Tagged Women’s Health

Call The Midwife! (If The Doctor Doesn’t Object)

Every morning at Watsonville Community Hospital in Northern California, the labor and delivery team divvies up its patients — low-risk ones go to the midwives and high-risk ones to the physicians. Then, throughout the day, the doctors and midwives work together to ensure the births go smoothly.

“We kind of divide and conquer,” said Dr. Julia Burke, chair of the hospital’s obstetrics and gynecology department.

The hospital began allowing certified nurse midwives to deliver babies in 2017, part of an effort to decrease cesarean sections and make mothers happier.

It wasn’t an easy transition, Burke said. Some doctors, for example, had been practicing for 30 years and never worked with nurse midwives, who are registered nurses with a graduate degree. Pharmacy, medical billing and other departments also were hesitant about the change, unsure of what it would take to integrate nurse midwives, she said. “It took a lot of convincing,” she said.

Throughout the country, hospitals and medical practices are battling old stereotypes and sometimes their own providers and staff to bring on certified nurse midwives. To do so, they have to overcome a lack of knowledge about the safety and benefits of midwifery care and the laws and policies that restrict the use of nurse midwives.

Certified nurse midwives are trained to provide women’s health care, including family planning services and maternity care. As for childbirth, they typically handle normal births and leave more complicated cases to physicians. There are more than 11,200 certified nurse midwives around the nation, including about 1,200 in California.

Women cared for by certified nurse midwives have fewer C-sections, research shows, which can improve birth outcomes and produce significant cost savings for hospitals. A 2017 study, for instance, also found fewer epidurals and less use of anesthesia among low-risk women with care led by certified nurse midwives, compared with care led by physicians.

Despite the data supporting the use of nurse midwives, they attend fewer than 9 percent of births in the United States. That’s far lower than in some European countries, where more than two-thirds of births are attended by midwives, said Laura Attanasio, assistant professor of health policy and management at the University of Massachusetts-Amherst.

Lack of awareness among patients and other providers is a key reason, Attanasio said. “When people hear the term ‘midwives,’ people think you are really talking about home births,” she said. In fact, she said, most midwife-attended births take place in hospitals.

Attanasio said that to significantly increase the number of births attended by midwives, physicians and hospitals must be willing to bring them on board, and more nurse midwifery training programs must be created. “Our maternity care workforce reflects the way it’s been for the last 100 years,” she said.

Administrative hurdles pose another challenge in some regions. Six states, including California, require nurse midwives to practice under the supervision of a physician, said Kim Dau, associate professor at University of California-San Francisco. Yet doctors may be reluctant to assume those supervisory duties because they’re worried about malpractice liability or a bigger workload.

Attempts to change the law in California have so far failed because of infighting between the state’s medical association and hospital association.

To help overcome the obstacles, the Pacific Business Group on Health, a California nonprofit health organization representing employers, is trying to expand the number of hospitals and physician practices that use midwives. They have created guidelines for how to integrate them, and are laying out a business case to convince doctors and hospitals.

They argue, for instance, that midwives can help reduce OB-GYN burnout and reduce malpractice cases associated with unnecessary C-sections.

Bringing midwives into hospitals and physician practices also can help increase their clientele, said Brynn Rubinstein, associate director of the organization’s maternity care program. “Women are really hungry for lower intervention in birth,” she said. “Midwives are a great option for them.”

More women would use midwives if given the option, according to a recent survey by the California Health Care Foundation. Seventeen percent of women surveyed said they would definitely want to be cared for by a midwife in a future birth, and 37 percent said they would consider it. (Kaiser Health News produces California Healthline, an editorially independent publication of the California Health Care Foundation.)

But women can’t always find them, or they may harbor misconceptions about the safety of midwife-led care, interviews conducted by the Pacific Business Group on Health reveal.

Lauren Lockwood, a midwife in Walnut Creek, said some of the doctors she works with at John Muir Medical Center also had misconceptions about midwives: “Most OB-GYN physicians don’t know what education I have gone through, what my experience is and what I am qualified to do.”

Lockwood said some physicians also may feel “a little threatened” by competition from midwives, but others see the value.

Some hospitals, including Highland Hospital in Oakland, have used midwives for at least 20 years, said Katie McKee, interim nurse manager of the midwifery program. There, the OB-GYN doctors work collaboratively with the midwives, who handle most of the prenatal care, triage and about 70 percent of deliveries, McKee said.

McKee said there is always at least one physician and one midwife at the hospital, and they communicate constantly. “We are always working as a team,” McKee said.

At Watsonville Community Hospital, about 15 miles south of Santa Cruz, administrators knew they had to do something to bring down their C-section rate for low-risk births, which was higher than the state average. In 2016, Burke, the OB-GYN, helped start a hospitalist program there so physicians would always be on-site. That allowed women to be in labor longer without doctors intervening with medication to induce labor.

Then Burke, who also directs OB-GYN services at the clinic network Salud Para La Gente, worked to bring in the nurse midwives from the clinic. They’re now at the hospital every weekday from 7 a.m. to 7 p.m.

It’s too early to tell if the nurse midwives have helped reduce the C-section rate, which is now 24.9 percent, but Burke said she expects it to decline.

Now Burke and lead midwife Sarah Levitan want to expand the program so midwives are always at the hospital. “To truly see the value of midwifery, we need to be there 24/7,” Levitan said.


KHN’s coverage of these topics is supported by
Blue Shield of California Foundation
,
Heising-Simons Foundation
and
The David and Lucile Packard Foundation

California’s Top Lawyer Cements His Role As Health Care Defender-In-Chief

SACRAMENTO, Calif. — Xavier Becerra, the political savvy Democratic attorney general of California, has sued the Trump administration 45 times in the past two years, often with much fanfare.

In winning a legal challenge Sunday against new government rules limiting birth control, he once against cemented himself as a national figure leading a fight against the administration across a range of issues — especially health care.

The 12 other states and the District of Columbia that had joined Becerra’s lawsuit also gained a last-minute reprieve from the federal regulations that would have taken effect Monday. They would have allowed most employers to refuse to provide insurance coverage for workers’ birth control by raising a religious or moral objection.

Those rules were also halted for the rest of the country on Monday when a Pennsylvania judge granted a nationwide injunction in a similar lawsuit.

The contraception case is one of several fronts where Becerra has led state coalitions to defend the Affordable Care Act in lawsuits in Texas, California and Washington, D.C.

“The Trump administration is trying to chip away at those protections,” said Andrew Kelly, an assistant professor at the Department of Health Sciences at California State University-East Bay. “It’s left to states like California and Attorney General Becerra in taking a lead in confronting these efforts.”

Becerra is perhaps best known for leading the opposition to the Texas v. U.S. lawsuit. In that suit, the Texas attorney general argued that the Affordable Care Act should be rendered unconstitutional because Congress eliminated the tax penalty on the uninsured. A federal judge last month sided with Texas, ruling that the federal health care law is unconstitutional.

Becerra, who said he helped write the health care law, said he felt compelled to step in when the Trump administration decided not to defend the law. Sixteen states and the District of Columbia joined that lawsuit, which is now on appeal.

The multistate strategy is one that attorneys general have used often in the past few decades when they don’t agree with policies coming out of Washington, legal and political experts say. And it’s not unique to one political party.

Republican attorneys general, for example, sued the Obama administration to block the expansion of Medicaid in their states. When George W. Bush was president, the state of Massachusetts led Democratic states in an effort to force the Environmental Protection Agency to regulate greenhouse gas emissions from cars.

The legal tit for tat is what Nicholas Bagley, a professor at the University of Michigan Law School, described as a disconcerting “militarization” of the state attorneys general offices to press an agenda in the courts.

“At a time of polarized politics, there’s every incentive to pull whatever levers are available to you to try to advance your goals,” Bagley said. “Over time, the state attorneys general have come to the view that the courts are an important forum to have these fights over important questions.”

The behavior of the attorneys general also comes in response to an administration that is using its executive authority to push initiatives that it can’t get Congress to approve.

President Donald Trump is left “to try to use either the regulatory process or executive order to accomplish his goals,” said Gerald Kominski, a professor of health policy at UCLA. “Anyone who opposes those goals has to proceed through the legal process to challenge them.”

Becerra, the first Latino to serve as California attorney general, has sued the Trump administration on a wide range of issues: health care, immigration, the Muslim travel ban, citizenship questions on the census, the border wall, climate change and clean-water rules.

When the former congressman was sworn in to his second term last week, he declared that he had “been a little busy keeping the dysfunction and insanity in Washington, D.C., from affecting California,” and defending the state from the “overreach of the federal government.” And he doesn’t have any plans to let up.

“Whether it’s the criminals on our streets or the con man in the boardrooms or the highest office of the land,” Becerra said, “we’ve got your back.”

But Becerra’s record has been mixed.

The victory in court Sunday was limited. Oakland-based U.S. District Judge Haywood Gilliam Jr. blocked the rules from taking effect in the District of Columbia and the 13 states that challenged them, but he refused to stop them from taking effect in the rest of the country. That national reprieve came a day later in a Pennsylvania court, with U.S. District Judge Wendy Beetlestone describing the harm to women as “actual and imminent.”

If the administration appeals, as expected, Pennsylvania, along with California and its legal coalition would move ahead with their cases to permanently throw out the rules, arguing that the Affordable Care Act guaranteed women no-cost contraception as part of their preventive health care, a provision that they say has benefited more than 62 million women since 2012, when the regulations went into effect.

The Trump rules, California argued in legal filings, would “transform contraceptive coverage from a legal entitlement to an essentially gratuitous benefit wholly subject to an employer’s discretion.” In its proposed regulations, the U.S. Department of Health and Human Services described the exemption as narrow and one that would affect a fraction of women — no more than 127,000.

That’s a number Becerra disputes.

In claiming victory on the birth control lawsuit, Becerra said Sunday that his coalition will continue to advocate for women’s access to reproductive health care.

How much more will Becerra fight during the next four years? Addressing the crowd who gathered this month to see him sworn in to a second term, he conveyed a simple response:

“The sky is the limit.”


This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

California’s Top Lawyer Cements His Role As Health Care Defender-In-Chief

SACRAMENTO, Calif. — Xavier Becerra, the political savvy Democratic attorney general of California, has sued the Trump administration 45 times in the past two years, often with much fanfare.

In winning a legal challenge Sunday against new government rules limiting birth control, he once against cemented himself as a national figure leading a fight against the administration across a range of issues — especially health care.

The 12 other states and the District of Columbia that had joined Becerra’s lawsuit also gained a last-minute reprieve from the federal regulations that would have taken effect Monday. They would have allowed most employers to refuse to provide insurance coverage for workers’ birth control by raising a religious or moral objection.

Those rules were also halted for the rest of the country on Monday when a Pennsylvania judge granted a nationwide injunction in a similar lawsuit.

The contraception case is one of several fronts where Becerra has led state coalitions to defend the Affordable Care Act in lawsuits in Texas, California and Washington, D.C.

“The Trump administration is trying to chip away at those protections,” said Andrew Kelly, an assistant professor at the Department of Health Sciences at California State University-East Bay. “It’s left to states like California and Attorney General Becerra in taking a lead in confronting these efforts.”

Becerra is perhaps best known for leading the opposition to the Texas v. U.S. lawsuit. In that suit, the Texas attorney general argued that the Affordable Care Act should be rendered unconstitutional because Congress eliminated the tax penalty on the uninsured. A federal judge last month sided with Texas, ruling that the federal health care law is unconstitutional.

Becerra, who said he helped write the health care law, said he felt compelled to step in when the Trump administration decided not to defend the law. Sixteen states and the District of Columbia joined that lawsuit, which is now on appeal.

The multistate strategy is one that attorneys general have used often in the past few decades when they don’t agree with policies coming out of Washington, legal and political experts say. And it’s not unique to one political party.

Republican attorneys general, for example, sued the Obama administration to block the expansion of Medicaid in their states. When George W. Bush was president, the state of Massachusetts led Democratic states in an effort to force the Environmental Protection Agency to regulate greenhouse gas emissions from cars.

The legal tit for tat is what Nicholas Bagley, a professor at the University of Michigan Law School, described as a disconcerting “militarization” of the state attorneys general offices to press an agenda in the courts.

“At a time of polarized politics, there’s every incentive to pull whatever levers are available to you to try to advance your goals,” Bagley said. “Over time, the state attorneys general have come to the view that the courts are an important forum to have these fights over important questions.”

The behavior of the attorneys general also comes in response to an administration that is using its executive authority to push initiatives that it can’t get Congress to approve.

President Donald Trump is left “to try to use either the regulatory process or executive order to accomplish his goals,” said Gerald Kominski, a professor of health policy at UCLA. “Anyone who opposes those goals has to proceed through the legal process to challenge them.”

Becerra, the first Latino to serve as California attorney general, has sued the Trump administration on a wide range of issues: health care, immigration, the Muslim travel ban, citizenship questions on the census, the border wall, climate change and clean-water rules.

When the former congressman was sworn in to his second term last week, he declared that he had “been a little busy keeping the dysfunction and insanity in Washington, D.C., from affecting California,” and defending the state from the “overreach of the federal government.” And he doesn’t have any plans to let up.

“Whether it’s the criminals on our streets or the con man in the boardrooms or the highest office of the land,” Becerra said, “we’ve got your back.”

But Becerra’s record has been mixed.

The victory in court Sunday was limited. Oakland-based U.S. District Judge Haywood Gilliam Jr. blocked the rules from taking effect in the District of Columbia and the 13 states that challenged them, but he refused to stop them from taking effect in the rest of the country. That national reprieve came a day later in a Pennsylvania court, with U.S. District Judge Wendy Beetlestone describing the harm to women as “actual and imminent.”

If the administration appeals, as expected, Pennsylvania, along with California and its legal coalition would move ahead with their cases to permanently throw out the rules, arguing that the Affordable Care Act guaranteed women no-cost contraception as part of their preventive health care, a provision that they say has benefited more than 62 million women since 2012, when the regulations went into effect.

The Trump rules, California argued in legal filings, would “transform contraceptive coverage from a legal entitlement to an essentially gratuitous benefit wholly subject to an employer’s discretion.” In its proposed regulations, the U.S. Department of Health and Human Services described the exemption as narrow and one that would affect a fraction of women — no more than 127,000.

That’s a number Becerra disputes.

In claiming victory on the birth control lawsuit, Becerra said Sunday that his coalition will continue to advocate for women’s access to reproductive health care.

How much more will Becerra fight during the next four years? Addressing the crowd who gathered this month to see him sworn in to a second term, he conveyed a simple response:

“The sky is the limit.”


This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday, where we’re 20 days and so-and-so hours (depending on when you read this) into the partial federal shutdown. As of today, it’s tied as the second-longest one in U.S. history, matching the funding gap that stretched from December ’95-January ’96 under President Bill Clinton. (Side note: The history of U.S. shutdowns is a good read for us policy nerds.)

Although health care has been somewhat insulated from the standoff (because funding for the Department of Health and Human Services had already been approved), the battle is really a lesson in the power of a ripple effect. Among the health-related things that have been touched by the impasse in some way: the CVS-Aetna merger, domestic violence victims, food stampswildfire and storm disaster funding, pollution inspections, drug approvals and the Affordable Care Act lawsuit.

But a lot of focus this week was on how the shutdown is curtailing food safety inspections by the Food and Drug Administration, especially following a year that was marked by several high-profile foodborne illness outbreaks.

Politico: FDA Looks to Restart Safety Inspections for Risky Foods Amid Shutdown


This week, my pharma files in Morning Briefing were bursting at the seams, and to be honest, I don’t see that changing anytime soon. This is definitely going to be a year of drug-pricing news, especially because it’s one of the few bipartisan topics that Capitol Hill watchers say might gain traction in a divided Congress.

In recent days, that — along with the fact that drug prices are most certainly a winning election issue — was on stark display. Democratic hopefuls for 2020 are jostling at the starting line to be the one to get THE big, flashy pharma bill out, with Vermont Sen. Bernie Sanders (joined by fellow hopeful New Jersey Sen. Cory Booker and others) as the latest to announce a proposal.

Sanders’ bundle of bills includes allowing the importation of cheaper drugs from Canada, letting Medicare negotiate prices and stripping monopolies from drug companies if their prices exceed the average price in other wealthy countries.

One interesting thing to note (from Stat’s coverage) is that even potential candidates from states that have a heavy biopharma presence (like Massachusetts Sen. Elizabeth Warren and New Jersey’s Booker) are coming out swinging against the industry — a sure sign that being firmly against Big Pharma is seen as crucial to securing the Democratic nomination.

Stat: Democrats Eyeing 2020 Put an Early Spotlight on Drug Prices

The Hill: Sanders, Dems Unveil Sweeping Bills to Lower Drug Prices

The pharma action this week wasn’t limited to the Hill, because the movers and shakers in the industry were all thinking big thoughts at the annual J.P. Morgan Healthcare Conference. There, Johnson & Johnson CEO Alex Gorsky argued that drugmakers were going to have to step up their own self-policing when it comes to pricing or face “onerous” alternatives. Looking at the stories above, I’m thinking he’s not wrong.

The Wall Street Journal: Health-Care CEOs Outline Strategies at J.P. Morgan Conference

Meanwhile, health systems tired of shortages and high prices are flocking by the dozens to the fledgling nonprofit that was created by a group of hospitals to manufacture its own generic drugs.

Stat: Generic Drug Maker Formed by Hospitals Attracts a Dozen More Members

It was hard to pick just a few pharma stories this week, considering the abundance of choices, but one that you should absolutely make time to read is this insulin-rationing piece. Insulin has become the new face of public outrage against outrageous price increases, and this piece presents a good overview of how that came to be, as well as the human toll the hikes have taken. The gut-punch sentence: “Within a month of going off [his mother’s] policy, [Alec Raeshawn Smith] would be dead.”

The Washington Post: Insulin Is a Lifesaving Drug, But It Has Become Intolerably Expensive. and the Consequences Can Be Tragic.


In a largely symbolic move, House Democrats voted to intervene in the health care lawsuit — a strategy geared more toward putting Republicans on record voting against the law (and thus against popular provisions they promised in the midterms to protect) than anything else.

The Hill: Dems Hit GOP on Health Care With Additional ObamaCare Lawsuit Vote

The vote highlighted a problem the GOP faces as it eyes 2020: For the longest time, Republicans have fallen back on “repeal and replace” as their main health care message. Now, the party is going to have to come up with a “positive vision” if they want to regain ground with voters, experts say.

The Hill: GOP Seeks Health Care Reboot After 2018 Losses


States, states, states! Everyone says that’s where the health care movement will be in the next two years, which certainly held true this week.

In California, new Gov. Gavin Newsom revealed his big health care dreams that include reshaping how prescription drugs are paid for, taking steps toward a single-payer system, reinstating the individual mandate, expanding Medi-Cal coverage for immigrants in the country illegally, and creating a surgeon general position for the state.

Reuters: New California Governor Tackles Drug Prices in First Act

Sacramento Bee: Gavin Newsom CA Health Plan Includes Individual Mandate

Meanwhile, up in Washington state, Gov. Jay Inslee proposed a “public option” health care plan for residents, a move that would set the stage for a universal coverage system. (It should be noted that Inslee is a 2020 contender.)

Seattle Times: Inslee Proposes ‘Public Option’ Health-Insurance Plan for Washington

In New York, several big health care developments emerged this week. NYC Mayor Bill de Blasio plans on investing $100 million into making sure that everyone in the city — including residents in the United States illegally — is guaranteed health coverage.

The New York Times: De Blasio Unveils Health Care Plan for Undocumented and Low-Income New Yorkers

And in Albany, Gov. Andrew Cuomo, citing the looming threat to Roe v. Wade, promised to cement a woman’s right to abortion in the state’s constitution.

The Wall Street Journal: Cuomo Vows to Codify Roe V. Wade Decision Into New York Constitution


It seems these days, you can’t swing a cat without hitting someone talking about “Medicare-for-all,” but what about a Medicaid “buy-in”? Some states are considering the option as a politically palatable alternative to help people who are struggling to buy coverage on the exchanges. The plans might not offer the full range of benefits available to traditional beneficiaries, but it could be something.

Stateline: Medicaid ‘Buy-In’ Could Be a New Health Care Option for the Uninsured

Speaking of MFA: A new Politico/Harvard poll shows that 4 in 5 Democrats favor Congress enacting a taxpayer-funded national health plan. Also to note, a fair amount of Republicans (60 percent) supported the idea of letting Americans under 65 buy into Medicare.

Politico: POLITICO/Harvard Poll: Many Democrats Back a Taxpayer-Funded Health Care Plan Like Medicare For All


As of Jan. 1, hospitals have had to post their prices online — which has resulted in much grumbling from industry and experts alike who say the numbers are meaningless to consumers. Centers for Medicare & Medicaid Administrator Seema Verma acknowledged the flaws with the rules this week, but still called them an important first step toward transparency.

Modern Healthcare: Verma: Chargemaster Rule Is ‘First Step’ to Price Transparency


In the miscellaneous file for the week:

• The Chinese scientist who used CRISPR to edit the genes of human embryos had scientists up in arms over the ethical dilemma late last year. But the path of medical breakthroughs is often littered with lapses such as his. Do the ends ever justify the means in these cases? And if so, where should the line be drawn?

CNN: Unethical Experiments’ Painful Contributions to Today’s Medicine

• Juul: Public health crusader? That’s the image the e-cigarette company (under ever-increasing government scrutiny for its marketing practices directed toward youths) is going with these days. But experts are calling its new ad campaign — which touts Juul products as a way to tackle adults’ smoking habits — revisionist history.

The New York Times: Juul’s Convenient Smoke Screen

• A woman who was in a vegetative state for more than 10 years reportedly gave birth last month. The workers at the nursing facility she was in didn’t realize she was even pregnant until she went into labor, raising all kinds of questions about quality of care, abuse and the medical complications of the process.

CNN: How Does Someone in a Vegetative State Have a Baby?

• HIV prevention medication has been shown to be highly effective and, quite literally, a lifesaver to vulnerable populations. But taking it was costing some people their chance at qualifying for life insurance. Now, though, one insurer has settled a lawsuit over the denials, possibly leading the way to changes in the industry.

The New York Times: Facing Legal Action, Insurer Now Will Cover People Taking Truvada, an H.I.V.-Prevention Drug


And good news! The E. coli outbreak is officially over, so you can go back to your romaine (yay?). Have a great weekend!

Where Abortion Fights Will Play Out In 2019

With Democrats now in control of the U.S. House of Representatives, it might appear that the fight over abortion rights has become a standoff.

After all, abortion-rights supporters within the Democratic caucus will be in a position to block the kind of curbs that Republicans advanced over the past two years when they had control of Congress.

But those on both sides of the debate insist that won’t be the case.

Despite the Republicans’ loss of the House, anti-abortion forces gained one of their most sought-after victories in decades with the confirmation of Justice Brett Kavanaugh to the Supreme Court. Now, with a stronger possibility of a 5-4 majority in favor of more restrictions on abortion, anti-abortion groups are eager to get test cases to the high court.

And that is just the beginning.

“Our agenda is very focused on the executive branch, the coming election, and the courts,” said Marjorie Dannenfelser, president of the anti-abortion organization Susan B. Anthony List. She said the new judges nominated to lower federal courts by President Donald Trump and confirmed by the Senate reflect “a legacy win.”

The Republican majority in the U.S. Senate is expected to continue to fill the lower federal courts with judges who have been vetted by anti-abortion groups.

Abortion-rights supporters think they, too, can make strides in 2019.

“We expect 25 states to push policies that will expand or protect abortion access,” said Dr. Leana Wen, who took over as president of the Planned Parenthood Federation of America in November. If the landmark 1973 Supreme Court decision Roe v. Wade is eventually overturned, states will decide whether abortion will be legal, and under what circumstances.

Here are four venues where the debate over reproductive health services for women will play out in 2019:

Congress

The Republican-controlled Congress proved unable in 2017 or 2018 to realize one of the anti-abortion movement’s biggest goals: evicting Planned Parenthood from Medicaid, the federal-state health insurance program for people who have low incomes. Abortion opponents don’t want Planned Parenthood to get federal funds because, in many states, it functions as an abortion provider (albeit with non-federal resources).

Though Republicans have a slightly larger majority in the new Senate, that majority will still be well short of the 60 votes needed to block any Democratic filibuster.

Because Democrats generally support Planned Parenthood, the power shift in the House makes the chances for defunding the organization even slimmer, much to the dismay of abortion opponents.

“We’re pretty disappointed that, despite having a Republican Congress for two years, Planned Parenthood wasn’t defunded,” said Kristan Hawkins of the anti-abortion group Students for Life of America. “This was one of President Trump’s promises to the pro-life community, and he should have demanded it,” she added.

Another likely area of dispute will be the future of various anti-abortion restrictions that are routinely part of annual spending bills. These include the so-called Hyde Amendment, which bans most federal abortion funding in Medicaid and other health programs in the Department of Health and Human Services. Also disputed: restrictions on grants to international groups that support abortion rights, and limits on abortion in federal prisons and in the military.

However, now that they have a substantial majority in the House, “Democrats are on stronger grounds to demand and expect clean appropriations bills,” without many of those riders, said Wen of Planned Parenthood. While Senate Republicans are likely to eventually add those restrictions back, “they will have to go through the amendment process,” she said. And that could bring added attention to the issues.

With control of House committees, Democrats can also set agendas, hold hearings and call witnesses to talk about issues they want to promote.

“Even if the bills don’t come to fruition, putting these bills in the spotlight, forcing lawmakers to go on the record — that has value,” said Wen.

The Trump Administration

While Congress is unlikely to agree on reproductive health legislation in the coming two years, the Trump administration is still pursuing an aggressive anti-abortion agenda — using its power of regulation.

A final rule is expected any day that would cut off a significant part of Planned Parenthood’s federal funding — not from Medicaid but from the Title X Family Planning Program. Planned Parenthood annually provides family planning and other health services that don’t involve abortion to about 40 percent of the program’s 4 million patients.

The administration proposal, unveiled last May, would effectively require Planned Parenthood to physically separate facilities that perform abortions from those that provide federally funded services, and would bar abortion referrals for women who have unintended pregnancies. Planned Parenthood has said it is likely to sue over the new rules when they are finalized. The Supreme Court upheld in 1991 a similar set of restrictions that were never implemented.

Abortion opponents are also pressing to end federal funding for any research that uses tissue from aborted fetuses — a type of research that was authorized by Congress in the early 1990s.

“It’s very important we get to a point of banning” fetal tissue research “and pursuing aggressively ethical alternatives,” said Dannenfelser.

State Capitols

Abortion opponents having pushed through more than 400 separate abortion restrictions on the state level since 2010, according to the Guttmacher Institute, an abortion-rights think tank. In 2018 alone, according to Guttmacher, 15 states adopted 27 new limits on abortion and family planning.

“Absolutely some [of these are] an exercise in what they can get to go up to the Supreme Court,” said Destiny Lopez, co-director of the abortion-rights group All* Above All. “Sort of ‘Let’s throw spaghetti against the wall and see what sticks.’”

But 2018 also marked a turning point. It was the first time in years that the number of state actions supporting abortion rights outnumbered the restrictions. For example, Massachusetts approved a measure to repeal a pre-Roe ban on abortion that would take effect if Roe were overturned. Washington state passed a law to require abortion coverage in insurance plans that offer maternity coverage.

The Federal Courts

The fate of all these policies will be decided eventually by the courts.

In fact, several state-level restrictions are already in the pipeline to the Supreme Court and could serve as a vehicle to curtail or overturn Roe v. Wade.

Among the state laws closest to triggering such a review is an Indiana law banning abortion for gender selection or genetic flaws, among other things. Also awaiting final legal say is an Alabama law banning the most common second-trimester abortion method — dilation and evacuation.


KHN’s coverage of women’s health care issues is supported in part by The David and Lucile Packard Foundation.

Podcast: KHN’s ‘What The Health?’ Ask Us Anything!

This week, KHN’s “What the Health?” panelists answered questions submitted by listeners.

Among the topics covered were why Medicare doesn’t cover most dental care, how to address high drug prices and what federal officials do with all that data they collect from health care providers.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Stephanie Armour of The Wall Street Journal and Paige Winfield Cunningham of The Washington Post.

The panel addressed questions including the following:

  • “Besides your podcast, what resources, including books and journals, do you recommend people read to build basic knowledge about the U.S. payer system?”
  • “What is the likelihood that Congress will pass legislation to include full dental care in Medicare, say in the next 10 years?”
  • “CMS collects an extraordinary amount of data from its various quality reporting programs. … What does the agency do with this data and is there any evidence quality reporting improves patient outcomes or achieves other policy aims?”
  • “Do you have a view on whether Medicare paying less money for prescription drugs would lead to drug companies charging more to private insurers?”
  • “There’s been a lot of back-and-forth lately between the National Institutes of Health, the Department of Health and Human Services and the media regarding fetal tissue research. HHS is currently doing a review, and the Trump administration just posted a ban to the NIH labs to stop procuring any new fetal tissue. This jeopardizes many research studies, especially those studying HIV. What do you think the long-term consequences of this will be?”

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Podcast: KHN’s ‘What The Health?’ Ask Us Anything!

This week, KHN’s “What the Health?” panelists answered questions submitted by listeners.

Among the topics covered were why Medicare doesn’t cover most dental care, how to address high drug prices and what federal officials do with all that data they collect from health care providers.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Stephanie Armour of The Wall Street Journal and Paige Winfield Cunningham of The Washington Post.

The panel addressed questions including the following:

  • “Besides your podcast, what resources, including books and journals, do you recommend people read to build basic knowledge about the U.S. payer system?”
  • “What is the likelihood that Congress will pass legislation to include full dental care in Medicare, say in the next 10 years?”
  • “CMS collects an extraordinary amount of data from its various quality reporting programs. … What does the agency do with this data and is there any evidence quality reporting improves patient outcomes or achieves other policy aims?”
  • “Do you have a view on whether Medicare paying less money for prescription drugs would lead to drug companies charging more to private insurers?”
  • “There’s been a lot of back-and-forth lately between the National Institutes of Health, the Department of Health and Human Services and the media regarding fetal tissue research. HHS is currently doing a review, and the Trump administration just posted a ban to the NIH labs to stop procuring any new fetal tissue. This jeopardizes many research studies, especially those studying HIV. What do you think the long-term consequences of this will be?”

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