This article was updated with links at 11:22 am, Monday, July 13th, 2009.
The Republican Party, apparently bereft of viable ideas on how to solve pressing issues, is living up to its reputation as a one-trick pony: launching misleading attacks either on economic policies or on health policies, in the latter case consistently throwing around the word "abortion" whenever and whereever women's health services are involved.
The most recent exercise in the party's "don't-let-the-facts-get-in-the-way" effort to obstruct progress on virtually any issue under consideration by Congress is an attack by Senator Orrin Hatch (R-UT) on a provision of a health reform bill--the Affordable Health Choices Act [17]--known as the Women's Health Amendment. Hatch is leading the charge falsely claiming that this amendment includes coverage for abortion services.
It does not.
The amendment, which would increase access to urgently needed preventive health care in low-income, medically-underserved communities, was introduced last week by Senator Barbara Mikulski (D-MD) as the Senate HELP Committee [18] (Health, Education, Labor and Pensions) considered amendments to the Act. It was supported by a wide range of groups, including, among others, Families USA [19], the Service Employees International Union [20] (SEIU), Campaign for America’s Future [21], Health Care for America Now [22], the American Nurses Association [23], the American Academy of Nursing [24], the American College of Obstetricians and Gynecologists [25], National Women’s Law Center, [26] and the National Partnership for Women and Families. [27]
Yet despite the fact that the United States is facing an unprecedented shortage of health care providers, that more than 40 million Americans lack access to health care, and that low-income, medically underserved communities are hardest hit by the concurrent crises we are now facing, Republicans sought to block the amendment.
It passed. Only one Democrat, Senator Bob Casey (D-PA), voted against the amendment. (As of the morning of July 13th, 2009, Senator Casey's office has not yet returned calls inquiring about the reasons for his vote).
Efforts by Hatch and others to remove the amendment were strongly opposed by advocates for gay, lesbian, and transgender communities, for HIV and AIDS prevention and treatment, and for women's health. The Human Rights Campaign [28], which supports the rights of gay, lesbian, bisexual and transgender persons, favors the amendment because:
Many HIV/AIDS service providers and health facilities that focus on LGBT people are [essential community providers] and serve as the primary source of health care for these individuals.
The National Minority AIDS Council (NMAC) pointed to the critical need for expanded access to the kinds of services offered by the Mikulski Amendment in a statement on its website [29]:
Preventative care is particularly important for women of color. Often the primary care takers of their families, they tend to put the needs of their family members and children ahead of their own – to the detriment of their health. Since 1992, HIV rates among women of color have risen nearly 10%, with over 80% of all HIV cases among women in this country occurring among Black and Hispanic women.
Undaunted by this first loss, Committee Republicans apparently see an opportunity to complicate the health reform process by using abortion as a wedge issue and perhaps try to poison the well in the next round of votes on this bill by spreading misinformation.
Again, the amendment does not include coverage for abortion care.
The amendment states:
A group health plan and health insurance issuer offering group or individual health insurance coverage shall provide coverage for, and shall not impose any cost sharing requirements (other than minimal cost sharing in accordance with guidelines developed by the Secretary) for, with respect to women (including pregnant women and individual of child-bearing age), such additional preventive care and screenings not covered under section 2708 as provided for in guidelines supported by the Health Resources and Services Administration.
It would:
include within health insurance plan networks those essential community providers, where available, that serve predominantly low-income, medically-under-served individuals, such as health care providers defined in section 340B (a)(4) of the Public Health Service Act and [in the relevant section of the] Social Security Act.
Expanding coverage to these populations is an urgent matter of public health. First, women have higher health care costs than men to begin with. Women of childbearing age spend 68 percent more in out-of-pocket health care costs than men, in part because of reproductive health-related needs.
Yet the economic downturn, loss of jobs and health insurance and expansion of the numbers of people living in poverty have led a growing number of women to forego preventive health care. Recent research shows that women are increasingly delaying or skipping preventive health care due the inability to pay for these services, thereby raising overall health costs in the long-run when treatment is required for originally preventable illness an disease. A May 2009 report by the Commonwealth Foundation, for example, found that more than half of women surveyed delayed or avoided preventive care because of its cost.
The Women’s Health Amendment seeks to address these gaps, something to which the Republican Party apparently objects.
What would the Women’s Health Amendment actually do that is so scary? It would:
- Increase access to basic primary preventive care. This includes cancer screenings, well-women exams, pre-natal care, pap tests and other preventive care, including contraception and STI treatment and testing not covered in the prevention section of the Affordable Health Choices Act.
- Support "essential community providers (ESPs)." ESPs expand access to medically under-served communities in part by relieving provider shortages. By requiring that health plans include ESPs "in-network," the amendment would ensure patients’ access to the health care providers that are located in and have built trust in their communities. Coverage would include migrant health centers; clinics providing HIV and AIDS prevention, treatment, and care; women’s health centers receiving grants under Title X; public hospitals and other hospitals serving low-income communities; and urban Indian organizations.
As NMAC noted, for example:
[The] Women’s Health Amendment would cover women of color’s access to services from minority faith- and community-based organizations (MF/CBOs), which provide culturally competent and easily accessible health and HIV/AIDS services in communities of color throughout the country. Over 4,000 strong, MF/CBOs have saved countless lives by providing their clients easily accessible health care services.
So what is the concern?
Because Planned Parenthood health centers are considered essential health providers, and because these providers would be supported by this amendment, Republicans are claiming that the amendment mandates abortion coverage.
Again: It does not.
It does however increase access to primary preventive health care, which constitutes more than 90% of the services provided by Planned Parenthood centers [30]--basic prevention and primary care. A recent study by the Guttmacher Institute found that more than six in 10 patients who receive care at a women’s health center like Planned Parenthood consider it their primary source of health care [31]. As we reported a few weeks ago [30], rates of cervical and breast cancer, sexually transmitted infections, and unintended pregnancies, among other health concerns, are highest in communities with the lowest access to essential reproductive and sexual health care. Providing these services makes sense, whether you are considering this issue from the vantage point of public health, human rights, community well-being, health disparities, or financial savings to the country writ large.
It also increases access to basic contraceptive services which, by reducing unintended pregnancies, reduces the need for and by extension the number of abortions. The very fact that the amendment does not fund abortion care, but reduces the need for abortion belies the Republicans real motives for opposing coverage for preventive care and essential service providers.
So Senator Hatch, and his comrades in the Senate and the anti-choice ocommunity (such as the Family Research Council) continue to attack health care reform by claiming that an amendment that will help ensure patients access to those health care providers they use and trust mandates abortion coverage.
Once again: It does not.
The Republicans, using fear as a motivator, continue to mislead on essential health debates, at the cost of the health and lives of millions of Americans. As time goes on, it is increasingly clear that these tactics are used as a foil for denying millions of Americans, primarily women and children, the most basic of health care services. In fact, the majority of people have turned on the lights, opened the closet door, looked under the bed and realized that neither women's health issues writ large, nor Planned Parenthood specifically are the bogeymen they have been made out to be by a political party otherwise without a cause.
As demonstrated by the votes of all but one Democrat on the HELP Committee in favor of keeping this amendment, the majority of Americans have left this bogeyman behind. In the interest of public health and fiscal responsibilty alone, the Republicans should do the same.
Follow Jodi Jacobson on Twitter, @jljacobson [32]