Hospitals twist prescription assistance program for their own benefit

By Adam J. Fein, president, Pembroke Consulting, Philadelphia - 04/29/13 03:00 PM ET

In 1992, Congress acted to help indigent and uninsured patients gain better access to prescription drugs. It authorized the 340B drug discount program, which lets eligible hospitals and other providers purchase outpatient drugs and receive discounts from pharmaceutical manufacturers.

But today, 340B discounts have left needy patients behind. Health Resources and Services Administration (HRSA), the government agency that oversees the 340B program, has developed the program with a tangle of regulations, non-public private letters, clarifications, and “Frequently Asked Questions.” Aggressive hospital strategies, all technically legal, have stretched the program’s goals beyond recognition. Hidden rebates from pharmaceutical manufacturers are instead subsidizing the operations of highly profitable, multi-billion dollar health systems.

The limited government oversight and foggy regulations let a 340B hospital profit from everyday outpatient prescriptions — drugs that are dispensed by your local pharmacy and are already fully paid by your insurance company. Thus, economic status and degree of need are irrelevant to a hospital’s ability to profit from a 340B prescription.

Hospitals grab these 340B rebates through a convoluted process. First, the hospital and its software vendors secretly match personal information from your retail prescription to their internal patient databases. If it is profitable, they convert the prescription to a 340B claim. Then, the retail pharmacy turns over its third-party and consumer payments to a 340B hospital. The hospital pays a fee to the pharmacy and submits a rebate claim for the retail prescription.

What’s more, the hospital benefits without your or your payer’s knowledge. Under existing regulations, the process is entirely permissible. However, it certainly wasn’t considered or intended in the original legislation.

This behavior sharply accelerated after a 2010 regulatory change, which lets hospitals build external networks of community pharmacies. HRSA projects that nearly one-quarter of the country’s 60,000 retail community pharmacies will be part of a 340B network. The biggest player is Walgreens. More than 4,000 of its drugstores act as 340B contract pharmacies.

Unfortunately, we can’t even detect the full scope of this practice. The National Council for Prescription Drug Programs (NCPDP), which set electronic communication standards for pharmacy care, allows easy identification of an individual prescription’s status under the 340B drug pricing program. This voluntary standard is purposely ignored by most hospitals and pharmacies.

Senator Charles Grassley (R-Iowa) has requested that the largest North Carolina hospitals provide details about their use of the 340B program. His work has exposed the small fraction of hospital 340B profits that now target indigent and uninsured patients.

Consider Duke University Health System, which has annual revenues of $2.5 billion and operating profits (revenues minus expenses) exceeding $500 million. Responding to Senator Grassley, Duke disclosed 340B pharmacy profits of $292 million — a 53 percent gross profit margin. Without these discounts, Duke's pharmacy profit margin would drop to 24 percent — comparable to that of a typical outpatient pharmacy. Only 1 in 20 patients served by Duke’s 340B pharmacy is uninsured. The remaining 95% have prescription costs paid by Medicare, Medicaid, or private insurance.

Today’s Congress should improve oversight and tighten 340B participation requirements.

To ensure that the program’s funds are being used appropriately, Congress should require that hospitals fully disclose how they use their 340B pharmacy profits. By allowing hospital’s to retain and then spend all 340B pharmacy profits, neither Medicare nor patients benefit from 340B drug discounts.

To limit abuse and increase transparency, hospitals and pharmacies should also be required to comply with established industry standards for identifying 340B prescription claims. Hospitals’ use of contract pharmacy networks should be scrutinized to be consistent with the program’s true intent.

It’s time to modernize the 340B program and help the neediest patients access valuable medicines.

Fein is president of Philadelphia-based Pembroke Consulting, Inc. He blogs at Drug Channels.

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If Obamacare Collapses: How States Can Protect Their Citizens

As the case against Obamacare continues to mount, states should be ready to act. Despite the President’s professions of confidence, recent concerns voiced by Members of Congress—added to lackluster support for and understanding of the law by the public—have further exposed Obamacare’s real and practical vulnerabilities.

In preparation for the likely collapse of Obamacare, states should advance their own patient-centered, market-based solutions that stimulate more affordable coverage, better access, and superior quality and innovation.

Cracks in the Foundation of Obamacare

President Obama recently tried to downplay the law’s implementation problems and their impact on everyday Americans. The reality, however, is that the massive disruption caused by this health care law has already started—and the worst is still to come. For instance, in the near future, Americans will see higher taxes, new penalties, and skyrocketing premiums; millions will be displaced from their current coverage, and millions will remain without health insurance.[1]

Even among supporters of the law in Congress, there is growing concern and discontent. At a recent hearing with a top Department of Health and Human Services (HHS) official, Senator Jay Rockefeller (D–WV) warned that the implementation is “so complicated and if it isn’t done right the first time, it will just simply get worse.”[2] At a hearing with HHS Secretary Kathleen Sebelius, Senate Finance Committee chairman Max Baucus (D–MT) expressed similar concerns:

I am very concerned that not enough is being done so far—very concerned. When I’m home, small businesses have no idea what to do, what to expect, they don’t know what affordability rules are, they don’t know what penalties may apply.…

A lot of people have no idea about all of this.… I just see a huge train wreck coming down, and you and I have discussed this many times and I don’t see any results yet.[3]

The American people remain skeptical and confused. According to a new Kaiser Family Foundation Tracking Poll, 40 percent of Americans have an unfavorable view of the law.[4] Moreover, 42 percent believe incorrectly that the law has been repealed or overturned by the Supreme Court or do not know.

The dismissiveness of the Administration, the lack of confidence in Congress, and the continued lack of public support and understanding of the law itself all add to the unavoidable structural challenges facing the law.

Getting the Right Health Care Reform Back on Track

Obamacare remains an obstacle to states advancing real health care reform. But states should be ready to act on the inevitable collapse of Obamacare and its full repeal. The following are a few among many state policy ideas that states could pursue and put them ahead of the reform curve:

Assess insurance rating rules and benefit mandates. Rating rules and benefit mandates raise premium costs. States’ experience with combining guaranteed issue (which requires insurers to accept all applicants) and community rating (which requires insurers to sell policies at the same price regardless of key factors) led to the deterioration of the individual market.[5] Excessive and costly benefit mandates also affect the cost of health insurance. One study estimates that mandated benefits increase the cost of health insurance anywhere from 10 percent to 50 percent.[6] Yet Obamacare imposes strict rating rules and new benefit mandates on health insurers. State policymakers should review their rating rules and benefit mandates and modify them to lessen their impact on the cost of insurance in their states.Extend portability of coverage to individually owned policies. Pre-Obamacare federal law provided protections for individuals who maintained credible group coverage, but those protections do not extend to non-group coverage.[7] Rather than shuffling individuals into government-controlled exchanges and Medicaid, as done under Obamacare, states should provide protections in the non-group/individual market similar to those provided in the group market. This would ensure that individuals who maintain credible coverage on their own can switch plans without risk of losing credible coverage protections.Expand access through the harmonization of state rules. Unlike in the purchase of other goods and services, individual health coverage options are limited to products that are available within each state. Obamacare further limits choice by, in essence, pre-empting state law and standardizing rules and benefits across the board. To increase the number and variety of products, states should harmonize their insurance rules, increasing the number of insurance products available to individuals within their borders. Of course, to put consumers truly in charge, it would be even more helpful if Congress would enact legislation to facilitate the interstate purchase of health insurance.Integrate choice and competition in Medicaid. Medicaid is consuming a greater portion of state budgets as demands grow, while access and quality remain problems. Obamacare ignores the structural problems facing Medicaid and makes matters worse by expanding the program to millions of new potential enrollees. It is critical that states reject the Medicaid expansion in Obamacare and consider reforms that will improve the quality of care, establish a path to independence, and harness the benefits of choice and competition to reduce overall costs. States that have pursued similar reforms have demonstrated the success of this course.[8]Adopt medical liability reforms. Rules governing medical malpractice and the cost of medical liability insurance are driving up the cost of medicine and jeopardizing access to care. Obamacare provides no legitimate path to reform. Moreover, this issue should reside with the states, not the federal government. Many states have already tackled this issue and provide a blueprint for others to follow. The states can and should be at the forefront of efforts to establish a more rational approach to addressing medical liability.[9]Remove certificate of need (CON) restrictions. CON laws empower state regulators to limit the supply of health care facilities or services in communities. These restrictions impede access and are almost always anticompetitive. In a report on health care competition, the Federal Trade Commission and the Department of Justice found that “on balance, CON programs are not successful in containing health care costs, and…they pose serious anticompetitive risks that usually outweigh their purported economic benefits.”[10] States should eliminate these types of policies.

States Should Lead the Way

The future of Obamacare remains uncertain. Higher premiums, exploding costs, and deteriorating coverage could ultimately lead to its downfall. Its repeal would pave the way for patient-centered, market-based reforms, and states should be ready to lead the way.

—Nina Owcharenko is Director of the Center for Health Policy Studies and Preston A. Wells Jr. Fellow at The Heritage Foundation.

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STUDY: CVS, Rite Aid, And Other Chain Pharmacies Sell Generic Drugs At Up To 18 Times Their Cost

According to a new Consumer Reports investigative study published Thursday, there is rampant variation in the price of generic drugs as large U.S. pharmacy chains — including CVS, Rite Aid, and Target — mark up the prices of generic drug versions for common medications by as much as 18 times what wholesale chains like Costco charge. That price variance ends up costing Americans, who spend an average of $758 out-of-pocket on drugs every year, hundreds of dollars in unnecessary spending each month.

Consumer Reports compiled the data by contacting hundred of pharmacies throughout the country and asking what their drug prices were for generic versions of Lipitor, Plavix, Actos, and other common medications. The results were striking, with pharmacy representatives claiming that the higher prices were necessary for covering overhead, and considering that selling medication constitutes most of their revenue and profit margins:

Costco was the least expensive overall, and you don’t need to be a member to use its pharmacy. A few independent pharmacies came in even cheaper, though their prices varied widely, as did grocery-store pharmacies. The online retailers Healthwarehouse.com and FamilyMeds.com also had very low prices. On the other end of the spectrum, CVS, Rite Aid, and Target had the highest retail prices. [...]

A representative of CVS told us that its retail drug prices reflect other services offered by the chain, including drive-through windows, automated prescription refill systems, free outreach programs to help make sure patients are taking their prescriptions correctly, and 24-hour pharmacies. Costco pharmacies, the cheapest overall, are open only from 10 a.m. to 7 or 8:30 p.m. and are typically closed on Sundays.

“Big-box stores such as Costco and Walmart use the pharmacy as a traffic builder for their stores, whereas traditional chain stores, such as CVS, Rite Aid, and Walgreens, make the majority of their revenue and profits from the pharmacy,” says Stephen W. Schondelmeyer, Ph.D., Pharm.D., a professor of pharmacy economics at the University of Minnesota.

The study’s full findings are illustrated in this chart:

The use of generic drugs — rather than their brand name counterparts — actually drives down spending on medications, consequently lowering Americans’ out-of-pocket costs and government spending on public insurance programs such as Medicare and Medicaid. But the Consumer Reports investigation suggests there are significantly more savings to be had.

This isn’t the first time generic drug makers have been in the news this week. On Monday, the Supreme Court took up Federal Trade Commission (FTC) v. Actavis — which one expert dubbed “the health care reform case of 2013? — a case centering on the legality and antitrust implications of so-called “pay for delay” arrangements in which brand name drug makers pay off their generic drug counterparts to delay a drug’s generic version from entry into the market. If the FTC winds up winning that case, it could save Americans and the government billions of dollars on drug costs every year. But as this new report demonstrates, they could save much more if pharmacies stopped jacking up their rates to startling degrees.

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NOM Spokesperson: Children Of Same-Sex Couples Will Resent Their Parents

Among the speakers at Tuesday’s anti-gay Marriage March was National Organization for Marriage spokesperson Jennifer Roback Morse, who heads up NOM’s Ruth Institute. Morse has a reputation of saying horrid things about gay people and young people’s perceptions of LGBT issues, and she did not disappoint at the rally. Stoking fears that same-sex marriage has some kind of unforeseen experiences, she attempted to speak on behalf of the children of same-sex couples, claiming they would resent their parents for depriving them of a parent of the opposite gender:

MORSE: Eventually, young people are going to see that redefining marriage sets aside the interests of children for the convenience of adults. Now in the unhappy event that the Court should redefine marriage, which we pray that they will not — we pray that they will allow us to continue this nationwide conversation and discussion that we desperately need to have. But if they do redefine marriage, 40 years from the young people of that generation will have one simply question for our generation, “What were you thinking?”

They’re going to say, “Dad, you and your partner are lovely guys, I love you Dad, but did you really think I would never need a mom? What were you thinking?” “Mom, I know you love me, you and your partner are nice ladies, but the biological connection that was so important to you — did you think it would never be important to me? What were you thinking? What were you thinking?” That’s what they’re going to ask us.

Watch it (via RightWingWatch):

Actually, same-sex marriage is in the best interest of the many children already being raised by same-sex couples. And usually, they call both dads “Dad” or both moms “Mom,” and they wouldn’t have to say “partner” to describe a husband and a wife. Morse clearly demonstrates that she has little understanding or empathy for same-sex families. Oddly, NOM does not actively campaign against same-sex adoption even though the well-being of children is supposedly at the core of the arguments against marriage equality.

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Senators Rockefeller And Begich Add Their Support For Marriage Equality

Two more Senators have expressed their full support for marriage equality, joining Sens. Mark Warner (D-VA) and Claire McCaskill (D-MO), who endorsed the freedom to marry earlier this week.

Alaska Sen. Mark Begich (D) issued a statement Monday night supporting same-sex couples’ rights to marry:

BEGICH: I believe that same sex couples should be able to marry and should have the same rights, privileges and responsibilities as any other married couple. Government should keep out of individuals’ personal lives — if someone wants to marry someone they love, they should be able to. Alaskans are fed up with government intrusion into our private lives, our daily business, and in the way we manage our resources and economy.

Similarly, Sen. John “Jay” Rockefeller (D-WV) told ABC News that government should not discriminate against couples based on their sexual orientation:

ROCKEFELLER: Like so many of my generation, my views on allowing gay couples to marry have been challenged in recent years by a new, more open generation. Churches and ministers should never have to perform marriages that violate their religious beliefs, but the government shouldn’t discriminate against people who want to marry just because of their gender.

Younger people in West Virginia and even my own children have grown up in a much more equal society and they rightly push us to question old assumptions — to think deeply about what it means for all Americans to be created equal. This has been a process for me, but at this point I think it’s clear that DOMA is discriminatory. I’m against discrimination in all its forms, and I think we can move forward in our progress toward true equality by repealing DOMA.

Rockefeller joins 21 other Senators who originally voted for the Defense of Marriage Act and later opposed it.

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Republicans Admit Intention To Sugarcoat Their Opposition To LGBT Equality

The Republican Party continues to struggle with its intentions moving forward in regards to LGBT equality. In its autopsy report of the 2012 elections — its “Growth & Opportunity Project” — the gay community was the one group that the Party was not actually interested in reaching out to. Instead, the plan was to convince young people to support conservative principles even if they support LGBT rights. Since then, GOP chairman Reince Priebus has attempted to model this by citing his own marriage as an example for building bridges and suggesting Mike Huckabee, a very vocal opponent of equality, be an ambassador on gay issues.

This week, both Priebus and potential presidential prospect Jeb Bush have both been a bit more candid about their intentions to simply sugarcoat their opposition to equality so it doesn’t sound so anti-gay. Bush told Newsmax that a different tone that expresses opposition to same-sex marriage “in a civil way” that is “not judgmental” would help keep conservatives united:

BUSH: I know for a fact that as it relates to gay marriage and other social issues there is growing divergence of opinion on this. When we talk about it, we ought to talk about it with a different tone — and we ought to talk about it recognizing that there is more than one point of view, and we should talk about it in a way that is not judgmental. If we can get to that point where people who have diverging points of view and express them in a civil way, the conservative coalition can stay intact.

Priebus, in turn, told USA Today that opposition to equality can be presented with “grace and respect”:

“We do have a platform, and we adhere to that platform,” Priebus said in an interview Monday on USA TODAY’s Capital Download video series. “But it doesn’t mean that we divide and subtract people from our party” who support the right of gay men and lesbians to marry.

“I don’t believe we need to act like Old Testament heretics,” he said, saying Republicans “have to strike a balance between principle and grace and respect.”

What the Republican Party cannot seem to accept is that no polishing of this message amounts to respect, grace, or civil discourse. Inequality is inequality, and no changes in tone can change that the GOP platform specifically calls for one group of people to be treated as second-class citizens.

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Apple’s Data Centers Reach 100% Renewable Power, Their Facilities Worldwide Hit 75%

This week Bloomberg caught an announcement from Apple that all of their data centers are now run on 100 percent renewable energy. Apple is at 75 percent for their corporate facilities worldwide — a remarkable increase from 35 percent in 2010.

Apple was targeted by Greenpeace last year, in a report that ranked the Silicon Valley giant 12th our of 14 large computer companies for use of clean energy to power data centers and cloud computing services. Apple received a “D” grade for energy transparency, efficiency, and renewables advocacy, and an “F” for infrastructure siting.

Apparently, that dismal assessment got the company’s attention:

We’ve already achieved 100 percent renewable energy at all of our data centers, at our facilities in Austin, Elk Grove, Cork, and Munich, and at our Infinite Loop campus in Cupertino. And for all of Apple’s corporate facilities worldwide, we’re at 75 percent, and we expect that number to grow as the amount of renewable energy available to us increases. We won’t stop working until we achieve 100 percent throughout Apple.

“Apple’s increased level of disclosure about its energy sources helps customers know that their iCloud will be powered by clean energy sources, not coal,” Gary Cook, an analyst at Greenpeace, wrote in a statement. According to Apple’s numbers, the company reduced its carbon emissions per dollar of revenue by 21.5 percent between 2008 and 2012 — though their overall carbon footprint still went up due to increased sales.

You can dig into Apple’s environmental self-reporting a bit more here.

Peter Oppenheimer, Apple’s chief financial officer, said that a 100-acre solar array set up next to its largest data center, located in Maiden, North Carolina, came online this past December. The company says it’s generating 60 percent of the center’s power on site — through a combination of solar power and fuel cells that convert biogases to energy — and that the rest of the electricity is drawn from renewable sources. Another data center under construction in Prineville, Oregon, will run on a combination of wind, hydro, solar and geothermal power.

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Colorado Sheriffs Threaten Not To Enforce Their Own State’s Gun Laws

For months, local sheriffs have been objecting to federal efforts to stem gun violence in the wake of the Newtown massacre, claiming they violate “states’ rights.” Now, with a package of gun violence prevention measures awaiting the governor’s signature in a state that has seen some of the most deadly and high-profile mass shootings, several Colorado county sheriffs are threatening not to enforce their own state’s measures to expand criminal background checks and limit ammunition magazines if they are signed into law. The Greeley Tribune reports:

Weld County Sheriff John Cooke said he won’t enforce either gun-control measure waiting to be signed into law by Gov. John Hickenlooper, saying the laws are “unenforceable” and would “give a false sense of security.” […]

“They’re feel-good, knee-jerk reactions that are unenforceable,” he said.

Cooke said the bill requiring a $10 background check to legally transfer a gun would not keep firearms out of the hands of those who use them for violence.

“Criminals are still going to get their guns,” he said.

Cooke said the other bill would also technically ban all magazines because of a provision that outlaws any magazine that can be altered. He said all magazines can be altered to a higher capacity.

Cooke said he, like other county sheriffs, “won’t bother enforcing” the laws because it will be impossible for them to keep track of how the requirements are being met by gun owners. He said he and other sheriffs are considering a lawsuit against the state to block the measures if they are signed into law.

El Paso County Sheriff Terry Maketa also said Thursday that several of the laws are unenforceable and that he would willfully ignore the high-capacity magazine limit. And Cooke’s position appears to have the support of a number of other state sheriffs; during testimony calling the law unenforceable, 20 other county sheriffs stood behind him in solidarity.

Sheriffs’ assertions that the laws are simply too difficult to enforce and/or ineffective is the latest in a string of arguments by a contingent of county sheriffs opposed to any new gun violence prevention measures. Other sheriffs, several of whom are part of a fringe militia group whose members believe that sheriffs are the highest law enforcement authorities and vow to defy any law or order that violates their radical view of the Constitution, have argued that federal regulation violates states’ rights and the Second Amendment.

Conservative legislators are also already committing to repeal the ammunition magazine limit if enacted through a 2014 ballot measure.

Other measures that passed both houses of the Colorado legislature include a requirement that firearm buyers pay for their own background checks, a ban on online certification for concealed-carry permits, and a ban on gun purchases by people convicted of domestic violence crimes.

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Carly Rae Jepsen Is Praying The Boy Scouts Abandon Their Anti-Gay Policy

Recently, “Call Me Maybe” singer Carly Rae Jepsen joined rock band Train in dropping out of the Boy Scouts of America’s National Scout Jamboree, citing the organization’s policy banning gay Scouts and Scout leaders. In an interview with MTV, she explained that the decision was not hard to make, adding that she’s praying it helps convince the BSA to make the right decision:

JEPSEN: I mean, it was sort of one of those things that I kind of have my opinions about, and everyone’s entitled to their own, but it wasn’t necessarily something that I felt comfortable backing once I learned more about it. And that being said here’s hoping they make the right decision and I’m praying that moves like this will help.

Watch it:

Jepsen’s comments come as BSA begins surveying its members about the possibility of allowing gay scouts. The questions include scenarios about gay Scouts tenting with straight Scouts, lesbians serving as den leaders when a troop’s church sponsor opposes homosexuality, and prohibiting would-be Eagle Scouts from receiving their badge just because they’re gay. Both those who want the Scouts to continue discriminating and those who don’t agree on one thing: As the “Don’t Ask, Don’t Tell” study proved, no amount of opinion will change what the right course of action is.

(HT: Pink News.)

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GOP Governors Refusing To Expand Medicaid Could Cost Their States’ Employers More Than $1 Billion

The Republican governors who are refusing to accept Obamacare’s optional expansion of the Medicaid program typically cite financial concerns; despite all evidence to the contrary, GOP leaders claim that accepting federal funds to extend health coverage to additional low-income American will end up being too costly for their states. According to a new study, however, they have it backwards. Continuing to resist health reform could be significantly financially riskier than simply agreeing to expand Medicaid.

Each governor resisting Medicaid expansion could end up costing the employers in their state over $1 billion dollars, a new Jackson Hewitt Tax Service report finds. That’s because, since the health reform law seeks to ensure that everyone has access to insurance, Obamacare holds businesses with more than 50 employees responsible for making sure their workers have adequate benefits. Employers won’t be penalized for failing to offer health care to their low-wage workers if those employees can access public insurance through Medicaid — but if states don’t expand their Medicaid pools, the workers who have no other way to get health care could end up costing their employers:

A clause in the 2010 health-care overhaul penalizes some employers when their workers aren’t able to obtain affordable medical coverage through the company. Employers can avoid those fees if their workers qualify for Medicaid as part of an expansion that as many as 22 states have rejected, according to a report today by Jackson Hewitt Tax Service Inc.

Without Medicaid, a “shared responsibility” payment of as much as $3,000 may be triggered for each employee who can’t get insurance through their company. In Texas, the largest state to refuse to increase Medicaid, employers may be liable for as much as $448 million in fines, the study found. In Florida, where the legislature has refused an expansion supported by Governor Rick Scott, employers may pay as much as $219 million. [...]

Of course, this won’t come as welcome news to many of the companies that have so far gotten away with denying their workers health benefits. Employers are decrying Obamacare’s “shared responsibility” provision for potentially raising their costs, threatening to slash their workers’ hours, freeze hiring and lay off staff, or raise the prices for their products.

But the health law is simply trying to work within an employer-based insurance system that hasn’t historically been able to ensure that poor Americans can access the benefits they need. If low-wage workers can’t qualify for public insurance programs because their governors won’t expand Medicaid’s eligibility levels, then they will need to be able to get health care from their employers. And if their bosses won’t provide it, they’ll have to turn to the subsidized insurance on Obamacare’s health exchanges — triggering the employer fine.

Even aside from Medicaid expansion’s potential to help alleviate the “shared responsibility” fee, several reports have projected that the states choosing to expand their Medicaid programs will actually save money by doing so. The financial benefits are largely thanks to the increased federal funding that will free up states’ funds for other purposes, but also because of the reduced strain of providing fewer health services for the uninsured once more people are covered.

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Kansas Bill Would Protect Doctors Who Mislead Women About Their Pregnancies

The Kansas Senate Judiciary Committee recommended a bill yesterday that would effectively allow doctors to lie or withhold information about debilitating genetic conditions or birth defects in order to influence women’s decisions about their pregnancies.

Kansas SB 142 provides blanket protection from “wrongful birth” lawsuits to doctors, with section 1(a) reading:

“No civil action may be commenced in any court for a claim of wrongful life or wrongful birth, and no damages may be recovered in any civil action for any physical condition of a minor that existed at the time of such minor’s birth if the damages sought arise out of a claim that a person’s action or omission contributed to such minor’s mother not obtaining an abortion.”

The Arizona State Senate passed a similar law in 2012, but that proposal contained a provision absent from the Kansas bill allowing wrongful birth suits in the event of “an intentional or grossly negligent act or omission.”

The proposal was included as a provision in an omnibus anti-abortion bill last year, but was so controversial that it ending up being submitted as a standalone bill in this cycle, according to Kansas NOW lobbyist Elise Higgins. Despite Kansas’s dismal reproductive rights record, Kansas legislators have already introduced over 90 pages of anti-choice legislation in 2013.

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Oklahoma May Deny Women Affordable Birth Control Because It ‘Poisons Their Bodies’

Oklahoma already prevents women from using their insurance plans to help cover abortion services, but Republicans aren’t stopping there. One state lawmaker wants to continue stripping insurance coverage for reproductive health services, advancing a measure that would allow employers to refuse to cover birth control for any reason — based solely on the fact that one of his constituents believes it “poisons women’s bodies.”

Under State Sen. Clark Jolley (R)’s measure, “no employer shall be required to provide or pay for any benefit or service related to abortion or contraception through the provision of health insurance to his or her employees.” According to the Tulsa World, Jolley’s inspiration for his bill came from one of his male constituents who is morally opposed to birth control, and wanted to find a small group insurance plan for himself and his family that didn’t include coverage for those services:

Jolley said the measure is the result of a request from a constituent, Dr. Dominic Pedulla, an Oklahoma City cardiologist who describes himself as a natural family planning medical consultant and women’s health researcher. [...]

Women are worse off with contraception because it suppresses and disables who they are, Pedulla said.

“Part of their identity is the potential to be a mother,” Pedulla said. “They are being asked to suppress and radically contradict part of their own identity, and if that wasn’t bad enough, they are being asked to poison their bodies.”

The bill has already cleared a Senate Health committee and now makes it way to Oklahoma’s full Senate. It is unlikely that either Jolley and Pedulla themselves rely on insurance coverage for hormonal contraceptive services — but if the measure becomes law, the two men could limit the health insurance options for the nearly two million women who live in Oklahoma.

Of course, contraception does not actually poison women. The FDA approved the first oral birth control pill in 1960, and that type of contraception is so safe that the American College of Obstetricians and Gynecologists recommends making it available without a prescription, as it is in most other countries around the world. Furthermore, considering that over 99 percent of women of reproductive age have used some form of birth control, the Oklahoma women who rely on insurance coverage for their contraception would likely disagree with Pedulla’s assertion that it “suppresses and radically contradicts part of their own identity.”

In reality, access to affordable birth control is a critical economic issue for women. When women have control over their reproductive choices, it allows them to achieve economic goals like completing their education, becoming financially independent, or keeping a job. But birth control can carry high out-of-pocket costs, and over half of young women say they haven’t used their contraceptive method as directed because of cost prohibitions. Nonetheless, Republican lawmakers have repeatedly pushed measures to allow employers to drop coverage for birth control.

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Faith Groups Add Their Voices To The ‘Forward on Climate’ Chorus

Sojourners and Young Evangelicals for Climate Action at the rally. Credit: Sojourners

By Catherine Woodiwiss

Eighteen months after the first major protests in DC against the Keystone XL pipeline made headlines for weeks and saw hundreds of protestors arrested, Sunday’s”Forward on Climate” rally gathered the “NO XL” faithful for what organizers called the “biggest climate rally by far in history.”

And as with anti-Keystone protests past, faith groups lent visible support; their banners, prayers, and chants joining the estimated 40,000 peaceful protestors calling on President Obama to show climate leadership in his new term by vetoing the Keystone XL pipeline.

Kevin Mason, a young man with The Catholic Worker hospitality house in DC, saw protesting the pipeline as a matter of justice and solidarity. “One person is hurt, we all are hurt,” he said over chants of “That’s not kosher!” from the assembled crowd. “Charity and resistance go hand in hand. There’s a huge need to get back to the Genesis idea of stewardship and beloved community.”

Faith groups have grown bolder in their pro-environment positions, and are gaining some momentum in joining and helping shape protests against fracking and tar sands removal. The shift hasn’t been easy — climate change is still a challenging conversation in many faithful communities, and remains completely off the radar in others.

Yet in the last year alone, several new groups and initiatives like Young Evangelicals for Climate Action and the Interfaith Moral Action on Climate have sprung up, major faith mobilizers like Sojourners have more publicly stepped in, and longstanding interfaith climate organizing networks like Interfaith Power and Light have redoubled their efforts.

“It’s great to see this interfaith energy,” said George Hoguet, a former Catholic now part of The Stillworkers, an engaged Buddhist community in Pittsburgh. “It’s great — there needs to be more.”

Tim Kumfer, representing Interfaith Power & Light at the rally, expressed hope for the direction of faith involvement. “I’ve seen, even today – there are more and more young people here who are publicly identifying with faith, connecting it to this issue,” he said, noting a common disparity between young climate organizers and older interfaith activists. Increasingly at climate actions, Kumfer noted, “there’s all ages and denominations joining in.”

In 2011, Keystone XL protests helped prompt a delay from the Administration on pipeline construction. This time, protestors want a full stop, and took their message directly to the man they see as the ultimate decider: the newly re-elected President.

Bill McKibben, founder of 350.org, issued a challenge to thunderous applause from the crowd. If the President were to veto the pipeline, he would, in McKibben’s words, “become the first leader in history to veto legislation because it was bad for the climate. And he can put an end to that with a single stroke of his pen.”

Van Jones, President of Rebuild the Dream, echoed McKibben’s charge. “Today, I direct my message to [the President]: all the good you’ve done, everything you’ve fought for…will be wiped out if you fail to act now. The decision is in your hands.”

He added, “If the pipeline is built, the first thing it runs over… will be your credibility.”

This stern charge came just days after 48 XL protestors were arrested in front of the White House, and President Obama’s State of the Union speech featured climate change as a pressing issue for his second term.

That the rally occurred over President’s Day weekend was no coincidence. “We’re showing [the President] visible support for his efforts,” said one woman in the faith march, identifying as Unitarian. “He needs it more than Congress. We need to show him we agree and want him to keep going.”

Reverend Lennox Yearwood, President of the Hip Hop Caucus and a host for the Forward on Climate rally, urged the crowd to remember the values that unite the climate movement.

Citing the influence of money and power in Washington, Lennox said, “We have other currencies to work with: passion, spirit, creativity. A love for the future is what brought us here today.”

On Sunday, protestors made it clear they are looking to the President to demonstrate his share in these values and veto the pipeline.

Catherine Woodiwiss is a special assistant on the Faith and Progressive Policy Initiative at the Center for American Progress.

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Republicans Try To Intimidate Nonpartisan Accounting Office For Debunking Their Economic Theory

House Ways and Means Committee Chairman Dave Camp (R-MI)

Last September, the non-partisan Congressional Research Service released a report showing that tax cuts for the rich — contrary to GOP orthodoxy — have minimal effect on economic growth or job creation. Instead, they simply increase income inequality. Republicans pressured the CRS to pull the report down; it was eventually re-posted with the same conclusions.

Last month, another non-partisan agency, the Congressional Budget Office, released an analysis showing that one of the GOP’s favorite corporate tax ideas would end up pushing jobs overseas. Again, instead of reexamining their ideas, Republicans are attacking the messenger:

The Congressional Budget Office is defending a recent report on how U.S. multinational corporations are taxed, after a top Republican criticized the analysis as biased. [...] “This report purports to provide an even-handed review of different policy issues related to the taxation of foreign source income,” [House Ways and Means Committee Chairman Dave] Camp (R-MI) wrote to [CBO Director Doug] Elmendorf last month.

“However, a closer analysis of the report reveals that it is heavily slanted and biased in favor of one specific approach to the taxation of foreign source income – and relies heavily on sources that tend to support that conclusion while ignoring sources that support a different conclusion,” he added.

Elmendorf defended the report, saying it “presents the key issues fairly and objectively and that its findings are well grounded in economic theory and are consistent with empirical studies in this area.”

The GOP’s idea — known as a “territorial” tax system — would permanently exempt U.S. corporations from paying taxes on profits they make overseas. CBO found such a system would result in “increasing incentives to shift business operations and reported income to countries with lower tax rates.”

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Presidential Memorandum -- Presidential Determination Regarding Drawdown Under Section 506 (a)(1) of the Foreign Assistance Act of 1961, as Amended, for Chad and France to Support Their Efforts in Mali

More Than 75 Percent Of Americans Delayed Their Retirement To Avoid Losing Health Benefits

Tying health insurance benefits directly to employment is forcing most Americans to work longer than they would have otherwise, a new study from the Employee Benefits Research Institute finds.

According to the study’s results, more than three fourths of retired Americans ended up working longer than they initially planned because they didn’t want to lose access to their employer-based health benefits. And a majority of the Americans who are currently in the workforce are also planning to delay their retirement in order to keep the insurance plans they have through their employer:

This builds upon previous research that shows the Great Recession has seriously impacted older Americans’ ability to retire. An estimated 62 percent of working Americans now report they’re planning to put off their retirement — up from 42 percent in 2010 — largely due to job losses and financial insecurity. These issues go hand-in-hand particularly because, as health care costs continue to rise, Americans are increasingly worried about being able to afford their insurance coverage.

And the United States’ primarily employer-based health insurance system doesn’t just impact Americans’ retirement decisions. It has also contributed to the “job lock” phenomenon, which prevents Americans from switching jobs or changing career paths because they’re too worried about losing access to their health benefits. “Job lock” ultimately creates an inefficient labor market, since workers may not take better jobs because they’re concerned about having a gap in health coverage.

Fortunately, Obamacare will take steps to address these dynamics by making health care more affordable to low- and middle-income Americans, as well as preventing insurers from denying coverage to people with pre-existing conditions. The health reform law “completely changes the playing field,” one of the study’s authors told Wonkblog’s Sarah Kliff. “If everything goes as planned, you’ve got guaranteed issue next year. You don’t need the employer to fill the gap.”

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California Restaurant Owners Pocketed The Money Intended To Fund Their Employees’ Health Care

Over 50 San Francisco-based restaurant owners are under fire for prioritizing their own profits over their workers’ health care coverage. A city-wide investigation revealed that, after the restaurant industry collected a total of $14 million in worker health care surcharges in 2011, just a third of that money actually went toward providing low-wage workers with insurance.

Under a city-wide requirement, businesses in San Francisco are supposed to set aside some extra money — about $2 dollars an hour for each worker — to help their employees afford their insurance costs. When the rule first went into effect in 2008, some restaurant owners avoided raising the prices on their menu by tacking a surcharge onto the bottom of their bills and explaining to their customers that the fee would help fund workers’ health care.

But according to San Francisco Supervisor David Campos and Assemblyman Tom Ammiano, who helped conduct the investigation into the restaurant owners’ practices, those customers were being deceived. “I can’t say all of them, but for some of these restaurants it was a marketing ploy,” Campos said. And that marketing ploy came at the direct expense of their workers, some of whom didn’t have health insurance at all:

In some cases, not only did the surcharge money go back into owners’ pockets, but employees were denied health care altogether, Ammiano and Campos said.

The inconsistencies were caught after the health law was amended in 2011, requiring city audits of the surcharges. Last year, 3,652 restaurants turned in their paperwork to the labor office, which found oddities in the accounting. The documentation was then turned over to the city attorney for a full-fledged investigation. [...]

For Campos, it’s a consumer-trust issue. “These diners thought they were paying for workers’ health care. Instead these owners were gaming the system,” he said.

Low-wage workers like the employees in San Francisco’s restaurant industry typically don’t have access to health insurance — in fact, more than half of low-wage workers at small firms were uninsured in 2010. And workers’ health care costs are continuing to rise while their wages are stagnating, so it’s nearly impossible for them to afford their own insurance on the private market if their employers choose to deny them health coverage.

Obamacare will help address some of these issues in a similar way as San Francisco began doing in 2008. Starting in 2014, the health reform law will help ensure that employers can’t deny their workers health care simply to protect their own profits, and require businesses with more than 50 employees to offer basic health benefits. Nonetheless, profitable members of the restaurant industry like Olive Garden, Taco Bell, and Wendy’s are already using Obamacare as a convenient excuse to keep perpetrating their anti-worker labor practices and avoid giving their workers any benefits.

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GOP Secretary Of State: Allowing Citizens To Register On Election Day Undermines Their ‘Individual Freedoms’

Georgia Secretary of State Brian Kemp (R)

Giving citizens the flexibility to register to vote (or update their existing registration if they’ve recently moved) on Election Day actually chips away at Americans’ “individual freedoms,” according to Georgia Secretary of State Brian Kemp (R).

During a panel discussion on voting at the conservative Heritage Foundation on Thursday, Kemp lambasted the idea of same-day voter registration. Ten ideologically diverse states, from Idaho to Wisconsin to California, have enacted the program, also known as Election Day registration. By removing barriers to voting and making it easier for citizens to register, studies have found that EDR boosts turnout on average by 7 to 14 percentage points.

Kemp dismissed EDR as a “buzzword” that is as an affront to Americans’ right not to participate in elections. “[It] really gets down to the individual freedoms of people in our state and Americans in general and their ability to decide for themselves, ‘yes I want to register to vote and participate in the process, or no that I don’t,” Kemp said.

KEMP: I think we do have to have commonsense protections to make sure that our rolls are secure to stop potential voter fraud. This whole issue with dealing with the federal government and universal registration and same-day registration and all these different buzzwords really gets down to the individual freedoms of people in our state and Americans in general and their ability to decide for themselves, “yes I want to register to vote and participate in the process, or no that I don’t.”

Watch it:

There are countless problems with our voting system, but infringing on Americans’ right to not vote is not one.

Regardless, Kemp’s assertion that EDR somehow compels citizens to vote is ludicrous. The law simply allows those citizens who want to to register on Election Day.

In fact, Georgia, as much as any state, could benefit from EDR. In 2012, the Peach State ranked 33rd out of 50 states with a voter turnout of 58 percent. Meanwhile, five of the top six voter turnout states have EDR.

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New Hampshire Bill Would Give Parents Veto Power Over Their Kids’ Sex Ed Teachers

New Hampshire has the distinction of being one America’s best educated states, with stellar college graduation rates and students achieving the highest SAT and ACT scores in the country. But Granite State lawmakers may want to brush up on their knowledge about public health and sex education.

According to the Concord Monitor, State Rep. Ralph Boehm (R-NH) introduced a bill to the House Education Committee yesterday that would allow parents to pull their children out of health or sex ed lessons for any reason at all. While New Hampshire law already allows parents to object to certain lesson plans on religious grounds, the proposed HB 161's wording causes some lawmakers to worry it would give parents carte blanche over the crucial public health education their children receive, and veto power over the educators who provide it:

“In a lot of school districts, this is already the policy,” Boehm said yesterday. “And a lot of schools say it’s up to the parent. But the law says it must be a religious objection.”

Boehm has the support of Rep. Joe Pitre, a Rochester Republican, and Rep. Rick Ladd, a Grafton Republican who’s also a retired school principal. Although, Ladd said he’d like Boehm’s bill rewritten to require parents to give a “justifiable” reason for objecting.

“It can’t be, ‘I walk into the classroom and I don’t really like that teacher, so I’m just going to opt out,’ ” Ladd said.[...]

Rep. Judith Spang, a Durham Democrat on the committee, expressed similar concerns. She talked about the intersection of public health education and sex education and worried that students could be excused from health classes on preventing sexually transmitted diseases under the bill and existing law.

The fact is, sex education works. Multiple studies and real world examples have demonstrated that locales with strong sex education programs have lower rates of STIs and teen pregnancy.

But buoyed by the conservative religious right’s intensive lobbying, Republican state lawmakers have kept abstinence-only programs the norm and comprehensive sex education programs optional, making America more regressive on sex education policy than many Catholic countries. It should come as no surprise that American youth are woefully ignorant about sexual health and safety as a consequence.

Luckily, the trend may be limited. Recent surveys have shown that even Evangelical youth are moving away from an anti-contraception and anti-sex education mindset.

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Persistent Exporters Recognized for their Achievements during E-Awards White House Ceremony

Ed note: This was cross-posted from tradeology, the official blog of the International Trade Administration

Today Commerce Secretary John Bryson presented 41 U.S. companies and organizations with “E” Awards and “E Star” Awards recognizing their significant contributions to the expansion of U.S. exports. These awards fall into two categories. The “E” Award for Exports honors manufacturers and service businesses, demonstrating a sustained increase over several years in selling U.S. products and services to overseas consumers. The “E” Award for Export Service honors export service providers that demonstrate how over several years they have assisted businesses to increase their exports.

The “E” Award was created by President John F. Kennedy on December 5, 1961, “to award suitable recognition to persons, firms, and organizations making significant contributions to the increase of American exports.” The “E Star” Award, which was authorized by the Secretary of Commerce in 1969, recognizes previous “E” Award winners for their continuing significant contributions to U.S. export expansion.

This year marks the 50th anniversary of the “E” Award and since its inception, more than 2,500 companies and organizations have been recognized for their excellence in exporting. The honorees this year are the largest group to be recognized with the “E” Awards and “E Star” Awards for their export achievements and the diversity of industries and communities represented is impressive. The 2012 recipients come from across the United States, from Bakersfield, Calif., to Baton Rouge, La., Bolingbrook, Ill., and Bradford, Pa. Of the companies recognized at today’s ceremony, 35 are small or medium-sized enterprises, 20 are manufacturers, and 17 companies are both.

For example, the 2012 recipients include:

Ambient Technologies is a small, Hispanic-owned business that has been providing geological consulting, drilling, geophysical and geographic services since 1993. With offices in Florida and Panama, Ambient employs more than 32 individuals in the United States and more than 12 internationally, mostly professional scientists, technicians, drillers and administrators. Ambient contracts with international consultants and engineering firms to deliver support services on projects in Central America, South America, and the Caribbean region. These projects include major construction and remediation projects with worldwide recognition, including the Panama Canal Expansion.

Founded in 1997, MyUS.com of Sarasota, Florida is a leader in international package forwarding and shipping, servicing more than 100,000 global consumer and business customers’ annually.  MyUS.com employs shipping experts to handle its customer’s international shipping logistics, package consolidation, export compliance and customs documentation needs for the approximately 2,000 packages MyUS.com receives daily.  With a global footprint in over 200 countries worldwide, MyUS.com has sustained its commitment to export expansion by continuing to provide excellent service to its customers. 

DeFeet International Inc., of Hildebran, North Carolina, manufactures high-quality, technical-performance sports socks, gloves, and base-layer apparel. Established in 1992, DeFeet has always manufactured its own products. In September 2001, the company lost their entire factory to fire. DeFeet was able to continue knitting and rebuild. The company is committed to making quality products using locally sourced materials, employing skilled craftspeople, and minimizing waste.

NuStep of Ann Arbor, Michigan, manufactures a recumbent cross-trainer designed for general fitness, as well as rehabilitation physical therapy of individuals unable to use regular exercise equipment.

McWong Environmental and Energy Group of Sacramento, California provides environmental design services and equipment for wastewater treatment projects in China.

These are just a few examples of the companies recognized today. Each story differs, but at the heart of their success is their willingness and ability to tap into markets outside of our borders.

Today people want products “Made in America” and these manufacturers, service companies, and export service providers from across the country are helping to make that possible.

Cory Churches is a Communications and Outreach Specialist in the Office of Public Affairs within the International Trade Administration

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