Come senators, congressmen
Please heed the call
Don't stand in the doorway
Don't block up the hall
Last week, Susan Orr resigned as head of the Title X (federal reproductive health grant)
program. Dr. Orr is not a supporter
of hormonal contraceptives,
so the resignation is welcomed by the reproductive health and reproductive
rights community. We hope it is a sign of change to come.
Walking the halls of Congressional offices last, I imagined echoes of change. Were they echoes from the past or the future? New voters are registering, activists are organizing, and communication technologies are harmonizing old and new ideals and activists. The current President and Congress united the old activist generation with a new generation of young activists and advocates by insulting and injuring all of us with a $1.5 billion federally endorsed chastity belt called ‘Abstinence-only Education,' which many reports classify as ineffectual at best. A new President and Congress could instead stop wasting $300 million every year and invest the money in proven comprehensive sexuality education programs.
This is a good time to plan
ahead and to advocate for health care policy change - especially
for reproductive health care. We know that access to voluntary
and confidential contraception, STD testing and treatment, and comprehensive
sexuality education is affordable, achievable, and long overdue.
The Wisconsin Family Planning and Reproductive Health Association (WFPRHA) recommended to an Institute of Medicine Review Committee (IOM) on Monday, May 19, that Title X, Medicaid-paid family planning, and access to public prescription drug pricing should be interwoven into a national reproductive health safety-net. The proposal would prevent unintended pregnancies among low income women and free up millions of dollars for preventive primary health care.
Here is a 2009 inaugural chorus
we can sing together next year proudly and loudly:
And, as unconscionable as the disparities across the U.S. are in access to reproductive health care, around the world they are even less defensible. While they're at it, the next President and the next Congress should also take the abstinence-only chastity belt off the President's HIV/AIDS assistance program (PEPFAR). Removing that restriction would help achieve worldwide access to primary preventive reproductive health care.
WFPRHA laid out a plan to the IOM, but whether we unite behind that
plan or another, it is time for all of us to think and plan ahead and
to speak out at every political and public policy event for the right
to universal access to evidence-based reproductive health care and education.
To our elected officials, we need to be clear that on reproductive rights and health care and education: "You better start swimmin' or you'll sink like a stone, for the times they are a changin'."
]]>Pro-Life Wisconsin's campus newspaper ads state: "Be good to yourself over spring break. Make smart choices the night before ... that way you won't have any emergencies to deal with the morning after!" Good point. Everyone agrees that good responsible sexual choices are safer, healthier, more respectful, and less likely to result in life-changing negative consequences -- just plain smarter.
But the PLW ad goes on to state that; "emergency contraception is a powerful, high dose of steroids that tricks a woman's body into thinking it is pregnant" and can cause "chemical abortions and deadly blood clots." PLW promiscuously crammed as many misleading and unsupported claims into one short statement as it possibly could, but the main and most clearly refutable points are often heard and too often echoed across the country: "chemical abortions" and "blood clots."
The latest World Health Organization information is explicit that EC works by preventing ovulation and fertilization. There is no evidence that EC prevents implantation and there is substantial evidence that Plan B's rate of not preventing implantation of a fertilized egg fully explains the pregnancies that occur after the pills have been taken. In other words, the primary argument that opponents of EC make (we should not risk the destruction of a single fertilized egg) is scientifically, theoretically, and statistically head-of-a-pin microscopic.
Weighed against the larger risks of an unwanted, untimely, or risky pregnancy or perhaps an abortion at a later stage of a real pregnancy, the microscopic objection should vanish completely. And, since unlike many forms of hormonal birth control, Plan B does not contain estrogen, PLW's warning about "blood clots" seems to be based on their own beliefs and very little else.
What will not disappear and what is impossible to ignore in this debate about possibilities, is the question of why an organization opposed to abortions would discourage women at risk of unwanted pregnancy from acting to prevent those pregnancies? Why is an organization repulsed at the idea of risking a single fertilized egg acting in a way that puts women (including those who will subsequently abort an unwanted pregnancy) at a greater risk of pregnancy?
To a rational person seeking to reduce abortions, an unproven possibility of the presence of a fertilized egg and a theoretical possibility of preventing a potential implantation on the uterine wall is simply not morally or ethically equivalent to an unwanted pregnancy. The imbalance is dramatically and clearly shown when the woman at risk is likely to have an abortion if she becomes pregnant.
Spring break is a good time for anti-abortion advocates and supporters of accurate safer-sex education alike to call for sexual responsibility and restraint. Perhaps we can agree to exercise responsibility and restraint in our advertising too. Opponents of abortion, like Pro-Life Wisconsin, could demonstrate that they will not risk increasing the number of abortions to quench an insatiable desire for public attention.
Related Posts
When I was one year old, she decided to place me in a foster home. Nine years later, when she remarried, I decided to stay with the foster parents I'd come to think of as my parents, too. She had two subsequent failed and deeply mourned pregnancies, but at last, she had two healthy births.
On the 35th anniversary of Roe v Wade, I'm thinking of the pain she went through with the failed pregnancies and her pain at the end of her life. I'm also reminded of a story broadcast on National Public Radio last year just before her death.
Victims of Chinese government officials in Quangxi Province described their forced abortions to NPR reporter Louisa Lim. The women told of involuntary injections and officials without the simple decency to provide follow-up medical care. Denying the accusations, local officials said: "We really love and care for women here."
According to Lim, "investigators" were hurriedly cleaning up the hospital beds and dispersing the young victims to rural and remote parts of the province.
I am also thinking of last year's U.S. Supreme Court ruling that denies a few desperate women access to what may be an ugly and troubling but would have been safe and legal late-term abortion. The Court has brought the government and the opposition to abortion together in an effort which: " . . . furthers the legitimate interest of the government in protecting the life of the fetus that may become a child."
Although one government claims to respect life and the other government acts to extinguish it, I have a sickening sense that these actions are not related by love and care for women. Instead, they are connected by a conviction that women must be prohibited from making their own decisions about pregnancy and reproduction. As justification, the Court's majority opinion says: "While we find no reliable data to measure the phenomenon, it seems unexceptional to conclude some women come to regret their choice to abort the infant life they once created and sustained. . . . Severe depression and loss of esteem can follow."
Justice Kennedy, writing for the majority of the court, admits using an unsupported belief that many women later regret having had abortions to justify a prohibition. The chilling common thread is an enforceable faith that the government's end justifies the brutal means they use to achieve it.
How is a preventable maternal death less repugnant than a late-term abortion?
There are parallel moral, ethical and spiritual issues at the end and at the beginning of life. Thankfully, despite its love and care for women, the administration did not interfere with my mother's final days. On the 35th anniversary of Roe v Wade and in her memory, I am compelled to say that if we love and care for women, we will stand together to respect and guarantee the human rights of each one.
My mother was entitled to her regrets, but when she told me she wasn't always there for me, she was wrong. She did the right thing for the right reasons.
]]>The grateful prisoner was freed and the princess demonstrated that to get results in the empire, a technically subtle approach might be successful where a direct approach might fail.
Now how about freeing access to reproductive health care for women in a half-dozen states who are receiving services under Medicaid Family Planning Waivers that will end before the term of the current "tsar" on January 20, 2009?
On December 7 Senator Hillary Clinton (D-NY) distributed a letter for cosigning to senators from the 26 states currently authorized to provide family planning services through Medicaid 1115 Family Planning Waivers. These Family Planning Waivers allow low and moderate income women who would otherwise be ineligible for Medicaid coverage until pregnant to receive Medicaid-paid family planning services before they become pregnant and before they have children. In the joint letter to House and Senate Leadership, she described the Waiver approval process states must go through:
Unfortunately, the current waiver process has proven increasingly unworkable. Over the last decade, only seven of the 20 proposals for income-based eligibility expansions approved by CMS have been approved within a year of when they were submitted by the state. Six applications took between one and two years for approval, and seven languished for two years or more before finally being approved. Particularly given the well-established value of these demonstrations, the current approval and re-approval required under federal law wastes critical staff resources, hamstrings states' ability to meet changing needs, and limits our efforts to reduce unintended pregnancies and meet reproductive health needs in our states.
Wisconsin is first up to the chopping block and our Department of Health and Family Services is locked in eleventh-hour plea-for-pardon negotiations with the Centers for Medicare and Medicaid Services (CMS) on behalf of health care for the 75,000 women enrolled in the program ending December 31, 2007. Beyond Wisconsin there are hundreds of thousands who would be helped in the six other states and beyond that, if Senator Clinton's proposal passes, women in the other 43 states and territories could quickly benefit as well.
Medicaid Family Planning Waivers save money by reducing more costly Medicaid-paid births by preventing unintended pregnancies. By expanding the program as Senator Clinton is proposing, the Congressional Budget Office has estimated an annual federal savings of up to $400 million. The Guttmacher Institute estimates even greater savings as well as benefits to maternal and child health.
It would be better to have a reasoned discussion of Medicaid-paid family planning services through full Congressional deliberation and passage of the Unintended Pregnancy Reduction Act (S. 1075 - H.R. 3162). But in the waning days of this empire, the women in the seven states with "Waiver execution dates" won't care whether it's a comma's position or a full debate that renders the result.
So pardon us, Mr. President.
Help win a pardon for family planning programs and a reprieve for women everywhere:
Let legislators know that the family planning expansion and access provisions of the Unintended Pregnancy Reduction Act (S. 1075 and H.R. 3162) must be included in the Medicaid physician reimbursement bill.
1) Contact members of the House Energy and Commerce subcommittee on Health and in the Senate Finance Committee. Use the ‘contact us' link at the House Energy and Commerce Committee subcommittee on Health's website at: http://energycommerce.house.gov/Subcommittees/health.shtml
2) Contact members of Senate Finance Committee at its website at http://www.senate.gov/~finance/.
3) Visit the ‘Write Your Representative" website at http://www.house.gov/writerep/ and the "Find Your Senator" website at http://www.senate.gov/general/contact_information/senators_cfm.cfm.
4) Ask friends and organizations who support expanded access to primary care, including reproductive care, to contact Congress. Direct them to this website and ask them to help spread the word.
Visit our website at www.FPHS.org if we can be of help or to learn more about us. If you do contact your legislator, let us know at info@fphs.org. Thanks for your help!
]]>Speaking of unintended consequences (and unintended pregnancies), the 109th Congress included language in the Deficit Reduction Act of 2005 (DRA) that deprived pharmaceutical companies of the ability to provide low cost drugs to campus health centers and "safety net providers." Drug companies quickly cut campus health centers off from low-cost contraceptives which forced them to increase prices to their students.
We recognize the public policy system is, at times irrational, but before we cause another accident trying to recover from this one, we should try to make sense of:
Family planning advocates aren't gamblers. In the same way that the consequences of limiting access to affordable contraceptives to students and low-income women is predictable, the consequences of relying upon the good will of pharmaceutical companies and Health and Human Services Secretary Leavitt to provide us with access to contraceptives is foreseeable. For risk-averse family planning advocates, it's a bad bet.
Drug companies, Congress, the NY Times Editorial Board, and our advocates all agree on the correction that needs to be made and we all know that the consequences of inaction will be borne by women in a far more personal and potentially devastating way than any threatened decrease in drug company profits.
Representatives Maloney and Crowley, and Senators Obama, McCaskill, and Clinton have introduced legislation to take control of the situation and restore the ability of drug companies to offer discounted pricing to campus health centers. In Wisconsin, our family planning association is wisely lining up behind the American College Health Association to help push the bill forward, but we must push deliberately or we might push ourselves into another collision with reality.
Restoring drug pricing regulations to what they were prior to the DRA still leaves student health at risk. Regulations to provide access to public sector drug discounts were deeply in need of repair long before the DRA.
In its current form, H.R. 4054/S. 2347 has neither a requirement nor an incentive to insure the pharmaceutical companies offer low prices to campus health centers or safety-net providers. Without a definition of ‘safety net provider' or an application process, the central question of access remains entirely up to the drug companies.
At the same time we push for this legislation, we must tell our elected officials and advocates that we need a clearly defined process to obtain ‘safety net provider' designation (to prevent another example of O'Rourke's theory).
"Go out and cause them yourself":
Visit our website at www.FPHS.org if we can be of help or to learn more about us. If you do contact your legislator, let us know at info@fphs.org. Thanks for your help!
]]>Senator Clinton took the opportunity to demonstrate a broad and detailed understanding of practical solutions to address gaps in access to reproductive health care. In this four minute vignette, she outlines a three-point immediate action plan to address gaps in the reproductive health safety net. We can act on each point right now:
1) Explicit and specific inclusion of contraceptive care and preventive reproductive health services in every discussion of health care reform. This means clear integration in health insurance coverage as well as regulatory reform. The senator says we can leave nothing to chance.
By including Senator Clinton's Unintended Pregnancy Reduction Act language in the Children's Health and Medicare Protection Act (as is done in the House version of the reauthorization bill), we integrate family planning with other maternal and child health services.
2) To insure that Title X's mission of access to reproductive health care for all regardless of income is fulfilled, Senator Clinton calls for adequately funding the Title X family planning program but she does not stop there.
3) When she mentions campus health care providers, she is referring to the loss of nominal pricing that was available prior to the passage of the 2005 Deficit Reduction Act.
There is language that would permit pharmaceutical companies to voluntarily offer nominally priced contraceptives included in CHAMP HR 3162, but Representative Bobby Rush has proposed much more comprehensive legislation to improve the integrity of the public sector drug pricing program - H.R. 2606.
Senator Clinton calls on us to "sound the alarm" on opponents of family planning services who are not just anti-abortion. They are anti-contraception and anti-women's rights. This is a challenge we can meet, beginning with advocacy for family planning integration in the CHAMP act.
The US Senate (SCHIP) and the House (CHAMP) passed Children's Health and Medicare Protection Act bills at the beginning of August. It will go to conference committee when they reconvene.
Now, for the first time, the Congressional Budget Office has recognized in a very conservative cost analysis, that expanding Medicaid-paid access to contraceptive care saves taxpayer dollars. Those savings can and should be used to offset the costs of providing coverage to uninsured children.
Reauthorization of the State Children's Health Insurance Program is extremely important and must be acted upon before the end of September. Because the Senate language does not include family planning access expansions, it is essential that senators and representatives hear from you right now how important it is that the conference committee's final product expands access to family planning services. With the House CHAMP bill language, we could do much more and we could do it with much less administrative red tape.
Leave nothing to chance - take these three action steps:
1) Contact Senator Clinton to thank her for her support for integrating reproductive health care access in every health care reform proposal, specifically in Children's Health Insurance negotiations.
2) Visit the ‘Write Your Representative" website and the "Find Your Senator" website and communicate to them your support for family planning in Children's Health Insurance legislation.
3) Ask friends and organizations who support expanded access to Children's Health Insurance coverage and primary care that includes reproductive care, to contact congress. Direct them to this website and ask them to help spread the word.
Visit our website if we can be of help or to learn more about us. If you do contact your legislator, let us know at info@fphs.org. Thanks for your help!
]]>The good news and opportunity for maternal and child health advocates is that the House version includes Unintended Pregnancy Prevention Act language! The Senate edition does not.
Although either bill, if adopted, would face a "road closed ahead" veto threat from President Bush, long before Congress arrives at that Presidential detour, a conference committee must reconcile the two plans. To be sure our elected officials don't take a wrong turn or lose their way, it's time for you to give them directions.
CHAMP is a critical bill reauthorizing the State Children's Health Insurance Program that must be acted upon before the end of September. House members who are supportive of expanding access to reproductive health care have selected House Resolution 3162 as a vehicle to carry us down the road toward universal access to confidential reproductive health care. Riding with H.R. 3162 are provisions of the Unintended Pregnancy Reduction Act which allow states to easily include or to continue (as in twenty-six states) providing expanded access to federally funded family planning services in their Medicaid programs. There are also provisions that would reduce burdensome identity and citizenship documentation requirements for minors so they can more readily and confidentially receive family planning services.
Because the Senate CHAMP language does not include family planning access expansions, it is essential that your senators and representatives hear from you right now so they know how important it is that the conference committee's final product expands access to family planning services. To prevent unintended pregnancies, sexually transmitted infections, and to reduce abortions, there is nothing less expensive or more effective than free access to confidential reproductive health care. Expanded Medicaid-supported access to reproductive health care through the current (more cumbersome) Family Planning Waiver process is already reducing unintended pregnancies and abortions, improving maternal and child health, and saving taxpayer dollars in more than half of the states, with the adoption of the House CHAMP bill language, we could do much more and we could do it with much less administrative red tape.
Four steps to help the conference committee find its way:
Let legislators know that the family planning expansion and access provisions of H.R. 3162 must be included in the final CHAMP bill because they will expand access to preventive health care and improve maternal and child health outcomes while saving taxpayer dollars.
1) Contact members of the House Energy and Commerce subcommittee on Health and in the Senate Finance Committee. Use the "contact us" link at the House Energy and Commerce Committee subcommittee on Health's website here.
2) Contact members of Senate Finance Committee here.
3) Visit the Write Your Representative website and the Find Your Senator website.
4) Ask friends and organizations who support expanded access to primary care, including reproductive care, to contact congress. Direct them to this website and ask them to help spread the word.
Visit our website at www.FPHS.org if we can be of help or to learn more about us. If you do contact your legislator, let us know at info@fphs.org. Thanks for your help!
]]>The 340B Program Improvement and Integrity Act
House Resolution 2606
Representative Bobby Rush, a member of the Congressional Black Caucus, is leading an effort in the Health subcommittee of Energy and Commerce, to expand and improve the 340B program which gives patients of safety-net providers access to low cost drugs, including contraceptives.
The 340B program requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at low prices to publicly funded health care agencies that serve uninsured and low-income populations. Representative Rush's bill would require pharmaceutical companies to expand access to the program to include community hospitals, rural referral centers, Maternal and Child Health care providers (e.g. services to children with special health care needs and family planning clinics), as well as mental health and substance abuse centers. Additionally, HR 2606 would tighten up holes in the program by strengthening the Department of Health and Human Services' ability to verify eligibility as well as pricing calculations. The net result: expanded access to drugs by people in need and a projected annual taxpayer savings of $217 million.
The Unintended Pregnancy Reduction Act
Senate Bill 1075
Over the past five or six years, there has been a quiet and powerful advance in access to reproductive health care from Texas to Wisconsin and from New York to Oregon, providing free reproductive health care for those in need. For preventing unintended pregnancies, sexually transmitted infections, and reducing abortions, there is nothing less expensive or more effective than free access to confidential contraceptives and routine clinical care.
The dramatic change in the scope and shape of the reproductive health care safety net has resulted in Medicaid providing more than half of all federally-funded family planning services received by patients. The simplest reason for that shift is that twenty-six states are operating Medicaid Section 1115 Family Planning Waiver demonstration projects. These demonstration projects have proven their effectiveness in reducing unintended pregnancies as well as their cost-savings (PDF).
Senate Bill 1075, the Unintended Pregnancy Reduction Act, would expand Medicaid funded family planning services to all states and territories and would make renewals of existing waivers much easier. The opportunity to design a program that meets patient needs in rural areas, in underserved areas, and to women and men in need should be available to all states, across the nation. The success is so widely and well documented (PDF) that maintaining their status as "demonstration projects" is an anachronism.
With a reasonably accessible and comprehensive design, these Family Planning Waivers have already been proven to do the following:
Three ways to move these bills forward:
Visit Family Planning Health Services' website if we can be of help or to learn more about us. If you do contact your legislator, let us know. Thanks for your help!
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