MOMocrats™

The MOMocrats Discuss Plan B: Why Did HHS Overrule the FDA’s Recommendation to Offer Plan B Emergency Contraceptive as OTC?

It all started with a smart, heated post cross-posted to the MOMocrats from Advocates for Youth (AFY), lambasting the Obama administration and the Secretary of Health and Human Services’ decision to override the FDA’s recommendation to offer Plan B as an over-the-counter drug. Plan B, of course, is known as the “day-after” pill, preventing the implantation of a fertilized egg in the womb, much as can happen randomly in any woman’s cycle without influence by any medicines.

In backchannel emails, we each weighed in.

Glennia: I'm all done making excuses for Obama. I can't even begin to describe my disappointment with Sebelius right now. ...I would have written something, but Kate said it all [in the Plan B post on MOMocrats], as far as I'm concerned.

Julie: This is a lot of how I feel too.

But then again, I'm the one who kept saying he was a lot more conservative than gossip had him. I was worried about a lot of issues.

Still this stunned me. Et tu Brute and Brutette?

Donna (SoCalMom): As for Obama -- as upset as this decision makes me, I do feel that by becoming President at this time in our country's history, he simply can never win with us -- let alone the vast right wing conspiracy that is making it impossible to do even the simplest things. Every tiny little victory is won with the greatest effort -- just look at how impossible the GOP has made it to get the Federal government fully staffed (or the CFPB, which Slate said they are "nullifying" by refusing to even vote on Cordray).

I think it's correct for those of us on the left to point out bad policy decisions -- but we also need to strengthen our support more than ever. 2012 is going to be an epic fight on every level of government and we need to be vigilant against all the misinformation the Fox and CNN machine and superPACs are going to throw at us. MOMocrats is filling a real vacuum by disseminating facts that are going to be drowned out by all the right wing noise.

I am reserving my disgust for the religious zealots that believe in freedom, so long as you're an evangelical Christian with a trust fund (everyone else is bupkis).

Glennia: Donna, for the most part, I agree that Obama needs to win 2012 election, but what kind of choice is that, really?  All that he and Sebelius had to do was let the FDA do its job. No HHS Secretary has ever overturned an FDA decision, so why not just let it ride and let the zealots do the dirty work?  I think that this may have a chilling effect on future decisions that might benefit women’s health.

I'm not giving money to Obama or fundraising for him this time. Sorry, I just can't do it. I'll vote for him, but any funds I have will go toward down-ticket women and advocacy groups.  I will vote for him, but that's it.

I haven't had much to say about politics lately because I am disgusted by the whole scene. I can't watch or listen to anyone from either party anymore.

Donna: I think that's a perfect strategy -- that the usual "coattail riding" effect this year will be reversed, with Obama doing well only if the Democrats do in state and local elections (and we need them there!)

The down-ticket women and advocacy groups are going to need all the money they can get.

I wonder what will happen in a second term, when there is no pressure to be re-elected. I know I would love a President who did what was right and didn't worry about re-election -- but I would be just as angry at him for doing a Jimmy Carter and making it impossible to elect another Democrat for another dozen years.

I often feel depressed over the direction our country has taken and the zealotry of the Right. Politics is more dispiriting than fun.

Karoli: I understand the strategy and to a large extent, agree with it. But I confess, I'm a little bit confused over the whole PlanB thing. I have basically been told I'm not a liberal because I don't think it should be available to younger children so easily. I also understand the arguments for making it available. It is a difficult, complex, emotional issue. I'm not sure there is an absolute wrong or right in this case. Only gray, murky areas. For example, Yaz was sold to younger women as the best birth control ever. After the fact, it emerges that it carries some pretty severe and even deadly side effects for some. PlanB is a hormone. I don't think it should be dispensed without some minimum instruction and oversight. That's just me. I also understand the arguments on the other side and respect them. But in the end, is this really a black and white, cut and dried issue?

Cynematic: Karoli, one of the more effective arguments for keeping Plan B OTC, aside from the fact that studies on pubescent girls under 17 showed they understood how and why they would use Plan B, is that when it's under the pharmacist's lock & key to dispense, women 17 and older are now effectively prevented from buying it when the pharmacy desk is not open but the rest of the drugstore/supermarket is. (That's setting aside the "conscience clause" -- for CONTRACEPTIVES!!! -- that some pharmacists might exercise, and might extend to Plan B. Like seriously, we're all Roman Catholics now??!?!? Rhetorical question.)

So in effect, young teen girls are being used as the excuse to curtail access for the older women who in all likelihood are the ones needing to use it. This fear of pregnant 12 year olds is being put forth at a time when teen pregnancy rates are actually declining, as are abortions in that age group. The same study shows that girls are using more effective contraceptives more frequently:

There are currently no direct data available to tell us why teens are changing their contraceptive practices. However, anecdotal reports indicate that recent changes in medical recommendations that allow teens and young adults to access hormonal contraceptives without a pelvic exam or Pap test have made it easier for them to start—and continue—using these methods.

Given the timely nature of Plan B's effectiveness, 12-24 hours delay in purchase and use could make a big difference to the woman who needs it.

I’m glad we’re talking about this on MOMocrats because there are no doubt many pro-choice women, especially moms of daughters, who feel this issue keenly both in disappointment with Obama *and* on another side with relief that he may have put his thumb on the scales by voicing his opinion on disallowing it to girls 17 and under.

Glennia: I think what set me over the edge was the fact that the administration put itself out in front of an FDA decision when it has not on any number of things that benefit pharmaceutical companies. Why this? Why now? was what I first thought. The answer seemed clear: at risk teenage girls are an easy target to throw under the political bus because they have no political clout.  The second thing that irked me was the fact that the decision was not based on science, but politics.

I guess we all have a line, and this was it for me. I think one of the things that I love most about this group is the fact that we don't always agree and that we can discuss things.

Donna: Like you, I love the fact that we are not a monolithic, marching orders type of group. (As in the famous Will Rogers joke, "I don't belong to an organized political party - I'm a Democrat.")

And I can only stomach so much of it, too -- I take frequent breaks from the news, because it's depressing when it's all so bad. That's why I'm grateful that there is a large group of us to populate the MOMocrats' blog, Facebook page, podcast, Twitter stream, et al with material.

Erin (QueenofSpain): The Plan B, abortion for teens with out parental consent, etc is a fight I have with my husband daily ... ok not daily but a lot.

He thinks anything to do with giving a drug to his daughter or doing a procedure on his daughter, who is a minor, requires his consent. HE doesn't care what other families are like. He doesn't care what could happen to some other girls, he just see it through the eyes of HIS daughter. And I think that's what happens with this issue. We're dealing with a President who had two young girls so I have ZERO doubt this is a discussion he and Michelle have had. Why the admin went this route, I am SURE has something to do with what they are going to get on the other end- which very well may be part of the upcoming battle over Affordable Care Act repeal and decisions and discussions. At least, that's what I hope. That there is some damn good reason we are unaware of. Of course, like in most cases, there is no good 'enough' reason and teenage girls certainly can't vote...so.... sigh.

I don't think anyone can see logically on this one. Regardless of how hard we try. If it were up to me abortions would be like flu shots right now -- at every CVS and Rite Aid and advertising out the wazzooIoo -- I have taken the morning after pill 'just in case. Once. And it admittedly was not the greatest experience and I was too embarrassed to ask my OBGYN questions. It would be typical of our society that any guy could easily grab a condom but for women it must be complicated -- drugs, hormones, etc.

I can see both side of this argument, and I live in a liberal household, I guess is what I'm trying to say. And the President has never been shy about how moderate he can be and there is a crap load going on behind the scenes as they deal with what is the most ignorant bunch of Republicans ever assembled.

I just hope everyone keeps their eyes on re-election. Because knowing he won't have to campaign again in his second term makes me very hopefully he'll be tougher on somethings he can't be tough on now.

Or I'm a big sucker. One of the two.

Julie: I hear [Erin's husband's] point here. I'm uncomfortable with abortions for a lot of reasons. I know you guys know this. But I strongly believe it’s a personal decision so I support the right to choose. And when it comes to this, I see babies in school bathroom trash cans. It is 2000 times more important to me to prevent, to prevent a greater tragedy or trauma. And sure babies are blessings and sure many teen moms see it as a great making of their lives. I'm glad for that. But sometimes it is just better for some people if things had not gotten to that point. I do carry a bit of a que sera sera belief, but when asked to choose, I always prefer prevention.

Donna: I take solace in the fact that Plan B is available to all but minors without a prescription -- especially since the anti-Choice crowd did not want it on the market in this country at all.

If my daughter should need it before she turns 18, I'll get it for her -- no questions asked. Unfortunately, I don't think she would come to me.

In the UK, almost all the meds we are used to getting over the counter must be obtained through consultation with a pharmacist. It threw me for a loop the first times I needed decongestant or a cortisol cream -- but I got used to it.

When I was a teen, condoms were also kept behind the counter. I worked at a drugstore when I was a teen; I don't recall it being a deterrent for those who wanted to buy. Just something to get used to, I suppose.

And when you remember what a fight it was to get Plan B approved in any form, I am just glad that most of us can get it without a prescription. If my daughter needs it before she's of age, I'll gladly purchase it for her (that is, if she feels comfortable enough to ask me - but that's another matter).

Erin (QueenofSpain): You never know Donna. It was hard but when I was 14 I asked my Mom to take me to get the pill. She told me over, and over, and over again that she would take me and not say a word when I wanted. And she was true to her word. I asked her, nearly puking I was so scared, to take me. She made the appointment, we sat in the waiting room (God I will never forget) and said very little ...we went in. I asked the doctor to go on the pill and got my pap smear...and that was that.

She filled it for me every month and left it on my dresser top. Eventually we talked a lot more about it and stuff but that initial visit was her in my head, promising me over and over and over again. Had she not done that, I never would have asked.

Joanne (Punditmom): Actually, I do doubt the Prez has consulted Michelle, at least regarding policy for all girls. And it makes me sad that I have that doubt.

Erin (QueenofSpain): Well as I said I'm sure they have discussed it because they have two daughters. Consulting her in an official capacity is entirely different. They have two daughters -- we have one who is 6 and we've discussed it already at our house. If they have any sort of marriage and speak about their daughters’ futures, I can't imagine this hasn't come up.

I'm curious if you actually doubt he and Michelle discuss matters that affect their daughters or if you mean he consulted her in an official capacity as decisions on this were being made?

Because that leads to a larger question of what sort of father and husband you think he may or may not be as opposed to what sort of President. Which is entirely different.

And that doubt may speak to what some voters are feeling- that he's an overall jerk who doesn't even talk to his wife about matters concerning their daughters OR if he simply wouldn't talk to his wife about matters on his desk about women and girls.

Considering the type of woman our First Lady is, I doubt very highly she is not involved. Much like First Lady Clinton. But Michelle has to be even more careful as the entire world seems to pounce on every word she says, which of course is a country not ready for a strong black woman. But that's another story. I wish she could be as outspoken as Hillary was when First Lady...but sadly our country isn't ready for it. And hasn't been, and made that VERY clear during the last election.

Stephanie (Lawyermama): This one stunned me too.  I knew he was the most conservative of the 3 real choices we had, but overruling the FDA really bothers me.

As for whether Obama consults Michelle, of course we can't really know what their marriage is like.  But having interacted with her quite a bit and, as Erin mentioned, knowing the type of woman she is -- I think she'd fit in nicely here, I can't believe she wouldn't offer her counsel whether solicited or not. She is definitely a women with strong opinions and a fierce mama bear. I've heard from some people in the administration that she has been very firm with her husband (and his administration) about what they need to do to help military families.  But then, that's not terribly controversial.  And that's the thing, I think it's hard to guess what Mrs. Obama's personal opinions would be about Plan B.  She's been very diplomatic about not delving into controversy.  For all we know, she fully supported his decision for the same reason Erin's husband does.

Cynematic: I get it that reasonable pro-choice parents can be deeply squicked by the idea that their daughters could be 1) sexually active before all family messages have deemed it wise 2) pregnant and then not without parents ever knowing and 3) that my abstract position of "yes teen girls including some very young early-onset puberty pre-tween and tween girls should have access to Plan B" is AN ABSTRACTION for me as the parent of a son. I do not have skin in the game directly with a daughter to think of in the way that I do as a grown woman.

Yep, I get it.

But I am still troubled that by making the pharmacist the gatekeeper, women older than 17 will be potentially subject to someone else's "conscience" about the taking of what otherwise would be OTC medication with the same status as other OTC medications. And scared young teens won't have access when they need it most.

Is the regulation standing in for what should be parental vigilance, especially parental vigilance in helping pre-tween and tween girls develop healthy sexualities, as well as older teens? Should or can an FDA/HHS regulation do that? It seems we’re freighting a regulatory decision with more than it can reasonably handle.

Karoli: Digby has a post up reporting that there is ZERO political upside to this decision. So stop for a minute and think about why a man who is as smart as he would have made it. I have two thoughts. First, as Erin says, he came at it as a father. That's certainly one possibility. The other is the possible concern that it would create issues with Sibelius' directive that BC be free under the Affordable Care Act. If Plan B lands in that classification it would not be covered 100% as OTC.

Erin (QueenofSpain): I get nervous asking for the real sudafed. Seriously. Like they think I'm going to make meth. But it's like EVERYONE is a suspect when the pharmacist has the lock and key. I think about how hard it is for teens to buy condoms. They get all embarrassed, etc. But to have to ask the pharmacist for Plan B... wow. I can't even imagine as a young girl. It was hard enough as an adult.

Cynematic: It's true that Plan B may be tied to the overall battle to get contraceptives covered for free under health insurance. There was noise about the latter last week, then radio silence. There's also been radio silence from many trusted pro-choice legislators who we'd ordinarily expect to have kicked up a fuss.

I had postulated on Twitter that perhaps it was horse trading: appearance of "capitulation" to the religious right/US Conference of Catholic Bishops on this one very circumscribed issue surrounding Plan B in exchange for their yielding on contraceptives as preventative care and therefore free under all health plans. (Why these things have gotten politically muddled, as they seem to, is a different question than whether they should’ve gotten muddled to begin with. And I think that’s what was so maddening -- the FDA gave cover and HHS did not take it.)

As we know, this president has had to thread the needle finer than any other president in recent history to get anything accomplished. I wouldn't be surprised if there was some mixture of the horse trading and/or "prescription/pharmacist-as-gatekeeper-but free-covered under ACA" or "24-7-access-but-OTC-costing $40+" calculus involved.

Joanne (Punditmom): I just doubt he [Obama] would have thrown at risk teen girls under the bus if he had talked with her [Michelle]. Just as I wonder about whether he consults with her on things like Paycheck Fairness Act. He's had Jarrett out front for years telling people -- including us -- that it's a priority. Yet nothing. Part of my doubt stems from Michelle's own accounts of how little he consulted her on big decisions before he was President, which makes me wonder -- if he cared so little about the opinion of his worldly & highly educated wife, why should I believe he cares about women in general ?

He talked the talk in the campaign, but forgot to walk the walk.

Karoli: Let's not forget that the decision-maker was Sibelius, a woman. Also intelligent and thoughtful. I thought her public reasoning was thin, it felt like an excuse. As Glennia rightly pointed out, she overrode the FDA for the first time in history. I keep asking 'why', and I keep coming back to her also-unprecedented decision to require 100% coverage of BCP. I believe they're related to each other and she may have sacrificed one for the other. I have no hard evidence of that, but I simply don't believe it was a 'throwing under the bus' moment without nuance and possibly some other undisclosed circumstances.

Joanne: Well, she announced the decision. I have no doubt she was directed, in some way, by the White House.  It's been too much of a hot potato for the administration to be out of the loop.

Grace: I'm leery of ascribing decisions to POTUS not caring about women that can just as easily be ascribed to him having male privilege, and women's and girls issues being an issue he can afford to table (again, because of male privilege). Similarly to what Jay Smooth says about conversations about racism, I think the conversation is more productively focused on what someone has done rather than who they are as a person. I doubt that POTUS doesn't care much for the opinion of women, but even caring about women's opinions wouldn't make him immune to male privilege in his decision-making.

I've been thinking of writing up a post for MOMo about POTUS's comments about his daughters from the perspective of having grown up Republican/pro-life and having a lot of friends who were convinced Senator Obama was the "most radically pro-abortion presidential candidate in history." One reason cited for this was his comments that he didn't want his daughters "punished with a baby" or STDs if they “made a mistake,” which pro-lifers pounced on as evidence that he thinks all babies are burdens. It's interesting to juxtapose that comment with the one re: Plan B and his daughters, because it shows how paternalism can go both ways when it comes to rights, but even when "benevolent" is no basis for real equality.

Glennia: I think the folks at AFY would like knowing they stirred up some discussion among moms.  Like Cyn, I don't have skin in the game on birth control for girls as the mom of a boy (and am glad that condoms are sold OTC). I think it is a very worthwhile discussion and would like to hear all views.

I too thought of how they have Sudafed [sold with pharmacist's assistance] because adults are not responsible enough to not make meth out of it.  

Melissa: The linkage between the contraception debate as a basic benefit
(opposed by the US Conference of Catholic Bishops) and emergency contraception/Plan B might seem like a natural one but they don't bear on each other. The decision to include contraception in the basic benefit package follows a recommendation by the Institute of Medicine (IOM) and the US Preventative Services Task Force (USPSTF). It covers drugs and devices approved by the FDA. As emergency contraception is an OTC medication, its status is unchanged. The basic benefit package will only concern itself with prescription medication.

I do think this was an incredibly cowardly act. When I was ranting to my husband over his shaky internet connection, he was especially taken by a quote from Norm Ornstein in this article: "I think they’re trying to create some political balance." To which my husband, replied, "Does this political table look wobbly to you? Yeah... just shove some women's bodies under the corner, that'll shore it right up."

And that's what it boils down to for me. I am not a political token. My reproductive freedom is not a political bargaining chip. I am REALLY tired of being told to wait. Give in on abortion in the health reform bill, give in as the administration waffles and plays nice with the United Conference of Catholic Bishops over contraception as a basic benefit (even though a Guttmacher survey found that 98% of Catholic women used birth control methods not approved by the Church) and over "conscience clause" wording in federal programs. I am TIRED of this administration assuming that because -- to paraphase Pat Schroeder -- because I have uterus and brain and they both work I'm just an automatic "yes" in their 2012 battle. I won't vote for any of the crazy GOPers. But that doesn't mean I'll spend this election season working for Obama either. It doesn't mean I'll open my wallet or checkbook. It doesn't mean I'll stand out in the cold for GOTV. It doesn't mean I'll put up a lawn sign. It doesn't mean I'll put a bumper sticker on my car. It doesn't mean I'll go to town halls. It doesn't mean I'll offer to volunteer as an election judge or drive people to the polls. It means I'll sit on my hands.

Except it has become so. Sure, sure, the argument is about the under 17 crowd and I'm just about twice that age. But can someone tell me what differentiates a 16 yr old from a 17 yr old? And if we can't make that distinction, how does a young woman magically change from not-studied to well-studied in a year? After all, we allow young people to access sensitive health services without parental consent in many states. Not just repro services, either; mental health and substance abuse counseling and treatment are protected in 20-odd states. We allow them to buy tylenol which, when mixed with alcohol, can be deadly.

I get the parental consent issues. I look at Ruth, just shy of 4, and of course I'd want her to come to me but here is what I ask myself: If she didn't want to come to me, felt she couldn't, does my desire for parental involvement outweigh the potential consequences? The answer is no. My desire for parental oversight is not great enough to overcome my dread at her becoming pregnant and having to make a much harder decision. We have a very open house -- my father-in-law practically turned purple when Ruth asked at breakfast one morning "How do babies come out?" and I answered "They come out of their mommy's vagina." (A friend's mom just had her 2d baby so we'd had a lot of questions about how the baby breathes in the tummy, how it eats and pees and poops, etc.) I would love it if every household had open and honest discussions around sexual health, pleasure, reproductive rights, biology, etc. I know that isn't realistic and so again, I weigh my desire for parental oversight against the potential consequences.

Spring Adams was raped by her father in Idaho. She told her mother who refused to consent to the abortion as she feared her husband. Some sympathetic Idaho Health Dept workers contacted Planned Parenthood workers who arranged for her to have an abortion in Oregon (she was 16 weeks by that point). When her father learned she planned to have an abortion, he shot her. He tried to commit suicide but failed; last I heard, he is in prison. Why she was still living anywhere her father might have access to her is beyond me.

And Glennia, AFY is awesome.

Julie: Here is the thing. The group of us sit here and discuss this. We’re educated women who work hard to provide good, safe, supportive, open homes for our kids. I’m a daughter, a woman, sister, friend, and also mother of daughters. My life is filled with females of all ages. But how typical are we? And how typical are some of our experiences, such as Erin getting such unconditional support from her mother?

My mother tried to be comfortable with this conversation but she wasn’t, and as a result, I never felt comfortable talking with her. Maybe it was a style difference, I don’t know. But I am trying to do differently with my girls. I want to talk with them, be open and honest, supportive, while still sharing my values. It’s most crucial to me to teach my girls that they own their own bodies -- and how can I not be contradictory and hypocritical when the government is naysaying this and saying it owns the girls’ bodies?

“Well, yes, girls, you own your bodies and can say no and make your own choices, until it comes to reproductive health care, in which case, the government -- predominantly the very people who keep advocating for LESS government -- think they get to choose for you and me and your doctor, and let themselves and other health care practitioners get in between you and the medical decision you believe is best for you all around because of their opinions, not fact, but OPINIONS.” It’s maddening.

How can I teach my girls they get the choice of when and how and what for their bodies when all around us is the constant message about everyone else owns a piece of them -- from the government and reproductive care, to commercials using female form to sell, to popular media that drills the message that girls exist to pleasure, and on and on.

As a parent of girls how can I not believe that the best and safest thing is to let the individual and her unbiased doctor (who keeps her or his moral choices in her or his own life and lets individuals guide their lives by their own morals and ethics -- otherwise, hello, major boundary issues) choose the best course of medical action? And that’s the point, right? Plan B keeps it from getting to a tougher place. A trickier wicket. Plus, when it comes to so many cases, kids have to feel safe to take care of themselves and not all do. Not all grow up in safe homes, or homes where dealing with sexuality and bodies and self care is safe and supported. Many girls grow up like me and need respectful support from people who are supposed to provide it. Like pharmacists. And doctors.

Melissa, your point is so on point. 1 in 3 girls are molested. I think rape stats are about the same. And that is what is based on reports. Those who need respectful support the most -- these victims -- are the least likely to get it. I'm also going to say I know very few women who were happy and ready when sex began in their lives. So many had times when they felt pressured beyond comfort and unsure of how to "be nice" like girls are supposed to be and please the boy, like girls are supposed to, but still care for their own needs. I really don't think we get enough healthy sex and sexuality in the world and the last thing we need is to create more of a culture where girls get more and more boxed in -- forced to sex, forced to parenthood. I love being a parent. I feel blessed by my children, who are so amazing. I am glad that my life worked that I was able to fulfill my plan of college, work, adulthood then parenthood. Had I been unable to do that....what would my economic and life prospects be now?

I don’t think we came to a single conclusion as a group, but I do know many of us tempered our initial reactions -- I know I did, feeling that my outrage over how anti-choice politics seemed to win out over what would otherwise be a simple recommendation from the scientific community would now have to take into account the numerous other real-life and very messy factors affecting this one ruling by the HHS, political and personal. I continue to wrestle with both the emotional sides of the argument (what good is knowing that teen pregnancy rates are down if it’s *your* teen daughter who is pregnant?) and the rational sides that say, Wait a minute, what *are* the numbers of at-risk girls specifically who are affected by this? Should access to Plan B by very young women set the bar in practice for all women? Is this really the case or is this my own bogeyman I’ve invented, and what are the moral implications of protecting young women and also needing to ensure that single adult women as well as women with kids have access -- because they’re some of the people most in need of Plan B because of their obligations to their existing children? So here it is, behind the scenes at MOMocrats. We wrestle with tough questions and have differences of opinion and yet are all at our core profoundly committed to pro-choice as part of reproductive justice. --Cyn

Medicaid In Extremis

Three months ago the Republicans opened debate on the FY2012 budget when Rep. Paul Ryan released The Path to Prosperity: Restoring America’s Promise. In that plan, he proposed a remaking of Medicaid that would eviscerate the program’s core purpose: provide health care to the most vulnerable.

Many labor under the misconception that Medicaid is health benefit open to any low-income American. In reality, states are only required to cover impoverished children (including those in foster care), pregnant women, some disabled persons, some adults with dependent children, and the elderly. In fact, more than 2/3 of Medicaid spending pays for services for the disabled and elderly; children consume about 1/5 of the total funds with the rest going to adults.

Childless adults, even those with incomes far below the poverty line are not automatically eligible for Medicaid. Nor are the parents of Medicaid-eligible children automatically eligible for coverage. For example, in Alabama, parents’ incomes cannot exceed 24% of the federal poverty line – less than $5000 a year for a family of three. Eleven other states all have income eligibility well below the FPL.

Whatʼs The Matter with Kansas? The 750 Mile Plan (Guest Contributor KSMom)

Once again, the elected officials in Kansas, who are more loyal to their version of the bible than to the citizens they serve, have managed to earn points on the attention meter.

 

Ten years ago it was evolution. Kansas was the first of many states to attempt to remove evolution from its Science classrooms. The good news is this insanity woke up Kansans, who worked to remove the zealots from the state board of education and restore evolution to the Science curriculum. The bad news is most people outside of Kansas donʼt realize this and still assume our kids are taught creationism instead of evolution. And this started the ball rolling for several other states to challenge the teaching of evolution.

Now it looks like Kansas has started yet another ball rolling, this time about abortion. In November, the most radical group of far right (mainly tea party) folks were elected to the state legislature. Thankfully, the state Senate remained more moderate, but they were out shouted by the extremists in the House.

HHS to Review Health Care Regulations

This morning Deputy Secretary Bill Corr released a statement announcing the Department's plan to retrospectively review existing health care regulations. Regulatory review is about as much fun as filing taxes while undergoing a root canal... an unmedicated root canal. But the Administration's willingness to undertake such a painstaking process is yet another sign of their commitment to providing all Americans with healthcare that is economical, efficient, and, most importantly, effective.

Regulations are the flesh on the bones of law. After Congress passes a law, executive branch agencies are left to formalize specific requirements. For example, the health reform law talked about creating accountable care organizations but the small details were announced late this spring by HHS. How much detail? Try 429 pages of proposed regulations to clearly outline the plethora of requirements for such organizations.

Of particular interest to me is the interplay between Medicare (which typically covers older adults and some persons with disabilities) and Medicaid (which typically covers low-income children and their parents and people in institutional-level care, such as nursing homes). As our population ages, we'll have more people eligible for   Medicare and Medicaid. In theory, whatever isn't covered by Medicare should be paid by Medicaid. In reality, these programs don't always play nicely since what Medicare covers differs from what is covered by Medicaid.

Even more complicated and increasingly common are people who have private insurance or military benefits and are eligible for Medicaid. Trying to coordinate benefits between private insurers, especially those not covered by the complex ERISA rules, and Medicaid is becoming a time suck for states.

The attention to telemedicine is interesting too. Historically, Medicaid and Medicare refused to pay non face-to-face services. In the last few years that has changed and some states are using telemedicine to overcome health care shortages -- an area that is also under exploration as it has been three decades since we first defined "shortage area."

I think it is excellent that the administration is undertaking this project in light of so many regulations to come: final regulations for ACOs, regulations on the basic benefit package, etc. Attention today will prevent confusion and lawsuits later.

FY2012 Budget Battle: The Opening Salvo

This morning Rep. Paul Ryan (R-WI) released a template for the FY2012 Budget Resolution. If The Path to Prosperity is, as the GOP promises, the road to restoring America's promise I encourage you to think about another road.

That is a picture taken during the Dirty Thirties, when our breadbasket crumbled. In the early 30s people turned their faces west. They did find work in California, though mostly as migrant laborers, picking fruit and harvesting lettuce. A few years later FDR would begin his New Deal of recovery, relief, and reform. Three decades on, the Great Society programs would reinforce our social safety net.

Mr. Ryan's budget doesn't even take pains to pretend to leave the safety net in place. Instead, he places all of us in the cradle of laissez-faire economics. The cradle metaphor isn't misplaced here, as it is children who are likely to suffer the most in Mr. Ryan's economic vision.

Food Aid

Mr. Ryan would turn the Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps) into a block grant (more on that in a minute). In 2015, when the economy is once again hale and hearty, benefits will be contingent on either holding a job or enrolling in job training.

This is replay of the 1994-5 debate on welfare reform, which required women to go to work. In general, I have no objection to requiring able-bodied adults to work given proper support. That means child care subsidies, food aid to cover the transition from cash assistance to full employment, transportation and housing subsidies, and so on. If we truly want women – and it is mostly women – to be self-sustaining, we must offer educational opportunities that end in a skilled job with family-supporting wages. How does Mr. Ryan intend to enforce a work or training requirement when very young children are in the home? Or if we have a double-dip recession and unemployment remains high?

Does Mr. Ryan not know that many food aid recipients are employed? They have minimum or low-wage jobs and, assuming a family of three, make less than $1,526 per month -- a couple grand more a year than a full-time, minimum wage worker would earn. Does he not know that increasing numbers of retirees -- again mostly women without pensions and with low Social Security benefits -– rely on SNAP? Will he require the elderly to work? And what about our service men and women who use food aid to make ends meet? Will they too have to get better jobs?

Medicaid

Medicaid is the health insurance program for America's poorest and most needy. The majority of beneficiaries are children and the elderly. I know that will surprise many, who think of it simply as program for the very poor. But Medicaid is much more restrictive than many imagine.

In general, states are only required to cover children (including those in foster care), pregnant women, low-income disabled persons, low-income adults with dependent children, and the elderly who have exhausted their savings and are in nursing homes. Childless adults, even those with incomes far below the poverty line are not automatically eligible for Medicaid.

Mr. Ryan, and Republicans in general, have argued that Medicaid is too expensive. Yes, it is expensive precisely because it is the payer of last resort. Children on Medicaid receive EPSDT services, aimed at preventing health problems. Children on Medicaid are sometimes medically complex and receive SSI income for extreme low birth weight or other serious maladies. Medicaid recipients under 22 or over 65 may be eligible via the need for inpatient mental health care. Elderly in a nursing home who have run through all their savings become eligible; Medicare doesn't cover long-term care. Medicaid is expensive precisely because it operates as a safety net and covers services unavailable via private insurance or Medicare.

Mr. Ryan argues about Medicaid's quality of care, pointing out that the health outcomes of beneficiaries is poor. He must have skipped the public health literature for the last decade or so. Medicaid beneficiaries are poor. Many rely on food aid and while I've save you a retread of Michael Pollan, our agricultural policies mean that healthier food is often more expensive. They are more likely to live in areas with high lead levels. More likely to live in areas too remote or unsafe to exercise. More likely to suffer stress. I recommend he look into the social determinants of health before commenting on Medicaid outcomes. Medicaid is not magic. It cannot heal all comers and then offer a ride home on a unicorn; it is limited medical benefit for people who have concomitant health challenges and outcomes to match.

Yes, Medicaid is straining states' budget and yes, reimbursement is too low to attract enough providers, particularly specialists. But block granting doesn't automatically solve those problems, nor does it solve the GOP favorite claims of fraud, waste and abuse. It just gives states the ability to hold the purse strings.

Mr. Ryan and almost every other R want to convert federal entitlement programs like Medicaid and Medicare to block grants. Block grants are Beltway-speak for bucket of money. Entitlement programs like Medicaid impose requirements and limits on the states to receive money (Rs call this bureaucracy). Do the limits impinge upon states' flexibility? Yes of course. Which is why the federal government allows demonstration projects and waivers – Section 1115, 1915(b) or (c) or some combination thereof, 1915(i). There are optional coverage services to be included or waived.

To simply gut the Medicaid rules that have guaranteed coverage for the most vulnerable citizens and instead hand governors a check is wrong. Mr. Ryan may decry the social safety net, thinking it is becoming a “hammock, lulling able-bodied citizens into lives of complacency and dependency” but I wonder how that image squares with the reality of Medicaid: a child, a pregnant woman, a bed-bound senior, or a disabled adult.

There are other changes in the budget. Ending Medicare for those under 55. Lowering corporate taxes from 35% to 25%. (I'd support that one, if it meant companies actually paid federal taxes.) Cutting federal workers salaries and benefits.

Mr Ryan may pretend that his budget represents some grand vision for America's future. But in truth it is the plan of someone who read too much Horatio Alger and Ayn Rand, of someone who has never lived in Section 8 housing, of someone who does not know hunger, of someone who never had to take their kids to mall to get warm in the winter, of someone who enjoys their comfortable, government-provided chair atop the House Budget Committee.

GOP Budget Wars on Reproductive Health

What's happened to the whole Republican "the economy and jobs are our first priority" mantra from the 2010 elections? Eric Cantor can say it all he wants, but that isn't making it true. Instead of jobs, conservatives are once again focused on our lady parts. While I am sort of getting used to the new TSA pat downs, I have to draw the line when it comes to the government getting its hands on my privates.

The GOP is focusing on the budget, but not for creating jobs -- they are trying to impact substantive issues through bills that control spending, as they recently did in their (thankfully) failed attempt to redefine rape in the "No Taxpayer Funding for Abortion Act." It initially called for limiting the availability of Medicaid funds for abortion only to women who had been "forcibly" raped.

Since the original passage of the Hyde Amendment in 1976, no federal taxpayer funds have been available to cover the cost of abortions through Medicaid except in instances of rape, incest or if the life of the mother is in danger. The forcible rape exception, introduced by Representative Chris Smith (R-N.J.), didn't explicitly spell out in the bill what that meant, but a variety of organizations, including NOW and EMILY's List, believed it would exclude victims of statutory rape, date rape, rape victims who initially said "no" but weren't able to fend off their attackers, and women who feared for their lives unless they acquiesced to a rapist's demands.

Urgent Call to Action: GOP House Pushing Anti-Woman Agenda

In November the American people sent a loud and clear message to Washington: work together to get the economy moving again. And during the lame duck session and then over the past few weeks, I was encouraged by the ability of Republicans and Democrats to come together to work for the American people. But now, just two weeks into the new Congress, it appears Republicans in the House are already seeking to end that spirit of cooperation.

They have introduced HR3: The No Taxpayer Funded Abortions Act, which would restrict women’s access to affordable reproductive care and even deny care to women when their lives are in danger. This bill would severely undermine women’s rights.

I hope you’ll join me in fighting this dangerous piece of legislation by signing this petition and sending a message to Washington that we must preserve and protect a woman’s right to choose.

Even as Republicans lament that the government is being too intrusive in people’s lives, it seems that the very personal, private and often painful issue of ending a pregnancy is one area they are determined to regulate. Tragically, the consequences of this intrusiveness could prove disastrous to the health and well-being of women across America.

The Republicans likely have a large enough majority in the House to pass this bill, but we must block this bill in the U.S. Senate. Earlier this week, Senator Blumenthal and I sent a letter to all of our colleagues in the Senate, urging them to oppose similar legislation.

In the letter we wrote:

We must work together to stop these bills in their tracks, as they represent an unprecedented effort to restrict women’s access to reproductive health care and to their trusted health care providers.

I pledge to you that, just as we did with the Stupak Amendment, we will organize our fellow Senators to make sure we defeat this legislation. Can I count on you to join us in this fight to make sure Republicans and some conservative Democrats don’t succeed in chipping away at a woman’s right to choose even further than they already have?

Please sign this petition and show my colleagues that the grassroots is behind us.

Thank you for your support.

Senator Kirsten Gillibrand

Cross posted from the Huffington Post.

2010 Politics in Review by the MOMocrats: President Obama's Trial by Fire

I think there's a musty old law somewhere that impels media outlets to produce some kind of year in review piece each end of December -- or maybe it's just an easy topic to riff on when all you really want to do is recover from one holiday while preparing for the next. At any rate, Karoli and I did our own Year in Review episode on this week's MOMocrats MOMochat radio show.

I prepared for the show by highlighting some of the posts here on the MOMocrats website for 2010, and even though I remember all of these events, I was surprised to see they had all occurred THIS YEAR. And what a year it's been.

Karoli summed up 2010 as "President Obama's Trial by Fire":

JANUARY

• Health care reform had still not passed by the time of the State of the Union (for some reason, I had been remembering HCR as a 2009 endeavor - maybe because it took ALL of 2009 before spilling into the first quarter of this year).

• Supreme Court hands down Citizens United ruling

• Scott Roeder convicted for murder of Dr. George Tiller

• James O’Keefe caught and arrested for dirty tricks at Senator Mary Landrieu’s office

• A 7.0 earthquake devastates Haiti

Remembering Elizabeth Edwards

In the Summer of 2007, I attended my first BlogHer convention.  I had been blogging for about a year and had just begun flirting with writing about politics.  I had very firm opinions about everything from women's rights to foreign policy, but I wasn't a political blogger.  Oh no.  Why would anyone listen to what I had to say about politics?

But at BlogHer 2007, sitting in an audience of women (and a few men), I listened to Elizabeth Edwards talk about politics, her battle with breast cancer, and the power of women online, and all of that started to change.

I had supported John Edwards from my cozy armchair during his presidential run in 2004. I supported him again during the Democratic primary in 2008. And shortly after BlogHer in 2007, I heard that a group of women I greatly admire were starting a political blog for mothers supporting John Edwards for president. I asked pleaded begged to be a part of it.  And all of a sudden, I was a MOMocrat.

I don't want to revise history.  Despite the fact that John Edwards turned out to be a complete asshat and a poor excuse for a human being, leading up to the 2008 primary he was the only one talking about the issues that mattered most to me.  He was the first Democratic candidate to come up with a comprehensive health care reform plan and his talk of "Two Americas" brought the plight of poverty in the US to light.  Poverty isn't something that politicians like to talk about.  Not a lot of poor people are out there making political donations and their advocates don't have a lot of money either. But John and Elizabeth Edwards were acting as the voice for the people in this country who need it most.  I admired that.  I still do.

Elizabeth Edwards inspired me to write about my convictions. She inspired me to become a MOMocrat, to let my voice as a mother, a woman and a citizen be heard. I like to remember the time I had a chance to participate in a conference call with Ms. Edwards. (Some of my lucky fellow MOMocrats in California got to meet with her in person.)  Here's an excerpt from my blog post after the call:

I was on the conference call on my cell phone parked at my laptop in the dining room.  My husband has been transferring the contents of said laptop to an external hard drive for the last 3 days, so I was grounded, so to speak, unless I disconnected the hard drive and undid all of T's hard work.  I couldn't lock myself in the bedroom away from the chaos created by two small boys.

During the introductions, I accidentally un-muted my cell phone.  Of course, H&H began screaming and running around on cue.  I didn't realize that anyone could hear them until Elizabeth said "Whoever has the kids in the background, don't shut them up!  I might have to bring my own in here too."  Everyone laughed while I was staring at my cell phone in horror and frantically pushing the mute button! 

Of course, I got over my embarrassment immediately.  This was a conference call with mothers.  Elizabeth is a mother too.  She and my fellow mom bloggers certainly weren't going to judge me for showing a bit of humanity.

Elizabeth Edwards helped me to realize that as a mother I have a special point of view, an important one, and that I have an obligation to make my country what I want it to be.  On that call, she said, "We don't get the change we want unless we're willing to work for it." Elizabeth talked about not just making this a better America, but about creating a better world.

Today, Elizabeth Edwards died. And all of us, but particularly those of us here at MOMocrats, have lost a source of hope and inspiration.

She changed me.  I know she changed all of us.  My hope is that Elizabeth, and her children, realized just how much of an impact she had on so many people.  She really did work to create a better world and all of us owe it to her to keep on fighting for our beliefs.

Stephanie Himel-Nelson also blogs as Lawyer Mama and now works to change the world in her own way as a Communications Director for a nonprofit.

Go Read It: The Young Guns Anti-Woman 9

If you live in certain districts in the states of Florida, Ohio, Virginia, Masschussetts, Tennessee, Connecticut, Michigan or Iowa, there's a possibility a Republican candidate with a pronounced, strongly anti-woman background--maybe even criminal allegations filed against him--could be elected.

Take a look at a summary of the anti-woman records of some of the GOP candidates for Congress.

One example: Republican "Young Gun" Tom Ganley (OH-13) is involved in a lawsuit filed against him by a disillusioned conservative female campaign worker alleging sexual assault and employment discrimination. It's troubling, especially when you consider the woman was a Tea Party "true believer" who seems to have withheld her accusations, not wanting to help another candidate who is pro-choice. (Incumbent Betty Sutton, the Democrat being challenged by Ganley, has no such record of sexual assault of her campaign staff, is pro-choice, and has voted in support of consumers, women, and supported the enormously popular public option as part of the health care reform bill.)

That is, Ganley's accuser is hardly a liberal with a political axe to grind, but instead a die-hard conservative who had every reason to prop up Ganley. While there's been no determination of guilt or innocence of the allegations, Ganley's involvement does raise the question: can he reasonably and impartially stand up as a lawmaker for women who have experienced those kinds of abuses? After all, what's wrong is wrong and sexual assault is wrong, no matter the politcal party of the person who committed it.

As usual, there are crickets on the right in support of the conservative woman who was mistreated and possibly assaulted by Ganley. You'd think "mama grizzlies" would speak up for one of their own. Too busy appearing on FOX tv, maybe?

Cynematic blogs at P i l l o w b o o k.