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contraception

A non-prescription pill

This sounds like a good idea.

If you’re one of the estimated 10 million people in the United States taking oral contraception, you probably needed a prescription to get it. But that could soon change: In July, a Paris-based company, HRA Pharma, announced it asked the US Food and Drug Administration for permission to sell its progestin-only birth control pill over the counter. For the first time since its approval in 1960, the Pill may be available with no requirement to consult a health care professional—a significant hurdle for those most in need of the medication.

The US wouldn’t be the first country to #FreeThePill; in fact, oral contraceptives are available without a prescription in more than 100 countries. That’s because the Pill is nearly 100 percent effective when taken regularly, and safe for most people. Blood clots, a risk associated with the drug, are serious, but rare in today’s formulations: Every year, between one and five out of 10,000 women who are not on hormonal birth control or pregnant experience a blood clot; for people on the combination (estrogen and progestin) pill, the risk rises to between three and nine out of 10,000 people. And there’s no increased risk of clots for those on a progestin-only pill. In recent years, dozens of US medical organizations have declared support for a nonprescription pill, and an overwhelming majority of voters appear to be in favor of making the change.

[…]

An FDA approval would be a “step forward,” California Latinas for Reproductive Justice Communications Director Susy Chávez Herrera says, “in terms of expanding health care access, and folks in our community having bodily autonomy.”

A decision from the FDA is likely several months away: A panel of independent experts was set to meet on November 18 to discuss HRA Pharma’s proposal, but the meeting was postponed, reportedly to accommodate more data. Now, the agency is expected to weigh in on over-the-counter birth control sometime next year.

In any case, the fight for access won’t end at the pharmacy. For one, the FDA typically only considers one product at a time; a green light for HRA Pharma’s pill won’t automatically free up other options. (So far, just one other company, Cadence Health, has said it plans to ask the FDA for approval to sell its combination pill over the counter, but has yet to complete the necessary research trials.) And just because a drug is available doesn’t mean it will be affordable. “Having the FDA approve an over-the-counter birth control pill would be a huge win,” Chávez Herrera says, “but it would not be complete if it was not accessible to the people that really need it.”

Research underscores the need to keep costs low. A 2018 study from Ibis found that generally, adults are willing to pay up to $15 for a one-month supply. “If the price goes up much more than that,” says Daniel Grossman, a professor in the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, and an author of the study, “then interest really kind of bottoms out.” When I asked HRA Pharma how much its pill would cost, their Chief Strategic Operations and Innovation Officer Frederique Welgryn told me in an emailed statement that the company would “set an acceptable price tested with consumers” and is working on developing a financial assistance program.

I’m in favor of anything that increasing reproductive freedom and gives women more control over their lives. I feel confident that the forced birth fanatics will fight back, via state laws that put restrictions on pill access and lawsuits that seek out friendly judges, but that’s a fight we should be willing to have. Whether this would blunt their already ongoing environmental attack is not known to me. Be that as it may, the important thing is finding ways to move the ball forward in whatever way we can.

The limitations of Plan B

A helpful and timely explainer from the Associated Press.

WHAT ARE EMERGENCY CONTRACEPTIVES?

Emergency contraceptives are used to prevent pregnancy after unprotected sex or if a method of birth control fails.

Two types of medications, sometimes referred to as “morning after pills,” are available: levonorgestrel, known by the popular brand name Plan B; and ulipristal acetate, known under the brand ella. They should be taken as soon as possible after unprotected sex.

The pills prevent ovulation, which is when an egg is released from an ovary, said Dr. Jonah Fleisher, director of the Center for Reproductive Health at the University of Illinois in Chicago. If an egg is not released, it cannot be fertilized.

ARE THEY THE SAME AS ABORTION PILLS?

No. Emergency contraceptives prevent a pregnancy. The abortion pill, mifepristone, ends a pregnancy after a fertilized egg has implanted in the lining of a woman’s uterus. It’s commonly administered with the drug misoprostol and can be taken up to 11 weeks after the first day of a woman’s last period.

DOES EMERGENCY CONTRACEPTION WORK?

Not 100% of the time. The pills’ effectiveness improves the sooner they are taken after unprotected sex, doctors said. The drugs won’t prevent pregnancies if they are taken before sex, Fleisher said.

The Food and Drug Administration has approved Plan B for use up to 72 hours, or three days, after unprotected sex. Ella is approved for up to 120 hours, or five days.

Timing is important because sperm can live inside a woman’s body for up to five days, so a woman can still get pregnant if ovulation occurs after intercourse, said Dr. Dana Stone, an OB-GYN in Oklahoma City. If a woman has ovulated prior to intercourse, the pills are unlikely to help.

“So that’s where the failure comes in. It’s based on the timing,” Stone said.

[…]

WHAT ABOUT RAPE VICTIMS?

Most rape victims don’t report the crime to law enforcement, according to Jude Foster, advocacy medical forensic and prevention programs director for the Minnesota Coalition Against Sexual Assault. Many also may not go in for immediate medical care. Not everyone knows that emergency contraceptives are an option and part of a routine rape exam, or that such an exam is free.

“Why is sexual assault used as a political football when you are talking about access to reproductive care?” Foster said. “Please don’t. It just really frustrates me.”

Stone said the belief that a woman can just take Plan B if she is raped is misguided.

“We need all kinds of options for women because nothing is a one size fits all,” Stone said. “People have transportation problems, they have financial problems. There are always barriers to some percentage of women that will keep them from accessing this in the short time frame that they have.”

See here for the reason I’m blogging about this. Note also the mention of cost in that last section. Cost is a legitimate concern.

Plan B One-Step usually costs about $40-$50. Generics like Take Action, My Way, Option 2, Preventeza, My Choice, Aftera, and EContra generally cost less — about $11-$45. You can also order a generic brand called AfterPill online for $20 + $5 shipping. (AfterPill can’t be shipped quick enough to use if you need a morning-after pill right now, but you can buy it and put it in your medicine cabinet in case you need it in the future.)

The brand of EC you buy or how much you pay for it doesn’t matter — all brand-name and generic levonorgestrel morning-after pills work just as well.

You may be able to get the morning-after pill for free or low cost from a Planned Parenthood health center, your local health department, or another family planning clinic. Call your nearest Planned Parenthood to see if they can help you get emergency contraception that fits your budget.

If you have health insurance or Medicaid, there’s a good chance you can get Plan B for free — you just have to ask your nurse or doctor for a prescription so your health insurance will cover them (even though you don’t need a prescription to buy these types of morning-after pills over-the-counter). The staff at your local Planned Parenthood health center can also help you figure out if your health insurance will pay for your morning-after pill. Read more about using health insurance to pay for emergency contraception.

Boy, it sure is a good thing that everyone has either health insurance, or Medicaid, or easy access to a Planned Parenthood near them in Texas, isn’t it? This sure would be a much bigger problem, one that would require engagement and compassion from our state leaders to solve otherwise. So clearly, anyone who needs Plan B can get it any time they want, right?

Plan B

I have three things to say about this.

On Friday, Gov. Greg Abbott told The Dallas Morning News that rape victims can take emergency contraception, like Plan B, to prevent a pregnancy. With abortion now banned in Texas, even in instances of incest or rape, the governor recommended the use of emergency contraception to ensure a victim of rape does not become pregnant.

But for the lowest-income people in Texas, emergency contraception isn’t widely accessible, advocates said — a consequence of the significant number of people of childbearing age who are uninsured and the state’s lack of programs that provide access to treatment like Plan B.

During a pre-recorded segment of Lone Star Politics, Abbott said of rape victims, “By accessing health care immediately, they can get the Plan B pill that can prevent a pregnancy from occurring in the first place. With regard to reporting it to law enforcement, that will ensure that the rapist will be arrested and prosecuted.”

[…]

After signing Senate Bill 8 into law last September, which banned abortions after about six weeks of pregnancy and didn’t provide exceptions for rape or incest, Abbott said the state’s goal was to eliminate rape. Abbott’s office did not return a request for comment on Saturday.

In 2020, Texas ranked 16th in the nation for total number of forcible rape cases per capita.

Emilee Whitehurst, the CEO of Houston Area Women’s Center, said a significant number of rapes aren’t reported, and the actual number of victims is higher than those that seek treatment at a hospital.

Whitehurst added that emergency contraception is not a substitute for abortion access in any way, but those responsible for the abortion ban in Texas have left victims of sexual assault with few options. She said it was insulting to hear that Plan B should be relied on to prevent pregnancies given the dangers victims of sexual assault already face.

“To presume Plan B could be a substitute for abortion care represents such a fundamental misunderstanding of the reality of women’s lives and our biology,” Whitehurst said.

While emergency contraception is available for purchase over the counter, it can cost $50 at a pharmacy. Some insurance plans cover the cost of emergency contraception, but those who are uninsured have to pick up that additional expense.

For women of childbearing age in Texas, more than a quarter had no health insurance in 2017 — the highest rate in the nation. This is caused, in part, because Texas has not expanded Medicaid and has one of the lowest eligibility standards in the country. A single parent with three children would have to earn less than $400 a month to qualify for Medicaid.

In addition to the lack of coverage, the state’s programs that target women’s healthcare don’t provide emergency contraception. Neither the Family Planning Program nor the Healthy Texas Women Program provide emergency contraception.

Title X clinics remain one of the few options for low-income people to access emergency contraception at an affordable cost. However, these federally-funded reproductive health clinics don’t operate in every community in the state.

1. How’s that plan to eliminate rape going, Greg? Making any progress on it?

2. Boy, it sure is a good thing that health care is so easily and affordably accessible in this state, especially for women and people of color and people who don’t have insurance.

3. It is true that Plan B remains legal in Texas, and that the author of SB8 insists that he doesn’t want to make Plan B illegal – for now, anyway. But come on, does anyone believe that the forced-birth fanatics don’t have the various types of emergency morning-after contraception in their sights? Those people already think Plan B is an abortifacient. It’s just a matter of time, unless there are other laws in place to ensure that it remains legal. In the meantime, here’s a question Greg Abbott will not want to answer: If a bill to ban Plan B passes the Legislature, would he sign it or veto it? We know what Beto would do. I think we can also be pretty sure about Abbott.

Dallas joins the abortion decriminalization queue

Good for them.

The Dallas City Council could consider a resolution in August aimed at blunting the impact of the Texas Legislature’s trigger law that will go into effect following the Supreme Court’s decision that overturned Roe vs. Wade.

Dallas’ measure would direct city staff—which includes the Dallas Police Department—to make investigating and prosecuting accusations of abortion “the lowest priority for enforcement” and instructs City Manager T.C. Broadnax to not use “city resources, including … funds, personnel, or hardware” to create records regarding individual pregnancy outcomes, provide information about pregnancy outcomes to any agency, or to investigate whether an abortion has occurred, a draft copy of the resolution obtained by D reads.

“I would say that it technically really does accomplish the decriminalization here locally,” said Dallas City Councilman Adam Bazaldua, who worked on the resolution and chairs the committee that will consider the matter before it goes to the full Council. “Being the lowest priority, … there’s not much of an investigation that could be done if there’s no resources that are able to be allocated.”

The measure does not apply to instances where law enforcement officials might need to investigate cases of criminal negligence by a practitioner in the care of a pregnant person, or where force or coercion is used against a pregnant person.

The resolution will be introduced in a special-called meeting of the council’s Quality of Life, Arts, and Culture Committee Tuesday. If approved by the committee, he aims to have it before the full Council at its Aug. 10 meeting. If it passes, Dallas would join many cities that have sought restrictions with similar resolutions, including Denton, Waco, and Austin. The San Antonio City Council will vote on its resolution Tuesday.

Yes, Denton and Waco. You knew about San Antonio and Austin, now you can add these three to the list.

Bazaldua said he knows the city can do little about the law itself, but he hopes this resolution would provide a measure of protection for healthcare providers who could face felony charges if suspected of providing an abortion. Pregnant people would also have similar protections, he said.

“There’s only so much that can be done at the local level and this is about as much as we can get,” he said, adding that after the resolution is passed, ideally the city would begin working with nonprofit and private-sector partners to help people locate resources if they need to travel to another state for an abortion.

He also doesn’t see this resolution endangering the city when it comes to another recently passed law that would penalize cities that “defund” their police departments. He argues that funding isn’t being reduced.

“What can they do? Punish a city for saying this should not be a priority of ours?” he said. “When we have violent crime that’s going on, that we should be focusing our resources and funding on?”

I mean, I wouldn’t put anything past Ken Paxton or the forced-birth fanatics in the Lege, but on its face that’s a strong argument. It’s also consistent with the earlier advice we saw about what cities can do on their end. I don’t know how this will play out – I cannot overemphasize how much effect the November elections could have in blunting the worst possible effects of the new anti-abortion laws and preventing the creation of new ones – but it feels good to do something, even if it may be transient. One has to wonder when there will be some action in Houston on this front. Is there a campaign going on about this that I haven’t seen yet?

San Antonio will make its statement for abortion rights

More symbolic than anything, but it still has meaning.

Five San Antonio City Council members and the mayor stood in support of a largely symbolic measure Wednesday that would attempt to “decriminalize” abortion locally.

Council is expected to approve a resolution during a special meeting called for Tuesday that would essentially condemn Texas’ abortion ban and recommend that no local funds be used to investigate criminal charges related to the ban.

“Women and individuals who are seeking access to abortion need to know that their elected officials are standing by them and will not allow city resources to be used to collect any data to potentially criminalize or prosecute them,” Councilwoman Teri Castillo (D5), who drafted the resolution and held the press conference outside City Hall, told the San Antonio Report after the event.

The resolution cannot prevent local enforcement from investigating criminal cases of abortion, Castillo acknowledged, because the council cannot tell police departments how or whether to investigate criminal cases, according to the city’s charter.

“But it’s a step in the right direction and it’s a step to build upon and implement additional policy,” she said.

Castillo didn’t elaborate on what additional policies council might consider, but said she was looking forward to hearing ideas from the community and her colleagues.

Castillo and Mayor Ron Nirenberg were joined by council members Mario Bravo (D1), Phyllis Viagran (D3), Melissa Cabello-Havrda (D6) and John Courage (D9); together, the six represent a majority of council.

The resolution is similar to the GRACE Act that the Austin City Council approved this week. That, too, was a symbolic policy recommendation, as Austin’s charter has similar rules around the direction of law enforcement.

See here for some background on Austin’s actions, about which you know what I think. I’m curious at this point to see how many other Texas cities follow in these footsteps. If it’s still relevant next year, – if there hasn’t been a federal law passed to reinstate abortion rights, and if the Lege hasn’t passed some crazy law to shut this down, and if this cause hasn’t been taken up yet here – I’ll be asking every candidate for Mayor and City Council that I interview what they think about doing the same thing in Houston. Texas Public Radio and the Current have more.

Austin takes its shot at protecting abortion access

I wish them great success. I don’t think the fanatics in the Legislature will let them achieve it, but we’ll see.

Austin City Council unanimously (in the absence of lone Republican Mackenzie Kelly) approved four items on Thursday, July 21 that aim to provide people within the city some legal protection should they seek or perform an abortion.

The special meeting was called following the U.S. Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Org. last month, which overturned its prior Roe v. Wade and Casey v. Planned Parenthood decisions guaranteeing a constitutional right to terminate a pregnancy. In Texas, 2021’s Senate Bill 8 already made those providing or “aiding and abetting” abortion care after about six weeks (before many people know of their pregnancies) liable to civil lawsuits that can be filed by anybody.

[…]

The item most likely to have immediate impact is known as the GRACE Act (Guarding the Right to Abortion Care for Everyone), a measure introduced by Council Member Chito Vela which directs the Austin Police Department to “deprioritize” investigations into criminal offenses related to abortion.

Effectively, that means Council is asking APD (technically, they’re asking City Manager Spencer Cronk to ask APD Chief Joseph Chacon) not to devote any financial resources or labor to investigating cases related to abortions. Exceptions in the measure include instances where an abortion is being coerced, or when a provider is accused of negligence.

For now, APD has not indicated how it will respond to the GRACE Act. Chacon will have to work with his executive team and the city’s Law Department on implementation, but have not provided insight into what that might look like or how long it might take. In response to questions from the Chronicle, an APD spokesperson said, “We are working through the resolution and we’ll present next time when we come back to Council.”

The unanimous Council (Kelly missing the meeting due to a previously scheduled surgery) also approved an ordinance initiated by CM Vanessa Fuentes to protect people who’ve received “reproductive health actions” from discrimination in housing, employment, or access to public services. The other two resolutions adopted at the meeting were both from Mayor Steve Adler and related to “long-term birth control,” including vasectomy. One directs Cronk to explore a public education campaign about birth control options and to ensure that city employees’ health insurance covers “low-cost birth control.” (From an insurer’s perspective, vasectomy and tubal ligation are lower-cost than ongoing hormonal or barrier birth control.) Cronk is expected to report back to Council no later than Sept. 30.

Adler’s second resolution asks staff to recommend budget provisions that would enable city employees to have “reasonable access to reproductive health care services that are no longer lawfully available in Texas.” This resolution does not include a report-back date, but presumably staff would need to offer recommendations soon if they are to be adopted along with the city’s fiscal year 2023 budget on Aug. 17.

Rockie Gonzalez, deputy director of the Austin Justice Coalition and founder of the Frontera Fund, which has organized around abortion access in the Rio Grande Valley since 2014, told the Chronicle that she was encouraged by the items Council passed. “The most important thing for advocates right now is to get decriminalization measures and protections in place for folks seeking abortions, those providing abortions and those helping other folks to get the abortion care that they need.”

The GRACE Act does not protect organizations, like the Lilith Fund in Austin, that had been helping individuals coordinate and pay for access to abortions. Depending on how APD implements the direction, however, it could protect someone who decides to help a friend or family member access an abortion. Still, Gonzalez said, the measures will help abortion care advocates in Austin because they will not have to focus as much on the criminalization of abortion in Texas.

“Locally, impact on abortion advocates is going to be a little bit of wiggle room and protection to do the advocacy work that we need to continue to do,” Gonzalez told us. “In Austin, at least, we won’t need to focus as much on creating bail funds and securing legal support for folks who might be criminalized” for seeking an abortion. She also hopes advocates can work together to pass similar measures in other cities throughout Texas.

See here and here for some background. If the Austin PD is amenable to this, then there ought to be some decriminalization benefit, at least in the short term. We know the forced-birth caucus in the Legislature will find ways to shut this down, but it’s still something for now.

The bigger problem in the meantime is the threat of SB8, the vigilante bounty hunter law, which hasn’t been used yet but is being prepped for weaponization as we speak. There’s not only nothing that the city of Austin can do to prevent those attacks, the city may find itself on the wrong side of SB8-enabled lawsuits as a result of these actions. Again, I hate to sound like a doomsayer, but these people aren’t subtle and they won’t hold back. The only way to really fight back is at the state and federal level, where the levers available to take action are much more powerful. I wish this kind of ground-level resistance could be successful. My fear is that it will be steamrolled. I hope I’m wrong. The Texas Signal has more.

House passes bill to protect access to contraception

They’re on a roll.

The House on Thursday passed legislation that would protect access to birth control, the latest move in a broader effort by Democrats to enshrine into federal law rights they fear could come under threat by the Supreme Court following its decision to wipe away the constitutional right to an abortion.

The vote was 228-195, with eight Republicans joining every Democrat in voting in favor. All 195 “no” votes came from Republicans.

[…]

The bill, called the Right to Contraception Act, now goes to Senate, where it is unlikely to attract the support of 10 Republicans needed to pass it. The measure would create a statutory right for people to access birth control and protect a range of contraceptive methods, as well as ensure health care providers have a right to provide contraception services to patients.

“We are not willing to play defense on this critically important issue,” Rep. Kathy Manning, a Democrat from North Carolina who sponsored the measure, said during a press conference to promote the bill on Wednesday. “We are playing offense.”

House Speaker Nancy Pelosi accused Republicans of attempting to roll back the clock for American women by curtailing access to birth control, but declared “we are not going back.”

“This is their moment. Clarence Thomas has made that clear, right down to the fundamentals of privacy they want to erase,” Pelosi said of Republicans. “With this passage, Democrats will make clear we will never quit in the fight against the outrageous right-wing assault on freedom.”

[…]

While Justice Samuel Alito wrote for the majority that “nothing in this opinion should be understood to cast doubt on precedents that do not concern abortion,” Justice Clarence Thomas wrote a separate concurring opinion urging his colleagues to reconsider landmark decisions that recognized rights regarding contraception and same-sex relationships.

No other justice joined Thomas, but his opinion, coupled with decisions this term from the court’s conservative majority involving the environmentreligionguns and abortion, has prompted Democrats to push back legislatively.

“This rallying call by Justice Thomas and the actions of extremist Republican legislators are about one thing: Control,” said Manning, the North Carolina Democrat. “These extremists are working to take away the rights of women, to take away our right to decide when to have children, to take away our right to control our own lives and our own bodies, and we will not let this happen.”

As noted, the House also recently passed bills to protect access to abortion and same sex marriage. The latter has some chance of passing the Senate, while the former and this bill will need a larger Democratic Senate to go along with a Democratic House to have a chance. Not a bad set of issues to run on this year, and it’s always good to be seen taking real action. As you might imagine, no Texas Republicans voted in favor, though Rep. Mike McCaul did not vote on it. I’d be perfectly happy for the House to find a few more items like these to vote on. Daily Kos, Mother Jones, and the Chron have more.

House passes bill to protect same-sex marriage

A surprisingly bipartisan vote, by which I mean “more Republicans than you can count on your fingers voted for it as well”.

The Democrat-led House of Representatives on Tuesday voted to pass a bill that would enshrine protections for same-sex marriage into federal law.

The bipartisan final vote was 267 to 157 with 47 Republicans joining with Democrats to vote for the bill. It’s not clear, however, whether the bill can pass the Senate where at least 10 Republicans would need to join with Democrats to overcome the filibuster’s 60-vote threshold.

The vote comes amid fears among Democrats that the conservative majority on the Supreme Court could take aim at same-sex marriage in the future, after the high court overturned Roe v. Wade in a highly consequential reversal of longstanding legal precedent.

The bill — called the Respect for Marriage Act — was introduced by Democratic Rep. Jerry Nadler of New York, the chair of the House Judiciary Committee.

In addition to safeguarding the right to same-sex marriage nationwide, the bill also includes federal protections for interracial marriages. The measure holds that a marriage must be recognized under federal law if the marriage was legal in the state where it took place.

The bill would also enact additional legal safeguards for married couples intended to prevent discrimination on the basis of sex, race, ethnicity or national origin, including empowering the attorney general to pursue enforcement actions.

[…]

House Democrats, leaning into cultural issues in the aftermath of the Supreme Court’s abortion decision, also are looking at moving a bill this week to guarantee access to contraception.

The Supreme Court’s bombshell opinion overturning Roe v. Wade has set off a debate over whether other precedents are now in danger.

The majority opinion from Justice Samuel Alito attempted to wall off its holding in the abortion case from those other rulings, but Justice Clarence Thomas wrote separately to call explicitly for other rulings to be revisited.

“In future cases, we should reconsider all of this Court’s substantive due process precedents, including Griswold, Lawrence, and Obergefell,” Thomas wrote, referring to decisions on contraception and same-sex relationships.

Liberals have said that those rulings are now at risk.

In their dissent, the court’s three liberal justices wrote “no one should be confident that this majority is done with its work.”

“The right Roe and Casey recognized does not stand alone,” they wrote. “To the contrary, the Court has linked it for decades to other settled freedoms involving bodily integrity, familial relationships, and procreation. Most obviously, the right to terminate a pregnancy arose straight out of the right to purchase and use contraception. In turn, those rights led, more recently, to rights of same-sex intimacy and marriage.”

The liberals added: “Either the mass of the majority’s opinion is hypocrisy, or additional constitutional rights are under threat. It is one or the other.”

See here for my post about the House passing a bill to restore abortion access. This one got one Republican vote from Texas, one more than the abortion access bill got (and yes, one more Democratic vote, as Henry Cuellar can get stuffed). Unlike the abortion access bill, this one may have a chance to pass the Senate; at the very least, it’s got Senate Republicans all discombobulated. (To be fair, Ted Cruz remains solidly un-discombobulated.) They apparently just never expected Dems to make them vote on this stuff, which honestly doesn’t say anything good about either of them. But at least the Dems are pressing the issue now, and it will either result in a good law being passed or a good campaign issue presenting itself. More like this, please. The Chron and The 19th have more.

Commissioners Court takes some action on access to contraception

From last week:

Harris County leaders on Tuesday passed a trio of items in support of women’s access to abortion and contraception in the wake of the Supreme Court’s overturning of Roe v. Wade.

The most significant of the three measures directs county departments to find ways to protect and expand access to affordable and no-cost contraception, sexual education, family planning, and other programs including “access to safe abortions where possible under the law.”

A second measure provided for the county to lobby the state Legislature to mitigate the effects of a near-total abortion ban in Texas, while a third item was a symbolic resolution to condemn the Supreme Court’s decision overturning Roe.

All three measures passed 3-2 on party-line votes.

Judge Lina Hidalgo, a Democrat, cast the deciding vote in favor of all three items, “in recognition of the fact that we’ve had a right curtailed, and what that might mean for future rights that might be curtailed. I’m very, very concerned about that.”

It’s hard to know how much effect that first item can have, as it is giving direction to county departments rather than implementing something specific. I hope there will be a report at a later date with some details about what actions can be taken and are being taken. It’s also important to remember that as long as the Republicans have full control of state government, they can pass laws forbidding or outlawing whatever these actions turn out to be. I very much approve of the intent here, but we have to keep the bigger picture in mind.

Republicans are not going to stop passing anti-abortion bills

It’s what they do. There is no finish line for them.

During their 20 years in control of the Texas Legislature, Republican lawmakers have steadfastly worked to chip away at abortion access.

Bound by the limits of Roe v. Wade, which stopped them from enacting an outright ban on the procedure, lawmakers got creative. They required abortion clinics to have wide hallways and deputized private citizens to sue providers in an effort to shut down facilities that offer the procedure.

Future lawmaking on the topic will likely not require such ingenuity. A leaked draft of a U.S. Supreme Court opinion, published last week by Politico, suggests the court will reverse the landmark abortion ruling in the coming weeks, allowing states to regulate abortion as they see fit. Texas has a “trigger law” that would make performing an abortion a felony, which would go into effect 30 days after the Supreme Court overturns Roe.

Their decadeslong goal achieved, Republican lawmakers said there’s still work to be done. Texas GOP leaders and members of the Legislature said it is now time to turn their attention to strengthening the social safety net for women and children and investing in foster care and adoption services.

“It only makes sense,” said Rep. Steve Toth, R-The Woodlands. “The dog’s caught the car now.”

At least some of the more conservative members of the House said they also want to ensure strict enforcement of the abortion ban and to prevent pregnant Texans from seeking legal abortions in other states.

“I think I can speak for myself and other colleagues that align with my policy beliefs — we’ll continue to do our best to make abortion not just outlawed, but unthinkable,” said Rep. Briscoe Cain, R-Deer Park, a member of the far-right Freedom Caucus.

Texas already has an arsenal of statutes to punish virtually anyone involved in the procurement of an abortion, said University of Texas at Austin law professor Liz Sepper. These include last year’s Senate Bill 8, which empowers private citizens to sue anyone who “abets” an abortion after six weeks of gestational age, as well as unenforced pre-Roe abortion statutes criminalizing a person who gets the procedure, which the Legislature never repealed — some dating to the 1850s.

“If Roe is overturned, there’s already a criminal ban, there’s already an aiding and abetting ban, there’s already a ban on mailing medication abortion,” Sepper said. “In terms of law’s ability to change behavior, they’ve almost filled all the gaps — with the exception of criminalizing the pregnant person involved in an abortion.”

And you better believe that’s where they’ll be going next, though to be sure there are plenty of other avenues for them to pursue as well. This is what gives creeps like Briscoe Cain their purpose in life. If somehow they do eventually run out of things to ban, next up after that is increasing penalties and making it easier for law enforcement to go after whoever the likes of Cain thinks are getting away with something. Listen to what they’re saying – they are not being coy at all about this.

Now as for the claims that maybe now it’s time to do a little something to “strengthen the safety net”, well, let’s just say that they are starting from a position of abolutely no credibility.

With a near-total abortion ban looming in Texas, advocates and experts say the state’s support systems for low-income mothers and children are already insufficient — and won’t easily bear an increase in need.

“When you say ‘social safety net’ in Texas, it sounds like a joke,” said D’Andra Willis of the Afiya Center, a North Texas reproductive justice group. “Everything they could have set up or increased to protect people if they really cared, they’re not doing it here.”

Pregnant women in Texas are more likely to be uninsured and less likely to seek early prenatal care than the rest of the country. They’ll give birth in one of the worst states for maternal mortality and morbidity. And low-income new parents will be kicked off of Medicaid sooner than in many other states.

This would make many Texans want to avoid pregnancy altogether. But learning about, let alone accessing, contraception can be a challenge in a state that does not require sex education and has narrowed family planning options in recent years.

Republican lawmakers, many of whom have focused on restricting abortion access in recent years, have said strengthening the state’s social safety net will now become a top priority. But advocates who have been working on these issues for years say any help will likely be too little, too late.

“People fail to realize that this is bigger than abortion access,” Willis said. “We’re going to be setting people up for generational poverty.”

As with so many other policy items, like boosting mental health care as their prescription to reduce mass shootings, the single biggest thing they could do to achieve that goal would be to expand Medicaid. More than 55% of all births in Texas are paid by Medicaid. I think you can guess how high that is on their priority list. But even if you want to give them a tiny bit of benefit of the doubt, note that it’s just now that they are on the verge of achieving an abortion ban that they’re even beginning to think about maybe doing something to benefit those who are pregnant and have given birth. Look at their priorities, that will tell you how much that counted for them. Why would you expect that to change going forward?

I’m just going to say this one thing about the pending evisceration of abortion rights

Chris Tomlinson gets at the issue but doesn’t take it all the way.

The Supreme Court’s apparent decision to allow state lawmakers to make women’s health care choices puts chief executives in a tough spot, forcing them to choose between their employees’ rights and right-wing backlash.

Disney’s recent experience defending LGBT rights against Florida Gov. Ron DeSantis’s demagoguery will sadly encourage cowardice.

Millions of Texans are waiting to hear how their employee health insurance will handle abortion coverage when the procedure becomes a first-degree felony punishable by life in prison.

Texas Republicans have made banning abortion their marquee issue for decades. In addition to prohibiting government health insurance from paying for abortions, the Legislature also banned state-regulated plans from covering them.

Employers of 60 percent of Americans with company-sponsored health insurance, though, use self-funded plans. These are exempt from state regulations, according to the Kaiser Family Foundation, a health care research organization. Only 14 percent of self-funded plans exclude some or all abortions.

Polling shows 59 percent of Americans think abortion should be legal under all or most circumstances, according to Pew Research.

After Gov. Greg Abbott allowed Texans to privately prosecute other Texans who seek an abortion after six weeks of pregnancy, many companies stepped up. Amazon, Citigroup, Salesforce, Apple, Bumble, Levi’s, GoDaddy, Match, and Hewlett Packard Enterprise, have all promised to help employees get abortions outside Texas.

“We are pro-woman. We will support a woman’s right to make health care decisions for herself, even if that means traveling out of state. It’s an investment that’s not just right, but good business too,” Curtis Sparrer, a principal at Houston-based PR firm Bospar told me in an email.

The company will pay for travel and other expenditures should a Bospar staff member need reproductive health care banned in any state where they live, Sparrer added.

“We want other companies and PR agencies to join the fight, especially since many are composed of women and are led by women. The rights of women are not just on the line,” he added. “As someone who credits his same-sex marriage to the legacy of Roe, I am imploring my colleagues and friends to end their silence and speak truth to power.”

Taking a stand on anything, though, is becoming more perilous for corporations and executives who would rather generate profits than controversy. Employees, especially younger workers, expect their company’s leadership to reflect their values.

“More than half of consumers will buy or advocate for brands based on their beliefs, while six in 10 employees will choose employers based on shared beliefs and values,” according to Edelman, a global PR firm. “A stunning 81 percent of respondents want CEOs to be front and center discussing public policy.”

The first thing to realize is that the forthcoming overturn of Roe and Casey is the beginning, not the end. Next up will be a nationwide ban on abortion, for which Senate Republicans are already writing a bill. Now that they will no longer have to pretend that this has anything to do with women’s health, rape and incest exceptions will go away, and it won’t be just doctors who are targeted for arrest and prison. I guarantee you, lowlife creeps like Briscoe Cain cannot wait to throw women in jail for anything that looks like an abortion. Lizelle Herrera was not an aberraion.

If you think I’m being alarmist, go find a copy of that draft opinion and read it for yourself. Note carefully the section in which Sam Alito claims that this opinion is only about abortion and not all of those other things that people like him despise and want to get rid of, like the previous SCOTUS decisions on same-sex marriage and contraception and “sodomy”. I will remind you that most if not all of the justices who have signed onto Alito’s opinion also swore under oath during their Senate confirmation hearings that they considered Roe to be “settled law” and that they respected precedent. There’s no reason at all to believe anything that a known liar says.

So get mad, get organized, and get everyone you know who has the same concerns as you to vote. Businesses are going to have to do more as well, if they actually do care about their employees. But it’s on us, to vote and to put pressure on the people we’ve voted for to act. The clock has struck midnight. What are we going to do about it?

More federal support for emergency contraception

Good.

The federal government announced Friday it is providing additional funding to Austin nonprofit Every Body Texas to address a potential increase in clients’ need for emergency contraception and family planning services now that Texas prohibits abortions as early as six weeks into pregnancy.

Health and Human Services Secretary Xavier Becerra said in a release Friday that the Office for Population Affairs will award funding to the group, which is the statewide administrator of the federal Title X funding program, which provides family planning and reproductive health services to low-income patients.

Friday’s move comes as the Biden administration is challenging Texas’ near-total ban on abortion in court.

The federal government is also launching a new funding program that allows any entity across the country, regardless of if it receives Title X funding, to apply and receive additional money to provide reproductive and family planning services to patients impacted by Senate Bill 8.

There is $10 million available for these two programs, though it is unclear how much Every Body Texas is receiving directly. According to the federal government’s website, the grant application for the new program, called Funding to Address Dire Need for Family Planning Services, says they expect to award 10 grants between $150,000 and $1.5 million by the end of this year. The announcement said Every Body Texas must use the money provided by March 31.

[…]

Becerra also issued a memorandum detailing two federal statutes he says his department would enforce to provide protection for patients who may need an abortion and health care providers who assist pregnant patients in certain situations.

“​​Today we are making clear that doctors and hospitals have an obligation under federal law to make medical decisions regarding when it’s appropriate to treat their patients,” Becerra said in a release. “And we are telling doctors and others involved in the provision of abortion care, that we have your back.”

It was not immediately clear late Friday how Becerra’s memorandum would impact people’s ability to access an abortion in Texas or providers’ willingness to perform the procedure.

The two federal laws Becerra referred to include the Emergency Medical Treatment and Labor Act and the Church Amendments. The federal government issued a memorandum reminding health care providers that patients who appear in the emergency room must receive appropriate medical screening, stabilizing treatment and a transfer, in or out of state, regardless of state laws, including pregnant patients or patients experiencing a pregnancy loss.

Becerra said the federal government would impose civil monetary penalties against hospitals or physicians if they violate that law.

Second, the federal Office of Civil Rights released guidance about the Church Amendments, which prevent discrimination against health care personnell who object to performing an abortion because of their relgious beliefs. Those amendments also protect health care providers from discrimination if they do assist or perform a lawful abortion, such as an abortion where federal funds are used to end pregnancies that result from rape or incest or to save the life of the pregnant person.

See here for the full statement from HHS. This is the sort of thing that would have been good to do at any time, but these are not normal times, and it’s everyone’s job to fight back against SB8. I hope the commitment continues once we have a (hopefully positive) resolution to the litigation. The Chron has more.

More birth control by mail options

Good to see.

“We want women to see us and say, ‘These are people who believe that if you want birth control you should have it,'” said Hans Ganeskar, co-founder and CEO of Nurx, a California-based site founded in 2015 that can both dispense and prescribe by way of computer or app.

Nurx (pronounced New RX) became available to Texas women in June, bringing the total number of states it serves to 17.

Women answer a series of health questions or in some cases undergo video consultation, and then their prescriptions are written by a state-licensed doctor affiliated with the company. The prescription is then sent to a local pharmacy to handle delivery. With insurance, the cost is generally free; without, it is $15 for a one-month supply of pills.

A similar company, The Pill Club, entered the Texas market in early July. It, too, is a California-based startup touting the same message of accessibility and inclusiveness.

The Pill Club differs from Nurx in that it provides all prescriptions and products in-house, without involving local pharmacies.

While it is possible to get an online exam and first-time prescription in some states through The Pill Club, founder Nick Chang said the exam service is not yet available to Texas women. In states where it is unavailable, women upload an existing prescription. The cost is typically covered by insurance.

Chang, a Stanford Law School graduate who also attended medical school, said his company takes its cues from the many personalized niche shopping sites such as Birch Box with its makeup or the Dollar Shave Club.

“All of these things are being delivered, but not birth control. There’s something wrong with that,” he thought as far back as 2014, although his company did not officially launch until last year. It is now in 13 states.

Contraceptives have been available through online pharmacies long before these new, more hip entrants, but Chang said for reasons not entirely clear many women were not taking advantages of them.

[…]

At Prjkt Ruby (note the text message spelling), contraception comes paired with social conscience. Also launched in 2015, the service arrived in Texas earlier this year, chief marketing officer Daniel Snyder said.

It also offers its own in-house mail-order pharmacy and prescription services. In Texas, those come after a video consultation. But the company does not accept insurance, instead charging the $20-per-cycle prescription services by cash or credit card.

For every order of a three-month cycle, the company donates 75 cents to Population Services International, a nonprofit organization that supports access for birth control to women in developing nations.

“We’re like the TOMS Shoes of birth control,” said Snyder, referring to the shoe seller that donates either a pair of shoes or a portion of the profits from other items to those in need.

Despite the white-hot political glow that surrounds all things reproductive these days, online contraceptive marketing has mostly flown under the radar, even as they also fill the controversial morning-after pills, said Dr. Kristyn Brandi, an obstetrician-gynecologist in Los Angeles and an advocacy fellow for the Physicians for Reproductive Health.

Despite some initial reservations, she said, the potential boost to access outweighs potential safety concerns in misdiagnosis.

“A lot of the trouble with contraception is getting it,” she said.

Snyder agreed, adding it’s impossible to extract the current political climate from what it happening with his company. In the days after the November election, he said they experienced a noticeable surge in business.

“People were panicking,” he said.

Indeed they were. I noted the existence of Nurx after its appearance in Texas. I think there’s a lot to be said for this business model, but I continue to be worried that it’s just a matter of time before it’s in the crosshairs of the the anti-abortion fanatics. It hasn’t happened yet – several more ridiculous anti-abortion items were on the agenda for this special session, so perhaps Greg Abbott hasn’t been informed about birth control by mail – but I’m sure it’s just a matter of time. Until then, if this is something that might be good for you or someone you know, check it out.

Birth control by mail

This is interesting, but doesn’t address a couple of key points.

About half the counties in Texas don’t have the number of public clinics required to meet the contraceptive needs of the population. So Nurx, an at-home birth control delivery app, decided to give women in the state the option to get birth control whenever they want and without ever needing to step into a clinic or even physically see a doctor.

Starting today, those in the Lone Star State will be able to tap the Nurx app and get contraceptives delivered straight to their door.

While Texas isn’t the only state with a giant “contraceptive desert,” or an area without at least 1 clinic to every 1,000 women in need of publicly funded contraception, it is certainly the biggest area of land in the United States not meeting these needs.

And with Trumpcare looming, and Trump’s recent “Religious Freedom” order, which allows businesses to deny birth control coverage based on religious reasons, many women could lose access to their publicly funded birth control pills and even more publicly funded clinics could go under, leaving a large and vulnerable population wide open to other, possibly dangerous methods of preventing birth.

As the story notes, there are other birth control delivery services on the market, but Nurx appears to be the only one operating in Texas. The legislative session is over, but I can easily imagine someone taking aim at this in a future session, though to be fair I thought there would be a reaction to the Mexican abortion option, too. Be that as it may, the real issue here isn’t lack of places to buy the pill, it’s the increasing restrictions on insurance coverage for it, which will become a crisis if Trumpcare passes in any form. It doesn’t matter what your delivery options are if you can’t afford to buy it in the first place. Still, it’s good that Nurx exists, and I hope it has some company in the market soon. I also hope it doesn’t have a large chunk of that market taken away from it by Congress.

Let’s talk about sex education

We’re not good at it.

Rep. Mary Gonzalez

A Democratic state lawmaker is looking to bolster high school sex education requirements in hopes that Texas can lower its teen birth rates.

Rep. Mary González, D-Clint, filed House Bill 1547 to require sex education classes to include “medically accurate, age-appropriate” human sexuality education. The bill would allow students to be excused from the course with the written request of a parent or guardian.

“It’s deeply troubling that Texas has one of the highest teen birth rates in the nation,” González said Tuesday. “Our young people deserve to have correct, accurate information.”

Teen birth rates in Texas are among the highest in the country. According to a 2014 report from U.S. Department of Health and Human Services, the teen birth rate among Texas women ages 15 to 19 was nearly 40 in 1,000 girls. The national birth rate in 2015 for teenagers of the same age was 22 births per 1,000 girls, according to the agency.

González filed the bill on the heels of the Texas Freedom Network’s most recent report that found that more than 80 percent of the state’s public school districts are not teaching sex education or exclusively teach abstinence-only birth control.

The study found that the number of school districts that do not teach sex education has increased to more than 25 percent in 2016 from 2.3 percent in 2008.

The group also found that another 58 percent of school districts took an abstinence-only approach to sex education last year. Those districts did not include information about condoms or other forms of contraceptives.

“All of these findings make clear that policy makers need to create common-sense, very necessary solutions,” González said.

That would be nice, wouldn’t it? For lots of things. There are lots of reasons why this would be a good thing for the Lege to do, and at least as many reasons why they won’t. We’re going to need a different Lege for that. The Trib and the Observer have more.

SCOTUS punts on birth control lawsuit

Wow.

Zubik v. Burwell was supposed to be an epic showdown over the power of religious objectors to limit the rights of others. A sequel to the Court’s 2014 decision in Burwell v. Hobby Lobby, Zubik involved regulations expanding women’s access to birth control that the conservative justices appeared to endorse in Hobby Lobby — even as they struck down a more direct method of providing contraceptive coverage to working women.

At oral arguments, however, the four remaining conservatives seemed to have a change of heart. Even Justice Anthony Kennedy, the justice who signaled the loudest in Hobby Lobby that he would tolerate the kind of regulations at issue in Zubik, appeared openly hostile towards the Obama administration’s arguments. The case seemed to be barreling towards a 4-4 non-decision. If conservative Justice Antonin Scalia had not died last February, it is all but certain that the case would have ended in a crushing defeat for the administration and for many women who hoped to benefit from the administration’s birth control rules.

But that’s not going to happen — at least not yet. On Monday, the Supreme Court handed down a brief, three-page opinion that effectively punts the case until next year at the earliest (and, presumably, after someone has been confirmed to fill Justice Scalia’s seat). The opinion explicitly “expresses no view on the merits” of Zubik and a raft of related cases. Instead, it sends these cases back down to the lower courts to consider the views expressed by both parties in supplemental briefing requested by the justices themselves.

[…]

As the Supreme Court notes in Monday’s opinion, the administration “has confirmed that the challenged procedures ‘for employers with insured plans could be modified to operate in the manner posited in the Court’s order while still ensuring that the affected women receive contraceptive coverage seamlessly, together with the rest of their health coverage.’” However, that’s not the end of the story. The administration also explained to the Court that the justices’ proposed compromise may not work for employers that self-insure (that is, employers who pay out health claims directly to employees rather than joining them into a broader insurance pool).

In any event, the one thing that’s absolutely clear from the Court’s very brief, unsigned opinion inZubik is that it will not resolve any of the nuances of how employers should exempt themselves, what should happen to women who seek birth control after an employer exempts itself, and whether self-insurance or other situations present unique problems that call for a distinct rule. The Court wants this case to go away, at least for now.

See here for the background. This is just amazing. SCOTUSBlog provides some further analysis:

One reading of Monday’s developments was that the Court, now functioning with eight Justices, was having difficulty composing a majority in support of a definite decision on the legal questions. Thus, what emerged had all of the appearance of a compromise meant to help generate majority support among the Justices. With this approach, the Court both achieved the practical results of letting the government go forward to provide the contraceptive benefits and freeing the non-profits of any risk of penalties, even though neither side has any idea — at present — what the ultimate legal outcome will be and, therefore, what their legal rights actually are under the mandate.

Those uncertainties are now likely to linger through the remainder of President Obama’s term in office, which ends next January. The appeals courts may well order the filing of new legal briefs, and may hold new hearings, before issuing a new round of rulings on the controversy. However, the entire future of the ACA, including its birth-control mandate, may now depend upon who wins the presidential election this year and which party has control of Congress when it reassembles in 2017.

The three issues that the Court had agreed to rule on, and then left hanging at least for now, were whether the ACA mandate violates the federal Religious Freedom Restoration Act by requiring religious non-profits that object to contraceptives to notify the government of that position, whether the government had a “compelling interest” in assuring cost-free access to contraceptives, and whether the move by the government to go ahead and arrange access to those benefits for those non-profits’ employees and students was the “least restrictive means” to carry out the mandate.

Doing on Monday much the same that it had done in several temporary orders at earlier stages of this controversy, the Court accepted that the non-profits already had given the federal government sufficient notice of their objection to the mandate, and that the government could use that notice as the basis for going ahead to provide actual access, at no cost, to the employees and students of those institutions.

The unsigned opinion that the Chief Justice announced included an attempt to explain why the Court was bypassing a definitive ruling on the legal issues. It cited the replies that both sides had filed, after the cases had been argued, in reaction to a suggested compromise plan devised by the Court.

The Court on Monday interpreted those filings as containing concessions that move the two sides somewhat closer together, but at the least provided a basis for letting the federal appeals courts be the first to analyze the meaning and impact of those concessions. The Court expressed the hope that the two sides would use this new opportunity, in the appeals courts, to work toward common ground that would protect the religious sensibilities of the non-profit institutions at the same time that women of child-bearing age would not be deprived of contraceptive devices and methods.

“We anticipate,” the Court said, “that the courts of appeals will allow the parties sufficient time to resolve any outstanding issues between them.” That appeared to be an invitation for the lower courts at least to explore whether the two sides could reach agreement without prolonging the court battles. It conceded, though, that there may still be “areas of disagreement” between the two sides.

It may just be my cynicism showing, but I don’t expect any of the litigants to go seeking common ground. This was from the beginning an ideological fight, and they’re not going to settle for anything less than victory. As the Trib noted, the district court in Texas originally found for the plaintiffs, HBU and East Texas Baptist University, but the Fifth Circuit overturned that verdict. I have no idea what happens from here, but I look forward to a Supreme Court with either a Justice Merrick Garland or a President Clinton-named Justice getting the case again in the future. TPM, Dahlia Lithwick, Rewire, and Daily Kos have more.

Once more with SCOTUS and birth control

Here we go.

In another major case concerning Texas women’s reproductive care, the U.S. Supreme Court on Wednesday will consider if the right to religious freedom is broad enough to completely exempt nonprofits with religious objections to birth control from providing women access to it through their insurance plans.

The case, formally known as Zubik v. Burwell, pits religious nonprofit groups — including East Texas Baptist University and Houston Baptist University — against the federal government over a provision of the Affordable Care Act requiring some employers to provide contraceptive coverage to female workers.

The Texas case is among seven related lawsuits the high court agreed to hear together in which religious nonprofits argue the mandate infringes on their religious freedom. The Obama administration says the groups are offered a way around the requirement through a mechanism that still gives women access to free contraception.

Under the federal health care act, employers with 50 or more full-time employees are required to offer health plans with “minimum essential coverage,” including access to federally approved contraception for women, without co-payments or deductibles.

Religious nonprofits can seek “accommodations” to be exempted from the contraceptive mandate by submitting a form or notification certifying the organization’s objection on religious grounds. Doing so transfers the administrative duties of providing contraception coverage from the employer to the insurance company or a third party, which takes over handling the claims.

But the nonprofits argue they should be exempted from the requirement altogether because they are still “being forced to facilitate access” to contraceptives they oppose. In this case, the religious groups object to emergency contraceptives, including the so-called morning-after-pill, and intrauterine devices, which they liken to so-called “abortifacients” — or drugs that induce an abortion. (Health experts and scientists have disputed that claim.)

That parenthetical statement really understates the matter. People are free to believe what they want, but when those beliefs are contradicted by objective reality, I’m not sure why the law needs to accommodate them. Too bad I’m not on the Supreme Court.

Anyway. I’ve been following the HBU/East Texas Baptist lawsuit from the beginning – see here, here, and here for the basics, and remember that the full Fifth Circuit – yes, that Fifth Circuit – refused to uphold the initial lower court ruling in HBU’s favor.

Given the current composition of the Court, the fact that nearly every appeals court rejected the plaintiffs’ arguments, and the way things went with the HB2 case, there was a fair amount of optimism going into this one that the good guys would prevail. Unfortunately, it looks like perhaps the Bad Anthony Kennedy showed up for oral arguments.

In Burwell v. Hobby Lobby, the last major case brought by religious objectors to birth control, the Court’s five justice conservative majority effectively wrote the “substantially burden” requirement out of the law. As Justice Samuel Alito wrote for the Court in that case, the Hobby Lobby plaintiffs “sincerely believe that providing the insurance coverage demanded by the HHS regulations lies on the forbidden side of the line, and it is not for us to say that their religious beliefs are mistaken or insubstantial.”

It quickly becomes clear during the Zubik argument, however, that the Court’s four justice liberal bloc wants to put the words “substantially burden” back into the law. Justice Sonia Sotomayor notes that, under the conservatives’ truncated reading of RFRA, it is unlikely that a plaintiff would ever fail to show a substantial burden because “we’re not asking you to do anything except identify yourself.” Justice Stephen Breyer even goes so far as to wax philosophic about how much easier life was in the few years before RFRA was enacted.

Kennedy, however, wants no part of this project to make “substantially burden” mean something again. “It seems to me that there is a substantial burden” in this case, Kennedy tells Solicitor General Don Verrilli in an uncharacteristically candid moment. About a minute later, Kennedy is even more candid, disclosing that he believes that this entire case comes down to whether the government could have used a less restrictive alternative (the third prong of RFRA) to provide birth control to women whose employers object to birth control.

For most of Verrilli’s time at the podium, however, Kennedy is sphinx-like, saying little and revealing little about whether he believes the government has made its case. Chief Justice John Roberts and Justice Alito spend this period taking shots at Verrilli. At a major argument over abortion earlier this month, the Court’s conservative wing appeared stilted and unsure how to seize the offensive with Scalia absent from the bench. Today, with Scalia’s seat literally absent from the Courtroom and just eight chairs facing the audience and the attorneys, it was clear that Roberts and Alito had their mojo back.

In their briefs, the religious objectors argue that requiring them to fill out a form in order to receive a contraceptive plan is not the “least restrictive means” of ensuring access to birth control. The government could have created a new birth control entitlement program funded by taxpayers (an alternative that Kennedy briefly appears skeptical of), or they could have offered birth control-only plans in the Affordable Care Act’s health care exchanges to women whose employers refuse to provide them with contraceptive coverage.

Alito focuses on the later of these two opinions, in a series of questions for Verrilli that can fairly be described as combative and nasty. At one point, Alito demands to know how the government can claim that Obamacare’s exchanges are “so unworkable” that they cannot provide an alternative for women that need birth control-only plans. It’s the sort of remark that seems more at home on Fox News than in the Supreme Court of the United States, and its delivered in a tone that seems to betray Alito’s bitterness over the fact that he has twice tried and failed to gut Obamacare by judicial decree.

In response, Verrilli argues that offering birth control-only coverage in the exchanges would not be a workable solution. For one thing, it’s not currently legal to sell such single-subject plans in the exchanges. For another, it’s far from clear that any private insurer would agree to offer such a plan. And even if they did, there’s no guarantee that a woman would be able to buy a plan that included the same doctors she relies upon for other medical care. This could lead to a world where a woman’s regular physician would be unable to prescribe contraception or even counsel the woman on many issues related to her reproductive health. And it would add an additional layer of complication that would discourage many women from seeking out contraceptive care.

Roberts, meanwhile, embraces the religious objectors’ argument that the government is “hijacking employers’” health plans via its fill-out-the-form regulation. This proves to be a very effective argument for Roberts, largely because it appears to sway Kennedy near the end of Verrilli’s time at the podium. In response to Verrilli’s attempt to explain some of the details of how the fill-out-the-form rules operate, Kennedy snaps back “that’s why it’s necessary to hijack the plans!”

In contentious cases, Kennedy often appears to play the role of Hamlet, asking questions of both sides and giving off an air of uncertainty about how he will ultimately vote. But when Kennedy shows real emotion in one of his questions, or when he adopts the loaded language of one of the parties, that’s normally a good sign that he’s made up his mind. When the votes are cast and the Court’s decision is released, it’s a good bet that Kennedy will vote against Team Birth Control.

Yeesh. The good news from our perspective in Texas is that a 4-4 split would leave the Fifth Circuit ruling against the plaintiffs in place. That’s a small consolation for anyone in a state governed by the Eighth Circuit, which was the one to buy into that dumb argument, of course. Perhaps some day we can get a ninth Justice confirmed and settle this once and for all. In the meantime, this may be the best we can do. Have I mentioned that this election is super important? A transcript of the oral arguments is here, while TPM, SCOTUSBlog, Kevin Drum, and the Trib have more.

HBU contraception lawsuit goes to SCOTUS

Here we go.

The U.S. Supreme Court will decide whether religious nonprofits should be required to provide birth control benefits to female employees even if the employers object to certain contraceptives on religious grounds.

The court announced Friday that it would consider a case brought by East Texas Baptist University and Houston Baptist University against the federal government over a provision of the Affordable Care Act requiring some employers to provide contraceptive coverage. It is one of seven related cases from around the country that the high court agreed to hear at once.

The religious universities oppose emergency contraceptives, including the so-called morning-after pill, and intrauterine devices, which they liken to “abortifacients” — or drugs that induce an abortion. (Health experts and scientists have disputed that claim.)

[…]

Under federal religious freedom laws, religious nonprofits can seek “accommodations” to be exempted from the contraceptive mandate by submitting a form or notification certifying the organization’s objection to paying for contraception coverage on religious grounds. Doing so transfers the administrative obligations of providing contraception coverage from the employer to the insurance company or a third party, which takes over handling the claims.

But the universities argue that requirement infringes on their religious freedom because female employees may still be able to obtain contraception under that process.

See here, here, here, and here for the background. As the Chron notes, the Supremes actually took appeals from seven related contraception/insurance cases and combined them. They’ll hear oral arguments in March and render their decision in June as usual, just in time to capture people’s attention during the Presidential race. ThinkProgress, RH Reality Check, and SCOTUS Blog, which details all seven cases, have more.

Full Fifth circuit denies HBU in contraception lawsuit

Still no joy for them.

A federal appeals court will not reconsider its ruling, delivered in June, that the Affordable Care Act’s contraceptive rules do not violate the religious freedom of church-based organizations in Texas.

The religious organizations, including two Catholic dioceses and the University of Dallas, had asked the full 5th U.S. Circuit Court of Appeals to reject the ruling by a three-judge panel.

The court refused 11-4, issuing an opinion that did not discuss the merits of the case.

Three of the justices on the losing side, however, issued a scathing dissent that called the original ruling “ironic and tragic” for denying the free exercise of religion and placing “literally millions of dollars in fines and immortal souls on the line.”

“This should have been an easy case for upholding religious liberty,” said the dissent, issued Thursday and written by Justice Edith Jones and joined by Justices Edith Brown Clement and Priscilla Owen. The three are among the court’s most conservative members.

See here, here, and here for the background. It would be far more accurate to say that those three are among the most ideologically driven judges, not just on that court but any federal court, though I suppose it’s not polite to say things like that. As of August, when Ken Paxton found time in his busy schedule to file an amicus brief on behalf of the plaintiffs, there wasn’t a circuit split in cases like this, but now there is and there’s been an even more radical anti-contraception ruling in another federal court, so the likelihood of SCOTUS hearing some case related to this, whether it’s HBU’s or one of the others out there, seems pretty high. And after Obergfell, one can only imagine the caterwauling and chest-thumping vows of defiance that will ensue if the plaintiffs lose there as well. The Press has more.

Paxton files amicus brief in HBU contraception lawsuit

Of course he does.

Female employees of religious nonprofits should not be given insurance coverage for birth control if their employers object to certain contraceptives on religious grounds, according to a brief filed at the U.S. Supreme Court by Texas Attorney General Ken Paxton.

Paxton’s “friend of the court” brief was filed Monday in support of a lawsuit brought by East Texas Baptist University and Houston Baptist University against the federal government over a provision of the Affordable Care Act requiring some employers to offer health plans that include contraceptive coverage.

The religious universities oppose emergency contraceptives, including the so-called morning-after pill, and intrauterine devices, which they liken to abortifacients. (Health experts and scientists have disputed that claim.)

[…]

In the brief filed by Paxton’s office, state attorneys wrote that the “supposed ‘accommodation’” will still “coerce employers to proceed with a course of action despite a belief in its religious impermissibility.”

“Many employers around the country feel driven by their faith to care for their employees by providing them health insurance,” the brief reads. “But some employers find it incompatible with their religious convictions to provide that health insurance when it means contracting with a company that then, by virtue of that very relationship, becomes obligated to pay for drugs regarded as abortifacients.”

A federal district court previously sided with the universities, blocking the requirement from going into effect. The U.S. Department of Health and Human Services appealed the case to the New Orleans-based U.S. 5th Circuit Court of Appeals — considered the most conservative appellate court in the country — which reversed that decision, saying the universities had “not shown and are not likely to show that the requirement substantially burdens their religious exercise under established law.”

In its ruling, the panel of the appellate court sided with the federal government in its argument that the universities’ religious exemption from providing contraception coverage did not extend to third parties left to administer insurance plans if a religious organization is exempted.

See here, here, and here for the background. While HBU and ETBU won in district court, no plaintiffs have prevailed at the appellate level yet. As such, there isn’t a district split yet for SCOTUS, though as we saw with the Obamacare subsidies case they don’t need to have one to take up an appeal. I’ll be surprised if it’s not on their docket by next year.

HBU appeals contraceptive case to SCOTUS

Here we go.

Houston Baptist University on Wednesday turned to the U.S. Supreme Court in its battle to avoid providing employees with forms of contraception it finds morally objectionable.

The appeal of a 5th U.S. Circuit Court of Appeals ruling was filed on behalf of the Houston university, East Texas Baptist University and the Westminster Theological Seminary in Pennsylvania by lawyers with the Becket Fund for Religious Liberty.

The Press fills in some important details.

HBU’s is just one of many cases challenging the Affordable Care Act’s birth control mandate. Under the law, religious employers who object to some or all forms of birth control (HBU, for example, takes issue with some emergency contraception that it wrongly likens to abortion) can seek an exemption from the feds. Typically this just means filling out a form letting the feds know of your objection to birth control and naming the company that administers your employee health plan. The government then works separately with the insurance company to make sure workers can get birth control coverage on another health plan if they want it.

East Texas Baptist University and Westminster Theological Seminary joined HBU in challenging the mandate. The schools have argued that by simply informing the feds of their objection – either by filling out a form or by some other means – they’re triggering or facilitating birth control coverage in violation of their religious beliefs. In their challenge, they’ve cited the federal Religious Freedom Restoration Act (RFRA), which says the federal government can’t, except in limited circumstances, “substantially burden a person’s exercise of religion.”

That the Fifth Circuit didn’t buy that argument is notable for a couple of reasons. First, every single federal appeals court that’s so far considered the issue has ruled that religious nonprofits can’t block their workers from getting coverage for birth control. Secondly, the Fifth Circuit, as we’ve written before, is perhaps the most conservative federal appeals court in the country. If anyone was going to buck the trend in favor of religious institutions, you’d have thought it would be the Fifth.

See here and here for some background. Basically, this is about employers attempting to control how their employees are spending their money, based on their belief in a demonstrable falsehood than none of them even gave a thought about as recently as a couple of years ago. But hey, religious freedom! Obamacare oppression! We’ll move to Irion County if we have to! You get the idea.

HBU contraceptive coverage decision overturned

Good.

The U.S. Court of Appeals for the Fifth Circuit has turned back a challenge brought by several Texas religious organizations that oppose offering insurance contraceptive coverage to their employees, concluding that the plaintiffs have no right to challenge the conduct of third parties.

The recent decision also found that U.S. Supreme Court’s controversial 2014 Hobby Lobby decision was of “no help” to the plaintiffs, which included East Texas Baptist University and the Catholic Diocese of Beaumont, among others. That 5-4 high court decision held that corporations opposed to offering contraceptive coverage to their employees are exempt under the Religious Freedom Restoration Act [RFRA].

[…]

In his decision, Judge Jerry Smith wrote that the Fifth Circuit was joining several other circuit courts in finding that the ACA’s contraception coverage mandate doesn’t present a substantial burden to the plaintiffs’ religious freedom.

“Although the plaintiffs have identified several acts that offend their religious beliefs, the acts they are required to perform do not include providing access to contraceptives. Instead, the acts that violate their faith are those of third parties,” Smith wrote, reversing the trial court decisions in the cases.

“Because RFRA confers no right to challenge the independent conduct of third parties, we join our sister circuits in concluding that the plaintiffs have not shown a substantial burden on their religious exercise,” Smith wrote.

While the plaintiffs complain that sending in a notion of opposition will authorize or trigger payments for contraceptives, that is “not so,” wrote Smith, who explained that “the ACA already requires contraceptive coverage.”

Smith also noted that the Hobby Lobby decision mentions that certain religious organizations have already been “effectively exempted” through the ACA’s accommodation.

“Thus, Hobby Lobby is of no help to the plaintiffs’ position, and the requirement to offer a group health plan does not burden their religious exercise,” Smith wrote.

See here for some background, and here for a copy of the opinion. As Think Progress reminds us, Judge Smith is a very conservative Reagan appointee who is a reliable vote against abortion rights, so it’s not a case of getting lucky with the three-judge panel. The full circuit may be asked to review this, and it will certainly go to SCOTUS, though as RH Reality Check notes, every appeals court so far has sided with the feds on this. So there’s some hope that the dreadful Hobby Lobby decision will not expand any farther in scope. Hair Balls has more.

State-run Women’s Health Program continues to be a failure

Quelle surprise.

Right there with them

Right there with them

Thousands fewer women are getting health services through the now state-run Women’s Health Program after Planned Parenthood was barred from being a provider.

A report released Monday by the state Health and Human Services Commission showed that almost 30,000 fewer women were served through the program in 2013 than in 2011, and 63,581 fewer claims were filed for birth control.

The program became fully state-funded in 2013 after lawmakers voted to prohibit taxpayer dollars from going to abortion providers or their affiliates. Planned Parenthood served about 40 percent of the women in the program before it was excluded for being affiliated with separate, privately funded abortion clinics.

Texas lost federal matching money that kicked in $9 for every one dollar the state spent, now costing the state about $36 million annually.

The program provides well woman’s exams, cancer screenings, contraception and tests for sexually transmitted diseases and infections to low-income women between the ages of 18 and 44.

“These numbers are so distressing and I think it shows Texas moving backwards pretty quickly,” said Sarah Wheat, spokeswoman for Planned Parenthood of Greater Texas.

Several Planned Parenthood family planning clinics closed after they lost funding. The report showed that the areas with the highest drops in the number of women served by the program occurred in areas where Planned Parenthood clinics shuttered.

I’ve blogged about this plenty – see here and here for a couple of examples – and by this point it should be clear to everyone that this is a feature, not a bug. The Republicans who did this were told, repeatedly and in detail, exactly what would happen when the cut the funding, gave up the federal match, and kneecapped Planned Parenthood. They went ahead and did it anyway, for the basest of political reasons. And after last year’s elections, who can blame them? It’s not like anyone has been held accountable for it. They should have the courage of their convictions and embrace studies like this with pride. It’s what they wanted to do, and they’ve been hugely successful at it. Newsdesk and the Observer have more.

The cost of unplanned pregnancies

From Wonkblog:

UnplannedPregnanciesMap1

Unintended pregnancies cost American taxpayers $21 billion each year, according to a new analysis released by the Guttmacher Institute. That averages out to a cost of about $366 per every woman of childbearing age in the U.S. Overall, more than half of U.S. pregnancies are unintended, and roughly 1-in-20 American women of reproductive age have an unplanned pregnancy each year.

Nationally there were 1.5 million unplanned births in 2010. Public insurance programs like Medicaid paid for 68 percent of those births. “On average, a publicly funded birth cost $12,770 in prenatal care, labor and delivery, postpartum care and the first 12 months of infant care; care for months 13–60 cost, on average, another $7,947, for a total cost per birth of $20,716,” the study found.

Both the rate and cost of unplanned birth vary considerably by state. As a percent of all births, unplanned births ranged from 31.8 percent in New Hampshire to 56.8 percent in Mississippi. Overall, states in New England and on the West coast had the lowest rates of unplanned birth, while Southern states had the highest.

In some states — Georgia, Mississippi and Oklahoma — more than 80 percent of unplanned births were paid for by public dollars. Georgia taxpayers spent nearly $1 billion on unplanned births in 2010, as did taxpayers in Chicago. California spent $1.8 billion, while unplanned births cost the state of Texas nearly $3 billion dollars in 2010.

As you will see if you read the study, those figures represent both federal and state money. The amount of its own funds spent by Texas was $620 million, which is still a lot of money that didn’t need to be spent. The study points out that were it not for state programs that fund contraception and women’s health programs, the cost incurred, nationally and by each state, would have been much higher. These figures are from 2010. What has Texas been doing since then? Yep, cutting funding for contraception and women’s health, partly for pure budgetary reasons, and partly due to an ideological war against Planned Parenthood. I’m betting that the $620 million we spent in 2010 would be at least that much, possibly quite a bit more, in the subsequent years thanks to this shortsighted and harmful policy. So the next time Texas Republicans whine about the cost of Medicaid, it would be nice if some journalist type asked them about their own role in that problem.

Abbott’s health care small ball

Is that all there is?

Increased funding for preventive care and luring medical professionals to Texas are at the center of gubernatorial candidate Greg Abbott’s health care plan, unveiled at St. Joseph’s Women’s Medical Center here on Wednesday.

The Republican attorney general, running to replace Gov. Rick Perry, unveiled a proposal that includes a $50 million budget increase for women’s health programs, additional funding for medical school residency slots in Texas, loan forgiveness for aspiring doctors who practice in underserved areas and compensation for doctors who provide care via telephone.

Abbott said the cost of the entire plan would be $175 million every two years, but said it could actually save more than it costs. “It may actually reduce the cost of health care,” he said.

The left-leaning policy group Progress Texas criticized Abbott’s proposal because it does not include Medicaid expansion to cover impoverished adults, a tenet of federal health reform that Texas’ Republican leadership has staunchly opposed. Texas has the highest uninsured rate in the nation, with about one in every four people lacking health insurance in 2012, according to U.S. Census data. About one million Texans could qualify for Medicaid coverage if the state were to expand the program under current federal guidelines, according to the Kaiser Family Foundation.

“Texans don’t need more small ideas from Abbott — we need and deserve a comprehensive plan for insuring those 1 million Texans, and we need it yesterday,” said Ed Espinoza, the group’s executive director, in response to the candidate’s proposal.

Abbott’s Democratic rival, state Sen. Wendy Davis of Ft. Worth, has endorsed Medicaid expansion.

There’s nothing here that I find objectionable, but let’s be honest – it ain’t much, especially compared to Medicaid expansion and the million or so people it would help. The 2011 cuts to women’s health and family planning services has done such extensive and lasting damage to patients and providers in the state that anything short of a pledge to re-establish a clinic for every one that had to close is inadequate. Even that doesn’t make up for the inconvenience and hassle of finding new doctors and establishing new routines, but it at least makes the attempt. This is little more than a band-aid. Not a surprise, given Abbott’s known priorities, just nothing to write home about.

Where are the women’s health providers?

The Republican jihad against Planned Parenthood continues to have real consequences.

Right there with them

Right there with them

In 2011, under pressure from Republican leaders, state health officials began enforcing a provision lawmakers wrote to exclude Planned Parenthood and any clinics with organizational ties to abortion providers from the Women’s Health Program. At the time, Planned Parenthood clinics provided 40 percent of the program’s services and often subsidized services not expressly covered by it.

To replace Planned Parenthood, the state recruited new providers, the majority of which are physician groups, to participate in the reimagined program. But unlike many reproductive health clinics, which qualify for additional federal family planning grants, physician groups generally don’t have the public financing to pay for services that aren’t covered by the state program. While physician groups can absorb some of these additional costs, in most cases a patient must pay out of pocket for additional services or find an alternative provider that receives federal subsidies, which can delay care.

Emma Moreno, assistant manager at Valley Women’s Specialists, a physician group in Weslaco that participates in the Women’s Health Program, said the program covers Pap smears, for example, but if a patient tests positive for the human papillomavirus and needs further treatment, that care isn’t covered.

“If you’re going to provide a program or a service, provide the full service and not just half of it,” said Moreno, whose physician group still encourages women who may be eligible to apply for the state program.

[…]

To be eligible for the Women’s Health Program, a woman must have an income at or below 185 percent of the federal poverty threshold, or less than $1,800 a month for an individual. The original Women’s Health Program, which was jointly funded by the state and the federal government, was an offshoot of Medicaid. The federal government discontinued its $9-to-$1 match for the program in January 2012. That followed the state’s exclusion of Planned Parenthood clinics, despite the fact that those clinics were already prohibited from performing abortions because they accepted taxpayer dollars.

The Texas Women’s Health Program is nearly identical to the former Medicaid program in scope, though it now covers STD testing and some routine treatment, and is run entirely with state funding — $35.6 million a year.

In the first six months of the state-run program, enrollment and claims for services dropped significantly.

“While these numbers were collected before we added increased funding [for] women’s health in the last legislative session, they are exactly the type of data we will be carefully reviewing in the months ahead,” state Sen. Jane Nelson, R-Flower Mound, the chairwoman of the Senate Health and Human Services Committee, said in an email to The Texas Tribune last month. “It is important that we make sure the dollars we invested are providing meaningful preventive health services for the women of Texas.”

When I talk about how the likes of Rick Perry, David Dewhurst, and Greg Abbott just don’t want people to have access to health care, it’s about more than just their mulish resistance to expanding Medicaid or their petty harassment of ACA navigators. Their actions have had real world consequences. I’ve talked about this at length – browse through my Planned Parenthood archives, there’s too many entries to link to individually – and the bottom line remains that the state of Texas took something that was working and broke it for ideological reasons. They can try to put it back together again, at greater cost to Texas taxpayers, but even if they succeed they will still have disrupted the delivery of health care to hundreds of thousands of women, forcing many of them to find new doctors, for no good reason.

HBU wins contraception mandate lawsuit

This is very disappointing.

The federal government cannot force Houston Baptist University to pay for emergency contraception services as part of its employee health insurance plans, according to a ruling Friday by U.S. District Judge Lee Rosenthal.

The decision is a victory for HBU and East Texas Baptist University in their joint lawsuit against the government over the constitutionality of Affordable Care Act provisions about employer-paid birth control.

“The government doesn’t have the right to decide what religious beliefs are legitimate and which ones aren’t,” said Eric Rassbach, an attorney with the Becket Fund for Religious Liberty, a public interest law firm representing the two Texas colleges.

The universities said that obeying the Health and Human Services contraception mandate would violate their religious conscience. In a 46-page opinion, Rosenthal said they proved their positions.

“The belief need not be long-standing, central to (their) religious beliefs, internally consistent with any written scripture or reasonable from another’s perspective. They need only be sincerely held,” Rosenthal wrote.

The Obama administration exempted churches from the mandate, but not affiliated organizations like religious schools and hospitals.

The Obama administration is likely to appeal this ruling, but I wouldn’t hold out much hope. In the meantime, there’s a bigger case working its way towards the Supreme Court, involving secular companies such as Hobby Lobby, which want to establish the principle that corporations can have religious rights. If they win, then the employees of these institutions, who may not share the religious views of the owners of said corporations themselves or who may not even be religious, will have their health insurance options dictated to them.

You may be thinking to yourself “Wait, I thought it was the Catholics that opposed birth control. What’s up with Baptists opposing it?” You would not be the only one wondering about this.

I’m proud to be a part of a movement whose great concern is learning to love your neighbor as you love yourself. And as we move into the New Year, I hope those voices of justice will grow stronger and I wish for some other things as well.

I hope that the Religious Right will drop birth control as an issue. During the political season, the conservative Evangelical case against birth control was loud and clear. I spoke to Frank Schaeffer, one of the founders of the Religious Right, trying to remember my days growing up in a conservative Evangelical household. “I don’t remember birth control ever being an issue before. It wasn’t tied to the Evangelical pro-life movement, was it? Did I miss something?” I asked.

“No. Birth control wasn’t an issue at the beginning.” Schaeffer replied. “This is a case of the enemy of my enemy is my friend.”

In other words, the Religious Right took up the cause of birth control because the Roman Catholic Church is against birth control. Since the Religious Right Evangelicals and some Catholics could join forces and become more powerful in their shared quest to defeat Barack Obama, then they decided to add birth control as an issue. We began to hear the pill referred to more as an “abortifacient.”

I am now a Progressive Presbyterian, but growing up as a teen in a conservative Christian culture, I read Passion and Purity. I was advised to take the pill for medical reasons and refused because I thought it would make sex more tempting. I also thought that using a condom would be like premeditated sin, because you would have to have to buy them beforehand and plan on having sex. But there was no sense that birth control was somehow tied to abortion.

I’m hoping that since the Evangelical tie of birth control to the pro-life movement was a pragmatic political flop, it won’t affect conservative women who want to decide when they are ready to have a child. There is already a teen pregnancy problem in red states. We don’t need to exacerbate the issue, jeopardizing the lives and futures of young women by demonizing birth control.

I guess it’s a good thing for HBU and ETBU that their “belief” need not be “long-standing, central to (their) religious beliefs, internally consistent with any written scripture or reasonable from another’s perspective”, because as recently as last decade, this wasn’t part of their beliefs. In fact, one of their peer institutions that also sued the federal government over this mandate was providing emergency contraception coverage as part of its health insurance plan at the same time it was asking for injunctive relief against being required to provide emergency contraception coverage. Don’t make me do something I’m already doing, Your Honor!

The key to understanding all this is in the quoted bit above. Take a look at the reason the lawsuit was filed in the first place.

Dub Oliver, president of East Texas Baptist University, told KLTV 7 that he opposes the provision because he believes that “life begins at conception” and that contraception drugs cause abortions.

But the statement that “contraception drugs cause abortions” is not a matter of faith, it’s a matter of testable, provable fact. And the facts as we now know them show that this belief is mistaken.

Several scientists and doctors said in interviews that this view did not reflect the way the birth control methods actually work. “There’s so much evidence for how these things work prior to fertilization,” said Diana L. Blithe, director of contraceptive development for the National Institute of Child Health and Human Development. “And there’s no evidence that they work beyond fertilization.”

She and other experts said these methods are so effective in preventing fertilization that the chance of an egg and sperm uniting is slim. If fertilization does occur, the embryo runs a high risk of not implanting for natural reasons. While several medical Web sites, including some from government agencies, raise the possibility that the morning-after pill could affect implantation, Dr. Blithe and others said it had not been scientifically verified that the drugs work that way.

One morning-after pill, Plan B, contains a synthetic progesterone that blocks ovulation, said Dr. Anita Nelson, a professor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California, Los Angeles. Recent studies have indicated that women who take Plan B after ovulation have a normal chance of becoming pregnant, and that Plan B does not prevent their fertilized eggs from implanting, Dr. Nelson said. Ella, the other morning-after pill, delays ovulation by blocking the body’s progesterone, she said.

She said that Ella was a hormonal cousin of the drug used in an acknowledged abortifacient, RU-486, which is given to women who are up to about seven weeks pregnant and stops the development of an already-implanted embryo. But the RU-486 hormone is a very high dose, between 200 to 600 milligrams, whereas the Ella hormone is 30 milligrams, Dr. Nelson said. She said that Ella had not been tested to see if it prevented implantation. But she added that the RU-486 hormone at low doses acts only to prevent ovulation.

See also this NPR story on the same subject. The evidence at hand was sufficient to convince Catholic bishops in Germany that emergency contraception was acceptable, at least in some cases. But that’s what this is about, conflating birth control with abortion, and teaming up with the Catholic Chuch – the “enemy of my enemy” – against the Obama Administration by conflating birth control with abortion. That says to me that this is much more about politics than it is about faith. To the extent that faith is involved, it’s a matter of convenience. I don’t think that’s worth trumping the rights of the employees of these institutions, and I’m disappointed that Judge Rosenthal bought into it. BOR has more.

It’s about much more than abortion

Yet another reminder that even if the Legislature had taken no action on abortion since 2011, it still grievously damaged women’s access to healthcare.

The closure of nine of 32 family planning clinics in the Rio Grande Valley — a result of the state Legislature’s decision to cut family planning financing in 2011 — has compounded the struggles of low-income, Latina women trying to access reproductive health services, according to a report released Tuesday by the Center for Reproductive Rights and the National Latina Institute for Reproductive Health.

“Profound barriers to reproductive health, including cost, lack of transportation, immigration status and lack of accessible clinics, mean that Latinas in Texas are systemically barred from the care they need to live with health and dignity,” Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health, said in a statement. “These conditions are dangerous to the health of Latinas and immigrant women.”

The Legislature’s decision in 2011 to cut two-thirds of the state’s two-year family planning budget — to $37.9 million from $111 million for 2012-13 — has caused 76 medical facilities across the state to close or stop providing family planning services as a result of lost public financing, according to the Texas Policy Evaluation Project (TxPEP), a three-year study at the University of Texas evaluating the impact of the cuts to family planning services.

The enactment of stricter abortion regulation in November — the constitutionality of which is currently being debated in federal courts — has also caused a third of state’s nearly 40 licensed abortion facilities, including the only two abortion clinics in the Valley, to stop performing abortions. The Center has provided legal assistance to the abortion providers involved in that lawsuit.

Although the report released Tuesday focuses on the Valley, TxPEP researchers have found women across Texas have lost access to trusted providers, experienced longer wait times for services and paid higher rates for contraception and other health services, as a result of the 2011 cuts to family planning services.

In its 2013 session, the Legislature sought to mitigate the impact of the 2011 cuts with the largest financial package for women’s health services in state history, increasing spending to $214 million in the 2014-15 budget from $109 million. Texas’ 2014-15 budget includes a $100 million expansion of a primary care program to provide services for an additional 170,000 women; $71 million to operate the Texas Women’s Health Program; and $43 million to replace family planning grants that the federal government awarded to another organization to distribute.

The efforts to rebuild access to reproductive health care is slow moving, as the state is still in the process of contracting providers to participate in the expanded primary care program. Texas Women’s Health Program, which replaced the federally-financed Medicaid Women’s Health Program in January after the state violated federal rules by ousting Planned Parenthood clinics, has fewer women enrolled and has processed fewer claims so far this year than during the same time period last year.

See here for some background. As I said before, even if a sufficient number of new clinics eventually opens and the state’s replacement Women’s Health Program matches the reach and breadth of the Planned Parenthood-anchored network that the Lege and Rick Perry killed off, you can’t undo the damage and disruption that the original cuts caused. Tens of thousands of women were left in the lurch, often to the detriment of their health, and most if not all of them will wind up with a different doctor than who they had before. All of this was done in the service of ideology. When we talk about a war on women, when Wendy Davis talks about truly being “pro-life”, this is what we’re talking about.

Remember how concern for women’s health was supposed to be a thing?

Now that the omnibus anti-abortion bill has been passed and signed, the Republicans can quit pretending to care about the state of health care access for women in Texas as before.

Right there with them

Right there with them

Three Planned Parenthood family planning clinics in Southeast Texas announced plans Thursday to close at the end of August. The closures result from reduced family planning funds and the removal of Planned Parenthood from the state Women’s Health Program, said Melaney Linton, CEO of Planned Parenthood Gulf Coast.

While the closures were announced the same day as Gov. Rick Perry’s signing of omnibus abortion legislation, House Bill 2, the closures are “a completely separate issue” from that new law, Linton said.

Linton said many patients who visit the three clinics cannot afford to pay for services and therefore would “go without the care they need.” She said the decision by the state not to expand Medicaid under the Affordable Care Act was “the final straw” that rendered the clinics unable to serve patients.

“This has been a long time coming,” she said.

But John Seago, legislative director for Texas Right to Life, said he believes women in that region will still have access to health programs, noting the recent legislative move to restore funds to participants in the Women’s Health Program.

In the 2013 session, the Legislature voted to add $71 million to the program.

“The Legislature has more than restored the funding that was effective last session,” Seago said.

It’s certainly good that the Legislature restored funding for the WHP after it was decimated in 2011, but the damage has already been done. Some sixty clinics closed their doors statewide after the 2011 budget cuts. and the number of clinics funded by the Texas Department of State Health Services dropped from 300 to 136 in the year following those cuts. If you burn my house down, then build me another two years later, you can claim you’ve made me whole but I was still homeless in the interim. Even if you could credibly claim that there are now as many clinics that provide health care and family planning services for women as there were in 2011 – I have no idea if this is true, and neither does John Seago; what’s more, I’m sure he doesn’t care – the fact remains that hundreds of thousands of Texas women had their health care disrupted. Even if every single one of these women now has a clinic that’s as close to them and as convenient for them and as affordable for them that they’re aware of and comfortable visiting, it still wasn’t their choice to make that change. It was done to them by Rick Perry, David Dewhurst, Greg Abbott, and the Republican friends of people like John Seago in the Texas Legislature. What was done can be ameliorated but it can never be undone. PDiddie has more.

The state begins preparing its excuses for its WHP screwup

The fail is strong in this one.

Right there with them

State health officials continue to insist that they have signed up more than enough providers to replace Planned Parenthood across most of Texas. Areas of limited coverage — including San Angelo, Corsicana and Paris — are being scoured to find health care providers willing to join the Women’s Health Project, they said.

In the meantime, the provider information that was pulled from the Health and Human Services Commission’s website is undergoing a belated check for accuracy to remove doctors and clinics that were mistakenly listed as participants in the Women’s Health Program or that provided only limited services, such as surgical contraception.

New information will not be posted online until a state contractor verifies that every listed health care provider is a participant in the Women’s Health Program — and state health agency employees double-check the revised list, said Stephanie Goodman, a spokeswoman for the state Health and Human Services Commission.

What went wrong?

Originally, the list was generated by the contractor, the Texas Medicaid and Healthcare Partnership, by using provider numbers for practices that had joined the health program, Goodman said. That shortcut, however, captured all locations of a provider group, even those that were not participating — including pediatric clinics, labs and surgeons.

“Obviously, on something this high-profile, that’s going to be this scrutinized, this is an area where we should have done a better job,” she said.

“Our mistake, honestly, was not calling on our own” to verify the contractor’s work, Goodman said. “On paper, picking up all those providers that could legitimately bill under the program made sense. We should have realized that pulling from billing records would make it difficult for women to use” the list.

Goodman said she expects the revised list to be published online this week.

That’s what you said last week, Stephanie. I guess one of these weeks you’ll be correct about that.

The mistakes were unfortunate, Goodman said, because they overshadowed a lot of hard work that has been done to launch the state program, particularly in signing up enough new providers to meet the need left by Planned Parenthood’s ouster.

“That’s one of the sad parts of this. I’d hate for women to see these stories and think, ‘There’s no help for me,’ ” she said. “There are clinics all over the state that said they have the ability to serve more women.”

The real mistake, of course, was believing that in Rick Perry’s Texas, where the 2011 Legislature slashed spending on family planning by two-thirds, there would be any incentive for this to be done right. Forget the scapegoating of the contractor, whose work was apparently never supervised or verified by anyone at the HHSC – we don’t need no stinkin’ project management! – and focus for a minute on the statement above on how “areas of limited coverage” – that is, places where only Planned Parenthood had done this kind of work before – are still “being scoured” to find providers more than three weeks after the state WHP was supposed to go live. No one could have seen this coming, because the Perry administration has such an admirable record of caring about women and children, especially poor women and children. If these women have received a message that there’s no help for them, there’s a good reason for it.

Where are the doctors?

The Morning News tries to verify that the Dallas-area providers listed for the new Texas Women’s Health Program are in fact providing health care services to the women in this program as advertised. It goes about as well as you’d expect.

Right there with them

A Dallas Morning News survey of 336 contacts listed online for the program showed that 18 percent of the 55 unrepeated physicians and offices surveyed knew they were a part of the program and are accepting new patients. Two listings point people to businesses with no connection to the program — a sports medicine clinic and a title company.

A spokeswoman for the Health and Human Services Commission, which operates the new program, acknowledged that the list has problems.

“It’s not that it’s a list that they shouldn’t be using, it’s that there are addresses on that list that shouldn’t be there, so we’re going to have to do some work to clean that list up,” said Linda Edwards Gockel.

Gockel said the list, which has been available on the program website for more than three months, is not the same list of 3,500 approved providers the state has touted. It represents all the locations a potential provider billed from in the past.

She said the commission hopes to have the list corrected by next week. Gockel could not say why it was not removed sooner, but that women can always call the 1-800 number listed on the website. After The News pointed out the list’s failings, subsequent press releases from the commission avoided mention of the website.

In fact, if you go to the Texas Women’s Health Program website now and click the Find A Doctor link, you will not see any providers listed at all:

According to Trail Blazers, the site “will be fixed sometime this week”, though it looks now like that has been pushed out a few more days. Reps. Donna Howard and Lon Burnam had previously found the same problems that the DMN reports on here in Austin and Fort Worth. Now other Democrats are getting in on the action.

“It is unacceptable that thousands of Texas women may be cut off from access to the program due to the program’s inability to meet demand,” said Rep. Jessica Farrar, D-Houston, the House Democratic Caucus chairwoman, in a prepared statement. “My main concern is to ensure that women may be given the opportunity to affordable and accessible health care.”

Using the Texas Public Information Act, Farrar requested that the agency release a list of the available providers enrolled in the Texas Women’s Health Program along with the number of patients they anticipate serving, the number of patients served by the former Medicaid Women’s Health Program and the geographical areas in the state where provider enrollment does not meet demand.

Good on you, Rep. Farrar. What all this says to me is that the list that had been given on the website was complete and unadulterated junk and that they have taken it down in a desperate attempt to fix it. Remember that the state has been bragging for months about how they’re all fired up and ready to go without Planned Parenthood and with a list of 3,000 providers all set to step in. Is there any reason now to believe that was anything but a lie? Further, given the obvious problems and the complete disconnect between what the state has been saying and what everyone who has bothered to check has discovered, is there any reason to think the state will get this fixed any time soon? I say no and no.

I also say it’s time to get the people primarily responsible for this mess on the record about it. That includes State Sen. Bob Deuell, who requested the AG opinion that declared the state could sever ties with Planned Parenthood while still receiving federal money for the WHP (and how has that turned out so far?); Kyle Janek, the chair of the Health and Human Services Commission; and of course Rick Perry himself. Good on the DMN and Reps. Howard, Burnam, and Farrar for uncovering this lie, but it’s time for everyone else to get in the game as well. Rick Perry isn’t going to care about this until he’s forced to care about it.

No injunction in state lawsuit for Planned Parenthood

Bummer.

Right there with them

Travis County District Judge Stephen Yelenosky on Friday refused to grant Planned Parenthood’s request for a temporary injunction to be included in the Texas Women’s Health Program.

“Probable injury is not really sufficient,” said Yelenosky, who ruled in favor of Planned Parenthood at a hearing in December, “… because it is unlikely that the plaintiffs will succeed at trial, I will deny the temporary injunction.”

Although Yelenosky agreed with Planned Parenthood’s arguments that the organization’s exclusion from the Texas WHP could endanger access to health services, his ruling indicated he did not believe their legal arguments would be successful at trial. Yelenosky also cited a “poison pill” rule that would cause the Texas WHP to self-destruct if a court overturned the Affiliate Ban Rule in the reasoning for his ruling.

“This allows us to continue to provide important family planning and preventive care to low-income women and fully enforce state law,” Dr. Kyle Janek, the state’s executive commissioner of health and human services, said in a statement on the ruling. “We’ve got the Texas Women’s Health Program up and running, and we’ll continue to provide help to any woman who needs to find a new doctor or clinic.”

Pete Schenkkan, a lawyer representing Planned Parenthood, said the organization is “confident in the merits of our case,” and will still consider taking the case to trial.

See here and here for the background. It’s not looking too good for Planned Parenthood at this point, though of course it’s the women who depend on their services that are the real losers. I suppose they could still win at trial, but as I said before it’s ultimately at the ballot box where the fight really matters.

As for the state’s claims that everything is peachy keen with their replacement WHP, Rep. Lon Burnam joined his colleague Rep. Donna Howard in checking with the providers that are listed on the Texas WHP website. You will I’m sure be shocked to hear that most of the providers listed are not in fact participating in the program. See his release beneath the fold and his much more accurate list of providers in Tarrant County here.

On top of this, the Better Texas blog reminds us that the problems run deeper than just the WHP:

Over the last year much attention has been paid to the fate of the 130,000 women in WHP, and especially the 40,000+ who choose Planned Parenthood as their provider. While this is certainly worthy of attention (and even outrage), comparatively little attention has been paid to the DSHS family planning cuts that took effect in 2011 and have already resulted in 147,000 women losing access and 53 safety net family planning clinics closing.

It seems the media followed WHP more closely, because of the attention-grabbing dispute between Texas and the federal government, and lawsuits between the state and Planned Parenthood. By comparison the 2011 Legislature’s votes to cut DSHS family planning by two-thirds ($73 million over the biennium) provided less drama, even though they’ve harmed more women and slashed or eliminated funding from more safety net providers. And the DSHS cuts didn’t just hurt that program. Clinics that closed in the wake of the DSHS cuts also provided care in WHP and had staff on site that helped women through the WHP enrollment process. Since the DSHS cuts took effect, client enrollment in WHP has declined.

On the bright side, the Lege is reconsidering that decision to slash family planning funds since someone explained to them that less birth control means more babies. So they have going for them.

(more…)

A family planning end run?

This is interesting.

Texas lawmakers have spent the past two years attacking family planning services in the state, cutting funds for programs that provide women with birth control and wellness exams. Now family planning advocates are fighting back.

A coalition of providers plans to bypass Gov. Rick Perry and the Texas Legislature and apply directly to the federal government for family planning funds. If the coalition wins the federal grant—called Title X (Title 10)—a slice of Texas’ family planning money would no longer go to the state health department—and would no longer be subject to the whims of the Legislature. Instead, the coalition, organized by Fran Hagerty of the Women’s Health and Family Planning Association of Texas, would distribute the money to family planning providers statewide, including perhaps Planned Parenthood, and restore services to tens of thousands of Texans.

Since 1982, the Department of State Health Services has received Title X grants in Texas, though any group can apply to the federal government for the money. The department then distributes the money, alongside cash from other federal and state grants, to providers delivering family planning and preventive care. The Title X grant is worth $14.5 million per year, part of the $111.5 million pot of money the state had to spend on family planning.

[…]

At $14.5 million per year, the Title X grant comprises only a small slice of Texas’ annual family planning budget. But it’s worth much more than its dollar value. That’s because Title X money comes with a confidentiality clause not always attached to other funding streams. This means that providers need only $1 from Title X to cast privacy protection over all their clients, especially teens who would otherwise need parental consent to access birth control.

Similarly, Title X recipients get a discount on pharmaceuticals. With this discount, clinics can buy drugs at half the wholesale cost. Again, just $1 of Title X casts this discounted rate over every drug purchased by the clinic. That often helps clinics prescribe the more effective, yet more expensive, types of birth control.

The protections afforded by Title X demonstrate how complex and delicate clinic funding arrangements are. Having it means that some providers, whose clinics teeter on the edge of financial viability, could continue operations. “When providers lost Title X funding, they lost much more than just the money,” Hagerty said. They also lost their patient confidentiality, discounted drugs and the more discretionary spending that Title X allows. Restoring those protections to providers is what Hagerty said gave her the impetus to take the project on.

There’s more, so go read it and when you’re done go back and read the earlier story about the devastating effect of the family planning cuts on Texas health providers. This isn’t a panacea, nor is it a guaranteed funding source going forward – among other things, as with any other government program it is subject to the whims of the prevailing political sentiments; I for one have a hard time believing this would have survived four years of Romney/Ryan budgeting intact – but if it can help the clinics that need it, it’s a good effort. We’ll see how it goes.

Draft Cecile?

Nonsequiteuse looks ahead.

Cecile Richards

I hereby kick-off (or join, because maybe others have beat me to it since I’ve been in a deep wormhole this summer) THE DRAFT CECILE RICHARDS TO RUN FOR GOVERNOR OF TEXAS MOVEMENT.

She’s going to be speaking at the DNC, and we all know that spot at the podium sets people up for a pretty sweet trajectory. She’s tough, smart, and must be at least a full foot taller than Goodhair. She could send him into hiding with a single side-eye.

More than that, she’s a clear win on the compassion front. She understands what it takes to take care of the least among us. She gets that strong, healthy women mean strong, healthy families, and that translates directly into a strong, healthy economy and community.

And, in this time of legitimate rape and vaginal probes and kamikaze Komen, she knows how to capitalize on the zeitgeist and rake in the big bucks. I’m nothing if not practical: serious green is what it will take to turn Texas blue.

Planned Parenthood might not be ready to let her go, but consider what it would mean to accelerate the demographic shift in Texas politics. I know great women are standing in the wings who could carry on the proud tradition Cecile has become a part of, leading that institution.

I believe federal law now mandates that all such movements begin with a Facebook page. I personally have hopped on the Draft Henry bandwagon so I’ll leave that task to someone else, but I’ll be happy to give the page a Like once it’s up.

That said, I’d be delighted to see this happen. I’d suggest that the second thing to do, after the Facebook page, is to convince Ms. Richards and her family to move back to Texas, since she currently resides in New York, according to her Wikipedia page. Her roots are deep enough here to overcome that, but better sooner than later, you know?

One more thing I’d point out is this: In addition to the “serious green” that Nonsequiteuse mentions will be needed to run and win a gubernatorial campaign, the other thing that we really ought to be looking for is a candidate with some personality. The last Democratic candidate for Governor for whom the word “charismatic” would be on the short list of accurate adjectives was Cecile’s mother, Ann Richards, in 1994. That’s a long time to go without pizzazz. Henry Cisneros has it, Cecile Richards has it, Julian Castro has it if he ever decides to move up his time frame (2018 is such a long way off), maybe someone else besides them who could mount a campaign will have it. I’m hardly the first person to suggest such a quality – McBlogger, call your office – but after so many elections without it, it’s hard to see why we’d not want to be looking for it this time around. Surely having a bit of Elvis in our candidate would help with the green-raising as well. That’s the argument, now it’s time for some drafting. Who’s on board with this? See Sarah Killf’s well-timed post for more on Ms. Richards.