Kate Michelman discussing strategy with women’s health care advocates and members of the General Assembly Health Care Agenda Caucus.

Yesterday (Monday, September 30, 2013), I attended a two-hour meeting with Pennsylvania’s House and Senate members of the joint Women’s Health Agenda Caucus led by Representative Dan Frankel of Pittsburgh. Some of the advocacy groups attending the meeting included the Women’s Law Project (WLP), Women Vote PA, and members of the Pennsylvanians for Choice coalition including Pennsylvania NOW whom I represented.

For a very long time Pennsylvania has focused on restricting women’s access to abortion services – currently accounting for over 1270 pages of legislation and regulations in the state.  This wrong-headed approach to health assumes that women’s sole need is to protect them from safe, legal access to decent abortion care services.  In other words, the state has wrong-headedly been crafting laws and regulations to deny access to abortion, sending more and more women to the back alleys similar to the Gosnell clinic and ignoring the broader issues of women’s health equity.

Women’s concerns about their health are broadly based in bias based on gender. Terry L. Fromson, Amal Bass, Carol E. Tracy, Susan Frietsche of the Women’s Law Project  created a report entitled Through the Lens of Equality: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women in 2012.  The WLP is Pennsylvania’s feminist legal organization that engages in litigation, advocacy, and education to ensure women’s equality and treatment in Pennsylvania. This report set the context for yesterday’s meeting.  The WLP framed the health care agenda as follows in this report and in the meeting this morning:

The legal and social status of American women has changed dramatically in the last fifty years. Half a century ago, it was legal to segregate jobs by sex, to refuse to hire or promote on the basis of a person’s sex, to fire women who became pregnant, and to limit the number of women admitted to professional schools such as law and medicine. Sexual and domestic violence were hidden from public view and public policy. Abortion was illegal and the birth control pill was not yet on the market. Today, women have taken their place in the working world and educational opportunities for women have expanded exponentially. Sexual and domestic violence are recognized as crimes and some resources are available to its victims. Abortion is legal and birth control is available.

Despite these advances, deeply embedded cultural biases and stereotypes about women’s place in society continue to impede women’s equal participation in society. In our homes and communities women are subjected to violence, poverty, and the burden of care taking responsibilities. In the workplace, women are paid less than men for the same work, remain concentrated in stereotypically female low-paying occupations, are subjected to sexual harassment and discrimination on the basis of pregnancy and care giving, and are denied advancement to managerial and higher paying positions. In school, young women are denied their fair share of sports opportunities and are sexually harassed and violated. Women are denied essential reproductive health care and subjected to discrimination in access to insurance coverage. Women pay more than men for the same coverage, and pregnancy is a preexisting condition that often denies pregnant women access to insurance coverage and therefore maternity care.  Access to abortion has been limited by burdensome legislative requirements, and providers and patients have been terrorized by an increasingly violent opposition. Attacks on access to contraceptive services have grown.

While many laws have been adopted to eliminate sex discrimination at work and at school, gaps persist that must be filled and enforcement needs to be strengthened. This is particularly true in Pennsylvania. While some Pennsylvania cities have outlawed employment discrimination on the basis of care-giving responsibilities and provide other accommodations for women who work, the Pennsylvania legislature has failed to adopt a statewide prohibition on discrimination on the basis of caregiver status or to provide family leave for caregivers. In Pennsylvania, the law permits insurers to price the cost of health insurance higher for women than for men, resulting in women paying more for individual health insurance policies and small employers paying more for health insurance for a predominantly female workforce. Pennsylvania’s sexual assault laws have for the most part eliminated discriminatory provisions, but the myths and stereotypes that continue to infect the criminal justice system hinder the investigation and prosecution of these crimes. The health care perspective on domestic violence and sexual assault is far too limited. Sexual assault is treated as a health care matter primarily in the immediate aftermath of a rape, even though the physical and emotional health consequences can be long lasting. Although a number of health care providers recognize that domestic violence is also a health issue, screening for domestic violence in health care settings is not universal. Poverty, which disproportionately impacts women, exacerbates the impact of sex bias in all of these realms….

Pennsylvania, with 6.5 million women, has consistently been found deficient in national studies on women’s health care measures. In their 2010 health report card, the National Women’s Law Center and Oregon Health & Science University placed Pennsylvania 32 among the 50 states and graded it unsatisfactory with respect to the status of women’s health….

To alleviate women’s health problems, it is necessary to eliminate adverse experiences — discrimination and bias — early in life and throughout life — and to improve access to health care, with an emphasis on care essential to women (pp. x-xii).

Representative Frankel heard this call to refocus the legislature from attacking women’s reproductive health to focusing — just like New York state’s “10 Point Plan for Women’s Equality” — on redirecting legislation in the General Assembly towards a women’s health equity agenda. So yesterday, almost 20 legislators from both houses attended a meeting with advocates seeking to improve women’s lives and health through a broad review and revision of Pennsylvania law.  The agenda covers reproductive health, women’s economic security, and women’s safety.

The ideas for change come from real-life stories of women in the state.  Calls to service agencies. Cries for help on hot lines. Requests for advocacy. And of course lots of research to back up the anecdotal stories.  The 24 suggested changes to Pennsylvania law that were presented are in areas where either no legislation has been introduced or where legislation to improve the bias are lagging or need to be revisited.  We, as advocates, understand that there are other areas of concern, but believe these health care agenda items are a good start.

Some of these ideas are conceptual at this point. Some have some preliminary model wording for new legislation, and some are already in the works.  Here’s the agenda:

Protect and Expand Women’s Reproductive Health Rights

1. Pregnancy Accommodations:  Require employers to provide accommodations to pregnant employees with temporary pregnancy-related conditions to allow workers to remain employed throughout their pregnancies while imposing minimal burdens on employers.
2. Support for Breastfeeding Mothers in the Workplace: Require all employers to provide compensated break time and a private, sanitary (not a bathroom) for all employees who need to express milk.
3. Buffer Zones:  Enact a statewide reproductive health care clinic buffer zone statute to protect safe access to essential health care.
4. Inmate Shackling: Strengthen pregnant inmate shackling law (Act 45 of 2010) to cover the entire pregnancy and a reasonable post-partum period for mother-child bonding and to eliminate the tasering of any woman known to be pregnant.
5. Medical Professional Conscientious Right to Refuse to Deliver Medically Inaccurate Information: Protect physician-patient relationships from political intrusion.
   

   Improve Women’s Economic Security

6. TANF (Temporary Assistance to Needy Families) Grant Amount: Increase TANF cash assistance grant levels.
7. TANF Asset Limit: Increase the TANF eligibility asset limit to encourage saving and financial independence.
8. Earned Income Disregard: Increase the earned income disregard and apply it to applicants as well as recipients.  FYI, the earned income disregard allows very-low income workers to continue receiving TANF, food stamps, and Medicaid if they make 50% or less of the poverty level.  This proposed legislation would raise this “disregard” level to 75% and would apply to applicants as well as recipients.
9. Childcare Works Waiting List: Eliminate the childcare works waiting list.
10. TANF Pre-Application Job Search: Eliminate or modify the TANF pre-application job search requirements.
11. Minimum Wage: Increase Pennsylvania’s minimum wage from $7.25 to $9.00/hour.
12. Gender Wage Gap: Strengthen Pennsylvania law to eliminate the 24% gender wage gap by prohibiting retaliation against employees for discussing wages (“pay secrecy”) and closing the “factor other than sex” defense to apply only to bona fide business-related factors.
13. Family Responsibilities Employment Discrimination: Prohibit family responsibilities discrimination in employment by amending the Pennsylvania Human Relations Act to prohibit family status discrimination in employment pursuant to an expanded definition of familial status to encompass the true scope of familial responsibilities shouldered by employees.
14. Paid Family and Sick Leave: Require all employers to provide employees with paid family and sick leave
15. Spousal Pension Benefits: Require spousal consent when a retiring state employee chooses how his or her pension benefits should be paid consistent with federal law protecting each spouse from his or her spouse’s selection of a pension benefit in all privately-sponsored pension plans and laws adopted by other states.
16. Domestic Worker Protection: Amend Pennsylvania anti-discrimination laws to provide domestic workers protection from employment discrimination
17. Sexual Harassment: Extend the prohibition on sexual harassment in employment to all employers, even small employers.
    

    Protect Women’s Personal Safety

18. Paid Leave for Domestic Violence, Sexual Violence, and Stalking Victims: Require employers to provide paid leave to obtain assistance for and pursue legal protection against domestic and sexual violence and stalking.
19. Housing Discrimination: Prohibit private and public housing discrimination against domestic violence victims.
20. Civil Orders of Protection for Sexual Violence and Stalking Victims: Authorize courts to issue civil orders of protection for sex crime and stalking victims.
21. Absolute Privilege for Student Victims: Protect victims/witnesses of sexual assault who testify in school grievance proceedings from being sued by their harassers.
22. Human Trafficking: Strengthen Pennsylvania’s criminal statute on human trafficking.
23. Veterans’ Real Estate Tax Exemption: Amend Pennsylvania law to provide veterans real estate tax exemption for veterans suffering from PTSD (Post-Traumatic Stress Disorder) due to sexual victimization during service and appoint women representatives to the House and Senate Committees on Veteran Affairs and to the Pennsylvania State Veterans Commission.
24. Voting Reform: Reform voting rules to provide online registration, same day in person registration, early voting, including early in person voting on weekends.

These ideas will be discussed in continuing meetings between members of the General Assembly’s Health Care Agenda Caucus and advocates for women’s equality.  I’ll post more on these issues as this legislative program becomes better defined.