A day at the Philadelphia Women’s Center: How staff navigate state restrictions to provide compassionate abortion care

By Julie Zaebst, Senior Policy Advocate, ACLU of Pennsylvania

On a recent day in March, a group of our staff was glued to our phones in anticipation of the Georgia state House vote on a draconian anti-abortion bill. The bill would ban abortion at six weeks gestation — a stage before most people even know they are pregnant. But as this circus was unfolding in Georgia, we were also preparing to spend the day at the Philadelphia Women’s Center, getting an inside look at what it actually means to provide abortion care under the current regime of restrictions and red tape in Pennsylvania.

The Philadelphia Women’s Center is an independent abortion provider that has been providing first- and second-trimester care for more than 45 years. Every day, their staff arrives at work prepared to navigate byzantine laws and regulations that were designed to make their jobs of providing safe, compassionate, and timely abortion care difficult. But despite the politically motivated restrictions, they’ve developed systems to make the experience as seamless as possible for patients.

By the time patients arrive for their appointment, they have already cleared countless hurdles. First, they must locate a provider and get themselves to the office. With more than 85% of counties in Pennsylvania lacking an abortion provider, this is no small feat. The number and locations of abortion providers is not a reflection of the need for care; rather, it is a reflection of the challenges of opening and operating a clinic, a task made more difficult by restrictions the state imposes only on abortion providers and not on other similar healthcare providers.

Of course, patients must arrange time off from school or work for their appointment. For low-income folks, this may mean a day without pay that their family counts on for survival. The majority of patients are already parents, so securing affordable childcare is often another obstacle that they face.

State law imposes a mandatory delay on patients: at least 24 hours before their procedure, they must receive state-directed counseling from a provider. The Philadelphia Women’s Center offers a couple of options to make this process as least burdensome as possible to patients. But if a patient misses their counseling session and they can’t reschedule quickly enough to satisfy the waiting period, they have to cancel their procedure and restart the scheduling process.

Perhaps the biggest barrier of all is the ban on insurance coverage of abortion care. During our visit, we had the chance to read patients’ entries in journals that the center provides in their waiting room. Many of them shared that their decision to get an abortion was driven by financial circumstances — they simply couldn’t afford to raise a child (or, in many cases, another child). According to a study by Guttmacher Institute, 75 percent of the people who received abortion care in 2014 were low-income.

Still, PWC staff must break the news to most of their patients that their insurance will not cover their procedure because state and federal law prohibit Medicaid from covering abortion care in most circumstances.*

Because most patients who are insured through Medicaid must pay out of pocket, some may wind up “chasing the fee,” as one staff member explained to us. A patient may take a few weeks to scrape together the money needed, only to find out that the cost of care has increased because they are now further along in their pregnancy — so they have to go back to the drawing board.

A patient must navigate all these barriers before they even arrive at the center for their procedure. And for some patients, the hurdles are even higher: for incarcerated folks, for instance, or for young people, who must obtain consent from a parent or get a judicial bypass.

When they arrive, patients will likely be greeted by anti-abortion protesters outside the clinic — but also by escorts, who help them make their way inside safely. There, staff will welcome them and prepare them for their procedure.

What we observed during our visit were dedicated, compassionate medical providers doing what they were trained and committed to doing: providing healthcare. The only difference we saw between the Philadelphia Women’s Center and any other healthcare facility? Doctors and patients — those who know best — face politically motivated restrictions and interference.

It’s the End of the Road for the State Legislative Session. So What Happened?

Football player Malcolm Jenkins lobbying in Harrisburg for the passage of the Clean Slate Act.

By Elizabeth Randol, Legislative Director, ACLU of Pennsylvania

It’s official: Today marks the legal end of the Pennsylvania General Assembly’s two-year legislative session. The ACLU-PA’s work in Harrisburg often ranges from hair-on-fire to hurry-up-and-wait. Sometimes we’re able to celebrate our proactive work getting good legislation enacted. But much of what we do, and no less important, is defensive — trying to prevent bad bills from passing or making bad bills less bad.

If there’s one mantra we repeat at the ACLU-PA, it’s to pay attention to your state legislators. Bills passed in Harrisburg often have a far greater and more immediate effect on your life than those enacted in Congress.

Wins

In the 2017-2018 legislative session, we celebrated two major victories that will significantly improve the chances of people getting back on their feet post-conviction. The first was the passage of the Clean Slate Act. This new law – the first of its kind in the nation – automatically seals from public view the criminal records of people convicted of certain summary and misdemeanor offenses if they are not convicted of another crime within ten years.

The legislature also repealed a longstanding mandate to suspend drivers’ licenses of people convicted of crimes unrelated to operation of a vehicle, many of them drug offenses. Repealing this mandate will prevent more than 20,000 Pennsylvanians a year from unnecessarily losing their licenses.

We also successfully beat back yet another attack on reproductive freedom when Governor Wolf vetoed an abortion ban that, had it been enacted, would have been the most restrictive ban in the country and stopped a discriminatory amendment from the CHIP (Children’s Health Insurance Program) reauthorization bill, which sought to prohibit insurance coverage for transgender-related healthcare services.

Losses

The most frustrating loss this session was a bill that enabled the use of police-worn body cameras in Pennsylvania. While the use of body cameras can be an effective means of ensuring police transparency, the bill exempts footage from the state’s right-to-know law, severely restricting public access to video recorded by police cameras. As a result, it undermines the ability to hold police accountable and instead equips them with a powerful data collection and surveillance tool.

On the Lookout

There’s no rest for the weary – the General Assembly returns and reboots in January. Next session we anticipate continued fights against abortion bans, so-called “sanctuary city” legislation, restrictions on police transparency, and a proposed amendment to the PA Constitution known as Marsy’s Law.

The most significant battle we are preparing for is a campaign to prevent the reinstatement of mandatory minimum sentences in Pennsylvania. Reinstating these archaic provisions is an invitation to regress by re-adopting outdated and ineffective “public safety” measures that disproportionately damage communities of color and concentrate unreviewable power in the hands of prosecutors.

The midterm elections didn’t change the balance of power in Harrisburg — we still have a Democratic governor and Republican-controlled House and Senate. Democrats did pick up five Senate seats (breaking the Republican supermajority) and 11 House seats, which may result in increased negotiating leverage for Democrats. But those wins came at the expense of losing most of the moderate Republicans remaining in the legislature. And that may, unfortunately, result in an even more polarized legislature heading into the 2019-2020 session.

We know that it can feel like there are a lot of fires burning right now for people who care about civil liberties – not to mention basic human decency. We’re going to need you to achieve our goals at the state legislature next year. So rest well, enjoy the holidays, and we’ll talk again in January.

Discrimination in CHIP Renewal is Hurtful to Transgender Youth. Shame on Our State Senators.

My name is Carrie Santoro, and I want to tell you about my son Finn.

Finn loves hiking and exploring nature.

His favorite holiday is Valentine’s Day, and he hates to see people in pain.

He is Student Council President, loves to read, and bemoans homework.

He has a little sister who would swear that he hung the moon and stars just for her.

Loving and nurturing other people is woven into the fabric of who he is. He is a ray of sunshine that makes our corner of the world a brighter place.

He is also transgender.

When Finn told us he was a boy at the end of the third grade, we supported him during his transition to live openly as male. The difference we saw in him was unbelievable. He did better in school, he was happier at home, he talked about his future, and he absolutely glowed, as the way he saw himself was finally reconciled with who everyone else saw on the outside.

Two years ago, we had our first appointment with a pediatric endocrinologist. The medical options available — which, make no mistake, can be life saving for trans youth — were largely not covered by insurance and incredibly cost prohibitive.

Luckily, federal legal protections expanded and eventually trickled down to states, and enough doctors, patients, and parents of patients successfully (and painfully) appealed insurance company denials of these services to set precedent that makes denials in Pennsylvania rare.

The state Senate’s recent passage of House Bill 1388, which renews the Children’s Health Insurance Program with a provision that discriminates against trans youth, threatens that progress.

Senator Don White, the author of the trans discrimination provision, chose to hold hostage 176,000 children insured through CHIP, fabricating a choice between them and care for my son, in a publicity stunt meant to turn people against each other for his own political gain.

For reasons lost on most, Senator White chose to politicize Finn’s existence to sow discord among those of us who have more in common than not, to demonize my son, and to turn other parents and, subsequently, their children against him.

As for the other 33 Republicans, including my state senator, Patrick Browne, and three Democrats who voted to advance a bill that says my son is less human and says appealing to the very worst of human nature for cheap political points is worth sacrificing him on the altar of your own ambition, shame on you.

Shame on you for stoking fear and prejudice and deciding to vote based on political expediency rather than public service or even facts.

Shame on you for being more concerned about re-election and intra-party political promotion than advocating for what is right and just.

Considering Pennsylvania legislators are the second highest paid in the country — topped only by California — I understand you have a lot to lose. But we have more.

You could have stood on solid moral ground and told your colleagues and constituents that the American College of Physicians, the American Medical Association, and the American Psychological Association are just a few of the many organizations that agree gender-transition services are medically necessary for children like my son.

You could have eased their economic concerns by sharing studies like the 2015 analysis by Johns Hopkins Bloomberg School of Public Health that show this care is cost-effective for insurance companies, as transgender people make up a small segment of the population and gender-affirming services actually reduce patients’ future health expenses.

You could have chosen to use your station as a source for change in public understanding of the trans community. You could have publicly called this amendment what it is — hateful, unnecessary, and absurd — and exposed the political motivations behind it. Instead, you continue to fail us. All of us.

Who will be Harrisburg’s next target for exclusions? Will they follow the national model of going after kids with asthma? Cancer? Perhaps cystic fibrosis? Where will they draw the line? The precedent set by this bill will not only affect transgender children nor will it only affect children insured by CHIP.

Bills like HB 1388 that include hateful and exclusionary provisions are not based in economics or medical science nor are they for the greater good. They are meant to call into question the humanity of children like my son and perpetuate the myth that they are less deserving of needed health care.

Our children deserve better. My son deserves better.

Carrie Santoro writes from Lehigh County.

My transgender son is trying to find his way. Politicians aren’t helping.

By Ellen*

I’ll never forget when my son, Jacob, told me that he is transgender. He was 13 years old at the time, and we were out for dinner. As he ate his lobster, he looked at me and said, “Mom, I’m in the wrong shell,” as tears welled in his eyes.

Since his decision to live openly as male, I have done everything that I can to support his healthcare needs, both physical and emotional. We found a pediatrician who has a well-deserved reputation for being supportive of transgender kids, and she has been wonderful. The Mazzoni Center in Philadelphia has also been an irreplaceable resource. He is now 15 and has the healthcare support that he needs.

His social isolation, though, has been a greater struggle. When Jacob came out, he was attending a brick-and-mortar charter school. Being an adolescent is hard enough, but being a transgender teenager is incredibly difficult. We all know that teens can be abominable to one another, and his classmates did not understand Jacob’s experience and gave no indication of interest in understanding what it’s like to be transgender. He had one friend who outed him to others who did not know that he’s trans, which compounded his social anxiety. He now attends a cyber charter school. He has become introverted, uncomfortable with other kids, and friendship with others his age is very difficult for him.

Philadelphia Trans March, October 7, 2017 (photos: Rick Urbanowski Photography)

I celebrate and am grateful for the many trans kids who are able to live their lives openly with support from their families and their friends. I want my son to live the fullest life possible as the person he is, and I hope we’re moving toward a day when transgender people in America are treated with the same respect and dignity as everyone else.

Politicians compound the challenges for transgender youth when they actively pursue discriminatory policies against the trans community. When elected officials use transgender people as a wedge to score cheap political points, it feeds a negative narrative about the lives of trans people, and that narrative is felt acutely by young people.

The Pennsylvania Senate recently engaged in this very kind of underhanded behavior when it passed a bill to renew the Children’s Health Insurance Program with a provision that prohibits CHIP coverage of transition-related surgical procedures. This isn’t a benign policy discussion about how expansive CHIP should be. This is an effort to diminish the humanity of trans youth. If it becomes law, this bill would deny coverage of medically necessary and sometimes life-saving medical care for transgender young people. It feels like nothing less than dehumanization of my son and kids like him.

Jacob and I are lucky that we are able to access private health insurance. Unlike our state senators, though, I have a basic level of empathy, and I don’t need the experience of using CHIP to be able to relate to any parent of a transgender child who just wants the best healthcare coverage possible for their kid.

The teenage years are fraught with challenges. And transgender teens face unique hurdles that cisgender kids do not. They don’t need politicians making things worse.

*Ellen and her son live in Lehigh County. She writes using pseudonyms for both herself and her son to protect their privacy.

Is it time to legalize marijuana in Pennsylvania?

By Matt Stroud, Criminal Justice Researcher, ACLU of Pennsylvania

Is it time to legalize marijuana in Pennsylvania? Photo via herb.co.

Citations and charges can ruin lives. It can be traffic tickets with fines too high to afford, disorderly conduct charges, other non-violent offenses, or even violent offenses that reflect an earlier time in someone’s life before they had a chance to grow up and reform. Any entrance into the criminal justice system can be an automatic ticket to second-class citizenship — a way for employers to discriminate, for judges to make unfair sentencing decisions, and for peers to judge.

As part of ACLU-PA’s efforts to reduce the commonwealth’s incarceration rate, it’s our goal to lessen the number of people ensnared into the criminal justice system. We consider Pennsylvania’s marijuana laws to be low-hanging fruit in that regard.

While a recent Franklin & Marshall poll found that 59 percent of Pennsylvania residents believe marijuana should be legal, retrograde laws nonetheless trap thousands of people in the criminal justice system for pot-related offenses every year. And those numbers have risen in recent years.

Over the last several months, we’ve worked with marijuana advocates and data specialists to quantify Pennsylvania’s cannabis crackdown. And on Monday, October 16, we plan to reveal what we’ve found during a press conference at the Pennsylvania State Capitol in Harrisburg.

Stay tuned for more about Pennsylvania’s cannabis crackdown.

IN OTHER NEWS

(Criminal justice news deserving of an in-depth look.)

Philadelphia Police Commissioner Richard Ross has some explaining to do. Photo via The Philadelphia Inquirer.

  • Philly.com: “Study: High rates of stop-and-frisk even in Philly’s lowest-crime black areas”

“It’s not just black people, but entire, predominantly black, neighborhoods that are disproportionately impacted by the Philadelphia Police Department’s use of stop-and-frisk. That’s a key finding of a new analysis of police data from 2014 to 2015 by Lance Hannon, a Villanova University professor of sociology and criminology who began analyzing publicly available police data after the presidential candidates clashed over the effectiveness of stop-and-frisk in debates last year. He found that mostly black neighborhoods drew 70 percent more frisks than nonblack areas, yet yielded less contraband. And, he discovered, the elevated rate of frisking was consistent whether the predominantly black neighborhood was a high-crime area or a very low-crime area. Although many African American neighborhoods in the city have low crime rates, he said, ‘People, police officers, and nonpolice officers tend to judge the dangerousness of a place based on racial predominance. When they think of a black area as being dangerous, they are thinking of the outliers — and all the other neighborhoods that are relatively safe get painted with the same brush.’”

  • Bloomberg: “Prison Video Visits Are No Substitute for Face-to-Face, Especially at These Prices”

“There are 650 U.S. correctional facilities offering some form of video viewing. Like Tazewell, most are county jails, and three-quarters have eliminated in-person visits, often as a stipulation of their contract with the company charging for the video feeds. Tazewell did so in 2014, when it hired Securus Technologies Inc., a prison phone company that now controls about a third of the video market. The business has been lucrative enough to attract the attention of the private equity world. In February, Platinum Equity LLC, the firm run by Detroit Pistons owner Tom Gores, agreed to buy Securus for $1.6 billion, more than double the company’s 2012 valuation. The proposed deal has come under scrutiny from both regulatory commissions and prisoners’ advocates, delaying its likely approval.”

  • TeenVogue: “Why Young Girls Die Behind Bars”

“Arrests of young women during fights with family members such as the one that led to Gynnya’s incarceration are unfortunately all too frequent. According to Unintended Consequences, a report by the National Girls Initiative of the federal Office of Juvenile Justice and Delinquency Prevention, ‘under state domestic violence laws, many law enforcement officers, arriving in homes in which girls are fighting with their parents or caregivers … often respond by making an arrest.’ As a result, ‘in-home conflict is a significant pathway for girls’ involvement in the justice system and many of girls’ arrests are for simple assault of their mothers or caregivers with no or minor injury.’ In fact, one study of 320 domestic violence calls in Massachusetts found that police were more likely to arrest young women in cases of disputes with parents and among siblings than between intimate partners.Nationally, girls of color are disproportionately arrested for assaults of family members in their homes. In Washington State, Black and Native youth are arrested for assault at a rate between 2 and 4 times greater than white youth.”

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Replacing Medical Judgment with Political Will: PA Pushing Extreme Anti-Abortion Bill, Again

By Amanda Cappelletti, Larry Frankel Legislative Fellow, ACLU of Pennsylvania

Gov. Wolf announces his intention to veto SB3 at a press conference in Philadelphia (credit: Ben Bowens)

The legislative session has barely begun, and we’re already seeing some of the most extreme bills being introduced and pushed through. In that collective is Senate Bill 3, a bill that would ban abortion after 20 weeks and would ban a medically proven, safe method of abortion. This type of legislation puts women’s health at risk by preventing doctors from making decisions based on their professional medical judgment, in consultation with their patients.

In addition to replacing medical expertise with political will, this bill provides the narrowest of exceptions for abortions after 20 weeks: to prevent death of the mother and substantial and irreversible impairment of a major bodily function of the mother. But with no definition of “major bodily function,” it is unclear when this exception applies. There are no exceptions for pregnancies that result from rape or incest. There are no exceptions for fetal anomalies. Every woman’s circumstance is different, and this bill takes away her ability to decide what is best for her.

Abortion bans punish women. Not only do they strip a woman of ability to make a personal medical decision, but they can force her to go through severe mental and physical trauma. A Texas woman was forced to wait for her fetus to die in utero and endure a stillbirth because of a similar law, something no one should have to experience.

Doctors are at risk of punishment, too. SB 3 bans a medically proven, safe method of abortion — anyone who performs that method is guilty of a third degree felony. Our lawmakers are criminalizing doctors for following their professional training and conscience. This is one of the many reasons why the American Congress of Obstetricians and Gynecologists opposes these types of restrictions.

Extreme legislation like SB 3 has been enacted, challenged, and temporarily blocked or not allowed to go into effect while litigation proceeds in four states because of the serious constitutional issues these types of laws raise. It would seem that Pennsylvania lawmakers would like to add us to the list of states being sued for extreme abortion bans.

While we may not agree about abortion, we can all agree that physicians and not politicians should be a part of the medical decision-making process. We cannot stand by while politicians push their agenda into our doctor’s offices, with no regard for the health and well-being of women. A woman’s health, not politics, should drive important medical decisions. Contact your legislators and remind them — they’re not medical experts and shouldn’t be meddling.

Senate Bill 3 passed the state Senate on February 8 and is now under consideration in the state House of Representatives. Call your state representative today to tell them to vote “NO” on SB 3. To find your state representative, use our “find your legislator” tool, enter your zip code, and look for your representative under “governor and state legislators.”