Emergency contraception

In keeping with the more traditional push for equality, women’s-rights and pro-choice advocates have filed new legislation that would make emergency contraception (EC) readily available in Massachusetts. The measure, "An Act to Provide Timely Access to Emergency Contraception," would improve women’s access to reproductive-health services.

The legislation — backed by the Massachusetts Coalition for Choice, the Massachusetts Medical Society, and the Massachusetts Coalition Against Sexual Assault and Domestic Violence, among others — would require all hospital emergency rooms throughout the state to provide female rape victims with EC, the contraceptive method commonly known as the "morning-after pill." It would also allow pharmacists to dispense EC through a collaborative agreement with a physician.

Proponents tout the bill as a necessary "first step" to increase access to one of the safest, most effective contraceptive methods around. EC prevents pregnancy when taken within 72 hours of having unprotected sex. It works by stopping fertilization. To date, however, many hospitals fail to provide EC to women. According to a 2002 survey conducted by Massachusetts NARAL (National Abortion and Reproductive Rights Action League), approximately 25 percent of the state’s 73 hospitals routinely refuse to give EC to rape victims who seek the pills; 51 percent refuse to give it to any woman who asks for it. And many women have found it difficult to get the doctor’s prescription needed for EC within the 24-hour time frame when the contraceptive works best — especially on weekends. Explains Melissa Kogut, the executive director of Massachusetts NARAL, which considers the bill its top legislative priority, "This is a broad approach to help provide all women in this state with real reproductive options."

Despite such benign intentions, bill proponents anticipate a tough fight ahead. Though EC (unlike another famous pill, RU-486) does not cause abortion, advocates expect that abortion foes will seize on this legislation. That’s what happened with the hard-fought battle over insurance coverage for contraceptives, which took six long years to pass the House before finally becoming law in 2002. "People will try to make this into an abortion issue," says State Representative Doug Petersen (D-Marblehead), who worked on contraceptives coverage and who’s sponsoring the EC effort. Petersen hopes to mitigate what he calls "the controversy among those who are anti-choice," yet he acknowledges uncertainties: "Who knows if we’ll be able to do that?" For one thing, Finneran, an anti-abortion stalwart, is a formidable obstacle. Two weeks ago, the powerful House leader gave a rousing speech at a Massachusetts Citizens for Life rally, during which he reiterated his long-standing commitment to restricting abortion services.

Then again, advocates aren’t about to let a potentially hostile House stop them. After all, one thing about EC remains certain: improved access to the contraceptive method could prevent as many as 1.7 million unintended pregnancies and 800,000 abortions every year, according to the American Medical Women’s Association. (Those numbers are based on the fact that about half of all unplanned pregnancies end in abortion.) So, as Petersen points out, "This is a way for us to prevent those unnecessary and unwanted pregnancies and abortions."

Civil unions and gay marriage

Massachusetts led the nation in the struggle for gay, lesbian, bisexual, and transgender (GLBT) civil rights last summer. That’s when former Senate president Tom Birmingham put a stop to an attempt to amend the state constitution so as to ban same-sex couples from ever marrying in this state. Now, the defeat of the anti-gay constitutional amendment has helped set the stage for two new bills that would give the state’s gay and lesbian community some measure of civil equality.

The Massachusetts Gay and Lesbian Political Caucus (MGLPC), a statewide advocacy organization, has drafted two measures that would give same-sex couples the right to either marry or engage in Vermont-style civil unions. Both pieces of legislation enhance the long-sought effort to grant domestic-partnership benefits to public employees, which has been filed yet again. In essence, advocates and their allies are taking a three-prong approach to the legislative process this time. Observes State Representative Alice Wolf (D-Cambridge), a sponsor of the civil-unions bill and supporter of the other two, "There are many roads to justice, and we’ll try them all."

Not surprisingly, the favored piece of legislation among advocates is the one that reads simply, "Any person ... may marry any other eligible person regardless of gender." The proposal would give homosexual couples access to the same things heterosexual couples get once they marry — some 1400 benefits granted under state and federal law. If enacted, gay men and lesbians who tie the knot would receive everything from access to their spouse’s Social Security benefits to hospital-visitation rights. For the gay community, civil marriage means ultimate fairness. "This is about equality under the law," says MGLPC’s Arline Isaacson. "We’d happily seek that."

On the other hand, most advocates would gladly settle for civil-unions legislation. In contrast to marriage, civil unions would grant same-sex couples access to about 350 to 400 state-authorized benefits, primarily related to employment and family. It’s a far cry from the number of rights that come with marriage, though advocates hasten to note that civil unions would represent a quantum leap in the right direction.

But even this watered-down version of equality has little chance of success. Keep in mind: gay-and-lesbian advocates have been fighting for the past 10 years for the most basic (and limited) forms of fairness and justice — namely, domestic-partnership benefits. For three sessions in a row, the Senate has passed a bill that would make it legal for municipalities to extend health-care benefits to domestic partners of their gay employees. Yet the House, under Finneran’s leadership, has refused to act on the measure even though a majority of state reps support it. So, says Isaacson, "We have got a hell of a battle ahead of us." (Though it should be noted that Governor Mitt Romney made it quite clear on the campaign trail that, while he opposed marriage rights for gay couples, he was in favor of domestic-partnership legislation.)

Gay-and-lesbian advocates have several things working in their favor, too. For one, they can point to Vermont’s passage of civil unions in 2000 to show that a state can recognize its same-sex couples without wreaking havoc on the system — as the opposition would have voters believe. For another, advocates can point to civil unions and gay marriage as two ways in which legislators could promote social justice without having to bust the cash-strapped budget. Passing this legislation, in Wolf’s words, "would be a major step that we could take that’s not a big-budget issue."

Prescription drugs

Soaring prescription-drug costs have become one of the biggest problems facing the state — and its residents — today. Every year, the state spends more and more money on prescription drugs; in FY ’02, for instance, it funneled nearly $1 billion into pharmacy items for Medicaid recipients — an 18 percent jump over the previous fiscal year. And that figure doesn’t even account for all the other state agencies, such as the Department of Correction and the Department of Public Health, that must buy costly medications annually.

Now, advocates are pushing their own solution to rising drug prices: a new bill known as the "Prescription Drug Fair Pricing Act." The proposed legislation, devised by the Massachusetts Senior Action Council (MSAC), an elderly-advocacy group in Boston, cobbles together bits and pieces of state laws that have succeeded across the nation. Thus it compiles the best regulatory models into one multifaceted measure that would affect not just state agencies and their beneficiaries, but also residents who lack coverage to pay for their own prescriptions. Its components include the following:

• It would call for state agencies to use a uniform drug list based on the lowest prices.

• It would require the administration to officially join other states in a "compact" that allows for bulk-purchasing of drugs.

• It would set up a program to extend the state’s Medicaid drug discount of about 25 percent to low-income residents without adequate medication coverage.

• It would force pharmaceutical companies to disclose any bonuses bestowed on Massachusetts doctors and hospitals for using their brand-name drugs.

Proponents tout the act as a sure-fire way to help the state save money at a time of mounting financial woes. They point to Vermont, which saved $10 million on prescription drugs after implementing a uniform drug list last year. So Massachusetts, a state with a population about 10 times that of Vermont, might be able to recover as much as $100 million from enacting such a list, advocates argue. Cost-saving efforts like these would mean more revenue. They’d mean more opportunity to restore the many health and human services that have suffered severe cuts in the wake of the budget crisis. As the MSAC’s Phil Mambler puts it, "A social-justice agenda ought to include ways to raise revenue so that we’re not just hurting people all the time with cuts, cuts, cuts."

Which, it seems, explains why the bill has become so popular on Beacon Hill. State Representative Pat Jehlen (D-Somerville), a chief sponsor, has managed to convince 57 reps out of 160 to sign on to the measure thus far, as well as three senators. Jehlen, who’s long worked to regulate drug prices, predicts that building on other states’ laws will make it difficult for pharmaceutical companies to argue that lower drug prices will cripple the industry — a claim that, furthermore, the State House is less inclined to fall for. Though it’s unusual for first-time bills ever to pass in one session, it’s an unusual moment for the legislature. "Legislators are looking at ways to save money," Jehlen says, "and the special-interest groups will be at a disadvantage."

Immigrant rights

Massachusetts immigrants have been among those hit hardest by budget cuts since the state’s fiscal crisis began in September 2001. Just this fiscal year, legislators gutted the safety net for legal immigrants by eliminating programs that give them food stamps and cash assistance. In many ways, they were easy targets: unlike traditional welfare benefits, they were fully funded by the state.

But immigrants’-rights advocates are striking back. They’ve filed a new bill, "An Act to Assure Equal Treatment for Lawful Immigrants in Massachusetts," that would effectively restore state-funded food stamps and cash assistance for legal immigrants — benefits that the state created in 1997 after the federal government had eliminated them under a draconian welfare-reform package. Restoration of the programs — which cost the state approximately $10 million altogether — amounts to a long shot. Okay, a long, long shot. But advocates see the effort as important nonetheless. "There’s no question the fiscal situation is dire and tight," acknowledges Aura Garfunkel, who heads the Massachusetts Immigrant and Refugee Action Coalition (MIRA), in Boston. "But there are people doing without the very basics. They’re here legally, and they’re hurting."

To be sure, the program cuts have had devastating effects. MIRA estimates that as many as 600 parents and children have lost cash assistance since last year. Another 7200 families have had to go without food-stamp benefits. The vast majority are permanent residents and asylum refugees who have young children, or are elderly and disabled. Some are victims of domestic violence who’ve fled their abusers. "Eliminating benefits for legal immigrants means eliminating them for the most vulnerable," says Patricia Baker of the Massachusetts Law Reform Institute, which drafted the bill. Baker relays the case of one Boston-area woman and her disabled child, whose debilitating condition resulted from abuse at the hands of the child’s father. The mother, a legal immigrant, has since left her child’s batterer (who was her permanent-residency sponsor) and has filed to change her immigration status. She receives no child support. And now, she’s lost all assistance from the state.

However slim its chances of passage, the restoration legislation comes down to basic fairness and justice. After all, these cuts affected only legal immigrants. They were among the first to be targeted for the ax, even though many immigrants helped fuel the state’s economy during the ’90s boom. That lawful immigrants have lost benefits other residents can still receive offers a strong moral argument for the legislation, says State Representative Eugene O’Flaherty (D-Chelsea), one of the bill’s main sponsors. These programs provided such basic necessities as food and clothing to an ever-growing segment of the Massachusetts population. So as far as he’s concerned, O’Flaherty adds, "There should be no distinction between a citizen and a noncitizen." He vows to do all he can to keep the issue alive, regardless of the fiscal hurdles that lie ahead. "We cannot just say we give up and not do what we need to do," he says.

Kristen Lombardi can be reached at klombardi[a]phx.com.