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Friday Femorandum: Meet the New Trumpcare, Same As the Old Trumpcare

The big news this week was the US Senate’s latest tax cuts for the wealthy health care “reform” bill, which in addition to eliminating coverage for millions of poor Americans who get their health care through Medicaid and setting up a death spiral for the individual market will once again make being a woman a preexisting condition, effectively end private coverage for abortion care, and defund Planned Parenthood. Here are some details from the “Better Care Reconciliation Act”—drafted in secret by 13 Republican men—that are especially concerning for women and for anyone who benefits from access to reproductive health care (that is, everyone).

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Vox focuses on the BCRA’s elimination of the “essential health benefits” mandate, which required insurance companies to cover ten basic health care services, including mental health and maternity care. (Under the bill, governors in conservative states will be able to opt out of the essential health benefits requirement by virtual fiat, with no consultation with their legislatures). “f the Better Care Act passes, it could mean we could turn back to a time before the Affordable Care Act, when some 88 percent of plans on the individual market did not provide maternity coverage,” Vox reports.

The bill would also defund Planned Parenthood for one year by barring Medicaid recipients from using Planned Parenthood clinics. Given that half of Planned Parenthood’s patients use Medicaid, the one-year cut would represent a devastating blow both to the clinic network and to women on Medicaid who use the clinics for basic health care, including birth control and cancer screenings.

The New York Times reports that despite a tidal wave of individual contributions in the wake of the Trump election, Planned Parenthood’s funding falls far short of what it would need to serve the millions of Medicaid clients who come through its doors every year. “those new funds do not come close to compensating for the money that the bill would strip away. The national office and affiliates of Planned Parenthood together rely on reimbursements and grants from the government for more than 41 percent of their total $1.35 billion in revenue, according to the group’s latest annual report.

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Dame Magazine points out another way in which the Republican health-care repeal bill is particularly cruel to women. By allowing states to seek waivers from the requirement that insurers can’t deny access to health care because of preexisting conditions, the bill could make it impossible for women who report their rapes to get health care coverage. Or, conversely, it could create a perverse incentive for women not to report their rapes, for fear of losing coverage in the future:

When women report an assault, people often ask, “Why didn’t she report it?” and inquire what the victim was wearing or why she was in that place at that time. Those questions are just one aspect of blaming victims of sexual assault that frequently discourages people from reporting attacks.

The consequences of sexual assault qualifying as a preexisting condition will be widespread:

According to Rape, Abuse & Incest National Network, an American is raped every 98 seconds. One out of every six American women has been the victim of an attempted or completed rape in her lifetime. And those are the assaults on the record; many go unreported.

“People ask, ‘Why didn’t she report it sooner? Why was she doing this? Why did this happen?’” Jessica [who reported her rape] said. “So she gets punished for doing that. And then I’d be punished for doing what they ask people to do. The fact that I saw a therapist to try and get better shouldn’t penalize me if I have to go see a therapist again.”

Vox explains how allowing insurance companies to discriminate against people with preexisting conditions will mean financial ruin for many Americans, by creating a “death spiral in the health care system. Basically, by allowing states to opt out of requiring coverage for preexisting conditions, and by allowing insurers to offer bare-bones coverage that doesn’t include essential health benefits, the Senate bill sets up a two-tiered system in which healthy people with no preexisting conditions buy the cheaper, minimal insurance and everybody else is stuck buying the more expensive, more comprehensive kind. As more and more healthy people leave the comprehensive insurance market, that market will fill up with older, sicker people, driving up costs so far that none but the wealthiest can afford decent insurance.

Consider, for example, a family with a spouse or parent with cancer whose drug treatment costs thousands of dollars for their drugs. They think they have a victory in that under the Senate plan, their insurance company can’t explicitly charge them more because of their family member with a pre-existing condition. But, unfortunately for them, they find that they live in a state that allows insurers to offer plans that don’t cover prescription-drug costs. This family will face nothing but bad choices.

Because the skinny, incomplete plans are a non-starter for them, they can’t take the cheap option. But everyone who’s young or healthy does. The only people choosing the alternative, signing up for a plan that actually meets their needs, are those with serious conditions. This will further drive up the costs of these plans—the only plans that actually cover the treatment that seriously sick people need—and will further drive the young and the healthy away.

And of course, the bill takes direct aim at abortion services, by effectively “prohibit[ing] any health insurance plan, private or public, from covering abortion care,” Rewire reports.

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“The abortion restrictions in the House-passed AHCA mirror the ACA’s failed Stupak-Pitts Amendment, according to Guttmacher Institute Senior Policy Manager Adam Sonfield, who spoke with Rewire in the lead-up to Thursday’s reveal in the Senate. Senate Republicans also appear to rely on the Stupak-Pitts model,” Rewire reports.

“For the uninitiated, then-Reps. Bart Stupak (D-MI) and Joe Pitts (R-PA) in 2009 played into the GOP myth that taxpayer money is fungible. Their amendment sought to bar the ACA’s tax credits from subsidizing any health insurance plan that covers abortion, not just abortion care itself in compliance with longstanding federal policy. The amendment passed the House with the help of 64 Democrats,” but failed in the Senate, which passed the slightly less-restrictive [Ben] Nelson Amendment instead.

Bottom line: Republicans are going beyond banning direct federal funding for abortion, and are trying to stop all health insurers from covering abortions—a lack of coverage that will disproportionately impact low-income women.

The expanded abortion funding ban originated with the far-right Republican Study Committee in the House, which wrote that they would not support any health care bill that did not include cuts to Planned Parenthood and restrictions on federal support for plans that cover abortion. “The bill, they wrote, fulfills ‘an important conservative commitment to promote life and protect the unborn,'” the New York Times reports.

 

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Friday Femoradum: Below the Fold

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There’s a certain danger in paying too much attention to the daily barrage of terrifying headlines that now dominate the daily news cycle. Today, alone, we learned that President Trump has acknowledged he is under investigation for obstruction of justice; that administration officials are genuinely afraid he will fire both the special prosecutor appointed to investigate him and the man who appointed him, deputy attorney general Rod Rosenstein; and that Trump has appointed a wedding planner with a possibly falsified resume to head up New York’s federal housing programs.

The problem is that while we’re paying attention to the latest crisis, Trump and his allies in Congress are hoping we don’t notice that they’re rolling back health care for millions of Americans with “preexisting conditions” like pregnancy and depression; appointing right-wing bloggers who compared abortion to slavery to federal judgeships; and opportunistically exploiting a tragic shooting by suggesting that Democrats are to blame for gun violence (while ignoring the common denominator that unites virtually all mass shooters).

So before you return to your regularly scheduled programming of late-night Presidential tweetstorms and speculation about modern-day Saturday Night Massacres, here’s a closer look at some of the stories that didn’t make it above the fold.

Senators have worked hard to keep the latest version of legislation repealing the Affordable Care Act under wraps, but Axios reported that it will likely allow states to request waivers so that insurance companies won’t have to cover “essential health benefits”—things like maternity care, which the so-called “pro-life” party does not consider an important part of health care coverage. (Hey, none of the elderly white men who run the party will ever get pregnant, so why should they)? States could also get out of a requirement that limits how much more older people can be charged than younger people—a provision that disproportionately impacts women, since women generally live longer than men.

Many people who get their insurance coverage through an employer would not be protected, because the Senate health-care bill would once again allow annual and lifetime limits on coverage for non-“essential” benefits in states that apply for waivers to the essential benefits requirement; this would apply to both the individual and employer markets. The Center for American Progress estimates that some 27 million people who get insurance from their employers would face annual caps on their coverage, and about 20 million would face lifetime caps—meaning that a single complicated pregnancy, or bout with ovarian cancer, could max out a woman’s insurance coverage for a year—or the rest of her life.

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You might think HUD director Ben Carson was the only underqualified Trump appointee who once compared abortion to slavery, but think again—John K. Bush, a right-wing blogger whom Trump nominated to the powerful 6th Circuit Court of Appeals, has written that “slavery and abortion” are “the two greatest tragedies in our country.” Think Progress reports that Bush went on to claim that Martin Luther King, Jr. “would have opposed Roe v. Wade had King been alive when that case was handed down. In reality, there’s no evidence that King — who supported efforts to increase access to birth control and said in 1960 that he’s always been deeply interested in and sympathetic with the total work of the Planned Parenthood Federation’— would have stood against reproductive rights.

Bush has also argued that there is no way a black man or a woman could become President without some unfair advantage; expressed outrage that passport applications were changed to acknowledge the existence of same-sex parents; and referred to the Rodney King beating as “a police encounter.” Politico calls Bush “shocking in his blatant disdain for equal rights and animus toward racial and other minorities.” The Senate is still considering his appointment, and the Leadership Conference is encouraging people to contact their senators to urge them not to approve the appointment.

Agent M Loves Gifs no annoyed facepalm judge GIFWhile Republicans, and many in the media, were quick to seize on the fact that Congressional baseball practice shooter James T. Hodgkinson had been a Bernie Sanders supporter,  ThinkProgress (and others) point out a far more relevant common denominator between Hodgkinson and the vast majority of mass shooters: A history of domestic violence and misogyny. Think Progress reports that Hodgkinson was arrested in 2006 for assaulting a woman who tried to intervene when she witnessed him “throwing his daughter around”a bedroom. Hodgkinson, the woman said, punched her in the face.

Men who hurt female family members often go on to hurt other people, yet most mainstream news organizations fail to connect the dots. Robert Dear, the man who shot and killed three people at a Planned Parenthood clinic in Colorado Springs, had a history of domestic violence; so did Omar Mateen, the shooter who killed 49 people at the Pulse nightclub in Orlando one year ago. The list goes on and on and on. Violence against women is one of the best predictors for future mass violence. Yet we don’t treat it as such. And that’s a tragedy.

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Friday Femorandum: Emboldened

As abortion-rights proponents predicted after the election, the battle against women’s right to choose in Trump’s America is playing out not just at the federal level—where Congress is working to defund Planned Parenthood and Trump’s health department is working to end access to affordable birth control—but in the states. Across the country, anti-choice state legislatures have felt emboldened by the anti-choice Administration to pass ever-more-onerous restrictions on abortion rights, and pro-choice legislatures have started passing protections to protect their residents if the federal government cracks down further on women’s rights. The likely result? A return to the days when a woman’s access to reproductive health care depends on where she happens to live, with women in red states facing major barriers to access and women in blue states holding on to protections.

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For example, the New York Times reports, several states (including Washington) have passed laws allowing women to get 12 months of birth control at one time, rather than having to go back to the pharmacy every month. New York’s attorney general has proposed a bill that would ensure access to birth control without a co-pay, as a rule related to the ACA requires, and Maryland has already passed a similar bill.

Meanwhile, the governor of Delaware just signed legislation that will enshrine abortion rights in state law, by codifying the right to an abortion the way Washington State already does, making Delaware the eighth state to guarantee women the right to an abortion even if Congress changes federal abortion law, the Hill reports.

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A parallel story is playing out in red states. In Ohio, abortion rights opponents have re-introduced legislation that would prohibit abortion after the first sign of a fetal heartbeat, or about six weeks’ gestation. The bill would effectively prohibit all abortions, because most pregnancies aren’t detected until after six weeks. The AP reports that supporters of the so-called heartbeat bill see it “as an opportunity to draw the legal challenge that could overturn Roe v. Wade, the landmark U.S. Supreme Court ruling that legalized abortion.” The bill has been vetoed three times before.

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In Texas, Governor Greg Abbott has no compunctions about signing legislation that might be unconstitutional; on September 1, legislation is scheduled to go into effect that would ban the most common type of abortion procedure after 13 weeks of pregnancy, ban an abortion procedure already illegal under federal law, require abortion providers to  bury fetal tissue resulting from abortions, and create medically unnecessary reporting requirements for abortion providers. Rewire reports that reproductive rights advocates are gearing up to challenge the law, just as they successfully challenged regulations that would have forced most of the state’s abortion clinics to shut their doors. Reuters points out that a federal court has already blocked implementation of a separate Texas law requiring burial or cremation of fetal tissue.

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Friday Femorandum: “Moral Objections”

Remember, 500 years ago, when you didn’t wake up every morning and wonder, as you opened your eyes, “What horrible thing has the President done to women while I slept?”

This week, women across the country learned that the serial sexual harasser, two-time divorcee, and proud p*ssy-grabber who occupies the Oval Office has decided our employers should be allowed to decide they don’t want to pay for our birth control coverage for virtually any reason, as long as they call it a “moral objection.”

Documents leaked to Vox this week showed that Trump plans to expand the religious exemption to the Affordable Care Act’s birth control mandate, which was established under the controversial Hobby Lobby case. The current rule allows a narrow exemption to the mandate for religious groups or “closely held” private companies like Hobby Lobby, whose owners object to the notion that women should be able to have sex without making babies. Everyone knew at the time that employers and anti-choice groups would push to expand the exemption, and now Trump has indicated he plans to do just that, by allowing any company to file paperwork stating that it objects to birth control coverage for religious or “moral” reasons, an undefined term that could mean almost literally anything.

HULU tv wtf what parks and recreation GIFThe new, broader exemption, the New York Times reports, could deny birth control coverage to hundreds of thousands of women who now receive birth control at no cost through the ACA. The language of the Trump rule explicitly says that there’s no clear connection between access to birth control and lower rates of unintended pregnancy, which have plummeted as contraception has become available to more women, including young women, and pregnancy rates have decreased. This claim contradicts numerous studies that are based on science and evidence, which definitively link access to contraception to lower birth rates (and teen birth rates); fortunately for Trump, the rule his administration drafted “does not require that the guidelines be ‘evidence-based’ or ‘evidence-informed.’ ”

Think Progress calls the new rule “devastating” to women, noting that the rule suggests women who no longer have access to low-cost birth control can simply get pills through Medicaid or Title X, the federal program that pays for health care (though not abortions) for low-income women. Trump, of course, has promised to decimate both Medicaid and Title X, which makes the rule’s suggestion that women use those programs for birth control breathtakingly disingenuous. wtf confused lost nervous unsure GIF

Mother Jones puts a finer point on Trump’s birth control doublespeak, pointing out that Trump has vowed to “defund Planned Parenthood” and other health-care providers that receive money through Title X . (Title X, like all federal dollars, can’t pay for abortions, but Republicans want to go further and yank Title X funding from all groups that perform abortions.) “The problem with the White House’s logic,” they write, “boils down to this:

As the nation’s largest provider of federal Title X-funded care, in 2015 Planned Parenthood centers served more than 40 percent of women nationwide using Title X-funded family planning care—a whopping 1.58 million patients. But if Planned Parenthood can no longer receive a single federal dollar to provide contraception and other family planning care—an oft-repeated goal of the Trump administration—then these nearly 1.6 million low-income patients will suddenly lose their family planning care. And now their employers may not cover that care either.

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Wonkette notes that many Republicans who want to make it harder, or impossible, for women to access birth control have wildly inaccurate ideas about what birth control costs; they think it’s basically like buying a latte a couple times a week, when it’s really more like a rent payment (Republican claims in quotes):

You will also be FOR SHOCKED to learn that HHS’s assumptions about the real cost of birth control are wildly off.

“Most forms of birth control are available for around $50 per month, including long-acting methods such as the birth control shot and the IUD.”

IUDs cost around $1,000 out of pocket. Girls will just have to hold off on a new iPhone for another month!

“Other more permanent forms of contraception like implantables bear a higher one-time cost, but when calculated over the duration of use, the cost is similar to other forms of contraception.”

Sure, Norplant costs $800. But if you put aside $50 a month to save up for it, it will only take you 16 months of abstinence to earn it! So keep those knees together, little lady!

Finally, Talking Points Memo looks ahead to the lawsuit women’s rights groups, like the National Women’s Law Center and the Center for Reproductive Rights, plan to file if and when Trump’s proposed rule becomes law. President Obama’s Health and Human Services Department spent years defeating lawsuits against the contraception mandate by arguing that the government has a compelling interest in ensuring that women have access to birth control; with the new rule, Trump is saying bluntly that such a mandate does not exist, opening his administration up to a whole new round of litigation. tv vintage 70s wonder woman superhero GIF

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Friday Femorandum: “A Significant Escalation”

Renee Bracey Sherman’s editorial in the Sunday New York Times, titled, “Who Should You Listen to on Abortion? People Who’ve Had Them” kicked off the week with a bracing dose of common sense—an antidote to a President and Congress who have spent their first few months of unilateral control imposing ill-founded policies based in ideology, not economics or science, on the millions of Americans who need abortions and other reproductive health care.

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Recalling one of her experiences as an abortion doula, Sherman writes, “The abortion debate rages on, but the voices of those who’ve actually had abortions are ignored. Few people try to understand our lives. And we are never asked the most simple but important question: Why did you do it?

“That’s intentional. It’s easier to strip us of our rights when we’re not treated as humans, when political candidates say we deserve ‘some form of punishment,’ when elected officials vote to define abortion as ‘murder,’ when people call us killers. Language matters and it leads to violence.”

In the context of this truth—that calling the doctors who perform abortions, and the one in three women who seek them, “murderers,” leads to violence, consider: This week, Trump appointed as a federal judge a right-wing blogger who compared abortion to “slavery,” and has made the case for shooting Obama supporters.

Language matters, and so do actions. This week, Trump released a budget that—in an unprecedented reversal of longstanding policy—strips all federal funding from Planned  Parenthood and all other health care providers that happen to perform abortions in addition to the services for which they receive federal funding. The effect would be to exclude Planned Parenthood and other abortion providers from eligibility for federal programs that currently pay for services like STD treatment, cancer screenings, and Zika prevention, Mother Jones reports—devastating these health care providers as well as their vulnerable low-income clients, who would no longer be able to use Medicaid for non-abortion services at  Planned Parenthood and other clinics that provide abortions.

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Federal law already bars federal spending on most abortions, so the extension of the ban to include all health care providers can be seen only as an effort to force providers to stop performing abortions or go out of business. This latest assault on reproductive freedom comes just weeks after Trump announced the expansion of the global gag rule, which now prohibits federal funding for all services, not just family-planning programs, provided by groups that also provide abortions or even discuss abortion as an option with women in countries that receive US aid. The rule, Rolling Stone editorializes, “is a significant escalation in the broader campaign by U.S. abortion opponents to use economic coercion to stop women from obtaining safe abortions at home and abroad – a strategy abortion opponents have embraced because, after losing the legal battle decades ago, they have utterly failed to convince women that ending a pregnancy is immoral.”

Yahoo! News takes a look at several other threats to women’s health that are embedded in Trump’s budget proposal, including the allocation of $277 million to “extending abstinence education and personal responsibility programs”—despite overwhelming evidence that “abstinence-only education,” which is not evidence-based or scientifically founded, leaves teens ignorant about how to prevent pregnancy and STD transmission, and may actually increase teen pregnancy rates. twin peaks GIF

And Think Progress digs into the details of another aspect of Trump’s budget proposal—his “paid family leave” plan, which fails to cover the vast majority of people who need time off work to care for a new child or family member and only provides six weeks of paid time off for new parents, which, Think Progress notes, is barely enough time for a woman to recover from an uncomplicated vaginal birth, much less a C section or any other complications.

Worse, the amount new parents would receive under the plan might not be enough to make it feasible to take time off in the first place. New parents would receive pay under the unemployment insurance program, and as Think Progress points out, “unemployment insurance checks are quite skimpy: On average, benefits replace only about half of a person’s paycheck. That could create some big problems. Men, who tend to earn more than women, could be less likely to take leave if they’re getting so little of their normal paychecks.” And thus we get back to Ivana Trump’s original plan—a brief bit of time off for new mothers that could leave them in a worse financial position, in both absolute terms and relative to men, than they were when they became pregnant.