Meet an AtMP board member – Alissa Wise
As a rabbi I have a complicated relationship to marriage. On the one hand, I believe in the transformative power of ritual and want to facilitate meaning-making and connection whenever we are able to have it. We live in an uncertain world where opportunities for celebration should not be passed by, and certainly people making bold commitments and affirmations of love are one of those opportunities.
On the other hand, as a spiritual leader, I can not stay silent when I see the harm marriage has long been in our culture. A coveted seat of privilege, marriage reinforces systems of privilege and oppression in our culture, dividing us in harmful ways, whether through ill-advised immigration laws, through cutting people off from their support networks in hospitals, by making invisible non-romantic love and connection, or by distracting the LGBTQ community to see marriage as the ultimate goal for gender and sexual liberation.
As a board member with AtMP, I am fortunate to be able to advocate for concrete changes in the way that our government links marriage and civil rights and to fight for the rituals, celebrations, and connections that we all so much deserve.
New national standards for hospital visitation
In August, AtMP commented on the proposed federal hospital visitation rule. We urged that it explicitly ensure visitation access by health care proxies, access to incapacitated patients who have not designated visitors and/or completed advanced directives, and access without discrimination on the basis of marital/relationship status.
In late November, the Centers for Medicare and Medicaid Service (CMS) published the final rule, along with general responses to all the comments it received (nearly 7,600, of which “more than 6,300 were versions of a form letter”). We didn’t get everything we wanted, but overall we’re delighted that a strong and inclusive visitation rule is now in place for practically all hospitals.
For this result, you should thank your fellow AtMP members, who bravely shared their private heartbreaks for the sake of preventing yours. Much credit also goes to Jess, who slogged through the regulatory process, and to Heather, who drafted AtMP’s initial analysis. And credit also Nancy Polikoff, who set us on this course back in 2008 by correctly predicting that hospital right were the low-hanging fruit for a valuing-all-families approach to policy change.
First, here’s the final rule, which goes into effect on January 18th, 2011:
Patient visitation rights: A hospital must have written policies and procedures regarding the visitation rights of patients, including those setting forth any clinically necessary or reasonable restriction or limitation that the hospital may need to place on such rights and the reasons for the clinical restriction or limitation. A hospital must meet the following requirements: (1) Inform each patient (or support person, where appropriate) of his or her visitation rights, including any clinical restriction or limitation on such rights, when he or she is informed of his or her other rights under this section. (2) Inform each patient (or support person, where appropriate) of the right, subject to his or her consent, to receive the visitors whom he or she designates, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend, and his or her right to withdraw or deny such consent at any time. (3) Not restrict, limit, or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability. (4) Ensure that all visitors enjoy full and equal visitation privileges consistent with patient preferences.
We are delighted that CMS directly addressed our concern that legally appointed health care agents be assured visitation:
One commenter suggested that health care proxies or powers of attorney that are legally recognized in one State also be recognized by hospitals in other States for the purpose of establishing visitation rights. Response: We agree that the patient’s representative and/or support person, as the individual responsible for exercising the patient’s rights on the patient’s behalf when the patient is incapacitated or otherwise unable to do so directly, should be granted direct access to the patient. This basic concept is embodied throughout the current hospital regulations, including through the requirement at § 482.13(a) and (b) that the patient or patient’s representative must be informed of the patient’s rights and how to exercise those rights. We also agree that using the information provided in an advance directive or other written document, whether it is or is not legally recognized by the State, may be useful for hospitals when trying to determine appropriate visitors when a patient is unable to communicate his or her own wishes and a legal representative as established consistent with State law or a support person is not available to exercise the patient’s visitation rights on his or her behalf.
We are also pleased with CMS’s approach to ensuring visitors for incapacitated patients.
[C]ommenters stated that, when a patient is incapacitated, the patient’s … support person should not be chosen solely based on an individual’s legal relationship with the patient. Commenters noted the lack of protection for ‘‘families of choice,’’ which do not necessarily fit a traditional definition of a family, one based on bloodlines, marriage, or adoption, make it difficult for visitors to gain access to sick loved ones. … Response: … In the absence of a verbal support person designation, hospitals would look to their established policies and procedures for establishing a support person for the purpose of exercising a patient’s visitation rights. … [T]here are numerous sources of information and documentation that may be appropriate to establish the appropriateness of an individual to exercise an incapacitated patient’s visitation rights on his or her behalf… [Furthermore] we believe that documentation to establish support person status for the purpose of exercising a patient’s visitation rights should be required only in the event that the patient is incapacitated and two or more individuals claim to be the patient’s support person. (emphasis added)
Obviously, we are disappointed that marital/relationship status was not added to the final rule. Here’s how CMS addressed that point:
Commenters stated that the protected categories in the proposed rule should be expanded to also include: marital status, family composition, age, primary language and immigration status. In addition, commenters suggested that the proposed rule make explicit that institutional or individual conscience cannot be used to deny a visitor access to the patient. Response: As revised, we believe that this rule makes clear that hospitals must establish and implement visitation policies that grant full and equal visitation access to all individuals designated by the patient or support person, consistent with patient preferences. Patients (or their support persons) may designate anyone as an approved visitor, and a hospital or CAH may not discriminate against any approved visitors (and may impose only reasonable, clinically necessary restrictions or limitations on visitation). We believe that this regulatory policy is responsive to the concerns of commenters while still adhering to the specific instructions of the President’s April 15, 2010 memorandum to the Secretary. Therefore, we are not expanding the list of explicitly protected classes at this time. (emphasis added)
This response proves how important it is to educate the President himself so that he sends good instructions to his agencies. It also offers a sobering lesson: identity-based advocacy yields narrow victories that can alienate rather than build the base.
***Lastly, it is easy to confuse visitation with medical decision-making rights. (In fact, CMS repeatedly noted that many commenters had addressed decision-making issues instead of or in addition to visitation issues.) Please remember that it is the states (not the federal government) that regulate who can make medical decisions for incapacitated patients who have not completed advance directives. In those situations, a hospital must follow the law of the state where it is located. You should complete advance directives naming your health care proxy, power of attorney or agent, today! Learn more, or go directly to your state’s free paperwork.
International news of note
South Africa considers cohabitation, quotes one of AtMP’s co-founders.
Iraq’s unmarried people especially lack security and face barriers to emigration.
Israel makes it somewhat easier for women to get divorced.
New York (not really a foreign country!) becomes the 50th state to allow no-fault divorce.
Meet an AtMP board member: Tom Amoroso
I have been polyamorous since 1999, when the woman I was then dating introduced me to the word. I embraced the idea immediately, as I felt it was much more consistent with my way of being in the world than monogamy had been. I’d been monogamous during my marriage, and while I was faithful, I felt constrained in ways I wasn’t happy about, especially when I learned that I was the only faithful partner in my marriage!
I now have two wonderful partners, Matt and Katherine. They recently had a commitment ceremony to celebrate their marriage of 6 years and their commitment of 10 years, and I was a central part of their ceremony. A guest remarked as he was leaving “That was the most openly poly wedding I’ve ever been to, including my own.” I’ve been with them for 5 years, and we’re happier now than ever.
Personally, I’m a practicing emergency physician and health policy analyst. My connection with AtMP also dates from 1999, when a former board member and close friend told me he was on the board and felt they were a great organization and I ought to consider supporting them financially. He was right, and I’ve been a donor since 2000. I’ve been able to help AtMP with issues around hospital visitation, health care decision making, and other health issues as they relate to unmarried relationships.
Last year I was invited to be on the board, an invitation I was delighted to accept. I’m looking forward to our ongoing work around health care issues, as well as new research into the legal status of marriage as it relates to public health.
Tom Amoroso is a member of AtMP’s finance committee and leads a new working group on changing the organization’s name.
Marriage is not an anti-poverty strategy
Last month we quietly celebrated the end of federal welfare funding for marriage programs. One reason our cheer was so muted was that Congress had let the programs die with a whimper by refusing to act on the President’s budget proposal. Instead of ensuring a safety net for very-low income people for years to come, Congress gave just a few months extension to Temporary Assistance for Needy Families (TANF – the main anti-poverty program). The extension did not cover marriage programs, nor did it cover “the Emergency Fund, which was created as a stimulus effort and helped millions of very low-income people make ends meet through the worst part of the Great Recession.” Next year we can hope for a full renewal of the safety net, plus a proper debate about whether marriage or relationship education belong in welfare funding.
At about that same anti-climactic moment, the Women of Color Policy Network published an interesting report about unmarried mothers. It has lots of good information, but strangely does not recommend policies to reduce marital status discrimination. This is especially surprising given single mothers’ low incomes, which might get a lift if we prohibited marital status discrimination in employment (yes, that’s still legal in all states except these).
Single mothers not only earn less than men, but they earn only 77 percent as much as married women with children and 87 percent as much as single women without children. In contrast, unmarried men with children earned 8 percent more than unmarried men without children.
As the report says, “lower earnings no doubt contribute to the wealth gap for single mothers, but they are just the tip of the iceberg.” Here are a few interesting excerpts about the intersection of wealth and marital status:
There is no single reason for the lack of wealth among single women mothers; the reasons are manifold and interrelated: lower wages and life-time earnings, occupational segmentation, lack of access to wealth escalators such as retirement and pension plans, and historic structural and institutional discrimination, among others. …
… Single mothers who have never been married have less wealth than women whose pathway to single motherhood was through divorce or widowhood. Divorced or widowed single mothers have a median wealth of $7,500 whereas single mothers who never married have a median wealth of zero. …
… Marriage is associated with higher wealth for two reasons: first, many women wait until they are financially stable to marry; second, marriage has wealth-building advantages such as economies of scale. Upon divorce, mothers may be able to access any wealth accumulated during marriage. Additionally, divorced single mothers are much more likely to receive child support, which gives them more disposable income to save or invest. …
Note to marriage promoters: these correlations still do NOT make marriage an ethical or effective anti-poverty strategy.
A touching friendship between single women
Book Review: Let’s Take the Long Way Home by Gail Caldwell
BY KATHLEEN PETERS
Often it is assumed that, through the course of one’s life, the closest relationship one will have is with their romantic partner. While this is far from reality, we are constantly bombarded with reminders and pressures of this supposed truth, whether it’s from T.V. commercials picturing a couple going shopping together or at family reunions when your relative asks you why you haven’t brought someone special home for the holidays yet. Everyone seems to be coupled off or wanting to be coupled off. Not so in Let’s Take the Long Way Home, a book by Gail Caldwell about her relationship with her friend and non-romantic partner, Caroline Knapp.
Caldwell takes the reader through the start and end of her relationship with Knapp, who passed away in 2002 from lung cancer. “We knew from the beginning, I think, that this friendship was different, that we would work to make it immune to the erosion of time” (175). Caldwell and Knapp connect with each other on multiple levels, whether it’s over their writing professions, their love of dogs, or their histories with alcoholism. Caldwell tenderly recounts the walks they share in the woods, the fights that both tested and strengthened their relationship, and the mutual love, affection, and dependence the women had upon each other.
While the book takes some time to grab your interest, the second half of the book is boiling over with emotion. Regardless of the fact that I cry easily at books and movies, the description of Knapp’s diagnosis, the way her friends gathered around her in those last final days, the struggles Caldwell went through trying to reorganize her life after the loss of her friend – all of it had me bawling and feeling for not only Caldwell’s pain, but the pain that everyone knows will come when they lose someone they care for this much.
Let’s Take the Long Way Home is not only a touching memoir of Caldwell and Knapp’s relationship, but also serves as a reminder of the intense intimacy and importance of friendship. Even though Knapp has a long-term partner, her friendship with Caldwell appears just as strong and loving, if not more so, as her romantic relationship. It challenges the concept of what it means to be single and what kinds of relationships are deemed most important. An easy, lazy afternoon kind-of-read, Let’s Take the Long Way Home is a wonderful memoir of friendship that won’t leave you disappointed.
Kathleen Shea Peters is currently living in Flagstaff, AZ as a graduate student in History. She has been a supporter of Alternatives to Marriage and their values for the last few years.
It’s time for single payer health reform
Amidst all the drama of the election, there’s been little coverage of this result of great importance to all unmarried people:
Massachusetts voters have, for the second straight election, overwhelmingly affirmed their support for single payer health reform by turning in majority ‘Yes’ votes in all fourteen districts where local single payer ballot questions appeared on November 2.
As you know if you’re on our email list, we always send out a reminder to vote. Unmarried people don’t vote as often as married people do – if we did, we’d shape every election. If you’re a Massachusetts resident, your reminder included a link to information about the single payer ballot question – it was great to hear that 20% of you were interested in learning more.
Single payer health reform is the best deal for all unmarried people. The current system of employer-based health insurance inevitably uses marital status or relationship status to keep employers’ costs down. Using narrow definitions of family to set eligibility for coverage discriminates against a wide variety of unmarried people and makes care-giving harder. Even after the big national health care reform effort last year, marriage remains the on / off switch for access to health care in America. Basic health care and costs should be equal for all individuals under a national single-payer system.
Part of this year’s election drama is the threat to roll back last year’s (inadequate) health reform. Enough already! It’s time for our national leaders to get serious about single payer. It’s time for us to make that happen! Sign our new petition and let’s get going for real change.
A day to remember
Jess and Jordyn (friend) at Rally to Restore Sanity
BY: JESS GAFKOWITZ
Last Saturday was unlike any other. I spent it in Washington, DC at the Rally to Restore Sanity / Keep Fear Alive. It was my first rally and I had a blast.
I carried a sign that read:
100,000,000 Unmarried Americans For Sanity!
www.unmarried.org/blog
A few people there, intrigued by my poster, decided to take a photo.
The night before I had an engaging debate with someone about how marriage is privileged, single payer health insurance and why health care proxies are important.
Were you at the rally too?
Marital and family status: relevant in news reporting?
BY KAREN HENNINGER
I read an article back in May with the headline “1 dead after car runs gate at Ariz. Air base” and I was struck by the last sentence.
“Azfamily.com said the car reportedly belonged to a single mother who had bought the vehicle Monday.”
The use of the term “single mother” is very telling of the writers’s mindset that the marital and family status of the woman seemed necessary to mention; but I am really puzzled and curious as to why that last sentence would be a relevant part of the story at all. That speculation is another piece of writing entirely, but reveals even more how we think about crime and single mothers in this society.
As a writer, I analyze other writing in the context of the people and identities within the story. Nothing is a mistake when logic is what it is – unexamined. I imagine alternatives and also question the use of words. For example, I notice when the word “father” is used, when the word “mother” is used, and when the alternatives, simply “man” or “woman” are used, even if those being reported on are revealed to be mothers and fathers in the overall story.
I also notice when and question why it would matter to mention if someone is married or single.
Also, in this particular piece I am struck by the fact that the headline itself reads “1 dead” – revealing no identity, not even personhood. In traditional media coverage, when an identity is missing, it is usually an assumed ‘man’ in the same manner that using the word “he” could mean a man or either gender.
In an attempt to show how alternate ways of phrasing, which do not follow “normal” language usage in dominant media channels, disrupts our normal procedures and thinking, here is the statement in many different forms.
A. Azfamily.com said the car reportedly belonged to a ‘married’ mother who had bought the vehicle Monday. (No need to mention married?)
B. Azfamily.com said the car reportedly belonged to a mother who had bought the vehicle Monday.
C. Azfamily.com said the car reportedly belonged to a single woman who had bought the vehicle Monday. (Why mention her status of children or no children?)
D. Azfamily.com said the car reportedly belonged to a married woman who had bought the vehicle Monday. (Mention that she is married and forget to mention she has kids and is a mother? It NEVER happens.)
E. Azfamily.com said the car reportedly belonged to a woman who had bought the vehicle Monday.
F. Azfamily.com said the car reportedly belonged to a person who had bought the vehicle Monday.
G. Azfamily.com said the car reportedly belonged to a man who had bought the vehicle Monday.
H. Azfamily.com said the car reportedly belonged to a married man who had bought the vehicle Monday.
I. Azfamily.com said the car reportedly belonged to a single man who had bought the vehicle Monday. (Note: a ‘single’ man no longer necessarily reads as MARRIED, but rather one lone man. At least to me, for others I don’t know.)
J. Azfamily.com said the car reportedly belonged to a single father who had bought the vehicle Monday. (How often is it necessary to mention the person is a single father in stories of crime?)
It is interesting to note that in this entire piece, none of the other people mentioned [only the single mother] have been identified as to whether they are married, single, or have children. Why not? I have my guesses. Take a moment to think about it and I am sure you will come up with your own.
Karen Henninger is a Media Literacy/Violence Prevention Activist, Cultural Environmentalist Consultant, Women Studies Independent Scholar and Community Education Specialist, Visual Artist and Visual Writer, and Creative Artist of Life.
Update on fair housing and federal employee benefits
There’s little happening in Congress these days – everyone is waiting for the outcome of the election. [PLEASE don't forget to VOTE on Tuesday November 2nd, if not earlier!]
Nonetheless, this week I found interesting tidbits about two federal bills we’re tracking. Both hint that the bills could start moving again soon.
First, our friends at the National Gay & Lesbian Task Force sent their members an email calling for “federal fair housing protections for marital status, sexual orientation, gender identity or expression.” It’s very exciting to see the Task Force including marital status in their list, and we look forward to working with them to amend and pass HR 4820, the Fair and Inclusive Housing Rights Act.
Second, a kerfuffle over pet insurance for federal employees led the Office of Personnel Management to cite “the President’s strong support of the Domestic Partnership Benefits and Obligations Act, which will provide full benefits to same-sex partners of federal workers.” Maybe that means HR 2517, the Domestic Partnership Benefits and Obligations Act, will get moving again. Here’s what I posted on a discussion site. If you’re a federal employee, please weigh in!
What we all have in common is our ability to care for others and our desire to be respected for our caring relationships. Employers really don’t want to know whom we’re caring for; rather, they want to know that we’ll be productive on the job. Sometimes that means helping us fulfill our caring responsibilities so we’re not distracted, absent, or looking for extra money to cover costs. Like all employers, the federal government should seek a solution to helping employees care for *whomever* they define as family. It is not an employer’s place to say that some families are better than others.
