Wednesday, December 16, 2009


At this point in the development of legislation, legislators usually are too invested in the process itself to see the grand arc of a given policy's trajectory. If Senators Wyden, Brown, et al would step back a bit and think in terms that history teaches us, they would see that the current health care legislative proposal is not reform. It is a windfall for for-profit health insurance companies. The wellspring of this windfall is the mandate for individuals to feed insurance companies buy buying medical coverage from them.

History teaches us that there is no "improving" bad legislation. Social Security and Medicare have been successful and expandable because the legislation creating these programs advanced bold visions and put sturdy new frameworks in place. Groups were left out initially, social justice deferred -- but the framework that the legislation put into place was conceptually friendly to including excluded groups. Slowly,coverage broadened to include mostly all persons in the labor market. The current health care "reform" bills, especially the Senate bill, is conceptually friendly only to tightening the grasp of for-profit private insurance on our discriminatory, punitive, and arbitrary medical delivery system. Don't let Democrats desperate for a win in the roll-call column tell you that "we can make it better later." It won't happen. To make anything better, we would have to overturn the paradigm the Congress currently is poised to put in place. We never have overturned a social provision paradigm in the short term, and we have never overhauled such a paradigm to make it more progressive. In fact, only one social provision paradigm has been overturned: the New Deal income assistance program for poor single mothers. That change hardly advanced social justice.

If enacted in its current form, health care legislation will come back to bite all of us -- with uncontrolled, soaring premiums; new methods of excluding and punishing patients; unequal access; unequal services. Worse, all Americans will be compelled to prop up the unjust system through mandatory buy-ins to the private insurance system.

If the Democrats need to salvage something, they should split the bill into its component parts. One big part could pass right away -- Health Insurance Reform, prohibiting pre-existing condition exclusions; gender and other demographic rating; annual and lifetime caps on coverage; churning of expensive patients from insurance rolls. Pass that now.

The other big part of the bill should be scrapped, and we should start from scratch. That's the part that is farcically referred to as "universal coverage." End the farce and let's get to work on a truly universal system that covers everybody in the same way.

Progressives should join Howard Dean in standing up for what's right instead searching for a silver lining that tarnished long ago.

Kill the Bill.

Monday, November 23, 2009


the shocking fertility and family control provisions in health care reform legislation

Gwendolyn Mink, Ph.D. and Dorothy Roberts, J.D.

While the latest clash over health care reform has focused on abortion funding, no attention has been paid to a shocking fertility and family control provision slipped into the House health care bill. Many reform opponents are up in arms over imaginary state intervention in medical care. But the House bill actually would authorize state intervention in a plan to monitor the childbearing decisions and family lives of low-income women.

The House health care bill (H.R. 3962), contains a provision affecting Medicaid recipients who are pregnant for the first time or who have a child under two years of age. Section 1713 allows States to use Medicaid funds for non-medical home visits by nurses to advance certain goals affecting reproductive decisions and family life. The goals include: "increasing birth intervals between pregnancies," "reducing maternal and child involvement in the criminal justice system," "increasing economic self-sufficiency," and "reducing dependence on public assistance."

These goals of the home visitation program have nothing to do with providing health care. Instead, they are based on the false premise that poor mothers’ childbearing is to blame for social problems. The proposed visitation program is eugenicist, deceptive, discriminatory against low-income women, and utterly inappropriate to the medical work of nurses.

Under the program envisioned in the House bill, government-sponsored medical professionals are charged with exhorting fertility control among poor women, based on the mistaken premise that reproduction among the poor leads to crime, neglect, low educational attainment, and dependency. According to the government's own statistics, –families receiving welfare have, on average, only 1.8 children; half the families receiving welfare have only one child, and only one in ten have more than three children.

Although the data show that poverty is not correlated with family size -- and that childbearing does not cause poverty -- the U.S. House of Representatives seeks to tell low-income women who receive medical assistance how many children to have and when to have them.

The House health care bill codifies some of the worst stereotypes of low-income mothers, suggesting that bad reproductive choices and misguided family practices make their families poor. Similarly, the provision blames low-income mothers for raising criminals and accuses them of maintaining unstable and neglectful home lives for their children.

Black mothers in particular have been subjects of deeply-embedded stereotypes about sexual and reproductive irresponsibility that have supported a long legacy of repressive state policies, including sterilization and coerced birth control. The mythical “welfare queen,” portrayed as a black woman who deliberately becomes pregnant to increase the amount of her monthly check, was propaganda used to support welfare reform. Several state legislators even proposed bills requiring women to use birth control or undergo sterilization as a condition of receiving welfare benefits. Immigrant women and other women of color have suffered similar injustices that devalue their reproductive decision making, as well as their parental rights and family practices.

These statutory devices and impositions should sound familiar to anyone aware of the 1996 welfare reform law. It too pivoted on the idea that regulating poor women's reproduction would end their need for welfare. Congress transformed welfare from a system of aid to a system of behavior modification that attempts to control the sexual, marital, and childbearing decisions of poor unmarried mothers by placing conditions on the receipt of state assistance. Section 1713 interprets literally the language of "pathology" from the welfare debate in its plan to "cure" the putative effects of poverty by curing poor mothers' fertility and motherhood.

We applaud the lawmakers who have banded together to take a stand against inclusion of the Stupak amendment in the final bill. But we urge them look beyond Stupak - to support a vision of reproductive justice that extends beyond abortion and respects the childbearing decisions and mothering of all women. Health care reform must not only ensure the right to abortion but also must protect the full spectrum of women's reproductive and family rights. Congress can start to promote the well-being of all women by rejecting eugenicist provisions such as the home visitation program. Any visiting nurse program in health care legislation should stick to providing medical care regardless of economic or social status. Economically vulnerable women should not be treated as sitting ducks for social engineers.


Gwendolyn Mink, Ph.D., an independent scholar, is co-editor of the two-volume Poverty in the United States: An Encyclopedia of History, Politics and Policy and author of Welfare's End. She can be contacted at

Dorothy Roberts, J.D., the Kirkland & Ellis Professor, Northwestern University Law School, and Professor, Departments of African-American Studies and Sociology, is the author of Killing the Black Body: Race, Reproduction, and the Meaning of Liberty and of Shattered Bonds: The Color of Child Welfare. She can be contacted at

Wednesday, November 11, 2009

Fertility Control of the Poor

The House Bill includes a section calling for home visits to poor pregnant families and poor families with children to provide cultural/relational and reproductive counseling. This provision is NOT about the delivery of medical services. It is about making the poor "self-sufficient" and less "dependent" on public assistance. In addition to providing for social/cultural interventions, the provision calls for INCREASING BIRTH INTERVALS among the poor -- READ: fertility control.

Tuesday, November 10, 2009

Say No to Health Care Legislation that Creates More Inequality

Kill so-called health care reform legislation UNLESS:

1) the public option is available to ALL;

2) the status quo ante is restored for private insurance coverage of reproductive decisions, including abortion;

3) public option coverage for individuals honors the complete reproductive rights of individuals;

4) the provision for government intervention into low income families with children through home visits is removed;

5) price controls on premiums are added; and

6) the scope of the basic benefits package is specified in the statute rather than delegated to an invisible administrative committee that will easily be captured by monied interests.

There are other reasons to defeat the current bills, no doubt.

The good parts of the bills -- eg, no exclusions for pre-existing conditions -- can be legislated separately. It makes no sense to authorize massive government income transfers to for-profit insurance companies. The structure of the current legislation, from abortion through the public option, will deepen inequalities in health coverage and provision, notwithstanding the extension of coverage to many who currently are uninsured.

Enough pussyfooting in the White House and horse-trading in Congress. Back to the drawing boards -- this time Medicare for All.

Wednesday, July 15, 2009

Sotomayor Hearings, Day 1

The Sotomayor confirmation hearings are a sorry reminder of the continuing hegemony of white male privilege. Racisms and sexisms of all stripes -- liberal, as well as reactionary -- so tightly cramp our discourse about inequality that if we don't all pray to the sameness/symmetry/colorblind god, we must be racists/sexists/UnAmerican.

Since the late 1980s, the Supreme Court itself has led the political suffocation of common sense and social justice, with its increasingly harsh insistence that race-sensitive policies of all kinds are evil, whether the policies are geared toward rectifying the marginalization of people of color or toward shoring up the power of white people. Where the Court in Brown v. Board saw marginalization and subordination of people of color as the evil, current jurisprudence holds that power and powerlessness are irrelevant aspects of inequality. Race-neutrality, color-blindness, "treating everybody the same" are the power-blind standards of the controlling discourse.

Gender jurisprudence for the most part has supported this cramped, power-preserving view of equality, with its preeminent concern for winning for women the same treatment/privileges men enjoy -- in sports, military academies, employment and the like. Winning sameness is an important goal where sameness promotes equality, but our singular focus on Constitutional equivalence between men and women has choked off claims and articulations for gender-sensitive remediations and provisions that also are necessary for equality.

In any event, we are stuck in the mid-1970s, circa Bakke, when vast numbers of women of all races and men and men of color could not say out loud what we all recognized as true: that the desegregation of American life entails more than peppering schools, workforces, and politics with a few colored or female faces just for the sake of visual variety; and that desegregation isn't merely about allowing isolated individuals to maximize opportunities and fulfill dreams. Desegregation, whether through bars on race or sex exclusions or through affirmative action, is also important because marginalized groups have something significant and distinctive to offer public discourse and the life of the polity -- because of their social, economic, and cultural experiences.

But if we say that out loud in mainstream political processes, we are called racists (or sexists) by white men who believe they own "neutrality." Jeff Sessions!!! and Lindsay Graham. And the white-dominated media doesn't interrogate their assumptions. Instead, they say things like "strong cross-examination by Senator Graham," or "Sotomayor didn't put the racism charge to rest."

The idea that ignoring race is good (even if to do so exacerbates racial disparities) so grips official consciousness that the obvious response to Lindsay Graham's assertion ("If I said that a wise white man would reach better conclusions than a wise Latino woman, I would lose my job." [sic]) -- cannot even be uttered. Equality is not just about exchanging modifiers in sentences; it's not just about flipping phrases. The reason inequality is still a problem and the reason we struggle over the path to equality is because the standpoint and power of a white man who claims superior wisdom is in no way comparable to the standpoint and relative powerlessness/outsiderness of the woman of color who claims a different wisdom that would improve an outcome.

More later.

Friday, May 22, 2009

TANF Reauthorization

TANF is due to be reauthorized by October, 2010. Now is the time to formulate an agenda to fix the program. Below are some basic elements of a TANF reform agenda (for starters)...

1) Revise the purposes of TANF. Dedicate the program to the goal of ending poverty.

2) Reframe the issue so that single mothers' poverty is clearly presented as a function of women's economic inequality (both as labor market workers and as caregivers).

3) Dedicate program changes to the goal of mother's economic security and equality. As a larger matter, this includes: a) specifically addressing wage inequalities; lack of paid family leave, UI for family quits, sick days, etc; as well as b) lack of economic valuation and support for caregiving work within families. Within TANF, it means: counting caregiving as work; guaranteeing child care and after care; emphasizing preparation for and access to jobs with living wages.

4) Call for restoring (and improving) the child care guarantee for recipients who are engaged in labor market work activities (including preparation for the labor market).

5) If the work activity formula is retained, broaden the definition of work to include: a) education; b) caregiving for one's own children; c) substance abuse and mental health treatment activities; d) overcoming barriers and time constraints imposed by efforts to escape domestic violence.

6) End marriage/fatherhood promotion within TANF. If the government insists on promoting heteromarital families, it should do so in entirely separate arenas that compel or meddle with everyone equally, regardless of income status.

7) End discrimination against single mothers -- eg the rule (i don't know if it's still in the program) that effectively permitted one parent in married families to remain at home while requiring full time "work" outside the home by lone parents.

8) Get rid of all surveillance of recipients.

9) Guarantee academic and vocational freedom to all recipients who engage in work-related activities. Recipients should not be tracked into certain majors/training programs or prohibited from others based on the government's view of what field of study/training is appropriate.

10) End time limits; end immigrant exclusions; end sanctions.

11) End mandatory cooperation with paternity establishment and child support enforcement for all custodial mothers -- take it out of TANF altogether.

12) Continue TANF as wage supplement for those who enter part-time and/or low wage jobs, to ensure a family income package up to 200% of the federal poverty line.

13) Fix/end barriers to participation in TANF, including diversion programs, discretionary application denials, arbitrary case closings, all sanctions.

14) Guarantee immediate access to TANF income assistance to those who are fleeing domestic violence.

15) Increase TANF benefit levels to 150% of the federal poverty line and provide a transportation subsidy to any TANF participant who must travel more than 5 miles to a job

Thursday, January 29, 2009

The Stimulus Package: Relief vs. Reform

From the Institute for Public Accuracy,

Co-editor of the two-volume "Poverty in the United States: An Encyclopedia of History, Politics and Policy" and author of "Welfare's End," Gwendolyn Mink said today:

"The stimulus package currently working its way through Congress would temporarily extend Medicaid eligibility to unemployed workers who are receiving unemployment insurance. Though much-needed and welcomed, Medicaid expansion does not repair the tattered safety net. It is a relief measure, by definition short-term and palliative. The COBRA proposal would expand COBRA eligibility for long-term workers and for workers over age 55 who lose their jobs. Though a useful health insurance bridge between jobs or until Medicare kicks in at age 65, the COBRA proposal advances a privatized solution to health coverage rather than expanding the safety net to guarantee health care for all. Neither health proposal takes us toward universal health care, and so neither proposal renews or redesigns the social contract -- unless palliative crisis intervention is meant to replace durable social protections that promote the long-term economic security of individuals.

"If the president and Congress truly are interested in repairing the safety net, they would immediately lift the time limits on welfare eligibility so that poor families can survive hard times. If the president and Congress truly are interested in universal health care, they would expand Medicare rather than tinker with Medicaid and COBRA. If the president and Congress truly are interested in investing in the economic security of all Americans, they would start by assuring that the stimulus package assists everyone -- including women, who need reproductive health care, living-wage jobs, comparable pay, and recognition for caregiving."