities.  In particular, the partnership will force Abington to stop providing comprehensive reproductive healthcare for women, thereby putting women’s lives at risk.

In 2011, Abington performed 64 abortions, primarily for women with high risk pregnancies that compromised their health.  For women with such high risk pregnancies, abortion can be a life-saving procedure.  For other women, abortion terminates non-viable pregnancies, possibly due to fetal abnormalities or placental problems.  For all women, regardless of the reasons behind needing the procedure, it is a fundamental right protected by the United States Constitution, and it should be a choice that is available at a hospital they trust.

Women who receive their gynecologic and obstetric care from Abington Health, which is one of the largest maternity care providers in the Commonwealth, will have to find abortion services elsewhere.  Hospital officials have not commented on whether Abington will continue to perform selective reduction, a process after infertility treatments where the number of embryos is reduced to increase the woman’s chances of carrying a pregnancy to term, which is typically banned at Catholic hospitals. The hospital claims that it will continue to perform contraceptive services and counseling, such as tubal ligations and vasectomies, which are typically prohibited by Catholic doctrine, but it is unknown if the services could be withdrawn at any time.  

Thus, the full impact of the imposition of Catholic doctrine on Abington’s medical services, if the joint venture goes through, remains to be seen.  Catholic health systems are slowly monopolizing health care across the country.  As of 2011, approximately one-fifth of all hospital admissions in the United States and between 10 and 20 percent of admissions in Pennsylvania are to Catholic hospitals.  These systems impose their religious beliefs, contained in the “Ethical and Religious Directives for Catholic Health Care Services,” on patients of all backgrounds and faiths, interfering with the medical practitioner-patient relationship.  In 2010, the Catholic Church made its position on women’s health very clear when it excommunicated a nun serving as a hospital administrator for permitting doctors to perform an abortion to save the pregnant women’s life.

The result of this policy in practice could be that women in need of abortion, possibly needed to save their lives, may have a delay in treatment or may require a transfer while they are unstable to a non-Catholic hospital.  Abington may thus become vulnerable to medical malpractice lawsuits and claims for violations of the Federal Emergency Medical Treatment and Labor Act (EMTALA) for putting religious doctrine before women’s health.  The imposition of Catholic Directives on patient care may cause experienced staff to leave the hospital, and it may also cause patients in the area to seek maternity and other care elsewhere.

Opposition to Abington’s partnership with Holy Redeemer is growing.  Rabbis from congregations in the area have written a letter to Abington’s Lawrence Merlis, protesting the planned joint venture.  A Facebook group, Stop the Abington Hospital Merger, has also formed.

To learn more about the dangers of receiving reproductive health care at Catholic-affiliated hospitals, see the prior posts on this blog, “Patients Are Denied Health Care on Ideological Grounds” and “Nun Excommunicated from Catholic Church for Saving Woman’s Life” and WLP’s 2012 report, Through the Lens of Equality: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women.

The United States Supreme Court has weighed in: The Affordable Care Act is here to stay.

By Women’s Law Project

The Affordable Care Act (ACA), signed into law by President Obama in March 2010, expands health insurance coverage to more than 30 million people, prevents insurance companies from discriminating against people with pre-existing conditions, and ends abusive insurance practices.  On June 28, 2012, the Supreme Court upheld the law, finding that the individual mandate (which is the requirement that everyone carry insurance or pay a fine) is constitutional under Congress’ taxing power.  The Court also upheld the Medicaid expansion provision (which expands Medicaid eligibility for residents to 133 percent of the federal poverty level) as long as states that refuse to comply do not lose all of their Medicaid funding.

While some provisions of the ACA have already gone into effect, other provisions will be in effect by 2014.  This law will improve the lives of women and children across the country, allowing them to access affordable health care.  The ACA benefits women in many ways, including by preventing insurers from using pregnancy, domestic violence, and sexual violence as a basis for denying women coverage (pre-existing conditions), prohibiting the practice of charging women higher insurance premiums than men for the same insurance (known as gender rating), guaranteeing maternity coverage, and ensuring that new insurance plans cover preventive services such as mammograms and pap smears. 

The ACA is constitutional and vitally important to improving the health of American citizens, particularly women.  However, gaps in coverage for health care essential to women remain.  Most notably, the ACA allows insurers to discriminate against women by refusing to cover abortion care, and the Pennsylvania legislature is considering legislation that will ensure that insurance plans sold through the ACA’s state exchanges do not include abortion coverage except in cases of life endangerment, rape, or incest.  Furthermore, the Supreme Court’s determination that states may decline to comply with the Medicaid expansion program without risking loss of their existing Medicaid funding raises questions about whether the federal government will be able to implement the expansion effectively.  If states decline participation in Medicaid expansion, many poor individuals, many of whom are women, will be left without health coverage.  Now the focus is on Pennsylvania to ensure coverage for everyone.

For more information on the ACA and WLP’s work on access to health care, see WLP Health Care Reform and WLP’s Report, Through the Lens of Equality: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women.

The Hypocrisy of Cuts to Medicaid Reimbursements for Newborn Care

Amal Bass, WLP Staff Attorney

When Pennsylvania’s politicians say they are for protecting the unborn, they mean it literally: the minute you’re born, you’re on your own.

Last month, Pennsylvania’s Department of Public Welfare (DPW), which is run by Governor Tom Corbett’s political appointees, yanked the rug out from under maternity wards state-wide by eliminating the $1,155 payment it used to make to hospitals for a newborn’s regular care when the mother is on Medical Assistance (Pennsylvania’s name for Medicaid).  DPW will continue to reimburse hospitals for the mother’s care, but it will no longer reimburse hospitals for the baby’s care unless the baby develops complications or needs to stay longer than normal for observation.

Nearly half of all births in Pennsylvania are paid for by Medical Assistance, so the reimbursement cuts will significantly impact hospitals across the state that provide maternity care, forcing them to absorb even more of the cost for the services they provide to pregnant women and their babies. Even prior to these cuts, hospitals typically lost money on Medicaid deliveries. One community hospital reported that every Medical Assistance delivery costs the hospital between $7,800 and $8,400, while the Medicaid reimbursement prior to May 1st was a mere $6,867 for both mother and baby. Now it is just $5,712.

Large hospitals that also serve many privately-insured mothers might be able to spread the loss among other deliveries, or even among other departments in the hospital. However, independent community hospitals that already have trouble breaking even will face greater financial difficulties.  As a result, they may have to close their maternity wards and lay off employees, making it even harder for Pennsylvania’s pregnant women to receive maternity care within a reasonable distance from their homes. Already, as the Women’s Law Project explores in our recent publication, Through the Lens of Equality: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women, many women in Pennsylvania, particularly if they are poor, have few options when choosing obstetrical providers. For these women, the result of the shrinking number of obstetrical providers that accept Medical Assistance is a delay or a denial in receiving prenatal care, medical care that is important for the health of pregnant women and their babies. DPW’s cuts to hospital reimbursements will only exacerbate an already dire situation for women who receive Medicaid.

DPW’s decision to cut hospital reimbursements for newborn care is another example of how misguided Governor Corbett’s administration is on issues relating to women’s and children’s health.  The governor pressed for controversial legislation that would mandate women undergo medically-unnecessary transvaginal ultrasounds prior to receiving abortions, justifying the bill by claiming these women can just “close their eyes,” but his administration will not even use a combination of federal and state funds to pay for the medical assessments and procedures newborn babies need in the crucial first 72 hours after they are born.

If Governor Corbett and DPW truly believed in the sanctity of life, they would promote policies that help women have healthy pregnancies and healthy babies. Their hypocrisy couldn’t be more apparent than in cutting maternity reimbursements for the care of newborn babies.

White House Holds Town Hall on Women’s Health

Molly Cohen, WLP Intern

With the Supreme Court’s ruling on the 2010 Affordable Care Act looming on the horizon, the White House recently held a town hall meeting on Women’s Health to tout the benefits of the Act. Panel members included Valerie Jarrett (Senior Advisor to the President and Chair of the White House Council on Women and Girls), Kathleen Sebelius (Secretary of Health and Human Services), Judy Waxman (Vice President of the National Women’s Law Center), Mayra Alvarez (Director of Public Health Policy in the Office of Health Reform, HHS), and other female leaders in Washington. The White House promoted the event as “an interactive, open dialogue about how the health care law, the Affordable Care Act, is improving the health of women and their families” and encouraged viewers to submit questions via Twitter and Facebook.

Secretary Sebelius spoke frankly about the discrimination women experience throughout the healthcare system. As our recent report, Through the Lens of EQUALITY: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women also illustrates, women are regularly denied coverage if they have ever had breast cancer, cervical cancer, a cesarean section, or medical treatment for injuries resulting from domestic violence or sexual assault.

Those who do qualify for coverage are subject to a practice known as “gender rating,” in which women pay substantially higher premiums than men of the same age. In fact, a Pennsylvania study found that some insurance companies charge higher premiums to non-smoking women than male smokers of the same age. At the White House town hall, Sebelius remarked, “Now let’s say you were lucky and healthy. Even then, insurers could charge women up to fifty percent more than men just for being a woman. Essentially, this meant that being a woman was, in itself, a pre-existing condition.”

The ACA, if fully implemented, will make gender rating and the practice of withholding coverage on the basis of a preexisting condition illegal in the individual and small group markets. The Act also greatly expands the range of preventive care covered by insurance. Section 1001, for example, requires new health insurance plans to offer all screenings and services recommended by the U.S. Preventive Services Task Force, free of charge to the patient. This includes regular mammograms for women over 40 and screenings for cervical cancer. Section 1302 includes maternal and newborn care in the list of “essential health benefits” new policies must cover, beginning January 2014. Women will no longer have to pay co-pays on prenatal visits, folic acid supplements, consultations with lactation specialists, or screenings for conditions such as gestational diabetes and anemia.

Secretary Sebelius explained that by making preventative care measures more affordable, the ACA seeks to eradicate existing inequalities. Currently, African American women are more likely to die of breast cancer than any other group, while Latinas have the highest rates of cervical cancer.  Under the current healthcare system, low-income women, especially those without insurance, are forced to delay seeking medical care because of the financial burden of doctors’ visits. They are therefore more likely to receive inadequate care and to die prematurely.

While a recent report found that the number of uninsured young Americans is on the decline, any progress made under the ACA is shadowed by the uncertainty surrounding the upcoming Supreme Court decision. If the White House’s worst-case scenario is realized and the Court strikes down the ACA in its entirety? Sebelius warned this outcome would have a “pretty cataclysmic impact.” In a blog issued after the town hall on Women’s Health, she stated:

“…for women, the law means peace of mind. Peace of mind that no matter their circumstance there will be a health system that works for them and cares about their needs. That’s what the law is all about.”

If you want to know more about the link between sex bias and adverse health effects in women, please read our new report Through the Lens of EQUALITY: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women. The Affordable Care Act is an important step for women in Pennsylvania and throughout the country.