The Obama administration will soon announce the final rule governing the reproductive health services insurers must offer women without additional cost sharing as a result of the Women’s Health Amendment in the Affordable Care Act. One question, however, remains: will President Obama cave to the pressure of religious groups and expand the interim rule’s existing conscience clause to allow all religiously affiliated organizations to deny comprehensive coverage to the millions of women who work for them? For the sake of anyone who has ever had to fear that a routine health care encounter could turn into a struggle between their medical needs and their provider’s private religious beliefs, including gay and transgender people, the answer should be no.

Broadening the conscience protections would not only undermine the potential of the Women’s Health Amendment (as well as of the Affordable Care Act) to improve the health and well-being of millions of women and their families. It would also perpetuate a dangerous precedent that already allows Bush-era religious refusal policies to continue to hinder the ability of public health efforts to reach populations in need of services.

For example, the PEPFAR program, which was established during the Bush Administration to bring health services to people around the world living with or at high risk for HIV/AIDS, contains a religious refusal clause that has had substantial negative impact on critical work internationally with populations most at risk for HIV. In places around the globe that have been hardest hit by AIDS, people in need of medical care may have only one health center accessible in their area. If that health center is run by a faith-based organization that refuses to provide proven preventive methods such as condoms or appropriate and comprehensive HIV prevention information, people must go without health care services that could save their lives.

And on World AIDS Day, we cannot forget that carving out ever-larger religious exemptions in insurance benefits and health care similarly has the potential to undermine efforts to halt the domestic AIDS epidemic, particularly among stigmatized populations such as men who have sex with men (MSM) and transgender people.

Right now the struggle is over contraceptives. But one day those same organizations who exploit religious refusal clauses to deny birth control to women or condoms to people trying to prevent the spread of HIV in their communities may take the opportunity to try to opt out of covering any HIV-related services, to refuse to administer exams or treatment for other sexually transmitted infections, to deny blood transfusions or end-of-life care, or to refuse to join the growing number of employees offering insurance benefits that are inclusive of transgender people or same-sex partners and their children.

One of the cornerstones of the Affordable Care Act is expanding access to insurance coverage and vital health services for everyone who needs them. An expanded religious exemption in the WHA rule would violate this fundamental principle by allowing private religious beliefs to trump evidence-based best practices in public health.

The Budget Control Act of 2011 includes a sequestration process that will make automatic cuts to domestic and defense spending in January 2013 unless Congress can agree on a proposal to lower the national deficit by at least $1.2 trillion over 10 years. Since the demise of the super committee, both parties have signaled their displeasure with the automatic mechanism and Republicans have promised to draft legislation that would eliminate or disperse the $600 billion of proposed reductions to military spending on to other federal agencies.

But today, a group of seven House Democrats led by Rep. Edolphus Towns (D-NY) beat the GOP to the punch and introduced H.R. 3519 in an effort to exempt Medicare from the $123 billion in cuts to provider reimbursements:

“Hospitals in New York are already slated to experience $15 billion in Medicare and Medicaid cuts under the Affordable Care Act over the next ten years,” Towns said. “If sequestration occurs, hospitals will lose another $2.6 billion — or over $116 million in my district alone.

“Cuts like these will severely harm patient access to care and undermine an employment base that supports over 700,000 jobs in New York State,” he said. “We simply cannot balance the nation’s budget on the backs of seniors, while simultaneously harming jobs.”

Meanwhile, a group of 40 other Democrats have penned a letter to President Obama urging him to maintain the sequestration cuts. Obama has threatened to veto any measures that reduce sequestration without making corresponding reductions to the deficit.

House Assistant Democratic Leader Rep. James Clybrun (R-SC), the House whip, is not an official sponsor of H.R. 3519, but has recently said, “I would love to see us do something that would not require that those triggers get pulled.” He added, “Because if those triggers get pulled, it’s across the board. It is going to be nasty. It would be a meat-ax approach, and I don’t think that’s the best way to do it. So there’s still time.”

Aside from advocating for a national individual health insurance mandate, Todd Zwillich notes that in January 2008, Newt Gingrich also called for mandatory physical education classes as a way to combat obesity. “I believe we ought to have mandatory, K through 12, five-day-a-week physical education,” Gingrich said, building on an idea he introduced in 2006′s Saving Lives & Saving Money. From page 155:

Demand that physical education be part of the school curriculum…The only place many kids can get supervised daily activity is in school. Physical education in schools is done under a federally mandated guideline. Although it states that schools are to provide physical education classes three to four times per week, the only state holding to this guideline is the state of Illinois. Demand it.

Interestingly, conservatives have repeatedly misrepresented First Lady Michelle Obama’s Let’s Move! obesity prevention campaign as a government assault on personal freedoms and liberties, when in reality that program only seeks to tackle the obesity epidemic through a mix of private and public incentives. Gingrich’s solution sounds calls for far more dictatorial measures.

Conservatives like to pretend that the United States enjoys the best private health care system in the world, where some may have trouble purchasing insurance coverage, but everyone has access to care when they absolutely need it. Case in point, Sarah Kliff’s interview this morning with House Majority Leader Eric Cantor (R-VA) about his support for Marilyn Tavenner, the administration’s nominee to oversee the Center for Medicare and Medicaid Services:

“I could absolutely work with her,” Cantor told me in an interview this morning. “She would be a real benefit for patients. Obviously she’s operating within a context, within the structure of a law that I didn’t support, but I do think she will bring to the job a perspective of the American health care system that has made it so great, a system that’s based on the private sector.”

Most health care providers work in the private sector, but it’s hard to argue that the American health care system is “based in the private sector” when the government finances almost half of national health care spending.

For instance, in 2010, growth in private health insurance premiums remained low, as 5.1 million enrollees lost their jobs or simply couldn’t afford to maintain their coverage. Many enrolled in safety-net health care programs like Medicaid, resulting in a spending increase of 7.2 percent. By 2014, private growth is projected to accelerate — thanks to health care reform — but even then, “private health insurance is anticipated to account for roughly 31 percent of national health spending, or about the same share as was expected without enactment of the Affordable Care Act,” actuaries at CMS estimate. “For 2011–13, government outlays (averaging 5.2 percent growth) are projected to roughly maintain a 45-percent share of total health spending.”

So in truth, ours is a hybrid public/private health care system, but if lawmakers like Cantor succeed in vouchering Medicare, block granting Medicaid and repealing the Affordable Care Act, then their mythology may become reality.

President George W. Bush called on “wealthy nations” — including the United States — to continue funding the President Emergency Plan for AIDS Relief (PEPFAR), a program he signed in 2003 for providing anti-retroviral (ARV) treatment to people living with HIV/AIDS around the world. Speaking at a panel discussion to commemorate World AIDS Day from Tanzania, Bush said, “I understand we’re in tight budget times,” but insisted that increasing federal funding for HIV/AIDS treatment and prevention should remain a national priority:

BUSH: There is no greater priority — and this is something our American citizens must understand and our government must understand — there is no greater priority than living out the admonition, to whom much is given, much is required. We’re a blessed nation in the United States of America and I believe we are required to support effective programs that save lives.

Watch it:

According to AVERT — an international HIV and AIDS charity — funding for PEPFAR from 2009-2010, “was effectively flat-lined in contrast to the much higher previous year-on-year increases in funding, especially from 2006-2009.” “President Obama’s proposed 2011 budget included almost $7 billion for PEPFAR, representing a 1.8 percent increase on the previous year. However, according to some activists this slight increase actually represents a ‘step backwards’ due to inflation and increasing demand for treatment.” The FY2011 budget “included a 5 percent ($50 million) decrease in funding to the Global Fund compared to the previous year.”

Despite the poor economy and an increase in the number of adults without health insurance, the uninsurance rate among children has declined from 9.3 percent to 8.0 percent nationally, a report from Georgetown University finds. The researchers are attributing the drop to growing access to the children’s Medicaid program as a result of the Affordable Care Act (states that reduce their eligibility are penalized), President Obama’s re-authorization of CHIP in 2009, and the additional stimulus funds that helped states maintain their safety-net health care programs.

Thirty-four states experienced decreases in the number of uninsured children between 2008 and 2009, with Florida seeing the most significant drop. Massachusetts still leads the nation with the lowest rate of uninsured children, while Nevada continues to have the highest. Seven states are now home to a higher rate of uninsured children, “but in only one state, Minnesota, was that increase significant“:

There are 16 states with a higher rate of uninsured children than the national average, 30 states with lower rates, including D.C., and five states with rates that are not statistically different from the national average.

States with rates that are higher than the national average are concentrated in the West and the South, while the majority of states with rates below the national average are located in the Northeast or the Midwest.

Just six states (Arizona, California, Florida, Georgia, New York, and Texas) account for more than half of the children without insurance nationally.

Look: