Earlier this week, the Department of Health and Human Services released the long-awaited set of preliminary guidelines for the development and operation of the health insurance exchanges. The exchanges, part of the reforms introduced by the Affordable Care Act, are intended to connect small businesses and individual consumers with health insurance options.

Gay and transgender people and their families stand to benefit significantly from the exchanges, as they are roughly twice as likely as the general population to be uninsured (largely because discrimination in employment and relationship recognition limits their access to employer-sponsored private coverage). The exchanges, which will utilize subsidies and tax credits to connect customers with coverage offered by private insurers, will help LGBT people access coverage even if they are unemployed, if they work for an employer who does not offer health insurance benefits, or if their employer refuses to offer benefits for same-sex couples. Thus, it is crucial that the design, implementation, and management of these new insurance marketplaces take the needs of LGBT people into account.

The proposed rule includes nondiscrimination protections on the basis of sexual orientation and gender identity. To buttress these protections, federal and state policies around the essential health benefits that private insurers participating in the exchanges will have to offer — guidelines that the Department of Health and Human Services is still developing — should provide similar protections.

This week’s rule is an important step in constructing the architecture of a state-based exchange system that is prepared to serve the needs of all its future consumers, including gay and transgender people and their families. The states should prepare to seize the opportunities offered by the proposed rule to create exchanges that combine flexibility of design with a firm commitment to ensuring that coverage reaches everyone who needs it.

Rep. Paul Ryan is disputing claims that two independent advisory boards he introduced as part of his Patients’ Care Act (PCA) mirror the Affordable Care Act’s Independent Payment Advisory Board — a 15-member panel that he argues would “ration” health care. Responding to a blog post by the Incidental Economist’s Don Taylor that highlighted the similarities between Ryan’s boards and the IPAB, Conor Sweeney — the House Budget Committee’s Communications Director — sent Taylor a letter defending its chairman:

-The PCA empowers beneficiaries whereas the ACA enmpowers IPAB — “an unconstitutional board.”

-The ACA IPAB will “impose price controls, cut provider reimbursements, or make coverage determinations by fiat,” but the PCA’s Health Services Commission “exists solely for the purpose of encouraging transparency and proper metrics with respect to health care services.”

-IPAB will control Medicare costs by cutting provider reimbursements, “denying care for seniors.” Ryan’s Health Services Commission has “no authority to influence Medicare spending.”

But Ryan’s “differences” don’t mask the striking similarities between IPAB and the two boards proposed under the PCA — the Health Services Commission and the Forum for the Quality and Effectiveness in Health Care. In fact, in many ways, the PCA’s boards are more intrusive and hit providers harder. Read the pages 206-215 of the PCA Act here. ThinkProgress has also assembled a chart to illustrate:

-Sarah Bufkin

An Oregon District Attorney denied the abortion request of an apparently suicidal woman who was in custody after she attempted to set herself and a hotel room on fire. DA Brad Berry argued that the woman, 23-year-old Bridget Burkholder, was not mentally fit and shouldn’t be allowed to get an abortion — just as she shouldn’t be allowed to get a boob job:

District Attorney Brad Berry said the case raises very difficult issues.

First and foremost, he said, is the issue of Burkholder’s mental competence to make an informed decision with such long-term consequences. He said that allowing a mentally incompetent person to undergo any elective medical procedure raises potential red flags legally.

He raised the question, “If we wouldn’t allow her to have her breasts reduced in this state,” or have a benign tumor removed, how could she be allowed to choose an abortion? He said a guardian might have to be appointed to make that decision for her.

Berry’s argument doesn’t hold water — if he believes she wasn’t mentally competent enough to have an abortion, why would she be any more capable of being a mother? Giving birth is, after all, another decision with “long-term consequences.” It’s disturbing that state officials were comfortable forcing a woman they believed to be unstable to carry a pregnancy to term.

The News Register notes that if she hadn’t been poor, “Burkholder would have been free to pursue the procedure on her own,” but “she lacked the means to meet her bail.” The judge and sheriff in the case also made it nearly impossible for Burkholder to terminate her pregnancy, refusing to authorize it and passing the responsibility back and forth to one another.

Berry’s comments are simply the latest example of rhetoric that disparages women seeking abortions as selfish, frivolous party girls “who would abort a pregnancy to fit into a prom dress.”

Rep. Michael Burgess (R-TX) badgered Health and Human Services Secretary Kathleen Sebelius during this morning’s Energy and Commerce hearing focused on the Independent Payment Advisory Board, insisting that HHS should cut a check to Congress for the money it has not spent in establishing the panel:

BURGESS: Who has been nominating to that board and is awaiting confirmation?

SEBELIUS: No one

BURGESS: And why is that?

SEBELIUS: Well, I think Congressman, the board is not activated until 2014, and I know that the President is in discussion with a number of potential nominees and I know that he’s consulted with various members of Members of Congress, but it will be up and running at the time.

BURGESS: So can we keep that $15 million that’s due October 1st because you apparently don’t need it…

SEBELIUS: We have no intention of using the money before there is a board up and running.

BURGESS: Well, who does the check go to?

SEBELIUS: I don’t think there is a check, there is money available that we would draw down.

BURGESS: Can we have that money back? We’re in a debt crisis, you may have heard.

Watch it:

First, keeping the Medicare growth rate below a certain point would do far more to reduce government spending than returning the $15 million needed to establish the board. Second, Sebelius couldn’t cut a check to Burgess even if she wanted to. The money is a mandatory annual appropriations that likely expires at the end of the year if it’s not spent by the agency. As Burgess well knows, that’s how the federal government operates.

Planned Parenthood of New Hampshire has stopped providing contraception to lower income women after the state’s executive council “rejected up to $1.8 million in funding for the group” because it also offers privately-funded abortions. As one council member, Raymond Wieczorek, put it, “I am opposed to abortion. I am opposed to providing condoms to someone. If you want to have a party, have a party, but don’t ask me to pay for it.”

But now, NARAL’s Blog for Choice is reporting that the council may be reconsidering its decision:

The Executive Council will meet again [today], and could reconsider its vote to defund Planned Parenthood. If you live in New Hampshire, take action through our affiliate.

And not a moment too soon: Nick Toumpas, New Hampshire’s commissioner of health and human services, said that cuts to family-planning funding put the state at risk of losing federal dollars.

So [today] will be a test of how far these politicians want to take their attacks on women’s health care.

Since losing its state contract — which also paid for education, distributing contraception, and the testing and treatment of sexually transmitted infections — Planned Parenthood clinics have “turned away 20 to 30 patients a day who have arrived to refill their birth control prescriptions.” An estimated 70 percent of patients are uninsured.

A recent national poll found that 78 percent of Americans believe the government “should subsidize birth control and other family planning services, excluding abortion, at government-funded clinics for low-income women.” Contraception improves women’s health and can help reduce the number of unwanted pregnancies and abortions. According to data from the Guttmacher Institute, 54 percent of women who have abortions “had used a contraceptive method,” but 76 percent of birth control pill users and 49 percent of condom users “report having used their method inconsistently.” Forty-six percent of women “who have abortions had not used a contraceptive method during the month they became pregnant.”