The Supreme Court's One-Two Punch Against Women's Health: McCullen and Hobby Lobby

Jul 2, 2014Andrea Flynn

The Court's rulings place more barriers, both physical and financial, between U.S. women and basic health care.

The Court's rulings place more barriers, both physical and financial, between U.S. women and basic health care.

In the last week the Supreme Court announced two decisions that could dramatically change the landscape of women’s health access in the United States. It will be some time before we know the full impact of McCullen v. Coakley and Burwell v. Hobby Lobby, but in the short term two things are for sure. The decisions will make it more difficult and less safe for many women to get the care they need, and they will undoubtedly embolden a conservative movement that hardly needs fortification.

The last three years brought record setbacks to women’s health and rights. More abortion restrictions were enacted between 2011-2013 (205) than in the entire previous decade (189). Today nearly 90 percent of U.S. counties do not have an abortion provider and more than 56 percent of U.S. women live in a state hostile to abortion. In many states the procedure has essentially been regulated out of existence. But it’s not just abortion rights that are under attack. The days of conservatives being “anti-abortion” but pro-family planning are long behind us. Today’s conservatives view birth control as the gateway drug to abortion, and regulate it with the same zeal they once saved for abortion.

Restrictions to Title X funding are closing publicly funded clinics around the country. Those clinics serve to provide reproductive health services to low-income and young women, and the majority do not even provide abortions. There is reason to fear that other conservative states are following the lead of Texas, where thousands of women are dealing with the consequences of a complete lack of access to basic health care thanks to lawmakers who have closed a record number of clinics. 

Making matters worse, today 24 states are not participating in the Medicaid expansion originally mandated by the Affordable Care Act (ACA), leaving two-thirds of poor blacks and single mothers and more than half of low-wage workers uninsured.

It’s against this backdrop that we have McCullen and Hobby Lobby, two decisions that are effectively a one-two punch to U.S. women. They allow employers to erect financial barriers to contraceptive choice and embolden protesters to serve as physical and emotional barriers to women’s basic health care. 

In McCullen, the Court struck down as a violation of free speech a Massachusetts law that provided a 35-foot “buffer zone” around clinics that provide abortion. The law was created to protect patients entering clinics, and many states have similar regulations in place. It’s unclear what will happen to those other buffer zones. It’s also more than slightly ironic that the Supreme Court, the very body responsible for upholding freedom of speech, has a 100-foot buffer zone that is still intact.

Protesters will feel vindicated in their attempt to persuade, intimidate, threaten, and terrorize women from accessing care to which they are constitutionally guaranteed. Last weekend the Boston clinic at the heart of the McCullen case saw a threefold increase in protesters. That’s just in Massachusetts. Clinics in more conservative states regularly see hundreds of protesters on a given day.

Hobby Lobby was just one of more than 50 companies (supported by organizations like the Beckett Fund for Religious Liberty) that took issue with the ACA’s “contraceptive mandate,” the requirement that all employer-based health plans fully cover, without cost sharing, all FDA-approved methods of contraception. These companies filed claims against the mandate, arguing that intra-uterine devices (IUDs) and emergency contraception (EC) constitute abortion and therefore being required to provide coverage for those methods was a violation of their religious liberty. Never mind that by all accepted medical standards those methods prevent, not terminate, pregnancy. The Court ruled in favor of Hobby Lobby, allowing “closely held” companies – generally understood to be those having more than 50 percent of the value of their stock owned by five or fewer individuals – to refuse coverage of certain contraceptive methods.

So, what happens now? Well, most women who work for Hobby Lobby and other such companies will no longer have access to the contraceptive method of their choice. They will have to decide if they want to pay for those methods out of pocket or go to a clinic where they can receive subsidized care, if they are lucky enough to have access to one. This will place additional and unnecessary pressure on an already embattled public health infrastructure.

The majority claimed the Hobby Lobby ruling was narrow and would not have the sweeping consequences suggested in Justice Ginsburg’s scathing and on-point dissent. I’m not convinced. According to Harvard Business Review, 90 percent of U.S. companies are considered closely held, and those companies employ more than 51 percent of U.S. workers. There are already at least 80 other cases waiting to follow in Hobby Lobby’s footsteps. Given conservatives’ strategic organizing and employers’ willingness to carry the anti-reproductive rights, anti-Obama, anti-ACA banner, others will surely join the cause.

For the time being, the ACA – and the mandate – remain intact, even if somewhat fractured. We should continue to fight for the full implementation of the ACA, a historic – and by all measures successful – piece of legislation that is advancing the vision FDR articulated more than 70 years ago when he called for a Second Bill of Rights. That vision included medical care to allow all Americans to achieve and enjoy good health.

In falsely pitting freedom of speech and religion against women’s rights – as if women don’t also have rights to those same freedoms – the Supreme Court has given momentum to an already fast-moving train. Conservatives will only have more resolve to continue tearing down the building blocks of women’s health and rights. It’s going to take a lot to stop them. A lot of outrage, a lot of action, and a lot of engaged voters committed to standing up for women’s rights. Here’s hoping we can make that happen.

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

Image via Thinkstock

Share This

Daily Digest - June 23: Weak Labor, Low Wages Feed Unstable Housing Market

Jun 23, 2014Rachel Goldfarb

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Housing Market Falters Amid Rising Prices, Lower-Paying Jobs (Bloomberg)

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Housing Market Falters Amid Rising Prices, Lower-Paying Jobs (Bloomberg)

Kathleen M. Howley reports on new, weaker forecasts for the housing market, and blames slow labor growth, which is primarily in low-wage jobs, and stagnant wages.

Poll: Fewer Americans Blame Poverty on the Poor (NBC News)

A new poll shows a major shift in how Americans perceive the causes of poverty since 1995, writes Seth Freed Wessler. Nearly half of respondents today blame structural causes.

The Economic Argument for Raising Women's Pay (Political Research Associates)

Mariya Strauss assesses the economic benefits of pay equity, which include increased economic growth and tax revenues, as well as a reduced need for public assistance programs.

Republicans Finally Admit Why They Really Hate Obamacare (NY Mag)

As the predictions of Obamacare skeptics are steadily debunked, Jonathan Chait says conservatives are forced to admit they just don't like transfer programs to help the poor.

The Big Lobotomy (Washington Monthly)

Paul Glastris and Haley Sweetland Edwards look at how Republicans in Congress have cut the Congressional workforce, reducing expertise and capacity as well as limiting their own effectiveness.

Why Inequality Might Make Kids Drop Out of High School (WaPo)

A new study suggests that the "economic despair" caused by increased inequality is the reason for higher dropout rates, reports Matt O'Brien.

Finally! Big Investors Declare War on Big Banks (The Fiscal Times)

David Dayen reports on a new front in the post-financial crisis legal battle:  a group of investors sues the trustee banks that assembled mortgage bonds for abandoning quality standards.

Share This

Daily Digest - June 12: Health Care Reform is Here to Stay, But Can It Be Improved?

Jun 12, 2014Rachel Goldfarb

Click here to subscribe to Roosevelt First, our Monday through Friday morning email featuring the Daily Digest.

Time to Bring Back the Public Option — Medicare in All Exchanges (The Hill)

Click here to subscribe to Roosevelt First, our Monday through Friday morning email featuring the Daily Digest.

Time to Bring Back the Public Option — Medicare in All Exchanges (The Hill)

Roosevelt Institute Senior Fellow Richard Kirsch says that as the discussion of Obamacare shifts from repeal to reform, the first improvement should be expanding access to Medicare coverage.

Ken Burns: Go Ahead, Campaign on the Affordable Care Act (U.S. News & World Report)

Nikki Schwab reports on Ken Burns's remarks on current big policy issues at the "Inequality Begins at Birth" conference, where he screened his upcoming documentary about the Roosevelts.

Republicans Just Killed Elizabeth Warren's Plan to Ease Americans' Crushing Student Loan Debt (MoJo)

Senator Warren's bill would have allowed borrowers to refinance at lower interest rates, writes Patrick Caldwell. Republicans filibustered over the cost, but the bill would have reduced the deficit.

U.S. Economic Recovery Looks Distant as Growth Lingers (NYT)

Binyamin Appelbaum reports on the government's reduced expectations for annual growth, which are leading some economists to wonder whether the economy can ever fully rebound.

What the Foreclosure Crisis Looks Like in Urban Neighborhoods with Few Single-Family Homes (WaPo)

When foreclosure hits neighborhoods filled with small apartment buildings, it reduces cities' already limited supply of affordable rental stock, says Emily Badger.

New on Next New Deal

Do Taxpayers Care if Student Loans Are Paid Off Too Quickly? (On Fair Value Accounting)

Roosevelt Institute Fellow Mike Konczal argues that while private lenders might not like it when student loans are paid off ahead of schedule, the public shouldn't worry about it.

Share This

Healing the Medical Field: How A Push Against Careers in Medicine Could Push Back on Burnout

Jun 10, 2014Anisha Hegde

When doctors speak out about burnout, it creates an opportunity to create a more sustainable way to practice medicine.

When doctors speak out about burnout, it creates an opportunity to create a more sustainable way to practice medicine.

This fall, I will join about 17,000 students matriculating into medical colleges across America. For all of us, gaining admission to a medical school was at least a four year long process of first discerning – through shadowing, taking rigorous science classes, and volunteering – that we want to be doctors, followed by studying for the MCAT and successfully completing the marathon-like admissions process. For most of us, gaining admission to a medical school is only the beginning of a decade of training in the practice of medicine.

A grueling work environment upon graduation from medical school apparently accompanies this daunting timeline. Domestically, there is a forecasted shortage of 130,600 doctors by 2025, which will likely be exacerbated by the millions of newly insured people under the Affordable Care Act and the increasing emphasis on preventive care. These changes are both tremendously positive for society, but create challenges in the field of medicine. With only 17,000 of the 40,000 yearly applicants matriculating into American medical schools, compared to 45,000 beginning law school and 100,000 beginning business school, reducing that shortage becomes hard to envision. The physician shortage is even more striking on a global scale, as reported by the New England Journal of Medicine.

We can also expect high burnout rates when we get to work. As I was completing secondary applications last fall, I noticed a plethora of headlines advising Millennials against careers in medicine, with multiple doctors leaving comments to express their agreement. I cannot recall reading even one article during that same time period encouraging students interested in service and science to pursue an MD. A survey by NerdWallet sums up the crux of the issues mentioned in the articles: doctors are deeply unsatisfied with their professional choices and would not choose careers in medicine if they could go back and do it all over again. 

Perhaps surprisingly, these articles never made me doubt my desire to become a doctor. Many of the doctors I have shadowed over the years have iterated the power of one positive patient encounter to carry them through the day, to recall as encouragement through the toughest moments. In these interactions between doctors and their patients, I have witnessed the privilege of serving someone in their time of need, the fulfilling skillset of helping someone stay healthy and the lifelong learning that is required in attempting to understand the human body.  These memories and observations have morphed into goals and have seen me through 2 am study sessions for organic chemistry tests and the aftermath of medical school rejection e-mails.

Though I haven't obeyed the command of the articles pushing back on medical school, they did lead to honest conversations with doctors about balancing work and family and about the weighty, taxing responsibility that accompanies a career in medicine. To address burnout, Diane Shannon highlights inexpensive yet seemingly effective measures, such as physician retreats and increased day-to-day clinical autonomy. She also points to larger overhauls and paradigm shifts, such as redirecting the reimbursement system to compensate for quality, as opposed to quantity, of care and employing third-parties to cultivate compassionate healthcare, which medical school curriculums also emphasize.

Maybe I am simply on a post-undergraduate-commencement high, but perhaps this deluge of articles from doctors who left their practices is an inception of a long-needed change in the world of medicine: elevating conversations about stress and concerns plaguing doctors onto a larger stage. This change promises to engage doctors before the final burnout and to fill doctor shortages in a sustainable way. At its core, this change is relevant to service sector fields from doctors to nurses to teachers. As a millennial entering medical school, I realize I know very little about what to expect when it comes to a career in medicine, but I am grateful to those who have spoken out. I hope that the attention they have brought to the dearth of humanity allotted to both the provider and the patient is the inception of a policy and culture-oriented journey to correct both.

Anisha Hegde is the Roosevelt Institute | Campus Network Senior Fellow for Health Care.

 

Share This

Daily Digest - May 27: Taking Stock of Piketty's Capital

May 27, 2014Rachel Goldfarb

Click here to receive the Daily Digest via email.

Why Geithner Drives Liberals Nuts (Politico)

Ben White quotes Roosevelt Institute Fellow Mike Konczal, who says tensions over Tim Geithner's work during the financial crisis will come into play in the 2016 elections.

Click here to receive the Daily Digest via email.

Why Geithner Drives Liberals Nuts (Politico)

Ben White quotes Roosevelt Institute Fellow Mike Konczal, who says tensions over Tim Geithner's work during the financial crisis will come into play in the 2016 elections.

Thomas Piketty Accuses Financial Times of Dishonest Criticism (The Guardian)

Jennifer Rankin reports on Piketty's response, in which he maintains that his conclusions are solid even when looking at more recent data than he used in his book.

I.R.S. Bars Employers From Dumping Workers Into Health Exchanges (NYT)

Giving employees tax-free dollars to pay for insurance on the exchanges won't satisfy the Affordable Care Act's employer mandate, reports Robert Pear, and the fines are steep.

  • Roosevelt Take: Roosevelt Institute Senior Fellow Richard Kirsch suggests that employers that don't want to provide insurance should pay an additional payroll tax instead.

The Slow, Quiet Death of Extended Unemployment Benefits (MoJo)

Patrick Caldwell blames the lack of momentum on this issue on the House GOP, given that long-term unemployment is higher than it's ever been without federal emergency benefits.

New on Next New Deal

The FT Gets Piketty's Capital Argument Wrong

Roosevelt Institute Fellow Mike Konczal argues the Financial Times misses Thomas Piketty's central theme: the size and importance of capital will soon dwarf the rest of the economy.

The New Conservative Reformers Still Don't Have a Plan for Wall Street

Mike Konczal looks at a new report from conservative reformers and finds it lacking on financial reform. It doesn't address any of the current debates on issues like Too Big To Fail.

Share This

In Georgia, Lawmakers Taking Pride in Policies That Hurt the Poor

May 16, 2014Andrea Flynn

This post is the final in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today, a close look at the state of Georgia, where the legislature is taking active steps against the Affordable Care Act.

This post is the final in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today, a close look at the state of Georgia, where the legislature is taking active steps against the Affordable Care Act.

Georgia has taken the lead in the mad dash to thwart the Affordable Care Act (ACA) and prevent poor people from accessing health care. Last week, Governor Nathan Deal signed into law two bills that ensure the state won’t be expanding Medicaid any time soon, and that make it decidedly more difficult for people to gain coverage under the ACA. These laws – a notch in the belt of conservatives preparing for the fall election – compound the social and economic injustices already experienced by many low-income Georgians.

House Bill 990 moves the authority to expand Medicaid out of the Governor’s office and over to lawmakers. In a state where conservative politics run deep, HB 990 is Governor Deal’s clever way of way of ensuring Medicaid expansion will never get passed, and abdicating all responsibility for the health and economic consequences that will surely result. The second bill, HB 943, restricts state and local agencies and their employees from advocating for Medicaid expansion, bans the creation of a state health insurance exchange, and prohibits the University of Georgia from continuing its navigator program once its original federal grant expires in August. The University’s navigators have been working throughout the state – especially in underserved rural areas – to help demystify the ACA, assist individuals in gaining coverage on the national exchange, and help those who already qualify for Medicaid to enroll.

“Someone else will now have to re-invent the wheel and figure out how to get resources to people in rural areas," said Beth Stephens of Georgia Watch, a non-partisan consumer advocacy organization.

Like many other states that refuse to participate in Medicaid expansion, Georgia isn’t faring so well by most socio-economic indicators. The poverty rate, which now hovers around 20 percent, is 50 percent higher than it was in 2000. Nearly two million Georgians do not have health coverage, ranking the state fifth nationally in numbers of uninsured. Close to half of those individuals between the ages 18 and 64 have incomes below 138 percent of the federal poverty level, many of whom would be covered under Medicaid expansion. Georgia has one of the nation’s highest unemployment rates (seven percent) and today the average family makes $6,000 less than it did 10 years ago, when inflation is factored in. Individuals living outside of major cities have few health care options. In recent years eight rural hospitals have closed, leaving residents with scarce health resources and hospital workers without jobs.

To make matters worse, lawmakers in Georgia have been systematically dismantling the state’s social safety net. Of the 300,000 Georgian families living below the poverty line, only 19,000 receive TANF and more than three quarters of those cases involve children only. That means that fewer than seven percent of low-income Georgians are able to get the welfare assistance they badly need. On the same day that Governor Deal signed the aforementioned bills, he also signed HB 772, requiring certain individuals to pass – and foot the bill for – a drug test before receiving welfare and food stamps. That bill is thought to be the nation’s most stringent when it comes to public assistance.

The environment is especially hostile for Georgia’s women, 21 percent of whom live in poverty (33 and 36 percent of Black and Hispanic Georgian women, respectively). More women in Georgia die of pregnancy-related causes than women in all but two other states. The U.S. maternal mortality rate (MMR) is 18.5; that is the number of women who die for every 100,000 births. Georgia’s MMR has more than doubled since 2004 and is now 35.5 (a shocking 63.8 for black women and 24.6 for white women). Expanding Medicaid would extend health coverage to more than 500,000 uninsured Georgians, 342,000 of them women. That coverage would surely save women’s lives.

Expanding Medicaid is the right thing to do, and it makes good economic sense. It would support the development of 70,343 jobs statewide in the next decade. In that time it would bring $33 billion of new federal funding into the state, generating $1.8 billion in new state revenue. Despite all this, and despite the fact that poverty is increasing, access to health care is decreasing, and more women are dying because of pregnancy than in any time in the past 20 years, conservatives in Georgia proudly reject Medicaid expansion.

Grassroots groups in the state are working hard to counter anti-ACA sentiments. SPARK Reproductive Justice Now, an Atlanta-based non-profit that is educating and mobilizing Georgians on issues related to the ACA, released a statement in support of Medicaid expansion immediately after the Supreme Court determined states could opt-out. In addition to hosting press conferences at the capital and participating in public education events, SPARK is empowering young people to collect and tell their own stories – and those of their families – to illustrate the need for improved health access in the state and clear up confusion about how the ACA would benefit various communities. The organization is also collaborating with health navigators, particularly those working in low-income, LGBT, and black communities, to get across the message that all Georgia citizens deserve health security. “We are telling them they shouldn’t have to worry about sacrificing gas, transportation, prescriptions, etc. We are putting it back on our state and our policymakers to make it right for everyone," said Malika Redmond, SPARK’s executive director.  

The majority of Georgians want lawmakers to make it right. Polls show that 59.6 percent disagree with the state’s refusal to participate in expansion. That sentiment is shared by 64.9 percent of women and by 82.9 percent of African-Americans.

Conservative lawmakers don’t seem to care. They are busy patting each other on the back for sticking it to Obama and undermining the ACA. But the ACA isn’t going away. It’s only getting stronger. And the only people conservatives are sticking it to are the poor families in their state that are already reeling from policies that are costing them their health, their happiness, and their lives. 

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

Banner photo via Flickr.

Share This

Places for Hope in the Fight to Protect Women's Health and Rights

May 15, 2014Andrea Flynn

This post is the fourth in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today's post looks at states that are taking positive, proactive steps on women's access to health care.

This post is the fourth in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today's post looks at states that are taking positive, proactive steps on women's access to health care.

It’s National Women’s Health Week, but with conservative lawmakers around the country in a pissing match to see who can propose and pass more anti-women laws, it is sometimes difficult to find occasion to celebrate. However, there is reason for hope. A number of states are currently deliberating (or have passed) legislation that protects women’s access to health care, showing that states can be safe havens, not just hostile environments, for women and their families.

There has certainly been reason to despair. We are not even five months into the year and have already seen a barrage of anti women’s health legislation at the state level. 15 states have introduced abortion bans that would replace Roe v. Wade by instituting gestational bans as early as six weeks. 14 states have introduced regulations on abortion providers, similar to those that have shuttered 20 of the 44 clinics that provided abortions in Texas (in September when new restrictions are fully implemented, there will only be six left in the entire state). Seven states have proposed banning abortion coverage on insurance plans purchased through the Affordable Care Act’s health exchanges, eight have proposed banning such coverage in private health plans, and nine have proposed banning or regulating Medicaid coverage of abortion. 11 states have proposed legislation mandating abortion counseling and waiting periods, and four of those states use inaccurate information about the links between breast cancer and abortion. This compounds the crises created by the litany of anti-women’s health bills that states have passed in the last three years.

However, some states are moving in the opposite direction. California is modeling legislation that can protect women’s access to health care. Last fall, Governor Jerry Brown signed a bill that expands access to abortion by allowing nurse practitioners, midwives, and physician assistants to perform abortions during the first trimester. And a few weeks ago, State Senator Holly Mitchell (D-Los Angeles) introduced the Contraceptive Coverage Equity Act, which reinforces the ACA’s requirement that insurance companies cover all FDA approved contraceptive methods and counseling without cost-sharing. It also mandates insurance coverage of birth control for men without cost-sharing.

A number of states (including CA) had contraceptive equity laws in place before the ACA was implemented. However, there are vague provisions in the ACA, such as allowing insurers to limit benefits through “medical management techniques,” which are sometimes being used by physicians and insurers to deny women the contraceptive method of their choice (certainly was not the intent of the ACA). Older equity laws do not necessarily protect women who fall through confusion in the law. Updates like California's are necessary to ensure continuity of care.

California is far ahead of the pack, but it’s not alone. Legislators in New York are again attempting to pass the Women’s Equality Act (WEA), an omnibus bill that aims to protect reproductive health and abortion rights by codifying Roe v. Wade at the state level. It would also prevent income, housing, pregnancy, and family status discrimination; reduce human trafficking; protect victims of domestic violence; and stop workplace sexual harassment, among other provisions. The WEA was introduced by Governor Andrew Cuomo last year but failed in the final minutes of the legislative session because of disagreements over the bill’s abortion provision. The bill moves the issue of abortion access from the margins and puts it exactly where it should be: in the context of women’s economic and social security. After failing to pass the bill last year, legislators and advocates are working to advance the agenda again this year.

Lawmakers in Washington state are deliberating a measure that would require all health plans (including those in the state's exchange) that provide coverage for maternity care to also include coverage for abortion services. At a time when states are aggressively working to restrict insurance coverage of abortion, the Washington bill (which does include religious exemptions), stands out as a model of pro-choice legislation.

If passed, these bills would be great news for women in those respective states. Unfortunately, women who live outside these states won’t be so lucky, particularly those living in states that refuse to participate in Medicaid expansion. It’s hard to believe that in 2014 we need to resort to one-off pieces of legislation that protect only some women’s access to basic health care. But such are the times. The ACA was meant to be a path to health insurance for most Americans, and for many it has drastically improved access to quality, affordable healthcare. But challenges and changes to the law have left some of those in greatest need without coverage.

Conservatives have been so successful at passing anti-women’s health legislation because they have scores of ready-made bills at their fingertips when they come into office. Progressives need those same resources to protect the rights of women and families. The bills in California, New York, and Washington are important models for advocates and lawmakers in other states and municipalities who are working to counter the tide of anti-women’s health legislation that is sweeping the nation. Perhaps they will spark a quiet groundswell of pro-woman and pro-family laws. Now that would be something to celebrate. 

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

 

Share This

To Stop Campus Sexual Assault, We Should Study the Men Responsible

May 13, 2014Andrea FlynnNataya Friedan

This post is the second in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today, a suggestion for how the White House's Task Force to Protect Students from Sexual Assault could use research to strengthen prevention efforts.

This post is the second in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today, a suggestion for how the White House's Task Force to Protect Students from Sexual Assault could use research to strengthen prevention efforts.

Finally, the national spotlight is focused on the issue of campus sexual assault. Not Alone, the White House’s first report on the topic, is a historic step in acknowledging violations that have long been ignored, mishandled, or silenced by universities and authorities. One in five women on U.S. campuses experiences sexual violence. Not Alone symbolizes President Obama and Vice President Biden’s commitment to reversing that tide.

Not Alone calls for increased prevention efforts, including the sharing of best practices and promoting the intervention of male bystanders. It urges schools to train the officials responsible for investigating and adjudicating assaults as victim advocates. But this isn't just a report: there's also a toolkit to help campuses conduct and evaluate “campus climate surveys” meant to illuminate the dimensions and scope of sexual violence.

Campus climate surveys ask students to anonymously report on topics ranging from their opinions on consent and the role of alcohol to their own encounters with sexual violence. The report calls on colleges and universities to voluntarily conduct the surveys next year, and the administration is exploring legislative or administrative options that would mandate the surveys in 2016.

These surveys are critically valuable and add to the important research done by the Centers for Disease Control (CDC) on a broad range of sexually violent behaviors, including verbal sexual coercion/sexual pressure. That research – included in the report’s toolkit of resources – shows that between 25 and 60 percent of men report some form of sexual misconduct in their lifetime. It also shows that nearly 80 percent of women who experience rape do so before the age of 25. Campus climate surveys expand on this research and give schools the data they need to institute change.

All of this research is important for understanding the continuum of sexual misconduct and violence. But to truly prevent sexual assault, it seems imperative that we understand the behaviors, triggers, and environments that contribute to these crimes. For that, we need to talk to the men.

When it comes to understanding rape, there is research worth revisiting and repeating: psychologist David Lisak’s study of college men, which found that the majority of campus rapes (and attempted rapes) in the study were committed by a small group of serial offenders. The study – referenced in the White House’s original Call to Action – challenges the myth that campus rape is somehow less real or serious than rapes that occur in other settings. Lisak’s findings disrupt the notion that campus rape is an issue of drunken confusion, or naivety about consent, rather than a violent act of will and force.

Lisak’s study is distinct in that it suggests that a small group of individuals are responsible for the majority of sexual assaults on college campuses. His research was conducted over eight years with nearly 2,000 students at a university in Boston. Unlike other studies, it asked men about their actions, not just their opinions. Lisak’s surveys asked participants to (confidentially) report on a range of their own experiences with interpersonal violence and sexual behavior. 6.4 percent of the participants admitted to actions that legally constitute rape or attempted rape. This small group was responsible for 85 percent of the study’s reported acts of interpersonal violence. Two-thirds of that group admitted to being serial offenders who committed, on average, six rapes each and those offenders committed more than 90 percent of the study’s admitted rapes and attempted rapes.

The study concludes that the campus rape statistics match up with data on convicted rapists. The admitted rapists' answers to questions about their viewpoints on women, sex, and violence closely mirror those of convicted rapists as well. Campus rapists, it turns out, aren't very different from any other rapists.

The study had a small sample size, which makes it difficult to generalize its findings to the larger population. That's why repeating the research on a larger scale would be so valuable: confirming the patterns and indicators of sexual violence could enable administrators to create and implement more effective prevention programs. Not Alone falls just shy of calling for such research, but that doesn’t mean we shouldn’t use this moment as an opportunity to be more expansive in our thinking and questioning of this important issue. Not Alone clearly emphasizes that education is not the only form of prevention: proactive investigation is needed to disrupt patterns of violence. Incorporating more male-focused lines of questioning into the campus climate surveys or conducting separate surveys similar to Lisak’s would allow administrators to focus not only on the experiences of survivors but also on the men who perpetrate these crimes.

The White House – and the activists who have bravely spoken out – has changed the conversation from one that historically blames the victim to one that calls on men to actively participate in ending sexual violence. As the report correctly states: Not all men are perpetrators of sexual assault. But most perpetrators are men, and a deeper understanding of those perpetrators' behavior will help universities build systems of accountability. Right now, too many institutions are doing too little to prevent sexual violence. Given time, resources, and the right kind of research, we can change that.  

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

Nataya Friedan is the Program Manager for the Roosevelt Institute's Women Rising initiative.

Share This

Daily Digest - May 13: When Conservatism Becomes a Health Hazard

May 13, 2014

Click here to receive the Daily Digest via email.

How the Right Wing is Killing Women (Robert Reich)

Robert Reich uses Roosevelt Institute Senior Fellow Ellen Chelser and Fellow Andrea Flynn's paper on poverty and family planning to explain how conservative policy is increasing maternal mortality.

Click here to receive the Daily Digest via email.

How the Right Wing is Killing Women (Robert Reich)

Robert Reich uses Roosevelt Institute Senior Fellow Ellen Chelser and Fellow Andrea Flynn's paper on poverty and family planning to explain how conservative policy is increasing maternal mortality.

  • Roosevelt Take: Andrea Flynn also writes about The Lancet's findings on rising maternal mortality in a series for National Women's Health Week.

The SEC Has Revealed Astounding Corruption in Private Equity (TNR)

Roosevelt Institute Fellow Mike Konczal cites the Securities and Exchange Commission's investigations into private equity firms as an example of effective public regulation.

Airport Workers Press to Join a Union (WSJ)

Laura Kusito reports that workers at New York City airports have voted, via card check, to join a union as part of their ongoing fight for better wages and benefits.

The Minimum Wage Loophole That's Screwing Over Waiters and Waitresses (MoJo)

While the law requires that employers make up the difference if servers don't earn minimum wage though tips, Dana Liebelson reports that wage theft is common.

Tenures Becoming Shorter at a Short-Handed Fed (NYT)

Binyamin Appelbaum speculates that faster turnover at the Federal Reserve is due to changing demographics and expectations, more lucrative outside opportunities, and increased burnout.

The Problem with Thomas Piketty: “Capital” Destroys Right-Wing Lies, but There’s One Solution it Forgets (Salon)

Labor organizing is key to fighting inequality, says Thomas Frank, and while it's not a perfect solution to plutocracy, it's easier to implement than a global wealth tax.

New on Next New Deal

To Stop Campus Sexual Assault, We Should Study the Men Responsible

Roosevelt Institute Fellow Andrea Flynn and Women Rising Program Manager Nataya Friedan suggest that researching the perpetrators will provide guidance for how to reduce sexual violence.

Negotiating With Iran Should be the United States’ Foreign Policy Priority

Roosevelt Institute | Campus Network Senior Fellow for Defense and Diplomacy Jacqueline van de Velde argues that to maintain influence in the Middle East, the U.S. needs to open diplomatic relations with Iran.

Share This

For U.S. Mothers, Conservative Policies Can Be Deadly

May 12, 2014Andrea Flynn

This post is the first in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today, a look at why conservative policies at the state level are leading to increased maternal mortality rates.

This post is the first in the Roosevelt Institute's National Women's Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today, a look at why conservative policies at the state level are leading to increased maternal mortality rates.

For much of the last decade, maternal mortality rates (MMRs) have declined globally. But in the United States, they have consistently increased and are now at one of the highest points in the last 25 years. If conservatives have their way with social and economic policy, it’s unlikely the U.S. will make significant strides to improve the health of mothers in the near future.

According to a report released last week in the The Lancet, the U.S. now ranks 60th out of 180 countries for maternal deaths. China is number 57. Only seven other countries experienced an increase in MMR over the past 10 years. They include Greece, Afghanistan, and South Sudan. The report estimates that for every 100,000 births, 18.5 mothers die in the U.S. By comparison, 13.5 women die in Iran, 6.1 in the United Kingdom, and only 2.4 in Iceland.

It is no coincidence that the U.S. MMR has increased as poverty rates have steadily climbed. In 2010, Amnesty International released a report that showed women living in the lowest-income areas were twice as likely to suffer a maternal death. States with high rates of poverty were found to have MMRs 77 percent higher than states with fewer residents living below the federal poverty level. Women of color have poverty rates more than double those of white women, and black women are 3-4 times as likely to die from pregnancy-related causes.

The numerous factors that contribute to the high U.S. MMR are complex, as are the solutions required to effectively address the problem. However, one solution is already in place and is working. The Affordable Care Act (ACA) will significantly improve maternal health by mandating coverage of pre-natal, maternity, and post-partum care in all insurance plans. But some of the women in greatest need will remain uninsured and at increased risk because of the refusal of 21 states to expand Medicaid. Many of those states have among the nation’s highest rates of poverty and maternal mortality.

Expanding Medicaid would save women’s lives. A 2010 study conducted in New York City showed that the MMR for women with no insurance was approximately four times higher than for insured women, and that the rate for women insured by Medicaid was comparable to that of women with private insurance.

Many states have higher Medicaid eligibility limits that enable pregnant women with incomes above the standard Medicaid threshold to receive coverage. However, that coverage does not begin until women are already pregnant, and it is often terminated soon after their babies are born. This short coverage period leaves women uninsured for much of their lives and places them at higher risk for health problems that can lead to complications during and after pregnancy. Following implementation of the ACA, some states reduced eligibility limits for pregnant women, and loopholes in other states will leave many women without coverage during this critical time. Expanding Medicaid would provide continuous coverage for women whose incomes exclude them from the program and who do not qualify for subsidized insurance through the exchanges.

Despite the maternal health crisis unfolding in many states, conservative state lawmakers stand firm in their refusal to expand Medicaid, even though the federal government will cover 100 percent of the cost for the first three years and a minimum of 90 percent thereafter. Some states, like Georgia, are so intent on undermining the ACA that they have passed laws to prevent state employees from advocating for expansion and have made it more difficult for people who already qualify for Medicaid to enroll.

Conservatives do not have plans to solve this crisis. In fact, their plans will only make it worse. Family planning cuts and abortion restrictions in places like Texas have shuttered women’s health clinics and obliterated the health infrastructure on which poor women relied for their basic needs. And while many women and their families are still reeling from the recession, cuts to safety net programs like food stamps have led to greater insecurity in health, income, and food than ever before.

Last week’s Lancet report is a stark reminder that women suffer heavy casualties in the partisan battles raging in states across the country. But what we are witnessing today is more than a nasty game of politics: it is a violation of women’s human rights. We should be ashamed and outraged.

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

Image via Thinkstock

Share This

Pages