May we never forget…
May we never forget…
May we never forget…
Tradition per se has no positive or negative significance. There are good traditions, bad traditions pilloried in such famous literary stories as Franz Kafka’s In the Penal Colony and Shirley Jackson’s The Lottery, bad traditions that are historical realities such as cannibalism, foot-binding, and suttee, and traditions that from a public-policy standpoint are neither good nor bad (such as trick-or-treating on Halloween). Tradition per se therefore cannot be a lawful ground for discrimination – regardless of the age of the tradition.
Wisconsin points out that many venerable customs appear to rest on nothing more than tradition – one might even say on mindless tradition. Why do men wear ties? Why do people shake hands (thus spreading germs) or give a peck on the cheek (ditto) when greeting a friend? Why does the President at Thanksgiving spare a brace of turkeys (two out of the more than 40 million turkeys killed for Thanksgiving dinners) from the butcher’s knife? But these traditions, while to the fastidious may seem silly, are at least harmless. If no social benefit is conferred by a tradition and it is written into law and it discriminates against a number of people and does them harm beyond just offending them, it is not just a harmless anachronism; it is a violation of the equal protection clause…
- Judge Richard Posner, U.S. Seventh Circuit Court of Appeals in the panels unanimous decision striking down the appeal of Indiana and Wisconsin same-sex marriage bans
Yesterday, a federal judge in Louisiana ruled that the state’s ban on same-sex marriage is constitutional. The ruling from U.S. District Judge Martin Feldman in Louisiana is the first ruling in over a year to uphold a ban on same-sex marriage, and therefore to uphold discrimination. Judge Feldman’s court is also the only federal court to uphold a marriage ban since the U.S. Supreme Court ruled on the Defense of Marriage Act last year.
In his ruling, Judge Feldman wrote, “The Court is persuaded that a meaning of what is marriage that has endured in history for thousands of years, and prevails in a majority of states today, is not universally irrational on the constitutional grid.”
While Judge Feldman’s ruling is certainly an upsetting setback for the LGBT community, particularly in Louisiana, the ruling underscores the necessity of a definitive Supreme Court ruling. Hopefully Judge Feldman will be the lone dissenting voice in history and quickly find himself on the wrong side of history.
Last week, Pennsylvania Governor Tom Corbett announced that the state had worked out an alternative Medicaid expansion plan with the federal government, bringing 500,000 low-income Pennsylvanians to the Medicaid rolls.
According to numbers from the Kaiser Family Foundation, about 281,000 of those people were falling into what’s known as the “coverage gap.” All state Medicaid programs generally cover some low-income adult populations with certain stipulations – for example, those with disabilities or single mothers. Under the original terms of the Affordable Care Act, states would “expand Medicaid eligibility” to all low-income adults earning up to 133% of the federal poverty level (roughly $15,500). In the wake of the Supreme Court’s ruling on the ACA, states no longer were obligated to expand Medicaid eligibility. These people fall in the gap, they don’t qualify for a non-expanded Medicaid but also don’t get subsidies for purchasing insurance on their own since they don’t make more than the federal poverty level either. According to the Kaiser Family Foundation, about 4.5 million people across the country fall into this coverage gap.
Currently, 23 states aren’t expanding Medicaid – but there are rumblings that a few more may follow in Pennsylvania’s footsteps.
After a series of state district courts in Florida ruled that the state’s ban on same-sex marriage was unconstitutional, a federal District Court judge came to the same determination today.
U.S. District Judge Robert Hinkle ruled today that the Florida ban violates the “due process” and “equal protection” provisions in the U.S. Constitution. The state’s ban was first put into law in 1977 and then written into the state’s constitution after a 2008 referendum. Judge Hinkle’s ruling applies both to whether same-sex couples can marry in Florida as well as whether their marriages elsewhere should be recognized in the Sunshine State.
In his ruling, Hinkle writes,
The founders of this nation said in the preamble to the United States Constitution that a goal was to secure the blessings of liberty to themselves and their posterity. Liberty has come more slowly for some than for others. It was 1967, nearly two centuries after the Constitution was adopted, before the Supreme Court struck down state laws prohibiting interracial marriage, thus protecting the liberty of individuals whose chosen life partner was of a different race. Now, nearly 50 years later, the arguments supporting the ban on interracial marriage seem an obvious pretext for racism; it must be hard for those who were not then of age to understand just how sincerely those views were held. When observers look back 50 years from now, the arguments supporting Florida’s ban on same-sex marriage, though just as sincerely held, will again seem an obvious pretext for discrimination. Observers who are not now of age will wonder just how those views could have been held.
He also writes, “The Florida provisions that prohibit the recognition of same-sex marriages lawfully entered elsewhere, like the federal provision, are unconstitutional. So is the Florida ban on entering same-sex marriages.”
Hinkle’s immediately stayed his ruling pending a likely appeal.
In case you’ve become confusing with the dizzying number of court cases regarding same-sex marriage, and you’re looking for a place to find all the info in one spot – look no further. A few months ago, The Guardian published an awesome infographic about LGBT rights in the United States – state by state. Below is the main infographic, but check out the website where they break each of the right down and cluster them into areas of the country. It’s pretty amazing that for how much progress has been made, some areas – namely the Southeast – still have a lot of work to do.
Let’s say you live in New Jersey and find a better insurance plan across the river in New York. Sorry. You’re out of luck. But don’t worry, you’re told. Your state insurance regulators are doing their job, upholding standards and protecting your interests. Naturally, they can’t protect you in another state. So you pay more.
This makes little sense. You regularly cross the Hudson River for dinner on the town – and entrust your health to New York restaurant regulators. You drive through a tunnel and count on highway safety as regulated by New York’s Department of Motor Vehicles. But out-of-staters cannot buy insurance there. Ask yourself this: Who are those law protecting?
Jonathan Bush doesn’t directly say it, but clearly these laws are protecting insurance companies…
I’m currently reading Jonathan Bush’s new book Where Does It Hurt? and it definitely got me thinking about a lot of issues in health care. More on that to come for sure, but in the meantime a little story.
A few weeks ago, a good friend of mine had an allergic reaction to something he ate. He broke out in hives, and his face became swollen. Out of concern for his health, he visited the Emergency Department at a local community hospital. His story continues from here and highlights the failings of our health care system and questions why our system can’t and won’t perform better.
My friend spent four hours in the Emergency Department before he finally gave up and left. In the intervening four hours, he had to recount his full health history, his religious affiliation and his emergency contact information multiple times. (Anyone reading this is probably not surprised – having to recount your story multiple times is pretty much a standard when visiting a hospital.) An EKG was performed, he never actually saw a physician and the nurse assigned to take care of him was minimally present. He left without a prescription for prednisone.
After leaving the Emergency Department, he texted me in desperation asking for a prescription for prednisone. As a general rule, I don’t like writing random prescriptions for people who’s medical history I don’t actually know. My friend was desperate though because it was Sunday. His physician’s office was closed, the on call physician refused to help (a problem all in its own), and the local community health center was also closed. I finally convinced him to come to the Emergency Department at my hospital after promising to call down to the ED so his wait would be shorter and checking to see how busy things in the ED were. I’m thankful he had a good experience – though I imagine part of that was because I told colleagues in the ED that he would be showing up – but why should it be so hard? Why couldn’t the system take care of a non-life threatening medical problem on a weekend without requiring a trip to the Emergency Department?
Every aspect of my friend’s story illustrates yet another failing of the health care system. There are so many things wrong that it’s almost hard to know where to start. For example, the community hospital didn’t have access to my friend’s health records – something that likely would have decreased the number of questions he was asked in the Emergency Department. But the hospital and his primary care doctor do not share an electronic medical record, barring the hospital access to the most important information in his health history. The simple solution is a nationwide electronic medical record, so that any physician anywhere could access your health information when needed. More to come on that too.
The greater failing is that my friend couldn’t access health care outside of an Emergency Department on a weekend. But how many of us have had a non-life threatening medical event occur “after hours” and had to go to the Emergency Department to get care? You’re more likely to find a plumber or electrician available in the wee hours of the night than a physician. Health problems occur 24/7, so why has our system, and the American people, become comfortable with a medical profession that doesn’t provide 24 hour outpatient comprehensive care? When did we let the Emergency Department become the default?
In days long since gone, physicians saw their patients in their homes. Time, cost, and reimbursement concerns moved the physician visit out of the home and into a centralized office, and in the process physician hours changed. There has been some movement to change that; for medical practices to be certified as a Patient Centered Medical Home, “extended hour” appointments with “medical professionals” out of the normal work day are required – a regulation brought about by the Affordable Care Act. But that’s hardly enough incentive (and truthfully, being fully patient centered would mean going back into the home). Jonathan Bush comments in his book on the need for business outsiders to enter into the health care industry in order to change the status quo, create competition, and hopefully lower prices. These outsiders will begin by focusing on the medical system’s inefficiencies and finding ways to profit. Enter the pharmacy based clinic.
Pharmacy based clinics only came about because some smart entrepreneur or thinker at CVS and Walgreens saw an opportunity to profit off of the medical system’s inadequacies. They realized that people get sick all hours of the day, not just from 8am to 5pm, and that you can’t plan on getting sick and making an appointment. They realized that people would love having a convenient located option to get a flu shot or check for strep throat that didn’t require a doctor’s appointment, wait time, and price tag. People with chronic illnesses could easily stop at a “Minute Clinic” to have their blood pressure checked or their diabetes meds altered. After all – the pharmacy is five feet away. And CVS and Walgreens had the resources to overcome the health care system’s intense regulatory environment. Physicians initially derided these clinics as money-making opportunities headed by nurse practitioners and physician assistants with less training than physicians (with the undertone being worse quality), but we should take note. These clinics were born out of our failure as a profession to offer convenient, comprehensive service to the public.
If you argue that health care needs to change in slow incremental changes, then it’s only a matter of time before some other corporation keys into another growth opportunity in health care – and one that could have much wider reverberations and affect far more than just the physician’s office. If there’s any good news, it’s that the outsiders are slowly revolutionizing medicine, chipping away at the Berlin Wall that the status quo has for so long help up in their way. One day they will succeed in turning the industry upside down, and health care as we know it will be forever changed.
The 4th Circuit Court of Appeals in Richmond, VA ruled in favor of same-sex couples’ freedom to marry today, upholding a marriage ruling out of Virginia from February. The landmark ruling follows a similar ruling from the 10th Circuit Court of Appeals, which held that banning same-sex couples from marriage in Utah and Oklahoma is unconstitutional. It is the 29th consecutive ruling in favor of marriage for same-sex couples in the past year.
The decision reads:
We recognize that same-sex marriage makes some people deeply uncomfortable. However, inertia and apprehension are not legitimate bases for denying same-sex couples due process and equal protection of the laws. Civil marriage is one of the cornerstones of our way of life. It allows individuals to celebrate and publicly declare their intentions to form lifelong partnerships, which provide unparalleled intimacy, companionship, emotional support, and security. The choice of whether and whom to marry is an intensely personal decision that alters the course of an individual’s life. Denying same-sex couples this choice prohibits them from participating fully in our society, which is precisely the type of segregation that the Fourteenth Amendment cannot countenance.
The 4th Circuit opinion also will affect marriage laws in other states within its jurisdiction, including West Virginia, North Carolina and South Carolina; however, separate orders would have to be issued for affected states in the region outside Virginia.
Gay and lesbian couples in Virginia cannot marry in the state for at least another three weeks, giving the time for another appeal to be filed on enforcement. The decision on an appeal is not clear as Virginia Gov. Terry McAuliffe and Virginia’s attorney general have refused to defend the ban in court as is tradition, leaving it to other state officials to make the case.
Yesterday, another judge in Florida overturned that state’s ban on same-sex marriage – this time in Miami-Dade County. It is the second such ruling in florida after Monroe County Circuit Judge Luis Garcia struck down the ban for the Florida Keys. Circuit Judge Sarah Zabel found the constitutional amendment approved by Florida voters in 2008 discriminates against gay people, saying it violates their right to equal protection under the law guaranteed by the U.S. Constitution’s 14th Amendment. She writes,
Preventing couples from marrying solely on the basis of their sexual orientation serves no governmental interest. It serves only to hurt, to discriminate, to deprive same-sex couples and their families of equal dignity, to label and treat them as second-class citizens, and to deem them unworthy of participation in one of the fundamental institutions of our society.
Garcia’s earlier ruling was put on hold when Republican Attorney General Pam Bondi filed notice of appeal. Zabel also stayed the effect of her ruling indefinitely to allow time for appeals, which could take months, and Bondi promptly followed up Friday by filing an appeal notice in the Miami-Dade case.
Both judges were appointed by former Republican Gov. Jeb Bush and have been re-elected.
The legal battleground will next shift to the Miami-based 3rd District Court of Appeal for both cases, and most likely after that to the state Supreme Court.
Earlier today, U.S. District Judge Raymond P. Moore ruled against Colorado’s constitutional amendment banning marriage equality. His ruling has been stayed until August 25 to allow the state time to appeal to the U.S. Court of Appeals for the Tenth Circuit, the same court which has already struck down bans on marriage equality in Utah and Oklahoma.
Moore’s ruling is particularly important for Colorado, where clerks in several counties began issuing marriage licenses to same-sex couples after lower court rulings that deemed marriage bans unconstitutional. The Colorado Supreme Court last week ordered Denver County clerks to stop issuing the marriage licenses, however today the same court declined the state’s request to force the Boulder County clerk to stop issued licenses.
The state of Colorado has not yet indicated whether it plans to appeal Judge Moore’s decision.
This is starting to become redundant, but the US Court of Appeals for the Tenth Circuit issued another ruling today, affirming the decision by US District Judge Terence Kern, that Oklahoma’s constitutional amendment banning same-sex marraige violates the US Constitution. The 2-1 decision was authored by Judge Carlos Lucero, who was joined by Judge Jerome Holmes – a President George W. Bush appointee.
The same court previously affirmed a similar ruling regarding the state of Utah’s marriage ban.
Same-sex marriages will be put on hold pending an appeal by the state of Oklahoma. The state now has the option to request an en banc appeal before the full bench of the Tenth Circuit, which decides whether or not to grant that request. It may also bypass an en banc session and appeal directly to the U.S. Supreme Court. The Utah attorney general announced earlier this month that he would appeal the Tenth Circuit’s ruling to the Supreme Court.
Earlier today, a judge in a state court struck down Florida’s ban on marriage for same-sex couples, deeming the ban unconstitutional.
Chief Circuit Judge Luis Garcia ordered the Monroe County Clerk to stop enforcing Florida’s anti-marriage constitutional amendment, saying that marriage licenses should begin being issued in Monroe County on July 22.
In his ruling, Judge Garcia writes:
It is our country’s proud history to protect the rights of the individual, the rights of the unpopular and the rights of the powerless, even at the cost of offending the majority. … The Constitution guarantees and protects all of its citizens from government interference with those rights. All laws passed by the legislature or by popular support must pass the scrutiny of the United States Constitution, to do otherwise diminishes the Constitution to just a historical piece of paper.
Of note – the ruling only applies to Monroe County, home to the Florida Keys.
A District Court judge today struck down Colorado’s ban on same-sex marriage, marking the 24th consecutive ruling in favor of the freedom to marry (with no rulings against) since June 2013. The ruling has been stayed for now, pending an appeal.
In the ruling, District Court Judge C. Scott Crabtree explained how civil union – which Colorado has had in effect since 2013 – is a lesser, unequal form of family status that does not compare to marriage. He writes:
The fact that the State has created two classes of legally recognized relationships, marriages and civil unions, is compelling evidence they are not the same. If civil unions were truly the same as marriages, they would be called marriages and not civil unions. If they were the same, there would be no need for both of them. The fact that Colorado denies same gender couples the same right to apply for federal benefits that it grants to opposite gender couples is a violation of the Equal Protection Clause.
In other marriage equality news, Utah’s Attorney General will be filing an appeal of the 10th U.S. Circuit Court of Appeals recent decision to overturn the state’s ban on same-sex marriage. Attorney General Sean Reyes will be filing the appeal directly to the US Supreme Court rather than asking for a review by the entire 10th US Circuit Court of Appeals. The Supreme Court is under no obligation to hear the appeal.
Marriage equality moved into another southern state today when U.S. District Judge John Heyburn struck down Kentucky’s constitutional amendment ban on same-sex marriage.
Judge Heyburn had previously struck down the portion of the marriage ban in Kentucky that denies respect to same-sex couples who legally married in other states.
In addition to the marriage equality news out of Indiana, the three-judge panel of the 10th U.S. Circuit Court of Appeals in Denver ruled 2-1 that Utah’s ban on same-sex marriage violates the U.S. Constitution. Federal trial court judge Carlos Lucero previously struck down the ban in December 2013.
With their ruling, the appeals courts becomes the first appellate ruling on marriage equality since the Supreme Court struck down part of the Defense of Marriage Act. In their ruling, the judges wrote,
Having heard and carefully considered the argument of the litigants, we conclude that, consistent with the United States Constitution, the State of Utah may not do so. We hold that the Fourteenth Amendment protects the fundamental right to marry, establish a family, raise children, and enjoy the full protection of a state’s marital laws. A state may not deny the issuance of a marriage license to two persons, or refuse to recognize their marriage, based solely upon the sex of the persons in the marriage union. For the reasons stated in this opinion, we affirm.
The judges put their ruling on hold in the event that it will be appealed, which is anticipated from the state of Utah. The judges have not yet issued a ruling in a similar case in Oklahoma.
A major marriage equality victory was handed down today in the Midwest, with a judge in Indiana ruling that the state’s ban on same-sex marriage is unconstitutional.
The ruling comes from U.S. District Judge Richard Young, who states the ban violates the U.S. Constitution’s equal-protection clause. The ruling involved multiple lawsuits from several gay couples.
The Indiana State Attorney General is expected to appeal the ruling.
If you happened to catch Hillary Clinton’s interview with Diane Sawyer last week, you undoubtedly heard the moment when the former Senator and Secretary of State told Sawyer that after leaving the White House, she and husband President Bill Clinton were… well, “dead broke”.
There’s been a lot of political talk about that comment since the interview, and I do love me some Hillary Clinton, but this someecard pretty much sums up my feelings on the situation. Sorry Hilz.
Back to work for the rest of us…