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Exit interview: NOW’s O’Neill on GOP health policy and maternal deaths

WASHINGTON — Terry O’Neill has a warning at the end of her eight-year tenure heading the National Organization for Women: there is a connection between increasing maternal mortality in the United States and GOP policies under consideration in the U.S. Congress.

O’Neill’s leadership of the nation’s biggest organization for feminist grassroots activists traces an arc from the passage of hundreds of state laws on women’s reproductive rights in states like Texas to the election of Trump, who is championing some of those same measures at the federal level, including defunding Planned Parenthood. The 64-year-old O’Neill is term limited, and with an election set for later this month, she didn’t hold back in a wide-ranging exit interview with USA TODAY before she leaves office.

“Women are so severely being pushed back at the state level,” O’Neill said in an interview surrounded by cardboard packing boxes in her downtown Washington office. “So far we’ve been able to hold it off” at the federal level, she said; yet with Trump in office and a GOP-controlled Congress, “our champions are way overworked trying to put out all the fires” and there is no longer “a backstop against really terrible anti-woman legislation.”

The United States has the worst maternal death rate in the developing world and research suggests health-related complications — including diabetes and hypertension as well as mental health and substance abuse — are major contributing factors. These outcomes will worsen if Congress succeeds in scaling back Medicaid, which funds half of all births in the U.S., defunding Planned Parenthood and allowing states to opt out of Obamacare’s essential health benefit requirement that include maternity and mental health services, said O’Neill.

O’Neill made a number of provocative statements about what she thinks the Trump era means for women, including calling for Supreme Court Justice Neil Gorsuch’s removal if Trump is impeached as a result of an investigation into his campaign’s ties to Russia and calling Ivanka Trump’s efforts to elevate women’s issues “100% phony.” The president’s daughter is pressing for a proposal that includes six weeks of paid leave for new parents, yet many Republican lawmakers are likely to oppose it.


Health care changes

She reserved her sharpest comments for the current congressional debate over replacing the Affordable Care Act and defunding Planned Parenthood.  The bill is being rewritten in the Senate. Republicans have said they’d rather shift Planned Parenthood dollars to federal community health centers that don’t provide abortion services. Yet the vast majority of federal money that Planned Parenthood receives goes toward preventive health care, birth control and other services.

Texas, a state that declined Medicaid expansion under Obamacare and has essentially defunded Planned Parenthood, provides a case study, said O’Neill. According to the National Institutes of Health, maternal death rates have increased in the U.S. by 26.6%, from 2000 to 2014, with California showing a declining trend and Texas showing a sudden increase beginning in 2011.  A separate study in the medical journalObstetrics and Gynecology described the Texas increase from 2011 to 2015 as “puzzling,” without making a connection to the closure of 82 family planning clinics caused by a 66% decrease in family planning funds in the 2011 state budget.

A biennial report by the Texas Department of State Health Services found a number of reasons for the deaths, including that mental health and substance abuse play a “significant role” and found “pervasive racial and ethnic disparities.” In its recommendations, the report emphasizes “health inequities” and the need for increased access to health services. “We definitely recognize that the maternal mortality rate in Texas has been increasing,” said Chris Van Deusen, media director at the Texas Department of Health. “We don’t know of any evidence that one has caused the other,” he said.

Yet O’Neill sees a link between clinic closures and death rates. Half of all births in the U.S. are covered by Medicaid, and Planned Parenthood is often the sole provider of health services for women in poor communities. In Texas, a doubling of death rates in a two-year period after 2011 compares to a “modest” increase in the decade prior, according to the medical journal. In California, where expanded Medicaid dollars go to family planning clinics or nurse practitioners and access to birth control has expanded under Obamacare, maternal death rates are on the decline.

Republican critics point out that even the journal’s authors call a doubling of deaths in such a short time period “unlikely” in the absence of “war, natural disaster, or severe economic upheaval.”

“The increase in the maternal mortality rates for 48 states and the District of Columbia is a national tragedy, but we need to learn why this is happening, not leap to unfounded conclusions,” said Grace-Marie Turner, president of the Galen Institute, a research group that advocates free-market ideas for health reform. A separate National Review article points out that many cuts wouldn’t have taken effect until after the the apparent spike in death rates. Ascribing the data to the closure of Planned Parenthood clinics is ”not supported by evidence,” she said.

Coding anomalies may have also contributed to the Texas numbers, said Marie Elizabeth Thoma, a professor at the University of Maryland’s School of Public Health. Yet her soon-to-be published research finds “we still see an overall increase” in Texas while there’s little dispute that California’s rates are on the decline, she said.

In the U.S. Capitol, Senate Republican leaders want to pass their own version of a new health law before a congressional recess next month; and there is also likely to be a showdown over Planned Parenthood funding as part of a measure to finance the government for the rest of the year.


Russia and Gorsuch

In the interview, O’Neill also tried to lay down a marker over the investigation into Trump’s ties to Russia and potential obstruction of justice. “One of the things keeps me up at night is that Donald Trump gets impeached but his lifetime appointments remain in place, specifically Neil Gorsuch,” said O’Neill. “He should be removed from the Supreme Court in my mind” if Trump is found to have “committed treason,” she said. “We are now one vote away from overturning Roe v Wade. The maternal death rate will dramatically increase,” said O’Neill, citing figures prior to the 1973 Supreme Court decision legalizing abortion.

In 1965, when abortion was still illegal nationwide except in cases of life endangerment, at least 193 women died from illegal abortions, and illegal abortion accounted for nearly 17% of all deaths due to pregnancy and childbirth in that year The number of abortion-related deaths per million live births fell from nearly 40 in 1970 to eight in 1976. The trend was caused mainly by a decline in the number of deaths from illegal abortion — from 39 in 1972 to two in 1976. Since then, the overall rate has been less than one death per 100,000 legal abortions.

Article source: https://www.usatoday.com/story/news/politics/2017/06/18/exit-interview-nows-oneill-gop-health-policy-and-maternal-deaths/102811984/

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