Delaying Abortions: A Harmful Consequence of the Pro-Life Agenda

Aug 2, 2013Andrea FlynnSusan Holmberg

The burdens placed on women's health by new anti-choice laws in the states have unintended consequences: more unplanned pregnancies, more abortions, and more abortions occuring later in pregnancy.

The burdens placed on women's health by new anti-choice laws in the states have unintended consequences: more unplanned pregnancies, more abortions, and more abortions occuring later in pregnancy.

Over the past two years, conservatives have successfully maneuvered around Roe v. Wade to enact sweeping abortion restrictions across the country. In the first half of 2013, lawmakers enacted 43 pieces of legislation restricting abortion access – as many as were enacted during all of 2012. These laws – and the ones that are sure to follow – infringe on women’s rights to access family planning and abortion services, will result in more unplanned pregnancies and therefore more abortions, and are likely to have the unintended consequence of pushing abortions later into pregnancy.

For years women have had to navigate numerous restrictions when they attempt to have an abortion. In deciding Planned Parenthood v. Casey in 1991, the Supreme Court overturned Pennsylvania’s spousal notification law but upheld both the parental consent and informed consent statutes on the basis that they did not impose an “undue burden” on women trying to abort their pregnancies. Since then, numerous states have implemented abortion restrictions on the basis that they do not constitute an undue burden.

  • Twenty-six states have waiting periods ranging from 24 hours to 72 hours. In South Dakota, weekends and state holidays do not count towards the 72-hour waiting period, meaning some women would have to wait nearly a week after their first visit before getting an abortion. Ten states have counseling requirements that also necessitate two visits to a clinic.
  • Thirty-eight states require minors to obtain parental consent and/or notification before having an abortion. Many of those states enable young women to obtain judicial bypass, a process many young women are likely to find intimidating and that surely delays the procedure into further into pregnancy.
  • Eleven states require that a physician be present to administer medication abortion, essentially outlawing telemedicine for this purpose.
  • Many states currently restrict abortion coverage in private plans, and others are beginning to impose the same restrictions on plans accessed through the health exchanges established by the Affordable Care Act. The Hyde Amendment already prohibits federal funds from being used to pay for abortions. The result is that women seeking abortion services – particularly low-income women who are un- or under-insured or are covered by Medicaid – must pay out of pocket.

Most recently, anti-choice legislators have added to those regulations even more restrictive policies that make abortion increasingly difficult to access – in some places almost impossible to access – let alone in a timely manner. Over the past few weeks, lawmakers in Texas and North Carolina passed sweeping regulations that threaten to shutter nearly all abortion providers in those states. The Texas law restricts medication abortions, places onerous requirements on physicians who perform abortions, and imposes the increasingly popular and effective TRAP laws (targeted regulations of abortion providers) on providers, requiring them to increase the width of hallways, add janitor closets, expand operating rooms, etc.

Women’s health advocates have argued that these laws will lead to more unplanned pregnancies and result in a greater number of unsafe abortions. It is also likely that women will require abortions later in their pregnancies – the very situation conservatives are legislating against.

TRAP laws have become a favorite strategy of the anti-choice movement and have the effect of closing clinics that actually perform a wide range of reproductive health services. Anti-choice activists and lawmakers often refer to these clinics as if their sole function is performing abortions. In actuality, these clinics are a pillar of our nation’s health infrastructure. They prevent thousands of unwanted pregnancies each year by providing poor women, young women, immigrant women, and women of color low- and no-cost family planning. These clinics provide pregnancy education, testing, and counseling, which enables women who do choose to have an abortion to do so early in pregnancy. It is not hard to imagine that women will have more unintended pregnancies and require abortions later into pregnancy as those providers close their doors. 

The Guttmacher Institute reports that already seven in 10 women who had a second-trimester abortion wanted to do so earlier in pregnancy but were unable to because they could not afford it. Economists who study family planning policy argue that the costs a woman seeking an abortion faces do not only come in the form of dollars, but also in the time required to access an abortion. A 2001 study by Marianne Bitler and Madeline Zavodny shows that state restrictions that impose mandatory waiting periods (in other words, a time cost) also delay abortions into the second trimester. A 1994 study of Mississippi’s mandatory delay laws showed a 17 percent jump in second trimester abortions after the law took effect.

Other research shows that adolescent women and low-income women are more likely to have abortions later in pregnancy. These are the very groups of people who rely on publicly-funded family planning clinics and who are most affected by the new abortion regulations. These studies are relatively dated; given that state-level restrictions have only ramped up since this research was conducted, the number of women delaying their abortions has likely escalated too.

These patterns are only deepened when lawmakers target not only abortion but the full range of family planning and reproductive health services that women rely on to take care of themselves and their families. Over the past two years, family planning providers across the nation have already been forced to decrease staff, cut hours, reduce services, and close as a result of funding restrictions and budget cuts. Under the new wave of restrictions, they will now face further cuts and many will be forced to close.

Anti-choice lawmakers insist their battery of abortion regulations aim to improve the health and safety of women and girls. This is simply not what the outcome will be. Women will experience more pregnancies and have abortions at later gestational ages, which only subjects them to greater financial burdens and much greater health risks. For example, the average charge for a second trimester abortion is double that for the first trimester. In addition, the potential for a major complication or death is also much higher for a second trimester abortion. If that’s not the definition of an undue burden, we don’t know what is.

Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States. You can follow her on Twitter @dreaflynn.

Susan Holmberg is the Director of Research at the Roosevelt Institute. She holds a Ph.D. in economics and studies gender issues, international development, and corporate governance. 

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Why the Right Doesn’t Really Want Euro-Style Reproductive Health Care

Jul 24, 2013Andrea Flynn

U.S. conservatives want Europe's abortion restrictions, but they oppose the generous systems and legal exceptions that support women's health.

U.S. conservatives want Europe's abortion restrictions, but they oppose the generous systems and legal exceptions that support women's health.

Earlier this month, Texas lawmakers witnessed and participated in passionate debates about one of the nation's most sweeping pieces of anti-choice legislation. That legislation, known as SB1, was initially delayed by Wendy Davis's now-famous filibuster and was signed into law by Governor Rick Perry last week during a second special legislative session. It bans abortions after 20 weeks, places cumbersome restrictions on abortion clinics and physicians, and threatens to close all but five of the state’s 42 abortion clinics. Throughout the many days of hearings anti-choice activists relied on religious, scientific, and political evidence to argue that the new Texas law is just and sensible.

Many of those arguments are tenuous at best, but it is the continued reference to European abortion laws that most represent a convenient cherry-picking of facts to support the rollback of women’s rights. Many European countries do indeed regulate abortion with gestational limits, but what SB1 supporters conveniently ignore is that those laws are entrenched in progressive public health systems that provide quality, affordable (sometimes free) health care to all individuals and prioritize the sexual and reproductive health of their citizens. Most SB1 advocates would scoff at the very programs and policies that are credited with Europe’s low unintended pregnancy and abortion rates.

Members of the media have also seized on European policies to argue that Texas lawmakers are acting in the best interest of women. Soon after the passage of SB1, Bill O’Reilly argued that “most countries in the world have a 20-week threshold,” and Rich Lowry, editor of the National Review, wrote, “It’s not just that Wendy Davis is out of step in Texas; she would be out of step in Belgium and France, where abortion is banned after 12 weeks.”

It’s hard to imagine any other scenario in which O’Reilly and Lowry, and most conservative politicians and activists, would hold up European social policies as a beacon for U.S. policy. After all, the cornerstones of Europe’s women’s health programs are the very programs that conservatives have long threatened would destroy the moral fabric of American society. One cannot compare the abortion policies of Europe and the United States without looking at the broader social policies that shape women’s health.

Both Belgium and France have mandatory sexuality education beginning in elementary school (in France parents are prohibited from removing their children from the program). France passed a bill earlier this year that allows women to be fully reimbursed for the cost of their abortion and guarantees girls ages 15 to 18 free birth control. Emergency contraception in both countries is easily accessible over the counter, and in Belgium the cost of the drug is reimbursed for young people and those with a prescription. Both countries limit abortion to the first trimester but also make exceptions for cases of rape, incest, and fetal impairment, to preserve woman’s physical or mental health, and for social or economic reasons. None of these exceptions are included in the new Texas law, and I’d guess it would be a cold day in hell before the likes of O’Reilly and Lowry advocate for more expansive health policies or for including such exceptions in abortion laws.  

But it would be wise if they did. This availability of preventative care contributes to the overall health and wellness of women in Europe and enables them to make free and fully informed decisions about their bodies over the course of their lifetimes. The demonization and lack of progressive sexual health policies in Texas, and in the United States more broadly, drives high rates of unintended pregnancy, teen pregnancy, maternal mortality, sexually transmitted infections, and abortion. 

Unfortunately, Texas couldn’t be further from France or Belgium when it comes to the care it provides to women and families before, during, and after delivery, as I’ve written about before. The Texas teen birth rate is nearly nine times higher than that of France and nearly 10 times higher than that of Belgium. Nearly 90 percent of all teens in France and Belgium reported using birth control at their last sexual intercourse, compared with only 53 percent in Texas. The infant mortality rate in Texas is twice that of Belgium and France. The poverty rate among women in Texas is a third higher than that of women in Belgium and France, and the poverty rate among Texas children is 1.5 times higher. Less than 60 percent of Texas women receive prenatal care, while quality care before, during, and after pregnancy is available to nearly all women throughout Europe.  

None of those hard facts were compelling enough to amend – let alone negate – the new law. It seems impossible these days to find a common ground between anti- and pro-choice individuals, but if conservatives wanted to have a conversation about enacting European-style sexual and reproductive health policies in the United States, that just might be something that could bring everyone to the same table. The more likely scenario is that once conservatives have plucked out the facts that help advance their anti-choice cause, they will promptly return to tarring and feathering Europe’s socialized health system.

Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States and globally. She is on Twitter at @dreaflynn.

 

Woman and doctor banner image via Shutterstock.com

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Daily Digest - July 10: Safety Nets Catch GOP Voters Too

Jul 10, 2013Rachel Goldfarb

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Whites and the Safety Net (NYT)

Paul Krugman builds on Roosevelt Institute Fellow Mike Konczal's argument on libertarian populism, and further examines why that model should not appeal to working-class white voters who rely on safety net programs like unemployment and food stamps.

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Whites and the Safety Net (NYT)

Paul Krugman builds on Roosevelt Institute Fellow Mike Konczal's argument on libertarian populism, and further examines why that model should not appeal to working-class white voters who rely on safety net programs like unemployment and food stamps.

  • Roosevelt Take: You can read Mike's piece on why libertarian populism is more of the same from Republicans here.

GOP Moves Closer to Splitting Farm Bill (The Hill)

Erik Wasson says that the House Republicans are considering the option of splitting farms subsidies and SNAP into two separate bills. Supporters of farm subsidies are concerned the split could destroy them, while the Democrats just want a bill with fewer cuts to SNAP.

Senate Democrats Spar Over Wall Street Reform (MoJo)

Erika Eichelberger explains why two groups of Senate Democrats are arguing about how to implement a Commodity Futures Trading Commission rule on overseas derivatives trading that is scheduled to be finalized on Friday. Senator Warren leads the charge for a stronger rule than the current proposal.

Wal-Mart Says it Will Pull Out of D.C. Plans Should City Mandate ‘Living Wage’ (WaPo)

Mike DeBonis reports that with only one day before the D.C. City Council votes on their living wage mandate for large retailers, Wal-Mart is making threats. It claims that paying $12.50 an hour isn't possible, despite its booming profits.

The 2 Supreme Court Cases That Could Put a Dagger in Organized Labor (The Atlantic)

Matt Bruenig and Elizabeth Stoker worry that two cases the Supreme Court has agreed to hear next year, one on recess appointments to the National Labor Relations Board and the other on union-employer organizing agreements, could be the end of new private sector unions.

New on Next New Deal

HHS Ruling Helps Workers But Spells Trouble for Employer Mandate

Roosevelt Institute Senior Fellow Richard Kirsch applauds the decision to allow workers whose employers delay offering insurance access to the exchanges, but he thinks they won't want to switch to employer-sponsored insurance in 2015.

Comcast Profits from the Poor with Internet Essentials Deal

Roosevelt Institute's John Randall, Program Manager of the Telecommunications Equality Project, explains how Comcast is up to its usual profit-driven motives when it claims to be expanding high-speed internet access. It's also not doing too well at actually expanding access in areas that don't have it.

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HHS Ruling Helps Workers But Spells Trouble for Employer Mandate

Jul 9, 2013Richard Kirsch

Workers won't be denied coverage because of the reporting delay, but they may not want to give up the insurance they get through the exchanges come 2015.

Workers won't be denied coverage because of the reporting delay, but they may not want to give up the insurance they get through the exchanges come 2015.

In my post last week, after the announcement that the employer mandate would not be enforced for a year, I wrote that it was vital that the Obama administration show as much concern for the workers who might be denied health insurance as it did for employers. Specifically, I asked the administration to make clear that a worker would be able to get subsidized health coverage through the new exchanges based on filling out an application, without having to get proof from an employer. On Friday, HHS issued that ruling.

The decision not to enforce the employer mandate for a year is certain to cost some people health coverage as some employers decide to postpone complying with the law. Their workers, possibly also confused by the delay, may not apply for subsidized coverage. But if they do apply, the new ruling will be a big help to them.

As noted, the HHS ruling made it clear that the exchanges should rely on the information workers provide rather than proof from their employers. Workers can ask their employer to help provide the information, but that is not a requirement. And the exchanges can try to verify the information if possible, but that will be difficult and again is not a requirement. Under the new ruling, a worker who reports that he or she is not offered affordable health coverage at work will qualify for subsidized coverage. (Affordability is measured by the employee share of premiums being no more than 9.5 percent of their income.)

The HHS announcement is an important measure to help get coverage to uninsured workers. Of course, it has received little attention compared to the news about the employer mandate. That news is almost always reported incorrectly, with most articles saying that the mandate itself has been postponed for a year. What has been postponed is the enforcement of the mandate through penalties for employers that do not comply. It’s still the law that large employers are required to offer affordable coverage. But if they don’t, there will be no penalty.

There’s one more potentially interesting twist to this story, one that could provide real benefit to some workers in 2014 and then highlight a big problem with the employer mandate in 2015. Workers who get health insurance through the exchanges will get coverage that is much more affordable – lower premiums and out-of-pocket costs than health insurance offered by employers. This will be particularly true for the low-wage employers most likely to not offer coverage. As a result, workers who get coverage in 2014 in the exchange may find in 2015 that they are forced to get coverage that is much more expensive to buy and use, and covers fewer health services, from their employers. The workers will want to stick with the exchanges, putting pressure on employers to pay a fine and let the employees stay in the exchanges, or to improve the coverage they offer.

We are likely to see a lot more debate about how to reform the employer mandate in Congress this year and next as the ACA is implemented. In a future post, I’ll describe ways to change the employer mandate to make good health coverage more affordable for workers. 

Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

 

Health care cost image via Shutterstock.com.

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Daily Digest - July 5: Part-Time World

Jul 5, 2013Rachel Goldfarb

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The Part-Timer Problem (TAP)

Harold Meyerson wonders if the employer mandate would really have helped many get health insurance in the first place, since full-time jobs have been on the decline for years. Saner, he thinks, would be to separate employment and health care entirely.

Click here to receive the Daily Digest via email.

The Part-Timer Problem (TAP)

Harold Meyerson wonders if the employer mandate would really have helped many get health insurance in the first place, since full-time jobs have been on the decline for years. Saner, he thinks, would be to separate employment and health care entirely.

Job Creation and the Affordable Care Act Have Little to Do with Each Other (On The Economy)

Jared Bernstein argues that the Affordable Care Act should not effect job growth, and in fact could lower the cost of labor. Besides that, he thinks we should judge the bill as a health care bill, because it isn't a jobs bill.

The GOP’s Endless War on Obamacare, and the White House Delay (Robert Reich)

Robert Reich suggests that the delay in implementing the employer mandate will only give Republicans more time to attempt to convince Americans that they don't want this law that will help to reduce health care inequality.

As Sequestration Cuts Bite, Congress is Content with Recrimination (The Guardian)

Heidi Moore sees the lack of action to fix sequestration as a sign of the larger problem of Congress's unwillingness to actually pass a budget or any other major legislation. She thinks the window for that work will close as soon as midterm campaigns begin.

How the Sequester Savages the Long-Term Unemployed (The Nation)

George Zornick reports that as sequestration continues, cuts to Emergency Unemployment Compensation are putting the long-term unemployed in an even tighter spot. His interview subject points out that meanwhile, Congress is still drawing a full salary and benefits.

Four Years Into Recovery, Austerity’s Toll is At Least 3 Million Jobs (Working Economics)

Josh Bivens and Heidi Shierholz look at data that demonstrates just how much austerity has cost job growth over the past four years, and suggest that ending austerity policies, starting with sequestration, is the most logical next step.

Rosy Data Suggest Faster Job Growth (WaPo)

Ylan Mui explains why some groups are saying that the jobs numbers being released this morning will be higher than recent months. Others think it is more likely that job growth will prove to continue at the same slow and steady pace.

 

 

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Daily Digest - July 4: Holiday Edition

Jul 4, 2013Rachel Goldfarb

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Happy Fourth of July! Today's Daily Digest is an abridged holiday edition. We will return to the full-length Daily Digest tomorrow.

Paid Sick Leave Laws Generate More Concern Than Pain (NYT)

Click here to receive the Daily Digest via email.

Happy Fourth of July! Today's Daily Digest is an abridged holiday edition. We will return to the full-length Daily Digest tomorrow.

Paid Sick Leave Laws Generate More Concern Than Pain (NYT)

Robb Mandelbaum reports that it turns out paid sick leave laws aren't such a big deal for small businesses after all. In municipalities that have already instituted such laws, more business owners are finding the costs minimal.

Progressives' Post-DOMA To-Do List (TAP)

In response to people questioning whether same-sex marriage has eclipsed everything else on the progressive agenda, Scott Lemieux has a list of projects to work on now that DOMA has been overturned.

Less-white and less male: Labor movement finds new support (MSNBC)

Ned Resnikoff reports on a survey that gives a new image of union supporters, full of women, people of color, and young people. Roosevelt Institute Fellow Dorian Warren explains that the past picture of labor is due to exclusionary policies that have shifted in most unionized fields.

New on Next New Deal

Will Delaying the Employer Mandate Deny Health Coverage to Workers?

Roosevelt Institute Senior Fellow Richard Kirsch questions whether the Obama administration's decision to push back the employer mandate in the Affordable Care Act for a year is going to increase costs for employees who thought they would be insured in January.

New Texas Abortion Law Could Be Worst Yet for Poor Women

Roosevelt Institute Fellow Andrea Flynn examines how the abortion law being debated in a second special session of the Texas legislature after its defeat by filibuster last week will harm poor women by destroying their access to clinics that provide low-cost reproductive health care.

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New Texas Abortion Law Could Be Worst Yet for Poor Women

Jul 3, 2013Andrea Flynn

The controversial SB 5 is the latest case of the Texas GOP pushing anti-abortion measures that marginalize low-income women.

The controversial SB 5 is the latest case of the Texas GOP pushing anti-abortion measures that marginalize low-income women.

Some 5,000 orange-clad men and women invaded the Texas capital in Austin on Monday in an emotional and enthusiastic show of support for reproductive rights. They faced off with Republican lawmakers still resolved to pass SB 5, the very bill limiting abortion access that was defeated last week after Senator Wendy Davis’s 11-hour filibuster. Yesterday, nearly 2,000 people showed up to testify against the bill as it was considered by the Texas House Affairs Committee, which approved it 8-3.

This latest effort to roll back women’s rights in Texas has met fierce opposition and resolve from Texans and other Americans who recognize the value of women’s health care. “When you silence one of us, you give voice to the millions who will continue to demand our lives, our choices, our independence,” Ilyse Hogue, president of NARAL Pro-Choice America, reminded us at Monday’s rally.

It has also highlighted the deep gulf between the lived experiences of women in Texas, particularly low-income women, and lawmakers who have inserted themselves into decisions that should only be made by women and their physicians.

Monday’s protest took place as Texas lawmakers convened for a second special session called by Governor Rick Perry. The bill they’re considering would make abortion after 20 weeks illegal, impose onerous requirements on abortion providers, and demand that all clinics meet costly and burdensome building requirements. If passed, 37 of the state’s 42 abortion providers will be forced to close their doors. This despite the fact that 79 percent of Texans believe abortion should be available to a woman under varying circumstances, while only 16 percent believe abortion should never be permitted.

This is just the latest in a seemingly never-ending assault on Texas women. In 2011, lawmakers decimated the Texas family planning program with a two-thirds budget cut that closed nearly 60 family planning clinics across the state and left almost 150,000 women without care.  Soon after, they also barred Planned Parenthood and other reproductive health clinics defined as “abortion affiliates” from the Women’s Health Program (WHP), a state Medicaid program on which thousands of poor women rely. Governor Perry insisted that former WHP patients could find new providers and claimed there were plenty to bridge the gap, but that simply is not the case. Clinics across Texas have reported a sharp drop in patients, and guess that former WHP clients are receiving no care at all.

To suggest so cavalierly that women simply find new providers is evidence that Republican lawmakers simply don’t understand – or don’t care about – the socioeconomic realities that shape women’s lives. Otherwise, they would recognize the absurdity of forcing women to navigate an increasingly complex health system to find new providers and then traverse hundreds of miles to receive basic care and services. This is a stark illustration of the privilege gap that exists between policymakers and the people they represent. 

After it became clear that the warnings of public health experts – who testified that such policies would impose a heavy economic toll on the state, result in negative health outcomes, and increase the demand for abortion – were becoming reality, lawmakers last month restored family planning funding to the 2014 budget. While this is certainly good news, returning to pre-2011 funding levels still leaves nearly 700,000 women without access to care and so far has enabled only three of the nearly 60 shuttered clinics to re-open. And even before the 2011 budget cuts, only one-third of the state’s 1 million women in need of family planning services received them through the state program. A provider shortage will persist for the foreseeable future; it is no easy task to reopen a clinic once it has shuttered its facility, released its staff, sold all its equipment, and sent its patients files elsewhere. 

If the current legislation were to pass, nearly all the state’s abortion providers would be forced to close. The majority of those are clinics that not only offer abortion services, but also provide contraception, STD testing, and cancer screenings for poor women. Many of those clinics are located in areas that are already bearing the brunt of family planning clinic closures (see map below). The few clinics that would remain open in Texas are located in urban areas, leaving women in rural Texas with even fewer health care options than they currently have. 

(Abortion data: New York Times and Planned Parenthood. Family Planning data: University of Texas Population Research Center)

What are women—especially poor women—to do? Women in Texas already face heavier burdens than women in many other states. Texas has one of the nation’s highest teen birth rates and percentages of women living in poverty. It has a lower percentage of pregnant women receiving prenatal care in their first trimester than any other state. It also has the highest percentage of uninsured children in the nation and provides the lowest monthly benefit for Women, Infant, and Children (WIC) recipients (an average of $26.86 compared to the national average of $41.52). And soon the majority of women may not have access to abortion care at any stage of their pregnancy.

Governor Perry’s policies have marginalized women who already bear the heavy weight of so many inequities. His latest efforts will only marginalize them further.

This anti-abortion legislation will not prevent women from getting abortions. It will simply push them across the border and into unsafe facilities like those operated by Kermit Gosnell. It’s passage will add to the fury that has escalated over the past three years as women have lost access to breast exams, birth control, and abortion services while being told it is for their own good. These lawmakers fail to understand that the full range of reproductive health services, including the ability to access an abortion, is absolutely central to women’s ability to lead happy, healthy, and productive lives – an ability that is itself essential to the strength of families, communities, states, and our nation.

On Monday, Planned Parenthood president Cecile Richards reminded the crowd in Austin of the old adage that you can measure a country by how well it treats its women. The same is true for Texas.  “We settled the prairie. We built this state. We raised our families,” said the ever-feisty daughter of former Texas governor and progressive icon Ann Richards. “We survived hurricanes and tornados, and we will survive the Texas legislature, too.”

Andrea Flynn is a Fellow at the Roosevelt Institute. She researches and writes about access to reproductive health care in the United States and globally.

 

Rick Perry image via Shutterstock.com.

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Will Delaying the Employer Mandate Deny Health Coverage to Workers?

Jul 3, 2013Richard Kirsch

The White House's decision shows sympathy for big employers, but it's not clear whether employees will have to shoulder the cost.

The surprise announcement from the Obama administration that it will delay for one year penalizing employers that do not offer health coverage to their workers is the latest capitulation by the White House to big businesses that want to shirk their responsibility to help pay for health insurance. But the decision leaves huge unanswered questions about whether health coverage for uninsured workers will also be denied.

The White House's decision shows sympathy for big employers, but it's not clear whether employees will have to shoulder the cost.

The surprise announcement from the Obama administration that it will delay for one year penalizing employers that do not offer health coverage to their workers is the latest capitulation by the White House to big businesses that want to shirk their responsibility to help pay for health insurance. But the decision leaves huge unanswered questions about whether health coverage for uninsured workers will also be denied.

Yesterday, the Treasury issued a notice delaying for one year, until 2015, the requirement that employers of more than 50 full-time employees (3 percent of all employers) report on whether they offer health coverage to their employees. The Affordable Care Act requires that these employers pay penalties when they they do not offer qualified coverage or when their workers access coverage through the new health care exchanges. The Treasury’s notice does not change the legal requirement that employers provide coverage, but it effectively negates enforcement of that requirement. The delay comes even though the Treasury has had more than three years to prepare to implement the law and an entire new industry has emerged advising employers on how to comply.

The notice, full of sympathy for employers who have to comply with the reporting requirements, totally ignores the implications for employees. What will happen to workers for companies that do not offer health insurance or that offer coverage that does not meet the law’s minimum requirements? These are huge questions, and it is remarkable that the Obama administration would publish the Treasury Department notice without addressing them.

Under the Affordable Care Act, workers who are offered acceptable coverage at work are not eligible to access health insurance through the new health insurance marketplaces (“exchanges”), which offer income-based subsidies to purchase health coverage. These workers must purchase the employer coverage or pay a fine.

So what happens under the Treasury Department rule if the marketplaces have no way to determine whether a worker has been offered qualified coverage? Would the uninsured worker be able to get subsidized coverage? It would be cruel to make employees, most of whom work for low wages, wait another year to get health insurance because the administration is giving big employers a break on reporting. If the administration is going to give employers a break, it should not do so at the expense of millions of uninsured or underinsured workers who have been looking forward to having health insurance available to them on January 1, 2014.

Another question is whether the penalty for not being insured, the individual mandate, would apply to an uninsured employee of a business that does not have to report on whether it is offering coverage and is avoiding the employer mandate penalty. What greater irony than to fine an employee because the Obama administration is eliminating fines for large employers?

The Obama administration’s decision continues a history, stemming from the business-friendly version of the Affordable Care Act that emerged from Max Baucus’s Senate Finance Committee, of bowing to the demands of big businesses to avoid responsibility for providing affordable coverage to their employees. The Affordable Care Act's only requirement for employers of 50 or more full-time workers is that they offer employers high-deductible plans, which require employees to pay a big chunk of their incomes for the coverage. If employers meet these skimpy provisions, they can avoid paying penalties and their workers are locked into the lousy coverage or required to pay a fine for the privilege of being uninsured. It is not clear how many employers will take this low-road route, but the history of the big low-wage employers – think WalMart and McDonalds – is not encouraging.

What matters now is that the White House treat employees with the same level of concern it has shown big business. To do that, the administration should make it clear that workers who state that they are not offered coverage by their employer, or that the coverage costs more than they can afford or has limited benefits, should be eligible to receive income-based subsidies in the new marketplaces. Simple justice, and the primary goal of the Affordable Care Act of guaranteeing affordable health coverage to all Americans, requires nothing less. 

Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

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Daily Digest - July 3: No One Really Needed That Insurance, Right?

Jul 3, 2013Rachel Goldfarb

Click here to receive the Daily Digest via email.

White House Delays Key Element of Health Care Law (AP)

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White House Delays Key Element of Health Care Law (AP)

Ricardo Alonoso-Zalvidar speaks to Roosevelt Institute Senior Fellow Richard Kirsch about the news that the administration is delaying implementation of the employer mandate. Kirsch is outraged about how this will affect employees who expected insurance on January 1, 2014.

Regulators to Beef Up Wall Street Rules…Thanks to Republicans?! (MoJo)

Erica Eichelberger asks Roosevelt Institute Fellow Mike Konczal why two Republicans on the FDIC want to tighten regulations on big banks' capital requirements. Konczal's explanation? They think it will reduce the blame on the FDIC if there is another bailout.

Murky Language Puts Homes Underwater (TAP)

David Dayen explains how banks are utilizing unclear language to make a loophole that allows them to dual-track homeowners, or continue pursuing foreclosure while the homeowner submits paperwork for mortgage modification. Until we fix this, people will continue to lose their homes.

How to Make Sure a Growing U.S. Economy Helps the Poor (Scholars Strategy Network)

Lane Kenworthy argues that the only way to ensure that economic growth helps the poor is to change the structure of the social safety net and tie benefits to growth. Otherwise, we leave swaths of people behind, which doesn't seem particularly American.

Making $7.75 an Hour, and Figuring There’s Little to Lose by Speaking Out (NYT)

Michael Powell talks to fast-food workers who are involved in the unionizing efforts in New York City. These workers have no fears about annoying their employers: what's the risk when you're making so little money to begin with?

Payroll Cards Are Under Scrutiny by New York’s Attorney General (NYT)

Jessica Silver-Greenberg reports that following Monday's story in the Times on payroll cards, the New York attorney general has opened an investigation. Employees must give explicit consent to be paid this way in New York, and why would anyone choose all those fees?

Hawaii Becomes Second State To Pass A Domestic Workers Bill Of Rights (ThinkProgress)

Bryce Covert discusses Hawaii's new law, which was signed on Tuesday and brings housekeepers, nannies and other domestic workers under the protection of labor laws such as the minimum wage, overtime, and anti-discrimination laws.

Oh, Right, the Jobs Crisis (The Nation)

John Nichols still sees the jobs crisis as the primary problem facing the U.S., and one that needs to be solved before many others. He's especially concerned with the groups that are struggling worst: people of color and young people.

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Daily Digest - June 21: Changing Definitions, Unchanging Realities for Workers

Jun 21, 2013Rachel Goldfarb

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Is it Time to Tweak Obamacare? Sen. Joe Donnelly Thinks So. (WaPo)

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Is it Time to Tweak Obamacare? Sen. Joe Donnelly Thinks So. (WaPo)

Sarah Kliff speaks to the Senator, who wants to change the definition of full-time hours in the Affordable Care Act from 30 to 40. He wants to prevent part-time workers from getting their hours cut due to employers who don’t want to offer health insurance.

Who Killed Equality? (Bloomberg)

Ezra Klein says that the usual arguments on economic inequality ignore the power of government to set the rulebook, drawing on the work of Dean Baker. The current set of rules exacerbate income inequality, but they don't have to stay on the books.

The Economy Can’t Recover If the Workers Don’t (Campaign for America's Future)

Robert Borosage is concerned by the Fed's changing tone on the economic crisis and recovery, because as far as most Americans are concerned, we're still in the middle of the crisis. Stock market improvements are not average worker recovery.

Cutting Wages Won’t Create Jobs (The Hill)

Jack Temple argues that when we don't raise the minimum wage, we're effectively cutting it due to inflation, and that isn't helping unemployment. In fact, an increase in the minimum wage would serve as a major stimulus for the economy.

The Unpaid Internship Racket (MSNBC)

Timothy Noah considers the moral failings of unpaid internships, which go alongside their frequent illegality as shown by last week's ruling against Fox Searchlight. Beyond the inequality and abuse, there's the simple formulation that interns are workers, and workers get paid.

Profits Without Production (NYT)

Paul Krugman suggests that the biggest difference between today's economy and the past's is the growth of monopoly rents, or profits tied primarily to market dominance. This depresses perceived return on investments and wages, contributing to our weak recovery.

Bank of America Whistleblowers Allege Rot at the Core of the Mortgage Industrial Complex (HuffPo)

Ray Brescia reports on some of the most serious charges revealed in affidavits filed in litigation against Bank of America. If this is Bank of America's way of reforming its foreclosure practices, then it is clear that more oversight is necessary.

New on Next New Deal

One More Day for Women's Equality in New York

Roosevelt Institute Fellow Andrea Flynn writes on New York Governor Cuomo's Women's Equality Act, which contains one of the most progressive pieces of abortion legislation in the country. But the legislative session ends today, and the State Senate seems unwilling to take a vote on the issue.

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