Health Care's Silver Lining

Abortion restrictions aside, the reform brings some good news for women and children.

Comments (18)
Thursday, April 01, 2010

For women's rights activists, fully embracing the newly, finally passed federal health care reform is a tough job.

While the law does not include the sweeping anti-abortion provisions pushed by political conservatives, it's still far from a pro-choice victory, given the executive order from President Obama that extends an existing ban on using federal funds to cover abortions. The White House defends that move as a simple maintenance of the status quo, which only allows public money to be used for abortions in cases of rape or incest, or when the mother's life is at risk. But frustrated choice supporters point out that, in fact, it expands the ban by applying it to any private insurer that participates in the new insurance "exchanges" and creates a cumbersome process of maintaining separate funds—public dollars that can't be used for abortions; private dollars that can—that might prompt some insurers to simply stop offering abortion coverage.

In a statement released the day the bill was passed by the House, Nancy Keenan, president of NARAL Pro-Choice America, said her group could not endorse the reform "because of the egregious abortion-coverage restrictions."

But like many women's rights groups, NARAL stopped well short of an outright condemnation of the entire reform package. "[B]ecause the measure has other very positive provisions for reproductive health, we couldn't in good conscience call for the bill's outright defeat and thus deny millions of American women and men the promise of better—although imperfect—access to health care services that are important to our pro-choice values," Keenan continued. "[W]e recognize that the bill will bring more than 30 million Americans into a system that includes affordable family-planning services, better access to contraception, and maternity care."

Among those victories are two provisions that are being applauded by women's and children's advocates—one that offers workplace protections for nursing mothers, and another that expands services for women with postpartum depression.


Those provision have not garnered such a high level of immediate public interest as the abortion language; rather, they've remained somewhat buried in the bill—which clocks in at more than 2,400 pages—to be ferreted out by concerned advocates.

That includes Tanya Lieberman, a Northampton lactation consultant who writes a blog about breastfeeding issues for the Motherwear company. "Whatever you think of the health care bill passed by Congress yesterday, you may be pleased to hear that the bill extends a right to pump at work to moms in every state," Lieberman wrote on March 22.

The new law will require employers with at least 50 workers to provide nursing mothers with "a reasonable break time" and "a place, other than a bathroom, that is shielded from view and free from intrusion from co-workers and the public." (The no-bathroom rule is an especially sweet victory for moms who've found themselves with no private place to pump other than a bathroom stall—leaving them to essentially prepare their babies' meals in the same place others are disposing of their own.)

Companies with fewer than 50 employees would be exempt if the requirement amounted to "an undue hardship." A woman will be guaranteed the right to a pumping spot for a year after the birth of her baby. "I'm not thrilled that it extends the right for only up to [one] year (I pumped longer for my son)," Lieberman wrote, "but what a huge difference this would make for mothers in the many states, mine included, that do not extend this right under state law!"

Massachusetts is one of 26 states that do not have any laws providing breastfeeding rights in the workplace, according to the National Conference of State Legislators. Much credit for the new federal guarantee goes to U.S. Rep. Carolyn Maloney, a New York Democrat who has pushed this and other pro-breastfeeding bills for years, and Sen. Jeff Merkley, an Oregon Democrat who supports promoting breastfeeding as a way to reduce health care costs and who got the provision into the health care bill.

The law has met with some grumbling from employer organizations unhappy over new government rules in the workplace. "Every additional mandated rule further burdens employers who are struggling to keep jobs afloat," Neil Trautwein, vice president of the National Retail Federation, told Kaiser Health News.

In fact, the law actually cuts employers a rather big break; as Lieberman noted, a provision initially introduced by Maloney that would allow women to sue employers who didn't comply with the requirement was dropped from the final version, removing any significant penalty for noncompliance. In contrast, Lieberman wrote, some states that already have laws guaranteeing workplace pumping have small penalties in place, such as fines. Such sanctions, she noted, are often enough to get employers to follow the law.

"For most employers this wouldn't really cost anything to implement," Lieberman continued, "and the benefits to them are significantly greater (less turnover and associated costs, higher morale, less health care costs, less absenteeism) [and] would greatly outweigh any cost."

Complaints from some employers aside, response to the law from advocates for women and children has been enthusiastic. "Wow! Has the word 'pumping' or 'breastfeeding' ever been in the language of a federal law before? I don't know," Melanie DeSilva, executive director of the Amherst-based non-profit MotherWoman, told the Advocate. "But what I do know is that from this point forward, when millions of mothers across America request time and an appropriate place to pump in the workplace, they now have the federal government on their side."


The reform package includes another hard-won victory for women's advocates: the Melanie Blocker-Stokes Act, a postpartum-depression bill that's been kicking around the Capitol for seven years.

The bill is named after an Illinois mother who developed postpartum psychosis after the birth of her daughter in 2001. Despite medical interventions that included several short stays in psychiatric wards, Blocker-Stokes did not improve, and eventually committed suicide, jumping from a window ledge when her baby was three months old. While postpartum psychosis—the most serious of postpartum mood disorders—is relatively rare, advocates say that many more new mothers suffer from less dangerous but still serious forms of depression, which often go undiagnosed and untreated. According to the American Psychological Association, 800,000 women in the U.S. experience postpartum depression.

The provisions included in the new healthcare law "will establish a comprehensive federal commitment to combating postpartum depression through new research, education initiatives and voluntary support service programs," announced Sen. Robert Menendez, a New Jersey Democrat, who sponsored the bill. The provision calls for $3 million in federal funding in fiscal 2010 for research on postpartum depression, public education and services for women with the condition, with "such sums as may be necessary for fiscal years 2011 and 2012."

"Millions of mothers nationwide who are suffering or will suffer from postpartum depression are among the winners as a result of the new health insurance reform law," continued Menendez. "These women understand that postpartum depression is serious and disabling, and that the support structure to help prepare for and overcome it has been woefully insufficient. We will attack postpartum depression on multiple fronts—with education, support, and research—so that new moms can feel supported and safe rather than scared and alone."

Health organizations including the American Psychological Association, the American Psychiatric Association, the American Congress of Obstetricians and Gynecologists, the American College of Nurse-Midwives and the March of Dimes have voiced their support of the Blockers-Stokes Act's inclusion in the healthcare package.

The federal law does not mandate universal screening of new mothers for postpartum depression, thus avoiding a topic that generates much controversy in discussions of postpartum mental health. In contrast, a proposed Massachusetts law, sponsored by Rep. Ellen Story (D-Amherst), would.

Story's bill calls for all new mothers to be screened a minimum of seven times, beginning in pregnancy and continuing through the first year of their children's lives, and would require insurance companies to cover the cost. The bill also calls on the Department of Public Health to train medical professionals on maternal depression, including screening techniques, and to strengthen postpartum support services.

While supporters of the bill say universal screening will circumvent the shame or stigma felt by mothers who are singled out for screening, the provision raises a number of red flags for others, including the Freedom Center, a Northampton organization that questions the validity of mainstream approaches to mental health and calls for a more holistic approach that empowers the person being treated. They see the mandatory screening component as a violation of privacy, and worry that the process could lead to an overdiagnosis of postpartum depression and an overuse of drugs as treatment—drugs, they say, that could be passed on to nursing infants, despite the lack of testing on their effects on children.

DeSilva of MotherWoman—which runs well-regarded postpartum programs, including facilitated support groups and training for medical professionals—sees the Blocker-Stokes law as an important public policy step. "The fact that the federal government has acknowledged postpartum depression—a major, largely underground, women's health care issue—and is putting significant funding towards research, education and support is massive," she said.

Comments (18)
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In Europe we watched astonished how a powerful nation like the USA, pours trillions of Dollars into war ventures and refuse social medical assistance to the needy, more so when it concerns mothers and children. Likewise, laws on abortion take into account women above all. Theirs is the decision to bear a child or not, without the fanatics of religious bigotry involved.

Posted by FernandoFF on 3.31.10 at 6:37

"Theirs is the decision to bear a child or not, without the fanatics of religious bigotry involved."

I'll let you figure out why the above statement is peculiar. Having said that, it's interesting to see that the argument has shifted from "women have the right to an abortion" to "women have the right to a publicly funded abortion." How did we get here? Either way, the key word in the statement above is "decision": as in, this is a medical situation that results directly from a choice (to practice safe sex or not). People don't choose to get cancer. With that in mind, I'd love to hear a compelling argument why tax payers should pay for abortions - it's not a pro-choice issue at all.

Posted by Joe on 3.31.10 at 8:27

Because, Joe, taxpayers already pay a much greater price for children born into families unable and/or unwilling to care for them.

Posted by Liberal Helping on 3.31.10 at 18:23

Liberal Helping: Do you believe many people choose to have a child because they cannot scrape together enough money for an abortion? Do you truly believe that?

Posted by Joe on 4.1.10 at 8:13

Change of subject? What are you talking about? I asked why abortions should be paid for by insurance.

You seem to think yes, because it costs taxpayers more if the child is born. I simply pointed out that the number of abortions performed will not drastically changed based on whether they are paid out of pocket or not. Your argument only makes sense if people start deciding to have abortions more often because they are free.

You are the one who changed the subject with your last comment. Let's try to stay on point.

Posted by Joe on 4.1.10 at 17:05

I'd prefer to stay on the point Fernando raised initially and you ignored: how can a powerful nation like the USA pour trillions of dollars into war ventures and refuse social medical assistance to the needy? I might add, how can conservatives possibly blame anyone other than themselves and the Bush administration for the financial disaster we now all face, and isn't it repugnant how so many conservatives jeer at the thought of public health insurance, but have quietly (happily?) accepted a decade of military action and escalation against sovereign nations that haven't attacked us?

Instead of tackling those issues, or referring to the story itself (which was only tangentially about abortion) you offered a diatribe on choice, and then asked for a reason taxpayers should pay for abortions. I gave you one. Rather than addressing what I said, you re-interpreted it, twisted it around and put words in my mouth. Then you tried to turn the discussion into whether or not publicly-paid for abortions would result in fewer abortions, which was not your original question and not one you "simply pointed out," but rather added after the fact.

But since you bring it up, I'd wager that if our country had an honest-to-god single health payer system, where every parent knew their child (and themselves) would be well taken care of for the rest of their lives, along with a drop in abortions, you'd likely see a drop in a lot of other societal ills that have been brought about by a select few making the US a desperate place for most others to live in.

Posted by Liberal Helping on 4.1.10 at 18:38

"refuse social medical assistance to the needy?"

That's a blatent lie, as no one is turned away from an emergency room. Try being honest and maybe we can have some constructive debate.

Applying basic logic to a point = "twisting" in your book and that's something you need to work on if you want to have political discussion.

Me: Why should other people pay for someone's abortion

You: Because it's cheaper than what we would pay if they had the kid.

Me: Who pays has little to no impact on the choice to have an abortion.

You: You are twisting my words (i.e. My thesis does not hold up to logical challenges and I will now change the subject)

Your original comment directly to me: "Because, Joe, taxpayers already pay a much greater price for children born into families unable and/or unwilling to care for them."

Liberal helping - Maybe you shouldn't make comments that you can't back up with reason and logic. That would be much easier than crying foul.

Posted by Joe on 4.1.10 at 18:51

Geez, Joe. You sure can string together a lot of meaningless sentences. I lie? If you bother to read what I've written, I wasn't stating that as "the truth" but rather, I was extrapolating your dumb hypothesis (abortions result from bad choices and therefor shouldn't be eligible for public funding), which you instantly dropped when challenged. The blatant lie in the above is that you were applying any kind of "basic logic" to any of your posts, or even trying to have a discussion. There is no discussion here, Joe, just you dodging and weaving and spouting nonsense. As you like to say, priceless. Blather on!

Posted by Liberal Helping on 4.1.10 at 20:10

"I wasn't stating that as "the truth" but rather" = priceless

"If someone gets in a car accident, should they be denied treatment if it's clear they could have taken the bus or walked but DECIDED not to?" BY the way, this is a stupid argument and you are now considering a fetus to be an ailment, similar to injuries from a car crash, cancer, and heart disease. How do you feel about that?

It's this kind of liberal thinking that shows why liberal talk radio and cable tv have been such overwhelming successes.

Posted by Joe on 4.2.10 at 9:49

Liberal Helping: I'm sorry that you'd rather insult me than challenge any of my points. You should stick to your likeminded circle of friends rather than attempt to engage in logical debate with me.


Posted by Joe on 4.3.10 at 10:17

Joe, I think if you bother to reread the above, you'll see every post you made, including your first, in no real way responds to the previous posts or attempts to dialog. Even after I respond to a direct question of yours, rather than formulating a response to what's been written, you pose different questions. What you engage in is not logical debate, where one thought builds on another, but rather, you spout other people's rhetoric randomly. No original thought here: just the party line. It's like having a conversation with a set of bumper-stickers.

Given the volumes you post on this site, and the very few "logical debates" you ever actually have, it would appear to me what you're up to is simply annoying people and wasting their time. If debate was what you were after, you would have given up long ago.

Posted by Liberal Helping on 4.5.10 at 9:15

"No original thought here: just the party line."

... says someone named Liberal Helping.

Posted by Joe on 4.5.10 at 21:01

Lib, ignore the Joe troll. It's clear he has neither the ability nor the werewithall to debate like an adult.

Posted by tiedyeguy on 4.6.10 at 8:36

I think it's wherewithal.

Posted by Joe on 4.6.10 at 8:38

Thanks, tiedyeguy, but his last response to mine is enlightening, I think.

It's not that he's incapable of debate, it's that he doesn't have any clue what debate is. He sees the stupid monicker I've used and instantly assumes he knows what I think and he takes a contrary position. I (and probably you, tiedyeguy) become sterotypes and he has a Pavlovian response to attack. He doesn't need to read or think, but his programming as a conservative has taught him there's only two kinds of people in the world: his kind and everyone else. And his kind doesn't debate amongst themselves or enjoy the notion of independent thought--they get their speaking points from on high and take to the streets looking for "the enemy." This explains such suggestions of his as I should go and talk to my friends, rather than try to debate.

Just to test the theory, I'm going to change my online name and see what happens. My guess is after initial confusion, he'll adopt his usual strategy for when he gets flustered, and he'll simply pick a phrase out of what I've written and mock it. Or perhaps he'll ask some other rhetorical question that has nothing to do with what's been said. Or, maybe he'll correct my spelling or grammar. The excitement is killing me...

Posted by Conservative Portion on 4.6.10 at 9:01

Let's try this again.

I asked why the cost of abortion should be covered.

You said because it is cheaper than the price paid if the child is born.

Your statement implies: 1) A significant number of women have babies because they can't afford an abortion, and 2) Funding for abortions will decrease the number of babies born (per #1), resulting in savings for taxpayers.

My point: The decision to have an abortion has absolutely nothing to do with its cost and public funding will offer no impact on that fact. Therefore your assertion that public funding will save us money is completely wrong.

Once again, feel free to respond to my point.

Posted by Joe on 4.6.10 at 10:12

Abortion should be covered by insurance as long as it is a legal medical procedure. No other legal medical procedures are excluded, are they?

Posted by itsmePaula on 4.6.10 at 19:29

Joe, thanks for your reply, but you've misinterpreted what I wrote. You're debating yourself, not me. Your implied arguments are not ones I would make.

I wasn't strictly talking finances or dollars when I wrote that "taxpayers already pay a much higher price for children born into families that are unwilling/unable to pay for them." More than the financial cost of giving birth to a child born into a family unable to care for it, I was thinking of the collateral costs in terms of quality of life for the family and child, and everyone that family and child comes into contact with for the rest of their lives.

I'm not concerned with saving money, per se. I'm concerned with with every American having access to the same quality healthcare, regardless of their financial standing. I'm also concerned about personal medical decisions becoming political ones.

Refusing to pay for abortions isn't a financial consideration. It's a philosophical/moral one. It's one group of people judging another and deciding what's right for them. One of the reasons abortion is a hot topic of national debate is because many families don't have access to the best medical care, and plenty of abortions are still done by non-professionals. Refusing to pay for them will perpetuate this situation, not remedy it. It's absurd to think that by not paying for them, the financial benefits will outweigh the quality of life ones.

Profit should play no part in deciding on what's the best possible health care system for the American people.

Posted by Conservative Portion on 4.7.10 at 10:43



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