20 January 2011

Memo to the Right: Preventing Pregnancy IS a Preventive Service

Yesterday, the Republican-controlled House of Representatives passed a repeal of the Affordable Care Act -- our nation's boldest, if flawed, step in the direction of health care equity since the New Deal. While this is tremendously disconcerting, little will happen as an immediate result. Democrats in the Senate, who still hold a slim majority, have vowed to block a vote for repeal, leaving the House vote in Congressional limbo.

While this means, for the time being, that the Affordable Care Act is here to stay -- a very good thing for the millions of people who will benefit from the law, many of them women -- it doesn't mean it isn't in jeopardy. The health-care law faces continued attacks at the state level, in the judiciary, and will likely be taken up again in Congress as House Republicans attempt to undo it piece by piece. What's more, certain provisions of health care reform, as passed, are still being debated by federal agencies -- with significant implications for women. 

High on the list of provisions in question is coverage of birth control -- specifically, whether new insurance plans will be required to provide free coverage of contraception as part of the preventative care services mandated by the Affordable Care Act, and supported by the Women's Health Amendment. This is not a small issue. If coverage of birth control is not included as basic, preventative care, low-income women and women of color (many of whom are disproportionately poor) will continue to face an undue economic burden in protecting their reproductive health. In short, if coverage is not an option, many women will continue to find themselves priced out of the market for contraception, resulting in more unplanned pregnancies and potentially higher abortion rates -- a fate you'd think the anti-choice movement would be working to avoid at all costs.

Well, not quite. Instead, according to Sharon Lerner in this week's issue of The Nation, there is a new and troubling fissure forming in the family planning debate -- thanks in large part to the battle over health care reform itself. With Democratic lawmakers deeply worried about the "political fallout" of any piece of legislation that veers too close to the abortion issue (remember how those concerns nearly torpedoed health care reform altogether?), Conservatives may have new latitude to undermine programs that promote access to true reproductive justice. As Lerner writes,
While birth control has always been somewhat contentious, it has long been the more politically palatable cousin of abortion, with a constituency that included some antichoice members of Congress who supported it as a way to decrease abortions. But, healthcare reform has created a new battleground for the issue, and, with more conservatives now in Congress and state governments, birth control is shaping up to be a divisive issue in the coming legislative session.
In other words, you can expect to see conservative lawmakers (even once moderate ones) lining up to push back hard against any policies -- or funding streams -- that bear even a passing relationship to abortion. Moreover, they will almost certainly use their new power to pressure the Obama Administration to back away, on the health care front, from any coverage, in Lerner's words, "that relates to sex and women's bodies" -- including, very likely, coverage of birth control.

Whether the President and his Administration will capitulate remains to be seen. The Department of Health and Human Services has already convened a panel of experts to make the final recommendation about whether contraceptives should be considered preventative care and therefore offered at no cost; notably, most of the experts on the panel already appear to agree, according to Lerner, that contraception does in fact carry significant preventive benefits.

But leaving it to these "experts" alone isn't enough. It's crucial that organizations with a grassroots base and a true understanding of how critical contraceptive coverage is to women and communities of color lift up their expertise. And that's exactly what groups like Ms. Foundation grantee National Latina Institute for Reproductive Health are doing. In addition to implementing strategies to protect the bill as a whole, they're working to ensure that the rights and needs of vulnerable constituencies aren't written out of the fine print: As of December 2010, NLIRH had formally submitted comments in support of treating birth control as preventive care to the panel that will make a recommendation to HHS; participated in the panel's first meeting on preventive women's care in order to give testimony on "the shared experiences of women of color in our struggle for health care services that benefit women"; and submitted comments to HHS on variety of other issues that impact the health and well being of women, low-income people, and communities of color. They also produced an important fact sheet [pdf] about why birth control coverage is a crucial element of any just health care legislation.

Efforts like the Latina Institute's could very well make the difference between a final plan for health care coverage that makes significant strides in uniting us as equals, or further divides us into "haves" and "have-nots." Whatever Conservatives may argue in the coming months, or however they may use attacks on health care reform to undermine reproductive justice, keeping the former as our goal must remain among our highest priorities.

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