As of last week, the Philadelphia Board of Health has avowed it will firmly stand behind the right to comprehensive reproductive health and abortion care.
The proclamation came in the form of a resolution adopted last week calling on the federal government, Pennsylvania Governor Tom Corbett, and the state’s General Assembly to uphold public funding for reproductive health care and reinstate insurance coverage for abortion care for all women regardless of income level and insurance type. Specifically, the resolution states:
“Be it therefore resolved, that the Board of Health of the Philadelphia Department of Public Health calls upon President Obama, the US Congress, Governor Corbett, and the Pennsylvania General Assembly to support public funding for comprehensive family planning services; to reinstate coverage for abortion services for women enrolled in public insurance programs, including women enrolled in Medicaid and Medicare, women in the military, federal employees, Native American Women, women in federal prison, women in the Peace Corps, and women who live in the District of Columbia; and to ensure that the Commonwealth of Pennsylvania does not withhold insurance coverage for abortion for women purchasing plans on a state insurance exchange.”
With this resolution, Philadelphia becomes the third city to stand behind women’s access to reproductive health care. It comes on the heels of similar resolutions adopted by the New York City Council Committee and the Travis County Commissioners Court in Austin, Texas in late January.
“If state and federal government were to provide comprehensive pregnancy-related coverage then it would be good for women and families of Philadelphia,” says Dr. Susan Schewel, executive director of Women’s Medical Fund (WMF) and Board of Health member. “The lack of pregnancy-related coverage is a public health issue and that’s what the Board of Health deals with. We know that when women can’t control their fertility and make their own decision about how many children they want to have and when and if they want to have them, then there are public health consequences for that, for women and for their children.”
A draft of the resolution was first brought to the Board of Health by Dr. Schewel a couple of months ago after gaining interest through her work with WMF. Initially, Dr. Schewel’s pledge only included the issue of abortion coverage but, she says, “They were so outraged about threats to public family planning services that they wanted to expand to include that issue.”
“We had no conversations about personal feelings about abortion and family planning because we’re here as servants of public health and so our personal beliefs are irrelevant, so they embraced it,” she told me after a press event on the resolution held Friday afternoon. “Cities are where we see the impact of state and federal policies. We see them here on the ground, the frontline. We see the impact on our city streets, in our city health centers, in our day care centers, everywhere.”
Ultimately, what the resolution signifies is the acknowledgment of rights for “women everywhere…on behalf of the Board of Health and the citizens that it represents,” says Brenda Shelton-Dunston, MPH, executive director of the Philadelphia Black Women’s Health Alliance.
“Those women that fall within those cracks and do not have an income level, should they be discriminated against with not being provided access to this service? No,” says Shelton-Dunston, who attended the Friday conference. “The same thing as far as those individuals who have no insurance, the essence of what is occurring is that they will be impacted by that. That’s why we’re here. That’s why we’re standing up.”
The resolution’s passing couldn’t come at a more appropriate time for women in the Commonwealth. The Pennsylvania General Assembly is presently considering Senate Bill 3 (SB 3) and House Bill 742 (HB 742), which would prohibit qualified health care plans offered in the Keystone state’s American Health Benefits Exchange from including certain abortion coverage once the Patient Protection and Affordable Care Act (ACA) is implemented.
“It’s a political statement from the Philadelphia Board of Health and it hopefully will reflect on the General Assembly and help them to make an informed decision as they consider that legislation,” says Jen Horwitz, director of Public Policy at Women’s Way and coordinator of Raising Women’s Voices of Southern Pennsylvania, also at the press event.
The legislation would, however, allow for publicly-funded coverage in the cases of rape, incest, and life endangerment, as permitted under the Hyde Amendment.
“That, in itself, is extremely restrictive because of other legislative issues that ring throughout the federal level,” says Horwitz, referring to ACA’s Nelson provision. “The challenge that we really see is, if this passes, there isn’t even exceptions for women facing serious complication issues. It doesn’t offer a type of health care coverage that woman actually need.”
As written, the Nelson provision requires insurances plans offering abortion coverage in state exchanges to create two separate accounts for premium payments. Insurers would deposit private premium monies for abortion care into one account (which cannot include any federal dollars), and process payments for all other covered benefits into the other. If implemented in its strictest interpretation, women would have to dole out two separate checks just to pay for their insurance, asserts NARAL Pro-Choice America.
Unsurprisingly, 25 of the 26 senators who’ve sponsored SB 3 are Republican, 24 of them men. Additionally, none of the senators actually serve Philadelphia County; rather, only six of the men represent the city’s outlining counties including Chester, Bucks, Delaware, and Montgomery. The bill’s prime sponsor, Republican Senator Donald White, represents District 41 in Western Pennsylvania.
“This requirement to purchase abortion coverage outside of the exchange imposes new, unnecessary burdens on consumers who purchase coverage in the exchange,” says Dr. Schewel. “Currently, 80 percent of private insurance companies cover abortion, so a woman who has coverage now would find this coverage withheld if her employer chooses to take part in the exchange. These restrictions could cause serious constraints on women’s ability to access abortion coverage in the exchange, even a woman with a serious health condition such as cancer. As well, this potentially creates unnecessary administrative burdens on the private insurance market at large.”
It would also add insult to injury. Unlike New York, Pennsylvania has not earmarked state funding to cover abortion care through its Medicaid program in order to fill the void left by Hyde; nor does it offer abortion coverage for government and military employees. That means 83,373 women ages 18 to 44 on Medicaid, and 87,039 women in the same age bracket with public insurance living in Philadelphia proper remain without access to comprehensive reproductive health care. And there are 84,900 Philadelphia women ages 18 to 44 who have no health insurance at all.
“We know that low-income women are often harmed first and worst by restrictions on reproductive healthcare access,” wrote Catholics for Choice’s Domestic Policy Director Sara Hutchinson in an email. She considers the resolution’s passage “one of the most sensible public policy statements…seen in a long time.” “As Catholics, we believe that each individual, no matter their circumstances, has a right and responsibility to follow his or her own conscience when making moral decisions.”
The implication of this resolution extends beyond the topic of family planning. It is also a rallying cry for all-inclusive reproductive health care services, including screenings for sexually-transmitted infections (STIs).
To illustrate the significance, Deputy Mayor for Health and Opportunity and Philadelphia’s Health Commissioner Dr. Donald F. Schwarz, who serves as the Board of Health’s president, presented statistics on current STI trends, specifically among the city’s youth, at Friday’s event, according to Horwitz. According to the Philadelphia Department of Health’s 2011 Philadelphia Youth in Crisis: Adolescents and Sexually Transmitted Infections report, over 45 percent of Philadelphia high school students are currently sexually active, nearly 20 percent more than youth in New York (over 10 percent of those students first had intercourse before 13 years of age, as opposed to about five percent of New York youth.) During their last sexual encounter, 37 percent of those Philadelphia students did not use a condom. And a little over 60 percent of the city’s high school students use condoms, about 10 percent less than those in New York.
The report also states that 10- to 14-year-olds are 5.3 times as likely to contract Chlamydia as American teens overall, with the rate of the disease at 3.5 times the national rate among 15- to 19-year-olds. Among this same age group, the gonorrhea rate in Philadelphia is three times the national rate, with four times the national among ages 10 to 14. Black and Hispanic youth ages 15-19 are more likely to contract these two diseases than White youth.
More telling, youth ages 13 to 24 make up 25 percent of all newly-diagnosed HIV cases, with African-Americans making up 70 percent of those cases. In Philadelphia’s STD clinic, 47 percent of those found to have the disease had a previous history of Chlamydia, gonorrhea and/or syphilis. Additionally, syphilis cases are also rising among 15- to 19-years-old, increasing from 1 percent in 2004 to 7 percent in 2010.
“That’s a key point to pay attention to,” says Horwitz. “It really paint[s] the picture of why this is particularly important for Philadelphia.”
“What Philadelphia has done is part of a growing national trend,” says Horwitz. “Other states are starting to say, ‘We want to make sure that we are supporting women, offering them comprehensive reproductive health choice.’”
While only three cities have passed a resolution of this type, the National Institute for Reproductive Health’s Urban Initiative for Reproductive Health is working with and connecting advocates, policymakers and public health officials on the city and county levels to bolster mass support for comprehensive reproductive health and abortion care coverage. According to a National Institute press release, additional cities will introduce similar resolutions and initiatives supporting insurance coverage for abortion in the coming months.
“The more you have a ground swell, a focus on the issues, hopefully from the legislature perspective, there will be less movement to repeal, less movement to bring in conservative legislation,” says Shelton-Dunston.