Sunday, February 9, 2014

For some in Sochi's gay community, attitudes trump laws

Andrei Tanichev has a request for well-meaning foreigners who intend to protest Russia’s homophobic politics at the Winter Games: Please don't bother.

As a prominent member of Sochi's gay community, Tanichev would seem to be the likeliest person to appreciate the tidal wave of support from athletes, politicians, and delegations who have gathered in Sochi from around the world. But Tanichev, who has run a popular gay nightclub here for 10 years, says that angry foreigners demanding that President Vladimir Putin change Russia's laws on sexual relations cannot help, and might only make things worse.

"If you go out to protest, you have to protest against Russian society. Because in reality, society is not ready to accept gays," Tanichev said in a lengthy interview at the club, Cabaret Mayak, where a drag queen revue attracted a healthy crowd of Russians and foreigners in the wee hours Thursday. "Russian society will think that it's not right when you're a guest and you start to demand some sort of rights."

Gay-rights activists protested
Tanichev's words shed light on a division of opinion among Russia's lesbian-gay-bisexual-transgender community over the effect of a Russian law that implicitly targets homosexuals. Many activists warn that its passage last year has given the go-ahead to violent homophobic groups. A video released by Human Rights Watch this week included graphic footage of what it said depicted gays being chased down, bullied, and assaulted. The rights group said it had compiled the video from posts to the Internet by the perpetrators.

"These are fascists who have chosen the easier prey, which are gay people," Igor Kochetkov, chairman of the Russian LGBT Network, said in the video.

Tanya Cooper of Human Rights Watch described "a total failure on the part of the Russian authorities to take measures, to prosecute hate crimes against LGBT people."

Human Rights Watch was one of 40 groups that sent a letter to corporate sponsors of the Olympics, urging them to support Russia's LGBT community.

In the week before the Opening Ceremony, AT&T, a sponsor of the US Olympic Committee, posted a statement on its website titled, "We stand against Russia's anti-LGBT law." United Nations Secretary General Ban Ki-moon spoke out against attacks on LGBT people.

Though Olympic rules bar athletes from taking political stands while competing, some have taken jabs at the law. Referring to Sochi's ubiquitous color scheme, American figure skater Ashley Wagner joked that the many-colored theme reminded her of the rainbow flag used to symbolize gay pride.

Asked about this Olympic wave of support, Tanichev instead spoke about how attitudes toward gays have improved in the 10 years since he opened the club. He has more customers, both gay and straight. He has straight employees.

"People are no longer ashamed to come to work here, their parents know they work at a gay club and no one is ashamed of it," he said, gesturing to the dark interior of the club, which is located on a side street and has a nondescript entrance. He said the law has not changed his life, or made him more afraid.

Changing the law, he said, won't change attitudes toward gays in a society.

"The people aren't ready for that," he said.

Sergey Baklykov, who performs as Isadora Vulkan in the drag show, said the protests over the law were pointless, because the law had not affected life for gays in Sochi.

"We are together, we have a place for meeting, we love each other, like it was before the law," he said as he prepared for the show in the makeup room. "Don't worry about us, we're OK."

International outrage

The law, signed by Putin last year, makes "propaganda of non-traditional sexual relations to minors" a fineable offense. Putin has sought to deflect criticism of the law by pointing out that it never mentions homosexuals -- but the replacement of that language with "non-traditional" was a late edit.

The idea behind the law, according to Masha Gessen, a Russian and American writer and LGBT activist, was to create a national ideology for Russia, as the defender of traditional families. A major Russian polling center released a survey that suggested more than 70 percent of Russians are against the justification and public display of homosexual relations, while only 12 percent were in favor.

Gays understood they were the targets, and many left the country. But the Kremlin underestimated international outrage, which began spoiling Putin's Olympic party back when President Obama sent a delegation that included prominent gay athletes.

At a briefing Friday, two openly gay members of that delegation -- Caitlin Cahow, a Boston College law student who won ice hockey medals in two Olympics, and gold medal-winning figure skater Brian Boitano -- expressed solidarity with Russia's LGBT community.

In what may have been a subtle dig of their own at the issue of gay rights, Russia's Olympic organizers chose the fake-lesbian girl-pop duo t.A.T.u. to perform at the stadium. The two singers played one of their two huge hits from a decade ago with lyrics and videos that depicted desperate lesbian lovers in what was later revealed as a publicity stunt.

In a more sinister reflection of Russian reality, four gay rights activists were arrested in St. Petersburg after they unfurled a banner that quoted the ban against discrimination in the Olympic Charter.

Mixed signals

Sochi has long been known as a more tolerant place for gay culture, even under the Communist government of the Soviet Union, which considered homosexuality a federal crime. In the 1970s, Tanichev said, gay men would meet under a statue of Soviet founder Vladimir Lenin.

Sochi today has two well-known gay clubs and gay beaches, which made it seem odd when the city's mayor, Anatoly Pakhomov, told the BBC recently that he did not believe any gays lived in the city. Tanichev, who said he has a good working relationship with the mayor, believes the quote must have been taken out of context or misunderstood.

Even outside Sochi, some gay Russians say their situation has been misunderstood because of the uproar over the law.

"People abroad mainly consider that there's absolute genocide against LGBT here in Russia," said Stanislav Petrov, 27, a public relations manager in Moscow. "Not yet. It's still possible to be open gay or lesbian and if you have good friends, parents, and employer, you'll be accepted. Of course it depends on your environment. At least in a big city you can choose."

The danger embedded in the law, he said, is what it does to young people who are starting to understand their sexuality.

"If a mother will say to a child, ‘Don't worry, you're not sick with your homosexuality,' it's going to be recognized as a crime," Petrov said. "This is the main threat of the law: The government has left teenagers alone with their suffering."

In places like Moscow, where many people have access to the Internet and the ability to travel abroad, attitudes about homosexuality are divided along generational lines.

Anastasia Borisova, 24, a radio reporter in the Russian capital, said her mother is "really shocked when we go on a holiday outside the country and we see gay guys together."

"I don't think there is anything wrong with it," Borisova said. "And neither do my friends."

By David Filipov, Globe Staff,, Twitter @davidfilipov.?

Source: The Boston Globe

New law offers protection to abused Native American women

Lisa Brunner remembers the first time she saw her stepfather beat her mother. She was 4 years old, cowering under the table here on the Ojibwe reservation, when her stepfather grabbed his shotgun from the rack. She heard her mother scream, "No, David! No!"

"He starts beating my mother over the head and I could hear the sickening thud of the butt of the shotgun over her head," Brunner said. "Then he put the gun back on the rack and called her a bitch. He slammed the bedroom door and sat down on the squeaky bed. And then I heard the thud-thud of his cowboy boots as he laid down, squeaking again, and he went to sleep."

There were many more beatings over the years, Brunner said. Twenty years later, she said, she was brutally assaulted by her own husband on this same Indian reservation, an enormous swath of Minnesota prairie that has seen its share of sorrow for generations.

An estimated one in three Native American women are assaulted or raped in their lifetimes, and three out of five experience domestic violence. But in the cases of Brunner and her mother, the assailants were white, not Native American, and that would turn out to make all the difference.

For decades, when a Native American woman has been assaulted or raped by a man who is non-Indian, she has had little or no recourse. Under long-standing law in Indian country, reservations are sovereign nations with their own police departments and courts in charge of prosecuting crimes on tribal land. But Indian police have lacked the legal authority to arrest non-Indian men who commit acts of domestic violence against native women on reservations, and tribal courts have lacked the authority to prosecute the men.

Last year, Congress approved a law -- promoted by the Obama administration -- that for the first time will allow Indian tribes to prosecute certain crimes of domestic violence committed by non-Indians in Indian country. The Justice Department on Thursday announced it had chosen three tribes for a pilot project to assert the new authority.

While the law has been praised by tribal leaders, native women and the administration as a significant first step, it still falls short of protecting all Indian women from the epidemic of violence they face on tribal lands.

President Obama, joined by Vice President BidenThe new authority, which will not go into effect for most of the country's 566 federally recognized Indian tribes until March 2015, covers domestic violence committed by non-Indian husbands and boyfriends, but it does not cover sexual assault or rape committed by non-Indians who are "strangers" to their victims. It also does not extend to native women in Alaska.

Proponents of the law acknowledge that it was drawn narrowly to win support in Congress, particularly from Republican lawmakers who argued that non-native suspects would not receive a fair trial in the tribal justice system.

For their part, native women say they have long been ill-served by state and federal law. U.S. attorneys, who already have large caseloads, are often hundreds of miles away from rural reservations. It can take hours or days for them to respond to allegations, if they respond at all, tribal leaders say. Native women also have to navigate a complex maze of legal jurisdictions.

"There are tribal communities where state police have no jurisdiction and federal law enforcement has jurisdiction but is distant and often unable to respond," said Thomas J. Perrelli, a former associate attorney general who was one of the administration's chief proponents of the amendment. "There are tribal communities where the federal government has no jurisdiction but state law enforcement, which has jurisdiction, does not intervene. And there are still other tribal lands where there is a dispute about who, if anyone, has jurisdiction. All of this has led to an inadequate response to the plight of many Native American women."

More than 75 percent of residents on Indian reservations in the United States are non-Indians. In at least 86 percent of the reported cases of rape or sexual assault of American Indian and Alaska native women, both on and off reservations, the victims say their attackers were non-native men, according to the Justice Department.

'Not enrolled'

The loophole in the American Indian justice system that effectively provides immunity to non-Indians is the story of a patchwork of laws, treaties and Supreme Court decisions over generations.

At the root of the confusion about Indian jurisdiction is the historical tension over Indian land. As American settlers pushed Native Americans off their tribal lands and then renegotiated treaties to guarantee tribes a homeland, large areas of the reservations were opened for white families to homestead.

That migration led to the modern-day reservation, where Indians and non-Indians often live side by side, one farm or ranch home belonging to a white family, the next one belonging to an Indian family. It is a recipe for conflict over who is in charge and who has legal jurisdiction over certain crimes.

"The public safety issues in Indian country are so complicated," said Deputy Associate Attorney General Sam Hirsch, one of the Justice Department officials who focus on tribal justice issues. "No one would have ever designed a system from scratch to look like the system that has come down to us through the generations."

Over the past 200 years, there have been dramatic swings in Indian-country jurisdiction and the extent of tribal powers.

In 1978, in a case widely known in Indian country as "Oliphant," the Supreme Court held that Indian tribes had no legal jurisdiction to prosecute non-Indians who committed crimes on reservations. Even a violent crime committed by a non-Indian husband against his Indian wife in their home on the reservation -- as Brunner said happened to her on the White Earth Nation reservation -- could not be prosecuted by the tribe.

The court said it was up to Congress to decide who had that authority.

"We are not unaware of the prevalence of non-Indian crime on today's reservations, which the tribes forcefully argue requires the ability to try non-Indians," the court said. "But these are considerations for Congress to weigh in deciding whether Indian tribes should finally be authorized to try non-Indians."

Congress took no action for 35 years.

As a result, native women who were assaulted were often told there was nothing tribal police could do for them. If the perpetrator was white and -- in the lingo of the tribes -- "not enrolled" in the tribal nation, there would be no recourse.

"Over the years, what happened is that white men, non-native men, would go onto a Native American reservation and go hunting -- rape, abuse and even murder a native woman, and there's absolutely nothing anyone could do to them," said Kimberly Norris Guerrero, an actress, tribal advocate and native Oklahoman who is Cherokee and Colville Indian. "They got off scot-free."

In 2009, shortly after taking office, Attorney General Eric H. Holder Jr. was briefed by two FBI agents on the issue of violence on Indian reservations.

They told him about the soaring rates of assault and rape and the fact that on some reservations, the murder rate for native women is 10 times the national average.

"The way they phrased it was, if you are a young girl born on an Indian reservation, there's a 1-in-3 chance or higher that you're going to be abused during the course of your life," Holder said in an interview. "I actually did not think the statistics were accurate. I remember asking, 'check on those numbers.'?"

Officials came back to Holder and told him the statistics were right: Native women experience the highest rates of assault of any group in the United States.

"The numbers are just staggering," Holder said. "It's deplorable. And it was at that point I said, this is an issue that we have to deal with. I am simply not going to accept the fact it is acceptable for women to be abused at the rates they are being abused on native lands."

Measuring tape

Diane Millich grew up on the Southern Ute Indian reservation, nestled in the mountain meadows of southwestern Colorado. When she was 26, she fell in love and married a non-Indian man who lived in a town just beyond the reservation.

Not long after they were married, Millich's husband moved in with her and began to push and slap her, she said. The violence escalated, and the abuse, she said, became routine. She called the tribal police and La Plata County authorities many times but was told they had no jurisdiction in the case.

One time after her husband beat her, Millich said, he picked up the phone and called the sheriff to report the incident himself to show that he couldn't be arrested, she said. He knew, she said, there was nothing the sheriff could do.

"After a year of abuse and more than 100 incidents of being slapped, kicked, punched and living in terror, I left for good," Millich said.

The brutality, she said, increased after she filed for a divorce.

"Typically, when you look backwards at crimes of domestic violence, if less serious violence is not dealt with by the law enforcement system, it leads to more serious violence, which eventually can lead to homicide," said Hirsch, the deputy associate attorney general.

One day when Millich was at work, she saw her ex-husband pull up in a red truck. He was carrying a 9mm gun.

"My ex-husband walked inside our office and told me, 'You promised until death do us part, so death it shall be,'?" Millich recalled. A co-worker saved Millich's life by pushing her out of the way and taking a bullet in his shoulder.

 It took hours to decide who had jurisdiction over the shooting.

Investigators at the scene had to use a measuring tape to determine where the gun was fired and where Millich's colleague had been struck, and a map to figure out whether the state, federal government or tribe had jurisdiction.

The case ended up going to the closest district attorney. Because Millich's husband had never been arrested or charged for domestic abuse on tribal land, he was treated as a first-time offender, Millich said, and after trying to flee across state lines was offered a plea of aggravated driving under revocation.

"It was like his attempt to shoot me and the shooting of my co-worker did not happen," Millich said. "The tribe wanted to help me, but couldn't because of the law. In the end, he was right. The law couldn't touch him."

Section 904

Last year, Millich and other American Indian women came to Washington to tell their stories to congressional leaders. They joined tribal leaders in lobbying for the passage of the 288-page reauthorization of the Violence Against Women Act, which included language proposed by the Justice Department that for the first time would allow tribal courts to prosecute non-Indians who assaulted native women on tribal lands. It would also allow the courts to issue and enforce protective orders, whether the perpetrator is Indian or non-Indian.

Opponents of the provision, known as Section 904, argued that non-native defendants would not be afforded a fair trial by American Indian tribes. In the case of Alaska, the Senate excluded Native Alaskan women because of especially complicated issues involving jurisdiction.

At a town hall meeting, Sen. Charles E. Grassley (R-Iowa) said that "under the laws of our land, you've got to have a jury that is a reflection of society as a whole."

"On an Indian reservation, it's going to be made up of Indians, right?" Grassley said. "So the non-Indian doesn't get a fair trial."

Sen. John Cornyn (R-Tex.), another opponent, said the Violence Against Women Act was "being held hostage by a single provision that would take away fundamental constitutional rights for certain American citizens."

The bill passed the Senate last February but was held up by House Republicans over Section 904. They argued that tribal courts were not equipped to take on the new responsibilities and non-Indian constituents would be deprived of their constitutional rights without being able to appeal to federal courts.

"When we talk about the constitutional rights, don't women on tribal lands deserve their constitutional right of equal protection and not to be raped and battered and beaten and dragged back onto native lands because they know they can be raped with impunity?" Rep. Gwen Moore (D-Wis.) argued on the floor.

Underlying the opposition, some congressmen said, was a fear of retribution by the tribes for the long history of mistreatment by white Americans.

With the support of Rep. Tom Cole (R-Okla.), a member of the Chickasaw Nation, the House accepted the bill containing Section 904 on a vote of 229 to 196. On March 7, President Obama signed the bill with Millich, Holder and Native American advocates at his side.

The Justice Department has chosen three Indian tribes -- the Pascua Yaqui Tribe of Arizona, the Tulalip Tribes of Washington state and the Umatilla tribes of Oregon -- to be the first in the nation to exercise their new criminal jurisdiction over certain crimes of domestic and dating violence.

"What we have done, I think, has been game-changing," Holder said. "But there are still attitudes that have to be changed. There are still resources that have to be directed at the problem. There's training that still needs to go on. We're really only at the beginning stages of reversing what is a horrible situation."

'Sliver of a Full Moon'

Last summer, several Native American survivors of domestic violence from around the country put on a play, "Sliver of a Full Moon," in Albuquerque. The play documented the story of the abuse and rape of Native American women by non-Indians and the prolonged campaign to bring them justice.

Using the technique of traditional Indian storytelling, Mary Kathryn Nagle, a lawyer and member of the Cherokee Nation in Oklahoma, wove together their emotional tales of abuse with the story of their fight to get Washington to pay attention.

Millich and Brunner played themselves, and actors played the roles of members of Congress, federal employees and tribal police officers who kept answering desperate phone calls from abused native women by saying over and over again, "We can't do nothin',?" "We don't have jurisdiction," and "He's white and he ain't enrolled."

By that time, Brunner's intergenerational story of violence and abuse had taken a painful turn. Her youngest daughter, 17, had been abducted by four white men who drove onto the reservation one summer night. One of them raped her, Brunner said.

It was the real-life version of author Louise Erdrich's acclaimed fictional account of the rape of an Ojibwe woman by a non-Indian in her 2012 book, "The Round House." In both the real and the unrelated fictional case, the new congressional authority would not give the tribe jurisdiction to arrest and prosecute the suspects, because they were not previously known to the victim.

Last week, inside her home on the frigid White Earth Nation, which was dotted by vast snowy cornfields and hundreds of frozen lakes, Brunner brought out a colorful watercolor she had painted of three native women standing in the woods under a glowing full moon. The painting was the inspiration for the title of Nagle's play, she said, but it's also a metaphor for the new law.

"We have always known that non-Indians can come onto our lands and they can beat, rape and murder us and there is nothing we can do about it," Brunner said. "Now, our tribal officers have jurisdiction for the first time to do something about certain crimes."

"But," she added, "it is just the first sliver of the full moon that we need to protect us."

By Sari Horwitz

Source: The Washington Post

Sunday, February 2, 2014

Protests over Russian anti-gay law focus on Sochi

Despite seven months of international outcry, Russia's law restricting gay-rights activity remains in place. Yet the eclectic protest campaign has heartened activists in Russia and caught the attention of its targets -- including organizers and sponsors of the Sochi Olympics that open on Feb. 7.

Over the past two weeks, two major sponsors, Coca-Cola and McDonald's, have seen some of their Sochi-related social media campaigns commandeered by gay-rights supporters who want the companies to condemn the law. Several activists plan to travel to Sochi, hoping to team up with sympathetic athletes to protest the law while in the Olympic spotlight.

And on Friday, a coalition of 40 human-rights and gay-rights groups from the U.S., Western Europe and Russia -- including Amnesty International, Human Rights Watch and the Human Rights Campaign -- released an open letter to the 10 biggest Olympic sponsors, urging them to denounce the law and run ads promoting equality for lesbians, gays, bisexuals and transgender people.

"LGBT people must not be targeted with violence or deprived of their ability to advocate for their own equality," the letter said. "As all eyes turn toward Sochi, we ask you to stand with us."

Russian anti-gay law
The law, signed by Russian President Vladimir Putin in July, bans pro-gay "propaganda" that could be accessible to minors -- a measure viewed by activists as forbidding almost any public expression of gay-rights sentiment. The law cleared parliament virtually unopposed and has extensive public support in Russia.

Since July, when they launched a boycott of Russian vodka, activists have pressed the International Olympic Committee and Olympic sponsors to call for the law's repeal. Instead, the IOC and top sponsors have expressed general opposition to discrimination and pledged to ensure that athletes, spectators and others gathering for the Games would not be affected by the law. Putin has given similar assurances in regard to Sochi, but remains committed to the law's broader purposes.

IOC President Thomas Bach has warned Olympic athletes that they are barred from political gestures while on medal podiums or in other official venues, but says they are free to make political statements at news conferences.

One Olympian likely to speak out is gay Australian snowboarder Belle Brockhoff, who told Australia's Courier-Mail newspaper that she plans to lambaste Putin.

"After I compete, I'm willing to rip on his ass," she told the newspaper. "I'm not happy and there's a bunch of other Olympians who are not happy either."

Brockhoff is one of several Olympians promising to display the logo P6 -- a reference to Principle Six of the Olympic Charter that says any form of discrimination "is incompatible with belonging to the Olympic Movement."

Hudson Taylor of Athlete Ally, an organizer of the P6 campaign, is among the activists going to Sochi. He hopes that some athletes, even if wary of wearing P6 symbols, will promote them via social media.

Also heading to Sochi is Shawn Gaylord, advocacy counsel for Human Rights First.

"We won't be looking to violate the law," he said. "But we think it's important that human rights not get lost in the mix."

President Barack Obama, who has criticized the Russian law, is skipping the Olympics and named a U.S. delegation that includes tennis great Billie Jean King and two other openly gay athletes.

"The only way you break down barriers is by being there and meeting people and getting these issues out on the table -- doing it in an appropriate and diplomatic way," King told The Associated Press.

In the U.S., recent protest initiatives have focused on Sochi sponsors, notably Coca-Cola and McDonald's.

In McDonald's case, the company's #CheersToSochi Twitter hashtag has been used by activists in tweets condemning the Russian law and assailing McDonald's for not speaking out forcibly against it.

Similarly, activists made use of an online "I'd like to share a Coke with..." promotion to circulate images of Coke cans with labels such as "Gaybashers" and "Haters." The gay-rights group Queer Nation posted a video online interspersing images of embattled Russian gay-rights demonstrators into Coke's 1970s TV ad featuring the song, "I'd Like to Teach the World to Sing."

Coke then posted a clip of the original ad on its Facebook page, drawing a flood of negative comments from gay-rights supporters. Coke has responded with declarations of support for diversity and inclusiveness, which are themes of Coke's new Super Bowl advertising.

A Coca-Cola spokeswoman, Ann Moore, said the company remained committed to the Olympics despite criticism from gay-rights activists.

"We share these groups' belief in human rights, equality, diversity and dignity for all, and we respect their right to protest peacefully," Moore said in an email. "We firmly believe, however, that supporting the Olympics focuses the world on the ideals that everyone strives for during the Games -- excellence, friendship and respect."

Becca Hary, a McDonald's spokeswoman, made similar points.

"Social media is all about conversation. Understandably, the LGBT community is focusing its conversation on the Russian legislation," she said in an email. "McDonald's is proud to be a top sponsor of the Olympics; our sponsorship dollars literally help the men and women who are working to achieve their Olympic dreams."

Hary and Moore said their companies were conferring with the IOC about human rights.

"We expect our ongoing engagement to include discussions on long-term, sustainable means for addressing human rights in the context of the Olympic Games," Moore wrote.

Minky Worden, director of global initiatives at Human Rights Watch, predicted that sponsors would henceforth insist that the IOC make human rights a more important factor in selection of host cities.

"There will be a reckoning after the Games," Worden said. "Olympic sponsorship is supposed to be the goose that lays the golden eggs, but this goose is not laying golden eggs. It's laying stinky, rotten eggs."

The international gay-rights group All Out plans to target Olympic sponsors in demonstrations next Wednesday in several cities, including New York, London, Rio de Janeiro and St. Petersburg, Russia. Even if the Russian law endures, All Out executive director Andre Banks considers the overall protest campaign a success.

"We've been able to elevate the voices and stories of Russian LGBT people ... and show there are people all over the world willing to stand behind them," he said.

While expressing appreciation for the allies abroad, prominent Russian activist Anastasia Smirnova said she feared that "dangerous self-censorship" might deter some Olympians in Sochi from taking stands against the law. In an email Friday, she also worried about a possible backlash against Russian gays once the Olympic spotlight fades.

By David Crary, The Washington Post, Twitter at

Source: The Washington Post

Repealing health care law would mean higher costs

Republicans may not agree with President Obama's State of the Union call to drop the idea of repealing the Affordable Care Act, but health experts say the law has taken such hold that it may be impossible to get rid of it.

The consequences of repeal, health care officials and industry analysts say, go beyond the fact that 9 million people would suddenly lose their insurance or that anyone with a pre-existing condition would either lose insurance or pay much higher premiums.

All consumers would take a huge financial hit, because health care costs would continue to rise, and insurers would probably recoup their losses by charging higher premiums.

President Obama'sRepeal "was a 2012 issue -- if the Republicans had won both the House and Senate and the White House," said Gail Wilensky, an opponent of the law and the former Medicaid program director under President George H.W. Bush. "It's here to stay.'"

Even a proposal by Senate Republicans issued last week includes many of the law's key elements.

Wilensky remains opposed to many elements of the law and calls the "screw-ups" surrounding the launch of the website Oct. 1 "mind-numbing." But people need health coverage, better health care and lower costs, she said, and the priority should be fixing problems with law, not throwing it out.

Repeal would be "cataclysmic," said Ezekiel Emanuel, a University of Pennsylvania bio-ethicist and one of the architects of the law. "There are probably north of 12 million who have gotten coverage," he said. "You repeal this, and they're all going to be hurt."

That includes the 3 million people who have enrolled in private insurance through the exchanges, 6 million who have enrolled in Medicaid and millions more people younger than 26 who enrolled in their parents' insurance.

Beyond providing insurance coverage to those who didn't have it, the law contains provisions aimed at saving money throughout the health care system, Emanuel said. Those, too, would be lost with repeal. They include:

  • A requirement that insurers clearly and quickly show exactly what is in a policy and how much it will cost the consumer to use.
  • Accountable Care Organizations, a program that moves providers from fee-for-service payment systems to payments based on quality and savings. Thursday, the government announced those groups saved Medicare $380 million in their first year of operation.
  • Incentives and requirements for providers to use electronic medical records to better track care as well as determine potential savings.
  • Explanations by insurers for big premium increases.
  • Penalties for hospitals if Medicare patients are readmitted within 30 days of a hospital stay for preventable ailments, such as infections or pneumonia. That is aimed at forcing hospitals to keep patients from landing back in the hospital when they can get less expensive treatment at home.
  • Increased competition through federal and state health exchanges, which allow consumers to make direct comparisons of health plan costs and benefits.

In addition, children insured before the law who had their Children's Health Insurance Program funding expanded because of the law would lose coverage.

"If you repeal the ACA tomorrow, the CHIP would actually then expire," said Bruce Lesley, president of First Focus, a bipartisan advocacy group for families. "So overnight, there's 8 million kids who would be gone."

Impact on insurers

Insurance companies, which are required to cover higher-risk customers, would lose money through repeal, said Alan Cohen, chief strategy officer for Liazon, which provides health exchanges to private employees.

"You think that somebody who works for a major Fortune 500 company thinks it doesn't matter, but it does," Cohen said. "The health plans who are taking that risk are the same ones that insure all of the people in this country."

The insurers have invested a lot in the law, and if they lose money through repeal, it could cause everyone else's premiums to go up, Cohen said. And if those premiums go up significantly, or, worst-case scenario, the insurers were to go bankrupt, it could lead to more changes.

"It would increase the case for national health insurance," he said. "I think that could increase the call: Medicare for all."

Political Costs

As the White House has learned from the experience of having up to 5 million people have their old health insurance policies canceled because they didn't meet the law's requirements, people do not like having their insurance change. Taking away the coverage of millions of people through repeal would be a similar political disaster for Republicans, said Ben Sommers, assistant professor of health policy and economics at the Harvard School of Public Health.

"They clearly would lose out, and you would have an unprecedented action by Congress to take away access to coverage," Sommers said.

Bob Moffitt, a senior fellow at the conservative Heritage Foundation's Center for Policy Innovation, said any repeal would have to be followed by a new law that includes many similar elements. Those include health insurance plans for those with pre-existing conditions and the ability for people to keep insurance purchased through health exchanges.

Moffitt cited the recent proposal from Republican Sens. Richard Burr, Orrin Hatch and Tom Coburn as a way to maintain those benefits.

Their proposal would eliminate the subsidies that allow people who make less than 400% of the federal poverty level to help pay for their insurance. One way to compensate for the lost subsidies, Moffitt said, would be tax credits because the law's subsidies "cut out an awful lot of the middle class."

States could still work toward market changes, Moffitt said, and they could even keep the exchanges created by the law although they would lose the federal money to help run them.

"Regulation for the health insurance market has been around forever, and that would just pick right back up," he said.

By Kelly Kennedy, USA Today, Follow @KellySKennedy on Twitter

Source: St Louis News and Weather