This is not the change we believed in. President Obama’s tiptoeing around our human rights is not the leadership we voted for.
The House health care reform bill, the “Affordable Health Care for America Act,” won’t actually create affordable health care for America. It will perpetuate our existing inefficient, often inhumane health care system, one that spends twice as much as any other nation on earth yet fails to meet the basic needs of many individuals and communities. The convoluted logic of our existing health insurance-based system is echoed in the cumbersome pages of HR 3962.
Already, over 30% of each dollar of our insurance premiums goes not to cover actual health care costs, but instead to pay for the overhead and profits of the private health insurance industry. With the House version of health care reform passed last night, we’ll throw more of our tax money into this inefficient, for-profit system. (Medicare, a single payer, not-for-profit, government-run health plan for seniors and some disabled people, spends 2-3% on overhead.)
The health insurance industry, which exists not to care for sick people or keep us healthy, but to reap profits, is the big winner so far in health care reform. As of today, women are the biggest losers. With the addition of the Stupak amendment, health care reform further chips away at women’s fundamental right to abortion by eliminating coverage through health insurance plans associated with Health Insurance Exchanges (what’s left of the ‘public option’). Ironically, the agency overseeing the Exchanges is called the Health Choices Administration. In fact, there will be no choice in the new health reform plans—the bill restricts any system funds from going to abortion care, even the premium monies women pay out of their own pockets.
The amended bill allows for “non federal entities” including local and state governments and individuals to “purchase supplemental coverage for abortion.” This provision would be hilarious in its absurdity if it were not so tragic. The point of health insurance—indeed, the point of all insurance—is to provide a safety net when life throws unexpected, difficult events our way. Of course, no one plans ahead for their abortion. When women and families are applying for insurance, they don’t think to themselves, “Well, are we going to need an abortion this year?” Plus, most companies and government entities will surely be unwilling to pay for supplemental coverage of any kind, much less for supplemental coverage for one particular highly marginalized and stigmatized (yet common) reproductive health service.
The House legislation is not all bad. It’s good that the law would prohibit insurance companies from discriminating against people with pre-existing conditions, like me with my cystic fibrosis and breast cancer. It’s good, and about time, that preventive health services will be fully covered under Medicare and Medicaid. It’s a relief that our government will finally be able to negotiate drug prices directly with pharmaceutical companies for Medicare Part D plans.
But HR 3962 is not good enough. It does not provide universal coverage and it will not control health care costs. It does not eliminate or even reign in the private insurance companies, who waste $400 billion each year—enough to cover health care for all 46 million of the uninsured. The law, if passed, will blindside a lot of women, from all walks of life, who won’t care much about the abortion restrictions until life throws them a curveball. When they find themselves in a situation they did not and could not have planned for, they will learn, as do poor women in most states, Native American women, and our soldiers and veterans, that their choices have already been made, by bishops, by corporations, and by their Congress.
]]>Together with Barack Obama's decisive win, the outcomes of the ballot initiatives give us hope for the future of Americans' reproductive health. We can use our momentum to work with our pro-choice president-elect on repairing the damage done to reproductive rights over the past eight years. Imagine a country where we don't have to constantly defend the existence of abortion and contraception, where we can dedicate our energy instead to guaranteeing comprehensive reproductive healthcare for all!
I practice in California, where Proposition 4 would have required notification of a minor's parents if she needed an abortion. This was the third time in four years that we've battled similar initiatives. While most teens do involve their parents when faced with a pregnancy, we have fought to protect the health of those who can't or won't.
I volunteer at clinics where
I see pregnant teens. Some have abusive parents, are estranged from
their families, or have other good reasons why parental notification
could be risky for them. To make Proposition 4 more palatable to voters
than its predecessors, its authors included exceptions for girls like
my patients. But teens could not take advantage of these exceptions
unless they either stated in writing that their parents abused them
or took themselves to court. With my fellow members of Physicians for
Reproductive Choice and Health, I explained to voters that the exceptions
would hurt the very minors they were designed to protect. They listened.
As we had in the campaigns
against the previous initiatives, we also told Californians that many
teens, regardless of their family situations, depend on confidential
reproductive healthcare and would not see a doctor without it.
The voters said no to parental
notification for the third time, 52% against to 48% in favor. Unfortunately,
California is not the only state to consider a mandate of parental involvement
for abortion. Thirty-four states already require either parental notification
or parental consent. We must continue to teach the public and our legislators
about the importance of providing adolescents both medically accurate
sex education and access to confidential reproductive healthcare.
The people behind Amendment
48 in Colorado wanted to place the government inside every pregnant
woman's body, treating zygotes as people with rights. This absurd
initiative would have jeopardized abortion, contraception, fertility
treatments, in vitro fertilization, and the rights of pregnant women.
The voters responded by thrashing this measure, 73% against to 27% in
favor. Without a doubt, a woman has the right to determine the status
of a blastocyst inside her own uterus. Here, too, Americans picked science
and medicine over government intrusion into women's health.
In South Dakota, the danger to women's health was even more concrete. Initiated Measure 11 would have prohibited all abortions in the state with exceptions only for rape, incest, and a serious threat to the woman's health. Even women who qualified for exceptions, however, would have had a difficult time getting an abortion under this law. As the South Dakota section of the American College of Obstetricians and Gynecologists noted, the health exceptions under Measure 11 were "ambiguous and unworkable" for physicians and the women they care for. ACOG stated, "This ban puts the physician in the unthinkable position of either treating her in a medically appropriate fashion and being prosecuted as a criminal, or not treating appropriately and not only facing claims of negligence but, worse, seeing her suffer."
Like Proposition 4 in California,
the proponents of Measure 11 created these so-called exceptions to mollify
voters, who rejected a total ban on abortion in 2006. If they won, Measure
11's masterminds hoped to provoke a lawsuit that they could use to
challenge Roe. But they lost -- the voters of South Dakota came
through for us all. I am delighted that they've protected not only
their own mothers, daughters, and sisters, but all women in the U.S.
In October, I spent four days
in Sioux Falls, Rapid City, and a blizzardy South Dakota plain in between.
I volunteered with doctors, medical students, and other dedicated advocates
as they tirelessly campaigned against this awful initiative. We educated
South Dakotans with medical facts about abortion and shared the stories
of women who needed the procedure. Our voices managed to overcome the
ugly words of a vocal anti-choice opposition-like the parade of doctors
in a disturbing TV ad, who implored people to vote yes on Measure 11
in order to "stop the use of abortion as birth control."
The Campaign for Healthy Families
succeeded -- South Dakota soundly rejected the measure and its virtual
ban on abortion by a ten-point margin: 55% against and 45% in favor.
Still, abortions in South Dakota are hard to come by, with just one clinic in the state and a 24-hour mandatory delay -- as if women hadn't thought about their decision before they drove five hours to the clinic. This reality of scarce, restricted abortion care in South Dakota reflects the situation in many parts of the U.S. Over the next four years, we must try to build equity in reproductive healthcare access, so that women everywhere can obtain the services they need.
As a physician, an activist, and a citizen, yesterday's election has brought me joy. I am deeply grateful to every person who fought against the anti-choice ballot initiatives, giving voters medical, scientific, and humane reasons for preserving women's right to abortion. Americans in three very different states all agree that the government has no place in the consultation between a pregnant woman and her doctor.
As members of the growing pro-choice majority, we can feel proud of ourselves and our fellow voters, and use our newfound strength to rebuild reproductive rights, and make reproductive healthcare a reality for all. ]]>