Abstinence-only education does not work, and is actually dangerous to women’s health. It prevents honest conversation about women’s reproductive health needs and keeps young women from getting information that could save their lives. And yet, without any notification by the Obama Administration, an abstinence-only curriculum was recently added to the pregnancy prevention program list endorsed by the Department of Health and Human Services.

The program, entitled “Heritage Keepers Abstinence Education,” made it onto the “evidence-based” list some time this month, according to RH Reality Check. And in fact, it’s not a new program at all:

[O]ne of the “new” programs is actually an old, dis-proven and dangerous abstinence-only-until-marriage program.[...]

Perhaps the Administration realized that the inclusion of Heritage Keepers Abstinence Education on this select list would call into question its commitment to young people and their sexual health. Once again, they have succumbed to the political pressure of social conservatives and allowed the ideology of the right to prevail over the health and well-being of the nation’s youth. The Obama Administration’s endorsement of this abstinence-only-until marriage program runs in direct contradiction to its stated commitment to the health and well-being of young people and, quite possibly, its promise to uphold science and evidence.

There have been many studies that prove abstinence-only education to be ineffective. In states that teach abstinence-only curricula, teen pregnancies are higher. One study found that teenagers who receive some type of comprehensive sex education are 60 percent less likely to get pregnant or get someone else pregnant. The Administration’s endorsement of this program is really tacit support for a completely ineffectual program that is bad for women.

Our guest blogger is Jessica Arons, director of the women’s health and rights program.

On Wednesday, the Supreme Court heard arguments on why the Medicaid expansion under the Affordable Care Act (ACA) may or may not be unconstitutional. For anyone familiar with the Spending Clause, it is perplexing to think that somehow the federal government might not have the power to give the states more money for Medicaid and in turn require them to provide more low-income people with access to health care. As has been pointed out already, if the Medicaid expansion under the ACA is unconstitutional now, that means it was also unconstitutional the four other times Medicaid was expanded, three of which occurred under President Reagan, and it was unconstitutional when the program was first enacted in 1965. That seems highly unlikely.

Because these arguments have been made mostly in the realm of theory and hypotheticals, it might be useful to take a look at a very current example of how the Spending Clause works in practice. Those who have been following the war on women’s health will know that Texas recently passed a law that disqualifies Planned Parenthood from participating in the state’s Medicaid Women’s Health Program (WHP) because some of its clinics provide abortion care, even though the organization is barred from using federal or state money to pay for abortion care. Instead, the state’s action cut off funds that Planned Parenthood used to provide contraceptive services and counseling, cancer screenings, diagnosis and treatment for sexually transmitted infections, and other preventive care.

The federal government pays for 90 of the WHP’s $40 million budget. From where does this money come? The Medicaid program. And why does federal Medicaid pay 90 percent of the cost? Because in 1972, Congress deemed family planning to be so important that it wanted to ensure every state would include those services and supplies in its Medicaid program. By the same token, Congress was so eager to ensure that every state adopt the Medicaid expansion under the ACA, that it will pay for more than 90 percent of the cost for that expansion. Yet the conservative justices on the bench yesterday questioned that incentive as “coercive.”

Unfortunately, in a game of political chicken that puts the health of 130,000 Texan women on the line, Texas has violated a core tenet of the Medicaid program in excluding Planned Parenthood from the WHP. Federal law requires states to allow beneficiaries to seek care from “any willing provider” that is qualified to provide the needed services. Because of Texas’ discriminatory action, the Health and Human Services (HHS) Department has had no choice but to cut off federal Medicaid family planning funds for the state.

It is incredibly frustrating that the very women the federal Medicaid law is intended to protect are the ones who are hurt the most, but those sanctions are the only tool HHS has at its disposal to enforce the law. It is the bargain that is struck when Congress uses its Spending Clause power to act, and it is a poignant reminder that the legal theories that have been debated in the halls of justice this week could have an all too concrete effect on the lives of everyday women.

Today marks one year since the Affordable Care Act’s Patient’s Bill of Rights went into effect. The White House unveiled the regulations in 2010 to expand coverage and better control costs for patients before the full health care reform law goes into effect in 2014. And so far, people are seeing a difference, according to a report from the Department of Health and Human Services.

The Patient’s Bill of Rights prevented insurance companies from denying coverage to children because of pre-existing conditions (this protection goes into effect for adults in 2014), and it allowed young adults to stay on their parent’s insurance plans until age 26 — allowing 1 million young adults to have health insurance in the last year. And the report highlights how regulations in the Patient’s Bill of Rights have allowed states to have more authority over health care costs in its state, using these examples:

-Connecticut’s Insurance Department rejected a proposed 20 percent rate hike by one of the State’s major insurers.
-In August 2010, a major insurer in Massachusetts agreed to a significant reduction of proposed increases – less than 13 percent instead of the nearly 23 percent they initially requested.
-In 2010, Oregon disapproved health insurance premium requests of 10 percent, 18 percent, and 20 percent in the individual market.
-Rhode Island’s Insurance Commissioner used his rate review authority to reduce a proposed rate increase by a major insurer in that State from 7.9 percent to 1.9 percent.
-Nearly 30,000 North Dakotans saw a proposed increase of 23.7 percent cut to 14 percent following a public outcry.
-In 2010, Californians were saved from rate increases totaling as high as 87 percent after a California insurer withdrew its proposed increase after scrutiny by the State Insurance Commissioner.

The report also outlines the stories of people who were helped by the Patient’s Bill of Rights, like Kylie Lodgson who was able to stay on her father’s insurance and receive a heart transplant. Providing the new regulations has helped families and individuals get insurance and keep their coverage, all while holding the insurance companies accountable. “By cracking down on insurance industry abuses and making sure we are spending taxpayer dollars wisely in our health care programs, we are ushering in a new day for American consumers,” writes Richard Sorian in an HHS blog post about the one-year anniversary of the regulations.

Critics of the Affordable Care Act have long played the double-edged game of criticizing the law for offering the nation a one-size-fits all solution to the health care crisis while slamming the federal government for providing states and businesses with greater flexibility to comply some of the new provisions of the legislation. It’s a cynical game and one that Republicans are playing in order to portray the nearly 1,400 waivers distributed by HHS as evidence that the law isn’t working or that the administration is using the process to grant exemptions to and reward its political allies.

The Associated Press considered some of these claims :

Q: Unions are getting these waivers. Doesn’t that show that the Obama administration is rewarding political supporters?

A: Several unions have gotten waivers, but most seem to be going to employer plans, according to statistics from the Health and Human Services Department.

Q: So an office headed by an administration bureaucrat is able to waive the entire health care law?

A: Actually, no. Mainly its two provisions. And the waivers are time-limited. One is a regulation that says insurance plans can’t impose a per-patient limit of less than $750,000 a year for medical care, including hospital stays, doctor visits and medications. So far, about 1,400 annual limit waivers have been issued, an approval rate of more than 90 percent. They cover plans that serve about 3 million people, or 2 percent of those with private insurance.

The other provision is a requirement that insurance companies spend at least 80 percent of the premiums they collect on medical care and quality, as distinct from overhead and profits. Three states — Maine, New Hampshire and Nevada — have gotten what the administration calls “adjustments” to the 80-percent standard. Insurers in those states will be held to a lower requirement, say, 65 percent. State officials had feared that some insurers who sell coverage directly to individuals would be unable to meet the higher standard and would just leave.

Q: Why do they even need to issue waivers for these things?

A: The explanation is the same in both cases: Without waivers, several million people would be at risk of losing their coverage.

In other words, the waivers are acting as a “safety valve” until the coverage expansions go into effect in 2014. What’s really happening is that the administration is in a tough spot. If companies respond to the early regulations by dropping insurance coverage, low-wage employees will have to either go uninsured until 2014 or try to enroll in Medicaid or the new high-risk insurance pools, for which they may be ineligible and may have some trouble affording. As Aaron Carroll of the Incidental Economist explains it, Democrats are facing the three-legged-stool problem. You can’t give people access to affordable coverage without regulating the insurers, getting everyone into the risk pool through the mandate and providing subsidies for those who need them, but the law implements the regulation leg four years before the subsidy and mandate legs are even attached. And so what you’re seeing now is a stool that just can’t find its balance.

Consequently, the government is exempting these companies for a year to give them an opportunity to gradually adjust their plans so they can meet the new requirements. As Paul Ginsburg put it, “I wouldn’t see that as special deals as much as bowing to reality.”

Today, the Department of Health and Human Services is hosting what can only be described as a health wonk’s dream — a day long conference on the the new health insurance exchanges. These new markets won’t be operational until 2014, but as this panel on small employers demonstrates, establishing effective exchanges that attract enrollees and insurance companies, won’t be easy.

Below is just a glimpse at all of some of the suggestions and policy recommendations for how to implement the small business exchanges:

- WEBSITE IS NOT ENOUGH: “The previous panel said, ‘we’re just going to provide a website for everyone to go to.’ That’s impossible. We will not be able to communicate. The way we have structured our program is that we are very much technically invested…but we distribute our product through brokers because what we have found is that there needs to be a touching point to these small employers. They don’t have that HR department. They’re looking for somebody to help them. Because it’s something they don’t understand and they want to run their business. [Phil Vogel, Senior Vice President, Connecticut Business and Industry Association Service Corp]

- EMPLOYERS WILL NEED TO WRITE ONE CHECK: “The employer [will need to] send one check out to the exchange….They’re going to have employees with multiple plans, employees can buy up and there is going to be all kinds of costs and deductions for employers…they need to be able to write one check. [Terry Gardiner, National Policy Director, Small Business Majority.]

- REAL COST CONTROL STILL IN DELIVERY REFORMS: “We talked about the expense structure of the exchange, the administrative expenses or pulling people together. Those are getting at the small dollar amounts of the premiums paid today. What we really need to make sure is that we look at the cost of care….Just pooling people together is not going to reduce costs.” [Phil Vogel, Senior Vice President, Connecticut Business and Industry Association Service Corp]

- RULES SAME OUTSIDE/INSIDE EXCHANGE: “If you’ve got products offered outside that are a lot cheaper than products offered inside the exchange, those products are likely to be more attractive to healthier enrollees, businesses with healthier enrollees and you’re going to winde up with higher prices inside the exchange than outside the exchange.” [Michael Johnson, Director, Public Policy, Blue Shield of California]

Watch a compilation:

Indeed, insurance brockers have been actively lobbying for a larger role in the reformed market place, arguing they can help the newly insured find affordable coverage in ways that the automated website cannot. Vogel’s experience with running a small business exchange in Connecticut, suggests that their services may be need.

During the health care debate, Jon Kingsdale had argued that businesses would not participate in the exchanges if they had to send separate checks to different insurance issuers. But since the CBO said it would have to score any efforts by the exchange to process the checks as an addition to the government’s ledger, the law currently foresees employers sending separate checks. This is something that could potentially be changed in the regulatory process.

Finally, establishing regulations that prohibit insurers from luring healthier enrolles out of the exchanges and implementing successful delivery reforms will be critical to lowering health care spending. For the latest thinking on the former, check out Sarah Lueck paper here.