Saturday, February 26, 2011

Women Health and the politics of repealing the Patient’s Protection and Affordable Care Act (PPACA)

Keywords and Terms: Public policy; Politics; Health Care; PPACA; State and federal budgets; Deficit Spending; Republicans; Women Health

It is always a daunting task to comment on a public policy that has implication for the health of a huge sector of our population. The debate over the relevance of the Patient’s Protection and Affordable Care Act in a time of austerity is deeply felt, intellectually and emotionally. The daunting task of explaining to skeptics that the 111th Congress meant well when it passed and the President signed into law the Patient’s Protection and Affordable Care Act (PPACA) comes out of the risk of losing out on a subject that has beleaguered the nation for decades: health care reform. The effects of the failure of the American health care system before the advent of PPACA, are demonstrated by tragic reports in daily news that women health suffers just as much as children's, and any machination that will adversely impact the quality of care women receive in hospitals, clinics and specialty-care centers, has the potential of impacting their children too, including the quality of both lives.

My comment on the blog today focuses on two themes. The first is the question of how relevant is the issue of federal or state budgets deficit to the end health care services received by women and children in the absence of the Patient’s Protection and Affordable Care Act (PPACA). The second is the issue of politics with respect to the current drive by Republican lawmakers to defund the Patient’s Protection and Affordable Care Act (PPACA) and the implementation of its provisions. I ask if, in the pursuit of political scoreboard’s advantage, PPACA is defunded, would Republicans feel better? Will the kind of potential health care deficit that millions will suffer be justified by Republican Party political power gains?

For whatever it's worth, the imaginary political gains sought by Republicans in their recent effort on capitol hill, is minuscule. Further, by nature, the imaginary political power gains anticipated are often transient and even at that, many of those political power gains often erode after one or two elections cycles. Thus, the brouhaha that we are having from Republicans regarding their efforts to defund the Patient’s Protection and Affordable Care Act (PPACA) is best described as selfishness and worthless. Their gains, if at all they are able to accomplish the selfish act, will be ephemeral and offensive to many interest groups in support of better women health. What is additionally disheartening is that by the time any new congress could arise to do something about the huge damage to women and children health because of the defunding of the provisions in the Patient’s Protection and Affordable Care Act (PPACA), it is often too late.

On the issue of federal and State budget deficits: Several decades of deficit spending both by the two levels of government cannot account for defunding a one-sixth sector of the total economy. All the reckless waste spending at the federal level on irrelevant wars would not bring back zillion of dollars that could have been spent on a domestic issue, like public health, especially on women and children health. More money has been spent on foreign wars than have been spent on eradicating heart diseases in women, the number one killer of women, infant mortality or finding cure for breast cancer in past half a century. Women have often not held managerial positions long enough to be able to change the course of spending on defense and US wars overseas.

Several billions of dollars have been devoted to wars started by Republicans and their Whitehouse occupancy. While the portion of the national budget that goes into fighting wars continues to quadrupole, just a fraction of the budget spent at the Pentagon has gone into finding cures for war injuries, not to talk of diseases as cancers and leukemia, diseases that have destroyed many homes, killed many women and changed the course of lives for many men and their sons. Yet Republicans want to defund the first step at ensuring that the quality of health services received by women and children are as good as what obtains in Europe and probably in some Asian countries. Indeed, it is gross irresponsibility for any lawmaker to aspire to defund any provisions of a health care law that could bring about improvement in the care received by Americans and their households.

Forensic investigations to several states budgets will provide explanations why so many states’ budget are in deficit. The wastes in multiple layers of bureaucratic administrations found in some state’s agencies make budget deficits inevitable. The fragmented and indisputable non-chalet attitude towards how human and money resources are allocated in many State Agencies, both managed under Republican and Democratic Administrations, liter the history of budget woes in many states. The dulling of essential work of state’s agencies’ expenditure oversight and imprudent budget management practices are part of the structural deficits found in many states' budgets. The need to shore up State budgets has now been translated to an affront on public union employees and health care programs delivery; rather than attempt to protect and preserve programs that serve many of the vulnerable groups among us. Republicans are seeking to damage the little safety net that is available to the poor, the disadvantage and the oppressed. An effort to defund the Patient’s Protection and Affordable Care Act (PPACA) is an affront on any decency that is left in Republican lawmakers.

I agree that there are some provisions of the Patient’s Protection and Affordable Care Act (PPACA) that could be improved. Yet I detect a sense of 'pull-it-down' for us to gain some political points in the current effort of Republicans to defund the Patient’s Protection and Affordable Care Act (PPACA). Raising questions as to the authenticity of Republicans to support and provide legislation that serve the needs of the public is in order at this time. In the current effort in the US House of Representatives, there are concerns and worries from some lawmakers and the public, especially advocates of women health, that the overwhelming impact of defunding the Patient’s Protection and Affordable Care Act (PPACA) will fall disproportionately on women and children.

The collective understanding is that a poor health care delivery system impacts the quality of life and health status of the disadvantaged members of our society, including older women who live a longer life than their male counterparts. Indeed, it was suggested by some groups that the current effort to correct for deficits in some state’s budgets have fallen disproportionately on women and their children in single households, especially in states where these women have relied on state subsidized health care support, as many of the associated programs in some states health delivery systems have be shelved or dropped. Untold volume of data on associated denials and discontinuance of basic health care programs at state level are available if anyone is in doubt. The discontinuance of the basic health programs in some states, programs that are the last point of defense for many rudimentary health cares for our growing children and population of single female heads of families, just make me whimper. Here, I am not talking about families who have other health insurance policies, but those who had depended totally on State sponsored or subsidized health care programs.

On defunding the Patient’s Protection and Affordable Care Act (PPACA) efforts by Republicans, I wonder whether these lawmakers ever consider that efforts as this always receive negative reviews, even by some of their supporters, when the impact of their efforts materializes. I wonder what Republican lawmakers will say, if they realize that some parts of the provisions of the law that were not implemented because of insufficient funds has led to deaths of women and children; or that the program had made a consumer protection program incapable of addressing the frauds found in the implementation of complementary programs. I detect a hint in some anxious conversations with doctors and hospital administrators, there is no way that it will be possible to deliver the best service to patients under a close to universal health care insurance system; or, police all the fraud found in the implementation of the health care system or health programs because of the politics of defunding parts of the provisions of the Patient’s Protection and Affordable Care Act (PPACA).

I see an increasing widening gap in the health care services delivered to women and children, when the Patient’s Protection and Affordable Care Act (PPACA)is inadequately funded or defunded. If Republicans truly have an enduring value for deficit reduction, they must work hard to find their wastes in other areas of the federal and state's budget; they must not balance the budget on the backs of women, children and least privileged members of our society. If Republicans are concerned about some provisions in the Patient’s Protection and Affordable Care Act (PPACA), they can seek to mend those provisions by introducing bills that correct for the shortcoming and not work, as they are currently doing, to railroad a useful and responsive law. And particularly in the future, if Republicans find that we may reallocate resources to better serve our public, even in the implementation of the Patient’s Protection and Affordable Care Act (PPACA), it is their prerogative if not responsibility, to help the nation do better by being constructive but not seeking to abrogate all the provisions of a law that is already delivering lot of goods to Americans.

Friday, February 25, 2011

Women Health Concerns: pondering on attacks on the Patient’s Protection and Affordable Care Act in 112th Congress?

Keywords or Terms: Women Health; Union Bursting; State Budgets; Repeal of PPACA; Consumer Protection; Ombudsmen Offices

It is often attacks from States Houses like those in Wisconsin, New Jersey and Ohio that often bring about unintended changes. Hard times often have an unintended consequence. The brazen affront on Public Employees Union in some State Houses is not just incidental. The Republican governors spear heading the affront on Public Employees Unions in Wisconsin, Ohio, New Jersey, and probably other states, are probably working toward a goal grandiose than just fixing State budgets or deficit. Imagine that after the Wisconsin Public Employee Unions have accommodated rollbacks in their wages, benefits and costs of living adjustments, Wisconsin Governor Walker still wants to decapitate the Public Employee Union(s) in that State.

What is now known or what will remain circumstantial, is the suspicion that the Republicans in State Executive Offices and lawmakers at Capitol Hill are working towards making all state budgets and hopefully federal budget leaner in the coming budget cycles. The strongest and probably greatest impact of this effort will be felt in State Health Care Budgets, since the care of states' residents continues to be huge portion in some states' budgets, when compared with other line items. Many State governors have already embarked on cutting budgets to the bare bone. And, it’s the immediate pain of cutting deep into State budgets, coupled with union busting efforts in some State Capitols by some Republican governors, that may end up steam roll many aspect of State budgets allocated to state’s portion of Medicare; and, eventually adversely impact and become a grave problem to vulnerable groups like women, children and the elderly.

Due to the complex nature of the politicking going on in Wisconsin and Ohio and the challenges of ensuring a balanced budget, the blog tonight will like to wait until the storms die down before coming to explore the nature of the beast regarding what Republicans and their governors in some State Houses are up to with regard to their current initiative to bring about balanced budgets in many state capitals. Tonight, we will like to look at some bills moving around the United States Congress, especially those that may delve a blow to women’s health in the current machination against the Patient’s Protection and Affordable Care Act of 2010.


The 906-page legislative wonder of 2010 continues to be a difficult document for many Republicans to accept and some provisions in the law seem puzzling to many lawmakers bent on de-funding the law. When the act was signed into law on March 23, 2010, it was to the chagrin of Republican lawmakers who swore to repeal it. Since the inauguration of the 112th congress, Republicans in the House have repealed the law and found they could not do better, as the Democrats in the United States Senate promised that the repealed bill is dead on arrival. While Republicans continue to work vociferously to do anything to undermine the law, their new efforts at chipping away at the law continue to bemuse many Democrats who see the law as the most golden opportunity to reform America’s health care system and are glad to be part of once in a life time experience.

Republicans will sarcastically refer to the law as ‘Obamacare’ just to undermine its flavor to the American Public. The Democrats see the law as what it is: A Patient Protection and Affordable Care Act; a law that has a human face when it comes to talking about care for Americans, especially the most vulnerable among us, women, children and the elderly. Recently, Republican lawmakers on Capitol Hill introduced many bills to undermine the Patient Protection and Affordable Care Act, specifically targeting a woman’s right to a healthy body when it comes to the question of abortion. Here again are the concerns of many women who consider Republican’s effort to undermine the provisions of this law as an affront to their civil right, especially, when the issue of the right to abortion and the funding of abortion under the Patient’s Protection and Affordable Care Act (H.R 3590), are raised.

Bills working their way through the 112th Congress that may jeopardize Women Health:

In an effort to bastardize and or confront the Patient Protection and Affordable Care Act of 2010, Republicans have introduced the following bills in congress, which have some ramification for women health:

H.R. 105 Dan Burton, GOP – Indiana : To repeal the Patient Protection Act & enact in its place incentives for people to buy health insurance;
H.R. 118 John Fleming, GOP – Louisiana : To permit a state to elect not to have an American Health Care Exchange;
H.R. 119 John Fleming, GOP – Louisiana : To prohibit hiring of Internal Revenue Service agent to implement or enforce health insurance reform;
H.R. 127 John Graves, GOP – Georgia : To de-authorize funding of Patient Protection Act;
H.R. 141 Steve King, GOP – Iowa : To repeal the Patient Protection Act;
H.R. 145 Connie Mack, GOP – Florida : To repeal the Patient Protection Act;
H.R. 154 Ted Poe, GOP Texas : To prohibit any federal funds to be used to enforce Patient Protection Act;
H.R. 171 Cliff Stearns, GOP – Florida;
H.R. 2 Eric Cantor, GOP – Virginia : Repeal of Patient Protection Act;
H.R. 38 John Fleming, GOP – Louisiana : Rescind funds authorized for Patient Protection Act;
H.R. 9 David Drier, GOP – California : Requires Committees to look into Patient Protection Act;
H.R. 26 David Drier, GOP – California : Repeal Patient Protection Act;
H.R. 215 Don Young, GOP – Alaska : Repeal Patient Protection Act;
H.R. 19 John Carter, GOP – Texas : Disapprove rules on MLR in Patient Protection Act;
H.R. 299 John Carter, GOP – Texas : Repeal Patient Protection Act;
H.R. 358 Joe Pitts, GOP – Penn : Remove abortion funding from Patient Protection Act (there is none);
H.R. 360 Michael Burgess – Texas : Amend Patient Protection Act to include President in Health Care Exchanges;
H.R. 364 Tom Latham, GOP – Iowa : To Repeal Patient Protection Act;
H.R. 371 Marsha Blackburn, GOP – Tennessee : Repeal Title I of Patient Protection Act;
H.R. 5 Phil Gingrey, GOP – Georgia : Repeal Patient Protection Act;
H.R. 397 Wally Herger, GOP – California :Repeal Patient Protection Act;
H.R. 429 Darrell Issa, GOP, California – Repeal Patient Protection Act;
H.R. 452 Phil Roe, GOP, Tennessee – A bill to repeal Patient Protection Act;
H.R. 450 Dave Reichert, GOP, Washington – A bill to repeal Patient Protection Act.

S. 19 Orrin Hatch, GOP – Repeal Health Mandate & therefore repeal patient protections;
S. 17 Orrin Hatch, GOP – Repeal Tax on Medical Devices;
S. 16 David Vitter, GOP – Repeal Patient Protection Act;
S. 196 Chuck Grassley, GOP, Iowa – A bill to to provide congressional staff gets to participate in Exchange; and,
S. 192 Jim DeMint, GOP, South Carolina – A bill to repeal health care

Some of these bills are either frivolous or done to demean the essence of the reform badly needed in America’s Health Care System, before the advent of the Patient Protection and Affordable Care Act of 2010. All of the bills, sponsored or co-sponsored by Republican lawmakers, were introduced with malice; which consequentially make them mindless to a sane mind in general and merit-less, in specific. When signed into law last March, some provisions of the law were considered controversial by some interest groups and organizations; however, many Americans wonder why Republicans are not making effort to improve the law rather than working to repeal it. For this reason, these Americans consider the current Republicans shenanigans as either malicious or backward in thinking.

Further, many women groups and health organizations contemplate that the vigorous effort to repeal the law in the house has the potential of creating some challenges for women health. Imagine the current acrimony over whether a privately funded health insurance policy purchase on the impending health care insurance exchange is a viable provision of the Patient Protection and Affordable Care Act? How would you interpret sponsored House Bill 358 by Republican Representative Joe Pitts from Pennsylvania, seeking to remove abortion funding from the act? It is obvious from reading the provisions of the Patient Protection and Affordable Care Act that there is no funding for abortion; yet, the honorable gentleman from Pennsylvania is seeking to defund abortion with H.R. 358. Notwithstanding that a bill like this stands no chance, the implication of having a lawmaker introduce a bill that will call to question all the potential advantage to women’s health from the act, make some concerned women groups ponder, if Republicans are not out to derail their progress on the status of women’s health and civil rights.

While many women groups believe that when provisions of the act begins to bear fruits, some skeptics may turn around to the tremendous benefits of the act, they still ponder if Republican governors, who under the cloak of attempting to balance their state’s budget, want to dabble into short changing their state’s contribution to Medicare costs. It is known that funding for the Patient Protection and Affordable Care (PPACA) Law was craftily designed under mandatory spending in the federal government budget by Democrats who did most of the leg walk to pass the act; however, nothing prevents a state’s governor who hardly cherishes the provisions of the law from short changing his or her State’s portion of Medicare contribution.

Worse still, how about some State governors, out of the need to balance their budgets, may want to divert funds meant for the State’s ombudsman offices and CAPs (Section 1002) into other uses. Unless specific guidelines are associated with the use of the grants when dispensed to the state for this particular purpose, nothing stands in the way of a governor from diverting the fund meant for say, the ombudsmen offices. There is nothing right now that prevents a mischievous governor from diverting this grant for other uses or purposes at the State level. Unless some accurate and specific language is attached to how funds going to the state’s ombudsmen offices operation, it may well be difficult to hold state government from serving their preferences rather than this essential part of the Patient’s Protection and Affordable Care Act.

I have heard suggestions regarding how to protect the vulnerable groups among us, especially women, with respect to the creation and running of the ombudsmen offices in each state of the federation; including, having the office made independent and free of states’ politics and interventions; requiring states to commit to helping consumers navigate the avalanche of information regarding the new health care reform law; ensuring that the consumer support office is supplemented with culturally and linguistically competent professionals who are ready to provide information support to working and vulnerable groups; and, mandating that all states and counties have a health consumer assistance program that supplement the federal grants. Unless this is done, women would likely have issues to deal with, especially in states where their Republican governors and attorney generals are working daily to undermine the provisions of the Patient’s Protection and Affordable Care Act.

Communicating the essence of the Patient Protection and Affordable Care Act (PPACA) is not too late. During the debate over the introduction of the law, it was difficult to convince Republicans to be part of the process. As they continue in their wanton repeal efforts, it is not too late to help them overcome the hump or learning curve by educating them further about what the law is doing even for their wives, children and parents, especially when they actually have not provided an alternative to the law and all they are driving at is repealing the law. It is hard to be humble when you are perfect in every way, goes that old song; maybe, we may want to help Republicans sing along! Republicans must now desist from serving only the interests of those who are going to line their pockets with money and consider the welfare of all those beautiful women in America who continue to work hard that we as a nation, do not go into extinction!

Friday, February 18, 2011

Miracle or Miracle: when BP oil spill chief reshapes the payment rule?

Keywords or Terms: Gulf Coast Claims Facility; Claims Report; Change; Plan Payment; Feinberg; BP

Since April 20, 2010, when BP oil spill became the talk of town, many people have wondered whether there is ever going to be justice with respect to how compensation are to be made to affected parties from the disaster. Local authorities and citizens of the Gulf Coast felt like captives when the disaster turned into a nightmare as many people lost their jobs, businesses and incomes. Around August 2010, the federal government entered a negotiated plan with BP to dole out 20 billion dollars as down payment for the size of disaster and compensation to affected entities, persons, businesses and states, in the impact area of the disaster, and people had a sigh of relief.

The Gulf Coast Claims Facility (GCCF) was inaugurated as the official body for delivering filed claims against the oil discharges from the Deep-water Horizon well; a well belonging to British Petroleum. However, things have not gone as anticipated. The administrator of the fund, Kenneth Feinberg, who spearheaded a similar pay plan for the September 11, 2001 victims, had a formula for paying out claims from the BP oil spill that has been criticized for being sluggish, inadequate and sometimes degrading to the affected parties. The blog tonight wants to address a few points regarding the announcement today that the central payment formula will remain unchanged from a proposal released earlier in the month.

BP Claims Report:

In an earlier BP claims report, only 32% of affected parties agree that the application forms for filing claims were easy to fill; over 73% of the same persons indicated that getting information about the claim process was difficult; Over half of the claims facilities employees were considered as underperforming; about three quarters of the affected parties believe that the length of time to receive a payment or denial was too long and more than 80% of claimants, believe that the administrator of the fund was not keeping to the promise and seems to be basically saving face for British Petroleum ( A somewhat retooling or readjustments in the process was expected to help smoothen out many of these inadequacies or misconceptions. To counter the negative assessment of the performance of the GCCF administrator and to be responsive, the administrator released the following advice, if one is impacted and feel he or she is being short changed:

1. Send additional documentation of your losses. The GCCF administrator says one of the main reasons for claims going unpaid is lack of documentation. If you can find additional receipts or records to back up your claim, sending them to the GCCF should speed up your payment, and improve the odds that you will be paid the amount you have claimed. Write a letter and tell them you are sending additional proof of your losses. Put your claim number on all the paperwork. Be sure to keep the original papers in case you need them later.

2. Amend your application to add any losses you may have forgotten to list on your original application. It’s not unusual for people to fill out forms and later remember other losses they failed to claim. If you have losses you didn’t list on your original application, send in an amended claim. List your additional losses. Once again, send a copy of any records proving your losses. Hold on to the original records.

3. Contact a law firm. If you have a regular attorney you use for business or financial matters, contact him or her. You can also contact a law firm involved in the BP litigation. Some of these law firms are experienced in handling mass tort cases, which are more complex than run-of-the-mill lawsuits. Some of these firms will review your BP claims free-of-charge, and will assist you during the BP claims process(

Last November, Mr. Feinberg indicated that roughly 71,000 claims had been paid out. However, criticisms persisted and many affected parties claimed that months after initial filing of claim forms, his administration had not gotten back to them. Mr. Feinberg fought back and indicated that where claims had been denied, they were justifiable denial. He cited that in all the 254 claims denied, the appeal process with U.S. Coast Guard had sided with the fund.

Notwithstanding, blame still persists regarding the way the administrator has been handling the compensation process. There are criticisms that the administrator of the fund is still stalling and prolonging claims process; despite all the accolades that the fund administrator has associated with how Gulf Coast Claims facility is delivering its task. With one claimant indicating that he was seeing a disaster as huge as the original spill in the way the administrator had gone about paying out claims. There are other insinuations from the affected individuals that BP would like to forget about the plight of the affected parties, knowing how desperate they have become after suffering a double jeopardy and that, some of them may be at the brink of trading their circumstance for lesser money or compensation.

To assuage further criticisms, Mr. Feinberg released additional addendum to his earlier released plan at the beginning of the month, indicating that:

• Claimants would receive twice their documented 2010 losses;
• Oyster harvesters and processors will collect same payments, which is four times their documented losses for 2010.

While this new release today seems as another effort to address dissatisfaction with how the facility and its administrator had met the promise to deliver fast and equitable claims, there are no indications that his addendum had made any significant change to the plan on how payments are to be made or how grievances are to be addressed with respect to payments and possible readjustments for insufficient payments. The administrator continues to maintain that the process of making payments to aggrieved parties are working well and the issues of inconsistencies and lack of transparency that have been levied against the fund are all but misconceptions and or fallacies. To become more transparent, to become more open, to address the concerns of more than half of the claimants at this time and to become a better partner rather than a perceived aggressor, Mr. Feinberg must find a way to work with all the aggrieved parties in the claims he has settled. It is possible that many of these affected parties may resort to legal battle to further settle their claims and feel whole all over again.

Whether we like it or not, it is a fact that the administrator of the fund has been doing a difficult job under a difficult circumstance. A lot of people affected do not agree totally with the compensation they have received though, because so many of what they consider as legitimate claims had been turned down. Incidentally, some lawmakers from the area are indicating to the White House that it ought to step in and complete more oversight of the work done by Mr. Feinberg; including, streamlining the claims process and making it possible for more generous payments to claimants.

Focus on Change

With the administrator’s release today, it is obvious the plan or rule he released earlier in the month will largely remain. To get a sense of fairness, it may be necessary to work out a much responsive claims adjudication process, where the claimants will feel they are better treated than what is going now. It is hard to imagine that after what all those residents of the Gulf Coast went through for five months, there could still be a difficulty in addressing their claims to mutual satisfaction. Once the GCCF gets past those filing illegitimate claims, the process of making out payments that will be considered as making the affected parties whole shouldn’t be as difficult as some of them are now claiming. GCFC has no competitor for the allocation of the fund, so to a large extent, it is the judge and jury in this process of delivering fairness to the aggrieved parties from the BP oil spill from the Macondo well. Maybe that is why the facility needs to be a little bit more flexible.

There are indications from press releases that the claim process is fraught with red tape and there is room for huge improvement in the way the facility continues to do its work. Yes, a little over three and half billion dollars have been paid out for some 190,000 claims; this is actually less than one quarter what was set aside for this compensation. The threshold of error is largely small and this may be the reason why many of the claimants are asking why the excessively stringent rule in the way compensation has been paid out to them. Is the rule of compensation designed to punish the aggrieved parties, or is it designed to appease British Petroleum? None of the aggrieved parties from this disaster expect huge compensation; and if there are some, they are too few to defraud the facility, if the staffs are doing their job. However, the facility does not want to find itself in a position where the aggrieved parties believe that they are being short changed or that the Gulf Coast Claims Facility is holding brief for British Petroleum.

Wednesday, February 9, 2011

Women Rights in Health Care Reform: the unfinished business of civil right?

Keywords or Terms: Women Rights; Abortion; Opposing Viewpoints; Funding Health Care

You’ll imagine that the debate over a woman’s right to her body has been settled in the badly fought civil right litigation on abortion in the fifties and sixties. Many of the recent issues that have arisen over whether the Affordable Health Care Reform Law provides for funding of abortion were debated in the passing of the 2010 Affordable Health Care Reform Law. While there is no disputation over whether federal funds could be used for abortion, since existing federal laws have vehemently said No, women now worry that the new movement in congress over what are in the health care reform law, may deprive them of legitimate abortion. The issue: can a woman seek the termination of a pregnancy under a privately funded insurance policy within the health care reform provision of the Affordable Health Care Reform Law? The new grandstanding regarding defunding or underfunding health care for women whose health may be in jeopardy due to unwanted pregnancies or associated risks of challenging pregnancies, is now threading on the issue of women rights. The blog tonight looks at some opposing views over whether the affordable health care reform law denies health insurance for the coverage of abortion, even when there is no government funds or subsidy of any sort.


For full disclosure purposes: I am neither in any camp nor affiliated with any feminist group. I am neutral and will inform my readers that, apart for two sisters, two daughters and my wife who is still in the child bearing age, my mother is the only other woman I have an avowed allegiance to on the issue of women’s right. However, I am neither holding brief for anyone of them tonight, nor for any woman at that, because I believe they all can stand up for their rights on issues that affect their bodies and welfare. Many women, if not all, can hold their own in the face of antagonism or aggression from immodest lawmakers or what have you.

On any controversial issue, it is very necessary to understand the argument of those who disagree with you. It is probably also safe to assume that those who completely disagree with your point of view have neither reached the Plato of understanding of where you are on the issue or, where you are coming from when you advance passionate and emotional position on the issue. A persuasive argument may then be essential for you to bring everybody, supporters and opponents together; especially, when the issue is funding legitimate abortion as part of the intended reform in the new health care system.

The definition of legitimate abortion here is strictly defined as: Non-gender selective abortion. It is already the law in about three states, including Illinois (1975), Pennsylvania (1989) and the 2009 Law in the state of Oklahoma, prohibiting the performance of abortion solely on the account of sex of the unborn child (House Bill 1595). Legislators in the three states were mindful and concerned about the number of pregnancies, reason and method of abortion, and the nature of the mother’s relationship with the child's father, when a woman seeks abortion services. The issue of possible complications in pregnancies, denial of care of female whose lives may be in danger were rather paramount and none of these states contemplated the issue of private insurance covering the termination of pregnancies.

The Debate

In the heat of the debate over the impending patient protection and affordable care act, the President issued an executive order on March 24, 2010, the body of which is appended below:


By the authority vested in me as President by the Constitution and the laws of the United States of America, including the "Patient Protection and Affordable Care Act" (Public Law 111-148), I hereby order as follows:

Section. 1. Policy. Following the recent enactment of the Patient Protection and Affordable Care Act (the "Act"), it is necessary to establish an adequate enforcement mechanism to ensure that Federal funds are not used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), consistent with a longstanding Federal statutory restriction that is commonly known as the Hyde Amendment. The purpose of this order is to establish a comprehensive, Government-wide set of policies and procedures to achieve this goal and to make certain that all relevant actors -- Federal officials, State officials (including insurance regulators) and health care providers -- are aware of their responsibilities, new and old.

The Act maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly created health insurance exchanges. Under the Act, longstanding Federal laws to protect conscience (such as the Church Amendment, 42 U.S.C. 300a-7, and the Weldon Amendment, section 508(d)(1) of Public Law 111-8) remain intact and new protections prohibit discrimination against health care facilities and health care providers because of an unwillingness to provide, pay for, provide coverage of, or refer for abortions.

Numerous executive agencies have a role in ensuring that these restrictions are enforced, including the Department of Health and Human Services (HHS), the Office of Management and Budget (OMB), and the Office of Personnel Management.

Sec. 2. Strict Compliance with Prohibitions on Abortion Funding in Health Insurance Exchanges. The Act specifically prohibits the use of tax credits and cost-sharing reduction payments to pay for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered) in the health insurance exchanges that will be operational in 2014. The Act also imposes strict payment and accounting requirements to ensure that Federal funds are not used for abortion services in exchange plans (except in cases of rape or incest, or when the life of the woman would be endangered) and requires State health insurance commissioners to ensure that exchange plan funds are segregated by insurance companies in accordance with generally accepted accounting principles, OMB funds management circulars, and accounting guidance provided by the Government Accountability Office.

I hereby direct the Director of the OMB and the Secretary of HHS to develop, within 180 days of the date of this order, a model set of segregation guidelines for State health insurance commissioners to use when determining whether exchange plans are complying with the Act's segregation requirements, established in section 1303 of the Act, for enrollees receiving Federal financial assistance. The guidelines shall also offer technical information that States should follow to conduct independent regular audits of insurance companies that participate in the health insurance exchanges. In developing these model guidelines, the Director of the OMB and the Secretary of HHS shall consult with executive agencies and offices that have relevant expertise in accounting principles, including, but not limited to, the Department of the Treasury, and with the Government Accountability Office. Upon completion of those model guidelines, the Secretary of HHS should promptly initiate a rule making to issue regulations, which will have the force of law, to interpret the Act's segregation requirements, and shall provide guidance to State health insurance commissioners on how to comply with the model guidelines.

Sec. 3. Community Health Center Program. The Act establishes a new Community Health Center (CHC) Fund within HHS, which provides additional Federal funds for the community health center program. Existing law prohibits these centers from using Federal funds to provide abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), as a result of both the Hyde Amendment and longstanding regulations containing the Hyde language. Under the Act, the Hyde language shall apply to the authorization and appropriations of funds for Community Health Centers under section 10503 and all other relevant provisions. I hereby direct the Secretary of HHS to ensure that program administrators and recipients of Federal funds are aware of and comply with the limitations on abortion services imposed on CHCs by existing law. Such actions should include, but are not limited to, updating Grant Policy Statements that accompany CHC grants and issuing new interpretive rules.

Sec. 4. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect: (i) authority granted by law or Presidential directive to an agency, or the head thereof; or (ii) functions of the Director of the OMB relating to budgetary, administrative, or legislative proposals.

(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees or agents, or any other person(White House Press Release).

The executive order was issued to ensure that everyone understand where the federal law stands and to re-assure concerned citizens or doubters that the affordable health care reform law was going to provide federal funds for abortion. However, none of the content of this executive order or provisions of the health care reform law specifically denies a woman’s right to abortion covered with private funds. If there were specific provisions regarding a woman’s choice to obtain health insurance that will cover abortion in the soon to be introduced insurance exchanges, the law is ambivalent. In order words, as long as the money used for buying the health insurance comes strictly from private funds, no federal law has been contravened. Can a woman seek health insurance coverage that will afford her opportunity to seek abortion in the course of a complicated and challenging pregnancy? My understanding is, yes. The new movement to deny funding of the provisions of the health care law, just because of suspicion that federal funds may go into procuring abortion or protecting a woman’s right to procure abortion in a situation where her life is in jeopardy, is probably out of order, as it abridges the women’s right to choice, which is probably a civil rights issue.

Critics of the last position could argue that government–controlled programs cannot afford funding of abortion of any kind. A response to which would be: the affordable health care reform law is not a government controlled program as the health insurance coverage or services is still being provided by private health insurance companies. The new reform is designed to reduce government share of funding of the nation’s health care. The reform is designed to make some rather structural and economic deficits in the way health care services were being delivered to Americans. The increased savings from reform to the Medicare and Medicaid programs for the government, as envisaged in the affordable health care reform law passed, is a first step in ensuring that these programs survive for a longer time than is possible under our previous health care system. It is absolutely disingenuous therefore, if anyone classify the new law as a government program or a government take-over of the health care system as is being advanced by Republicans.

When opponents of woman's right to legal abortion advance argument that the affordable health care reform law does not accommodate women choice to seek health insurance coverage for abortion purposes, one begin to wonder whether other selfish considerations are not being interjected. We have had heated debates on woman's right and have often gone away disagreeing on what is good or bad for women with respect to their bodies. The strategy of opponents of women right to abortion is to label any argument in support of women choice, as tantamount to being unchristian, un-Jewish, un-Islamic or caving in to pressure from feminist groups. Many of us in the neutral camp are not in agreement with this strategy and probably see it as a way to deny legitimate rights of women. Our position, the neutral camp, is to allow for all interest groups to contemplate the maitre: do unto others as you want them to do unto you!

Women deserve all the credit for the way they have been pulling together to assert their right under the oppression of a patriarchal ideological movement in congress. Opponents of woman’s right to choice, including the right to obtain health insurance that serves their needs, in the face of possible male aggression, introduces a difficult but justifiable claim, that the issue of denial of woman’s right to obtain health insurance covering abortion, is a civil rights issue. Seeking a rationale to deny women their inalienable right will be tantamount to discrimination on the basis of sex; which the civil rights law of 1964 and subsequent amendments of 1972 and thousands of litigation, have long settled. Using the protestant pedagogy and bourgeois Victorian injunctions, endemic of the far right Pentecostal values that are driving the new call from Republicans to deny women their right to purchase health insurance that serves their needs, is bordering once again on discrimination. Hello?..

Monday, February 7, 2011

Of UFOs, Democracy and Political instability in Egypt!

Keywords or Terms: Democracy; Political Freedom; political Instability; UFOs; Egypt; Mubarak

A number of recent events in the Middle Eastern political terrain highlight the old cliché: If you build it, they’ll come. That cliché has been our maître as a nation in foreign policy and spread of freedom across the globe. We have worked hard to spread these words around the world: Democracy is superior to any system or form of government. When the Uprising in Egypt began about two weeks ago, the suspected lukewarm attitude of our government probably was misinterpreted by Egyptian Democratic Groups: America is hardly serious about supporting Democracy in the Middle East. We know that there are many despots in the Middle East, but we are not ready to contend their authority; we are not ready to rock the boat as long as our country or a close friend is benefitting from the despotisms!

The Egyptian uprising is a sign of emerging success of our campaign for Democracy over the world; yet, we are denying the success of our campaign across the globe. Just like the UFOs that is claimed to have been spotted about the same time on the Dome of the Rock, Jerusalem, Israel and American Fork and Highland, Utah, we’ve worked hard to spread democracy across many landscapes, wished democracy in many countries just as enthusiasts of UFOs, wished themselves seeing unimaginable objects simultaneously everywhere, funded many groups working to unseat some of our unfriendly governments and like a miracle, we are reaping the reward of unintended consequences. We’ve let the genie out of the bottle and it may just be too late to get it back. When it seems our campaign for Democracy was about to yield some success in the middle east, a political terrain that has pre-occupied our foreign policy and probably our psyche, we are troubled by the successes of our campaign to the extent of willing to throw the advocate of our maître under the bus, because the new development is happening in a delicate part of the world; or, to our previously negotiated political agreement and arrangement.

Is this truly us, or is our campaign for the spread of freedom and Democracy, a fluke? Are we serious about Democracy for the world or is it, democracy only for our chosen few, the rest may choose as they please? Unfortunately, the conflicting message and the fine line that our administration has taken is justifying this paradigm and exhibiting our trepidation when it comes to Democracy in some parts of the world. Listen to a couple of criticism from many political juggernauts: 1) if Egypt’s uprising leads to the replacement of Mubarak, we will label Obama as the President under whose watch we lost Egypt! 2) The threat of the loss of Egypt is a threat to Israeli’s Democracy! 3) The Muslim Brotherhood must not replace Mubarak, even if they are chosen by a Democratic process; 4) we cannot allow a loyal and close friend to be strung out to dry! Is this what we believe or is it, just the difficulty of letting go that is beclouding our sense of good judgment? Are we like those UFOs enthusiasts, who maintain that out of a red light came a firework with phosphorescent silver illuminating Highland, Utah! Are we wishing the unthinkable for a long time advocate of Democracy for all?

Tonight I remember Donald Rumsfeld, the architect of the Domino effect and I am tempted to give him his due credit, except for the fact that Dick Cheney may get too jealous and complain about how contrariwise or partial I am on this one; giving credit where credit is due. All the same, it is important that the domino effect of what initially was limited to Tunisia, from an unlikely person and unsuspecting unemployed college graduate, may balloon unto the world stage. But this is what has happened and it is mesmerizing to the eyes of millions watching the events unfold in the Middle East. From Tunisia to Egypt, Yemen, probably to Jordan, Lebanon and maybe the whole middle east. These are trying times and no foreign policy expert can predict the times. There was no crisis, no rending of the fabric of political arrangement in Egypt for close to thirty years, and then all of a sudden: bam! Amy, the times are changing! It may be difficult for us to comprehend why the youths in Egypt want Mubarak to leave after twenty-nine years plus, but the reality is: that type of leader, would never rule a state in the union let alone the good old USA! The concept of getting rid of a despotic leader maybe difficult to comprehend for some of us, when it comes to our personal or close friend’s interests, but the truth is: many people across the globe are yearning for the freedom we enjoy in this country and no one can stop that!

In fact, the current state of instability in Egypt is a sign of success for Democracy and the highest default foreign policy success for an unsuspecting Obama’s Administration. The current administration had suffered a huge setback after the break down of the Israeli-Palestinian talks; and, the failure to move both parties ahead on the two-party state arrangement. In an atmosphere as this, the Egyptian instability from forces of Democracy in the middle east is a windfall for the Obama’s Administration, as we watch senior members of the administration, including senior foreign policy experts, State Department diplomats, the Secretary of State and the Vice President of the United State junketing across the globe, to stop the hemorrhaging and bleeding of the success of spreading Democracy. If the administration is able to halt the hemorrhaging, if it is able to hold forth and accommodate Mubarak to remain head of state in Cairo for another day, it would have succeeded in accomplishing what it never dreamed about: working against forces of democracy, while attempting to balance the confliction in the Egyptian landscape.

Respected observers who once imagined delays in our mobilizing of forces for democracy across the globe are wondering if something greater is amiss with the Egyptian landscape. Well, here essentially, is a learning moment for us with respect to countries like China, Burma and Indonesia. If the Democratic forces in China are able to succeed as far as those in Egypt has done, can we or are we able to manage such crisis? If we are concerned about the difficulty of the Muslim brotherhood in Egypt, what will a similar upheaval do for another outlier element or group in China? If we are right about our campaign for Democracy across the globe, we must not be surprised by the conventional objects in the sky that is being interpreted as UFOs in Jerusalem, Israel or the hoax in Utah that has gone viral on the WEB! There are illusions associated with success of an unsuspecting drive just as the spectacular sighting of lights in the skies that is being peddled as unidentified flying objects. Successes in the spread of Democracy make a good reading, until it is spotted in an unwanted political environment or when it disturbs an already tense equilibrium.

The maître of one man one vote has a recurring theme throughout the world; however, are we ready to bear the weight of events that surround this maître in some countries. There are some current political arrangements that are not in tune with Democracy, which have worked very well for the governing of the state. With due apologies to political philosophers that have gone before us: For forms of government let fools contend, for what is best administered, is absolutely, best! In the case of Egypt, we do not want to accept the concept of self-determination, because for now, it seems not rather suitable for us and one of our friends. We did not anticipate the mixing together of the Egyptian youth groups’ yearning for democracy with the goal of a group once labeled a terrorist group. Do we have diverse perspectives of the concept of Democracy or is it our premonition that Arabs are not qualified to know what is good for them? Are we saying an unyielding loyalty to despotic Mubarak is much more important than having Egypt go Democratic! Are we subscribing to the notion that there is a dark matter galaxy-X hiding out there in the search for political freedom and democracy? Your guess is as good as mine.

Wednesday, February 2, 2011

Repealing the Health Care Reform Law in the House: A Strategic Republican Mistake?

On a vote of 51 to 47, Senate Democrats put the final nail in the Republican’s Coffin of wanting to repeal the Affordable Health Care Reform Law. When House Republicans bound together to advance their desire to repeal the Affordable Health Care Law last month, all of them thought their party was up to something; or, so it seemed. Many Democrats worked so hard in the house to convince their counterparts that the fight was not worth the effort, but the Republicans refused and imagined it will be possible to overturn the mammoth effort of Democrats and their leader, that had delivered the most progressive reform to the American Health Care System in half a Century.

In a unanimous opposition to the repeal, all the fifty Democrats and one independent present at the voting tonight affirmed their party’s conviction and commitment to a reformed system, that will not deny health insurance to children with leukemia and multiple sclerosis, because they have pre-existing condition. If Republicans were not aware, children with these types of horrendous and dilapidating diseases are among the groups they were working against when they sought to repeal the Affordable Health Care Reform Law of 2010 in their latest effort.

Even, if Republicans had a strategic plan to introduce some reform, they are better served by attempting to improve the existing law rather than repeal it. This is probably the reason why a separate health-care amendment offered by Sen. Debbie Stabenow (D-Mich.) sailed through the Senate with bipartisan support. The small business group interest call to repeal tax-reporting provision in the law was passed on an 81-to-17 vote. Another amendment offered to the law failed because it lacked merit and because it was strategically attached to an unrelated bill. Enough of the gimmickry Republicans! When and where there are needs for genuine amendments, let’s work together to achieve them; however, none of those grand standing, cowboy gun-toting, we are going to shoot the bird down dream, anymore!

The rest of the blog tonight contemplates the human angle of repealing the health care reform law and why many supporters of the law are gong-ho against any attempt to repeal the law. The excruciating pain of a parent seeking extended care for a sick child and the denial of health insurance coverage by insurance executives for doctor's recommended treatment(s), including unilateral decision to cap ceiling on treatment cost of care, make any effort by anyone to repeal the Affordable Health Care Law 2010, untenable. For the first time, a law that prevents insurance companies from having artificial life time treatment costs' ceiling or boundaries, is now part of the package or instrument for underwriting health care insurance to millions of Americans. The affordable health care law ensures that Americans can get the care they badly need at a reasonable cost and with options of insurance coverage, through the creation of an exchange. To fight this type of law is tantamount to abridging the liberty of the people and is an affront on American Democracy. This law is all we've got for now, to ensure that some of our badly sick kids get the care they deserve. Republicans, its time to back off!

To understand why supporters of the law are crying foul, as they are doing, the former status quo, which we would have reverted, if the health care reform law of 2010 was repealed, with the uncertainty over whether Republicans actually have a viable alternative to substitute for the law, one would need to be in the shoes of some parents nursing a child with any of those fatal diseases, rather than wishing things away by depending on a Republican promise. For many, promises from Republicans to introduce another bill to replace the current law, seems more of a ploy to attack the current President's initiative to do something about the broken health care system when he took office. It is rather a mirage to believe that repealing the law will do anyone in the nation any good. According to the leukemia & Lymphoma Society: “An estimated 259,889 people in the United States are living with, or are in remission from, leukemia. An estimated 43,050 new cases of leukemia will be diagnosed in the United States in 2010. Chronic leukemias account for 11 percent more cases than acute leukemias. Most cases occur in older adults; the median patient age at diagnosis is 66 years. Leukemia is expected to strike more than 10 times as many adults as children in 2010. (About 39,733 adults compared with 3,317 children, aged 0-14 years). About 31 percent of cancers in children aged 0-14 years are leukemia. The most common cancer in children 1 to 7 years old is acute lymphocytic leukemia (”

With raw statistics as these from the Leukemia & Lymphoma Society, insurance companies have the laxity to deny these groups of people health insurance coverage because of pre-existing conditions, under the former health care system or dispensation. It just seems unfathomable that any lawmaker will be seeking to repeal a law that accommodates these human frailties, especially among the most vulnerable in our society. The risky promise that Republicans have a health care reform bill that will address the concerns of many vulnerable groups amidst us, who are currently claiming the promise of the Affordable Health Care Reform Law, is hardly believable at this time. The hateful chain of brouhaha going on in Congress among Republicans against the health care reform law, sometimes make many wonder about the true meaning of lawmaking; and, how legislators go about serving the interest of the people. We can hardly understand why Republicans want to repeal the law, when they can offer amendments to re-shape the provisions in the law.

Republicans had imagined associating the health care reform law with job loss or as Republicans called it, ‘a job killing law’, was the quickest way to get momentum behind their efforts to repeal the law. Their advocacy and chances of winning enough fellowship behind their effort was daunted immediately John Boehner began to read too much into the November election results. His claim to a mandate from the people to repeal the health care reform law and his highly publicized drive to stop Democrats at all cost on this one, was probably tempered with the vote in Senate tonight. With the solid vote from all Democratic Senators on the floor, fifty of them and one independent, Sens. Joe Lieberman (I-Conn.) and Mark Warner (D-Va.) were not present, a tall and permanent nail has been driven into the coffin of the exclusionary dream of Republicans to repeal the law.

The discussion on repealing the law is now dead, except Republicans are deaf-tone. As the result of the voting in Senate has demonstrated, including some other amendments that failed, it is all but certain that we will not hear the huge shouting from the Republicans anymore. With the voting results tonight, we can now assume that the Republican's desire to halt the implementation of the law by siphoning or tightening funds needed to implement provisions in the law will come to an end. There are lots of good in the Affordable Health Care Reform Law of 2010; and, there is no need for Republicans to be bent out of shape over the desire to repeal the law. The introduction of a bill to repeal the law threatened not only the implementation of the provisions in the law, it looked much like a looser to the insurance industry that had invested a lot on implementing part(s) of the provisions of the law. It was clear that many insurance executives were not in favor of complete repeal of the law. The Pharmaceutics and hospital industries were not far behind on a disagreement with repealing the law, but had held their peace, knowing fully well that change had finally come to their industries and they had very little influence at this stage.

Welcome to a new day in America's Health Care System. May the Force be with you all!