A Doctor’s Story: The Erosion of Abortion Care in Missouri
Speaker: Colleen McNicholas, DO. Dr. McNicholas, an obstetrician-gynecologist, provides abortion care in clinics in Missouri, Kansas, and Oklahoma and is a founder of Gateway Women’s Access Fund, which provides funds that help Missourians in need of access to abortion care.
Why Are We Discussing This in 2018?
“Why is having access to abortion still an issue long after the Supreme Court’s Roe v. Wade decision that legalized abortion?” asked an audience member. Dr. McNicholas enlightened us in an informative presentation. She explained that the 1973 Roe decision established that a woman’s right to privacy included the right to decide whether or not to have children. The decision, however, also permitted some state regulation of abortion, especially in the third trimester of pregnancy. At this time, a state could forbid abortion except when necessary to preserve the woman’s health or life. In 1992 another decision, Planned Parenthood v. Casey, established that states could regulate abortion if regulations did not pose an “undue burden” on women. Based on Casey, states have created multiple regulations, many of which limit access without scientific evidence of their benefit, McNicholas explained. Some state regulations have been overturned by courts that found the rules did pose an undue burden.
In addition to state regulations, the onerous 1976 Hyde Amendment prevents the use of federal funds for most abortions, which significantly affects the access of patients with Medicaid. This amendment “enshrined economic injustice” for the poor, McNicholas said.
Where Are We Today?
In the United States, access is becoming more difficult. States have passed 1,193 abortion restrictions since Roe, one third in the past seven years and 63 in 2017. These restrictions, enacted under the guise of protecting women’s health, make it nearly impossible for many women seeking care to receive it. Today, 87 percent of U.S. counties have no abortion provider, and four states (North Dakota, South Dakota, Arkansas, and Mississippi) have only one abortion clinic.
In Missouri today, 99 percent of counties have no abortion provider; and 94 percent of Missouri women live in those counties, McNicholas said. Three clinics, in St. Louis, Columbia, and Kansas City, and Washington University offer abortion care. Missouri has among the most stringent laws limiting abortion care, including 67 added in a special session of the Missouri legislature in 2017. Limitations on access to care include a 72-hour waiting period, the requirement to travel to see the same physician two or three different times, rules on how clinics are constructed, and a ban on telemedicine for abortion. In addition, Missouri forbids abortion providers from providing sex education in schools, so an anti-choice organization has provided factually incorrect information in schools. Missouri has also prohibited abortion coverage by private insurers.
What Can We Do?
McNicholas recommended the following ways to support women’s right to abortion care:
- Take direct action by contacting your legislators, following legislation, and supporting pro-choice candidates.
- Support organizations that are challenging laws limiting access to abortion care: Center for Reproductive Rights (reproductiverights.org), Planned Parenthood (www.ppaction.org), NARAL Pro-Choice Missouri (www.prochoicemissouri.org), American Civil Liberties Union (www.aclu.org).
- Support organizations breaking financial barriers: Gateway Women’s Access Fund (gwaf.org), National Network of Abortion Funds (www.abortionfunds.org).
Support an organization working to restore public health insurance coverage for abortion: All Above All (www.allaboveall.org).
Thrivers & Strugglers: A Growing Economic Divide
Speaker: Ana Hernandez Kent, policy analyst, Center for Household Financial Stability, Federal Reserve Bank of St. Louis. Her primary research areas are economic disparities and opportunity, wealth outcomes, class and racial biases, and the role of psychological factors in making financial decisions.
- By race: white, non-Hispanic–$163,000; black– $16,000; Hispanic– $22,000
- By education: GED or no diploma–$24,000; high school diploma—$77,000; some college–$66,000; 4-year degree–$229,000; graduate degree–$443,000.
- By age: Under 40–$17,000; 40-61–$131,000; 62 and over–$236,000
Parents’ education also affects family wealth, Kent said. In families where no parent attended college, the median worth was $87,000. When one parent had a college degree, the worth rose to $131,000, and when both parents had a college degree, $162,000.
Single women are at a disadvantage. Overall their median net worth in 2015 was $3,210, versus single men’s net worth of $10,150. But for single women with a high school diploma the amount was only $1,060; single men’s worth was $3,000. Data also show a positive correlation between marriage and income. Almost 84 percent of people earning more than $50,000 were married, while 39 percent of those earning less than $50,000 were married.
So, as several members asked, what do we do with all this information? Clearly, Kent and other audience members said, we need public policies that invest in education, especially early childhood education. Kent said child development accounts (CDAs) have been established in a few states. Most are 529 education savings plans that are opened at birth or when a child enters kindergarten. Parents can contribute to the accounts, and research shows they lead to improvements in maternal mental health and help parents establish expectations for their child’s education.
Women’s Voices presented this program with the hope that the data can be used to convince policymakers to pass legislation and develop efforts such as CDAs that promote upward mobility. Women’s Voices member Linda Zazove suggested the data may help organizations obtain grants. As the speaker and the audience emphasized, the current growing inequality in wealth is negatively affecting the nation’s health, mortality, education, crime, and trust in government and society. All agreed: This unjust inequality must be addressed now for the good of all.
See also The Demographics of Wealth: How Age, Education & Race Separate Thrivers from Strugglers in Today’s Economy, www.stlouisfed.org/hfs.
Immigration: Frankenstein Law Tears Families Apart
Speaker: Javad Khazaeli, a nationally-known immigration lawyer, is the only private attorney to have served in senior immigration positions in both the Department of Homeland Security and the Department of Labor. He spent nine years with the Department of Justice and then the Department of Homeland Security, U.S. Immigration and Customs Enforcement, National Security Law Division. While with the federal government, Mr. Khazaeli prosecuted terrorists, terrorist financiers, and aliens engaged in espionage and other criminal acts.
“The immigration laws of the United States are totally broken,” Khazaeli told a packed audience as he traced the country’s checkered history of dealing with immigrants. Both Ronald Reagan and George H. W. Bush, Republican presidents, favored giving law-abiding, working immigrants a process for becoming productive citizens, including access to education and health care available to citizens. Under President George W. Bush, Khazaeli said, Congress came close to passing reforms that provided a path to citizenship, but the effort failed when Republicans in Congress resisted allowing immigrants to become citizens with the right to vote.
Today President Trump has reversed the views of his predecessors. Khazaeli blasted the ways conservatives and the Trump administration are denigrating immigrants:
- “Chain migration.” Conservatives have coined this term to stoke fears that immigrants would flood the country with family members. But the government’s Visa Bulletin, easily available on the Internet, shows that only close relatives are allowed in, and then it takes years. For example, to bring in a grown son from France would take 7 years, and to bring a sibling from Mexico, 21 years.
- DACA (Deferred Action for Childhood Arrivals). President Trump claims that this policy will encourage bringing in thousands of children, even though only children who were here in June 2012 are eligible for protection.
Khazaeli described how the administration’s capricious priorities have harmed law-abiding immigrants who contribute to this country. Before the Trump election, immigrants caught without papers who passed background checks were allowed to stay in the U.S. under an order of supervision. They were required to regularly check in with authorities, work, pay taxes, and obey the law. Under President Trump, many people who have lived here for years are deported for no other reason than “they have been here too long.” Refugees, formerly granted temporary protected status, are being sent back to El Salvador, a country the State Department says is very dangerous.
Khazaeli suggested what we can do:
- Urge Missouri lawmakers to allow immigrants to obtain a driver’s license, as other states do.
- Vote for candidates that favor immigration reform.
- Donate to and volunteer with the Migrant & Immigrant Community Action Project. MICA uses legal services and education to help immigrant communities.
Thursday, March 8, 2018
Opioid Crisis: One Nation Overdosed
Howard Weissman, Executive Director, National Council on Alcohol & Drug Abuse-St. Louis Area;
Ellis and Patti Fitzwalter, whose son died from an accidental heroin overdose
More than 900 Missourians died of an opioid overdose last year in the worst drug epidemic in U.S. history. The heroin crisis is killing far more than the drug epidemics of the1970s (heroin) and 1980s (crack), Howard Weissman told the audience of more than 70 people. “We can’t arrest our way out. We can’t treat our way out,” Weissman said. Prevention, he insisted, is the only solution.
He called for approaches that remove the stigma from addiction and treat it as a disease. “Until we come to an understanding that addiction is a brain disease and that it can be prevented,” he warned, we will not stop the crisis. He said we must help young children develop their ability to withstand painful situations and protect them from toxic stress and abuse that can lead to later susceptibility to drugs. His organization has prevention programs in 30 schools in the St. Louis area, he said, but we need a well-staffed and funded federal program.
Following Weissman’s presentation, Patti and Ellis Fitzwalter echoed his message that prevention is the only practical solution. Their son Michael died of an overdose at the age of 22. As Michael began to use drugs, Patti and Ellis knew nothing about opioids. “We didn’t know painkillers and anti-anxiety drugs were highly addictive. We didn’t know heroin was so cheap and available,” Patti said. “It is an easy transition from prescription drugs to heroin because you can snort it or take a pill; you don’t have to shoot up.”
Patti warned the audience “All kids are at risk.” She said drugs are everywhere–schools, dorms, the street–and “the not-my-kid” mindset is dangerous. “Educate yourself so you can educate your children,” she said. “Talk to your children early and often.”
The Fitzwalters have dedicated themselves to telling other parents what they wish they had known. Ellis said that after their son’s death they were ashamed and silent for more than a year. But they realized they had to erase the stigma and break the silence about drug addiction. Today they are raising awareness through their organization H.E.A.L.: Heroin Education & Awareness League. See www.facebook.com/healstopheroin for information and upcoming activities.
Juvenile Injustice: Kids in Crisis from School to Courts
A large audience that included social justice students from St. Joseph Academy, Washington University law students, and other community representatives, came to hear from two women who work with youth facing crisis in the juvenile justice system.
The Rev. Dr. Dietra Wise-Baker, a chaplain for Episcopal City Mission, provides services to incarcerated children in St. Louis. She is also organizing “Break the Pipeline,” a Metropolitan Congregations United program to dismantle the system that takes many children in Missouri from school to prison. Rev. Wise-Baker said the system disproportionately targets African American children and those with a history of abuse, neglect, poverty, or learning disabilities. Because many youth enter the juvenile justice system through school referrals, schools need to institute clear policies that clarify the role of school resource officers and the rights of students and parents, she said. Teachers should have training and support to implement discipline alternatives. In Missouri African American students are 4.5 times more likely to be suspended from school than their white peers and 2.5 times more likely to be referred to the adult prison system. St. Louis Public Schools and the Ladue, Maplewood-Richmond Heights, and Normandy school districts have agreed to stop suspensions of students in kindergarten through third grade and others are exploring the issue. More information at www.mcustl.com
Kathryn P. Banks, a lecturer in law and the director of the Children’ Rights Clinic at the Washington University School of Law, explained the rights of children, which she said are often misunderstood. A juvenile facing delinquency prosecution has similar legal rights as an adult: the right to remain silent, the right to an attorney, the right to notice of charges, and the right to confront and call witnesses.
Two types of attorneys represent children and can influence legal outcomes. A guardian ad litem, usually used in foster care, divorce, custody, and adoption cases, represents the best interest of the child. However, an attorney’s individual biases can influence the attorney’s recommendations to a judge as to what constitutes the child’s best interest. In cases involving delinquency or crime, an attorney for the child represents the child and must follow the child’s direction, making sure the child understands the implications of his or her decisions.
An investigation of the St. Louis County Family Court begun in 2013 by the U.S. Department of Justice found that the court deprived African American and poor juveniles of their constitutional rights. As a result of the DOJ’s findings, a December 2016 memorandum of agreement between the court and the DOJ addressed many issues, including training of juvenile justice attorneys, disproportionate minority contact with the juvenile justice system, and ensuring juveniles’ access to an attorney. Banks said the court is making progress and the number of juveniles in detention centers has dropped significantly.
According to both speakers, the next important issue in advocacy for juvenile justice is raising the age of juvenile court jurisdiction to 18. Scientific evidence that the human brain does not fully develop until the age of 25 supports this measure, Baker said, and the change would give children the benefit of more services, reduce incarceration and recidivism, and ultimately save money.
Remembering our Lost Children Five Years After Newtown
Five years after the murder of 20 children and six educators at Sandy Hook Elementary School, Newtown, CT, gun violence continues to take our children. So far this year, 33 Missouri children have been killed–some in preventable shootings in which they found unlocked guns, some in street violence. Each had a name and left behind precious memories. At the beginning of the meeting, Women’s Voices remembered each of Missouri’s lost children with a moving video featuring their photos and identifying them by age and first name.
See video below **video updated January, 2018 to include all 37 children killed by gun violence in 2017
Charles Adams, former University City police chief, lost his 17-year-old grandson, Taylor Simpson, in a drive-by shooting near his school in University City on April 12 at 10:43 am. Taylor was a good student and “Nana’s right hand” to his grandmother, Dr. Joylynn Pruitt, former superintendent of University Schools. Chief Adams described the heartbreak of planning Taylor’s funeral—“something you’d never think you’d have to do for a 17-year-old,” and his entire family’s continuing anger and sadness. Although time heals somewhat, he said, “you never get over the loss.” Events such as Christmas or the child’s birthday are especially difficult, and unexpected things like a violent movie scene can trigger grief and pain.
As Bishop’s Deputy for Gun Violence Prevention for the Episcopal Diocese of Missouri, Rev.Marc Smith said his efforts focus on collaborative, strategic activities. The diocese has partnered with Women’s Voices Raised for Social Justice’s Lock It for Love program. Episcopal churches in Kirkwood, Eureka, and Cape Girardeau have distributed LIFL free gun locks, and Episcopal parishes have purchased hand-woven scarves to support the program. The diocese has worked with Washington University Medical School to provide education to individuals and groups dealing with victims of gun violence who are experiencing chronic post-traumatic stress and grief. The American Hospital Association selected the diocese to participate in its gun violence prevention activities.
The Rev. Kathie Adams-Shepherd, rector of Trinity Episcopal Church in Newtown, CT, at the time of the Sandy Hook tragedy, counseled many of her 800 grieving parishioners from 2012 until she moved to St. Louis in 2016. Calling for sensible gun solutions such as a ban on semiautomatic weapons, high-capacity magazines, and bump stocks, she echoed the frustration of the parents of Sandy Hook. “Many believed this shooting would be the tipping point [for gun control], she said, “but it wasn’t. Not one piece of federal legislation has passed in five years.” Almost 3,000 children and teens are killed by guns each year, she said. Paraphrasing a Sandy Hook father’s accusation, she said in America one person’s right to own a gun, even an assault weapon, is higher than a child’s right to live a life.
Video remembering the children killed by gun violence in Missouri 2017.
A Shameful Connection: Zip Code and Infant Mortality
Each year almost 300 babies die before their first birthday in St. Louis. The infant mortality rates in some neighborhoods are three times higher than in developing countries such as Syria and Vietnam. Residents in many of these neighborhoods (e.g., zip codes 63106 and 63107) are mainly African American. “Infant mortality is a racial equality issue because two out of three babies who die in St. Louis are African American,” said Kate Kasper, manager of strategic initiatives with Generate Health, an arm of FLOURISH St. Louis dedicated to improving birth outcomes and promoting healthy families. Visit FLOURISH St. Louis and Generate Health for more information.
“Even though St. Louis has some of the highest ranked hospitals in the country, Kasper said, “the needle isn’t moving [to lower the infant death rates in the region].” To figure out how to “move the needle,” Generate Health held community listening sessions over two years to learn first-hand from community members about their needs. It also received input and help from numerous social agencies, service providers, and governmental agencies.
The research revealed a multitude of barriers to healthy birth and infant development. Premature birth emerged as the primary cause of infant death. “Babies are born too soon and too small,” Kasper said.
Generate Health identified priority areas and goals to address the barriers:
- Prenatal care. Goal: to increase use of health services during pregnancy
- Infant health. Goal: to reduce sleep-related and other sudden infant deaths (although these cause only 13 percent of deaths)
- Healthy communication and navigation. Goal: to coordinate ways to connect people to resources
- Behavioral health. Goal: to increase access to mental health and substance use services
- Transportation. Goal: to work with transportation organizations to improve access to health and social support services
Action teams–composed of community members and representatives from health care, insurance, business, faith, support services, and government–are working toward each goal.
Transportation issues affect many other problems, Kasper said. Without transportation, pregnant women and families often cannot get to medical appointments or findaffordable healthy food in the “food desserts” where they live. They are excluded from living wage jobs and affordable safe housing.
African American families suffer disproportionately from lack of reliable transportation. One in four in St. Louis has no car, and both public and Medicaid transportation have often proven unreliable and unsafe, Kasper said.
Kasper cited the transportation team’s progress: It has convened Bi-State, legal services, community health workers, paramedics, and health systems (BJC, Mercy, SSM) to create an outreach education campaign and develop legislative policies on transportation. To demonstrate the difficulties people face in using public and Medicaid transportation, the team has drafted a Riders Bill of Rights. Due to the team’s work with managed care organizations, Missouri has modified some onerous procedures. The state approved a single toll-free number for MCO members to call for appointments, and it now allows pregnant women to make same-day medical appointments and receive bus exclusions.
Audience members, speaking from personal experience, called attention to systemic racism as a cause of pregnancy complications and infant mortality. They said the racism African American women face in daily life and in encounters with medical professionals causes especially high levels of stress for them. Kasper agreed that toxic stress is a major factor and said the Generate Health teams “see all their work through a racial equity lens.”
Missouri’s confusing new photo ID law, which became effective last June, threatens to deter voters who lack the required state-issued photo ID, said Denise Lieberman. The law disproportionately affects seniors, low-wage workers, women, voters with disabilities, students, and voters of color. Voters without a photo ID are more likely to have difficulty obtaining transportation, time to go to the DMV, or a birth certificate.
Lieberman, a constitutional and civil rights attorney with the Advancement Project, heads the Missouri Voter Protection Coalition, a nonpartisan group of 3,000 organizations, including Women’s Voices Raised for Social Justice.
The coalition questions the high cost of putting the law into practice. Lieberman said the state has allocated only $1.5 million, an amount inadequate to fund voter education, free voter IDs and birth certificates, and training of poll workers. Challenging Missouri’s funding for the law’s implementation, the Advancement Project and the ACLU have filed a lawsuit on behalf of the Missouri NAACP and the League of Women Voters. “People need knowledge and tools to execute their right to vote,” Lieberman said. For voting questions, call Lieberman at the Advancement Project, 314-780-1833, or the Advancement Project, 866-687-8683.
Brandon Alexander and Chrissy Peters, co-directors of the Missouri Elections Division of the Office of the Secretary of State, assured skeptics that the voter ID law will not prevent anyone from voting. Explaining the law’s complex requirements, they said registered voters without a photo ID may vote if they present an approved type of identification and sign a provided statement. If they do not have one of these forms of identification, registered voters may vote a provisional ballot. The ballot may be counted if the person’s signature matches the signature in the voter registry. Audience members questioned the matching’s accuracy.
Alexander said the state will provide a free birth certificate to use in order to obtain a photo ID, and the elections division will help citizens obtain one from another state if necessary. He was unable to predict how long it would take to obtain an individual’s certificate because of varying state requirements.
For help or more information on voting requirements, call or email the office of the Elections Division: 866-868-3245, email@example.com.
Mary Timmel of Jobs With Justice explained the Clean Missouri initiative, which calls for a constitutional amendment to target gerrymandering and promote ethics reform. She said the measure would make Missouri’s voting process fairer by preventing any political party from having an advantage when district maps are redrawn after the next census in 2020. The amendment would require that an independent state demographer, rather than political appointees, create state legislative districts, which would be reviewed by a citizen commission.
The Clean Missouri measure would also require that legislative records be open to the public and that politicians wait two years after leaving office before becoming lobbyists. It would eliminate most lobbyist gifts in the General Assembly and lower campaign contribution limits for state legislative candidates.
Timmel said volunteers are needed to collect 300,000 signatures on the Clean Missouri petition to place the initiative on the ballot. She urged the audience to sign the petition, help gather signatures, donate money, and spread the word. For more information: www.cleanmissouri.org.
Thursday, September 14, 2017
BIG PHARMA: Market Failure
In our fall kickoff meeting, Women’s Voices members learned about an exciting concept for helping our country become a healthier society: a single-payer health system. Dr. Weisbart, chair of the Missouri chapter of Physicians for a National Health Program, made us laugh and riveted our attention during a fact-filled presentation. The facts left no doubt that we must change our current health care “nonsystem”:
In 2010, the United States spent 18 percent of its gross domestic product (GDP) on health care while Canada spent only 9 percent. Yet Canadians live 3 years longer on average than Americans.
The U.S. annual average per capita expenditure on health care is nearly $10,000, twice as much as that of other developed countries, yet we rank 28th in life expectancy.
In value for our money, we lag far behind other developed countries, all of which have some form of universal coverage. But we can learn from other nations, Dr. Weisbart said. Canada’s national health insurance program, which employs public funding and private delivery, as does our successful Medicare program, is a model the United States could draw from.
Dr. Weisbart said that our current “wild west” health insurance system, with its complex mixed funding and delivery, is not only peculiar among industrialized nations but also expensively inefficient. The one segment of our system that works well for people is the Medicare program, which has far lower administrative costs than traditional insurance and gives millions of seniors access to comprehensive care. As a result, the life spans of one portion of our population–Medicare recipients–match those in other countries.
Expanding Medicare coverage to the entire population, including members of Congress, would improve Americans’ lives. With universal coverage, families and children would have the same level of care that has benefited seniors. As Dr. Weisbart acknowledged, covering more people raises fear of higher costs. Those fears, however, don’t take account of the great savings that the country would achieve under a single-payer system, like Medicare.
Twenty-five independent studies, Dr. Weisbart said, confirm that a single-payer system could fund care for all U.S. residents through savings from:
- Increased efficiency. The government would administer only one program instead of many it runs today. States and employers would no longer have the administrative burden of financing health insurance and programs.
- Less bureaucracy. An expanded Medicare system would dramatically reduce the cost of care by cutting overhead expenses. For example, with everyone on one plan, there would be no need for costly sales and marketing. Insurance companies currently pass millions of expenditures on to purchasers of insurance.
- Accumulated buying power. A Medicare panel could establish a national formulary and negotiate better prices with providers and drug manufacturers.
Because drug prices drive a major portion of health care expenses, it is especially important that any new plan include measures to control current drug pricing and purchasing practices. Dr. Weisbart said the United States is the only developed country that does not regulate drug prices. “Big Pharma” (pharmaceutical companies) are allowed to set prices without restraint. Also, the Medicare Part D drug program is prohibited by law from negotiating drug prices with drug manufacturers. To keep these rules in place, Big Pharma spends huge amounts of money to employ more than 1,000 lobbyists to influence the U.S. Congress. As a result of legal price gouging and Wall Street fueling big mergers, prices for brand prescription drugs increased 264 percent between 2008 and 2015.
Dr. Weisbart punctured the myth that pharmaceutical manufacturers need to charge heavily to finance their research and development. Returns on drug sales far outpace Big Pharma’s R&D expenses, he said, and taxpayers foot the bill for 80 percent of R & D through funding to entities such as the National Science Foundation and universities.
The audience viewed the documentary, “Big Pharma: Market Failure,” which contains much more information about the corruption in drug pricing. It also focuses on how the rising cost of prescription drugs is affecting families and businesses. The average family is now spending $4,270 annually on prescription drugs. Twenty million Americans did not fill their prescriptions because of cost (2015 study). In 2015, American businesses paid $660 billion for employees’ health insurance, a figure that is projected to rise to $1 trillion by 2022 if nothing changes. Many companies find themselves declaring bankruptcy, closing, or freezing employees’ wages.
Dr. Weisbart is hopeful that the time is right for a single-payer system. Many physicians, politicians, and citizens support the model. Two bills have been introduced in Congress (HB 676 and Bernie Sanders Medicare-for-All-Act of 2017). To help him spread the word, Dr. Weisbart urged audience members to contact him to arrange a speaking event: pnhpMO.org, PNHP-MO Facebook page.