Sunday, October 30, 2022

The NCSA on Abortion Access

The following is a position statement from the National Council on Severe Autism on Abortion Access:

Abortion Access: Potentially Devastating Consequences for Vulnerable Girls and Women with Intellectual Disabilities and Autism

An Open Letter to State Legislators

In the wake of the Supreme Court’s Dobbs decision, we are aware that many states are positioned to impose sweeping bans on access to abortion, even in cases involving risks to the mother. 

When one thinks of abortion, girls and women disabled by autism and intellectual disability — who may have reproductive capacity but lack capacity to defend against rape, may have little to no ability to speak, and may function at a preschool level — probably don’t come to mind. But those of us parenting or providing healthcare for such girls and women can only shudder as we ponder what may now happen to many of our vulnerable loved ones, patients and clients in the wake of Dobbs. 

The CDC estimates that 1 in 145, or .69 percent, of girls (as of the 2018 surveillance of 8 year-olds) has autism (the rate among boys is 1 in 34), with well over half suffering from intellectual disability (ID) or borderline intellectual disability, as well. Beyond that, at least 1% of our population has intellectual disability, without autism. It is well-known that medical, psychiatric, and behavioral comorbidities abound in ID and autism, and many individuals require lifelong 24/7 adult supervision, support and services to reach even a modicum of personal safety, health and quality of life.

These girls and women are highly susceptible to abuse, including sexual abuse, assault and rape. A 2021 analysis documented a 32.9% prevalence rate of sexual abuse in adults with intellectual disability, with prevalence increasing with severity of the ID. Though seldom discussed, it is no secret that vulnerable intellectually disabled girls and women will involuntarily become pregnant. 

In Dobbs, the Court established a “rational basis” test for abortion laws, saying a state law must be sustained “if there is a rational basis on which the legislature could have thought that it would serve legitimate state interests.” We write this letter to make it clear that there can be no rational basis for a state to deny access to abortions for girls and women disabled by autism and intellectual disability who are victimized by rape and involuntarily pregnant. Indeed, such a ban would be so barbaric as to shock the conscience.

Many of these autistic/ID females are so profoundly impaired they require lifelong, intensive support and care to accomplish the most basic activities of daily living. They would not understand the changes to their bodies, and typically would not even understand the concept of pregnancy or prenatal care. In labor they would not comprehend the pain of contractions or have the ability to follow even the simplest of instructions, like “push.” Forcing the girls and women to give birth would be overwhelmingly dangerous and traumatic. The alternative of a C-section is equally problematic, as it is a serious, highly invasive surgery involving complex anesthesia and that requires adherence to post-operative care the girl or woman would be unable to follow. 

In addition, they also may have medical, genetic, or psychiatric comorbidities that sharply increase risks to themselves and the fetus. Studies have documented the increased risk of serious pregnancy and birth complications for women with intellectual disability, including preterm labor, low birth weight, low Apgar scores, pre-eclampsia, post-partum hemorrhage, C-section, perinatal mortality and stillbirth.  

In addition, many of these patients with significant ID require various medications, such as anticonvulsants and antipsychotics, that raise the risk for fetal abnormality, including birth defects, autism and intellectual disability. Combined with a genetic predisposition to mental disorder, these fetuses would be in tremendous peril.  

Then there is the question of care and support services following a birth. It goes without saying that these girls and women typically have no capacity to care for a child. Indeed, our country’s burgeoning population of people disabled by autism often lack access to Medicaid and other necessary services to fulfill their own care needs. Who will care for these mothers and children?

An abortion law that lacks attention to the dire realities we have enumerated must lack a any rational basis. No just or humane society would force a severely cognitively disabled woman, a traumatized rape survivor, to carry an involuntary pregnancy and give birth, while forcing a fetus to be subjected to compromised prenatal care and neurotoxic drugs, all without any plan for long-term care that the mother could not possibly provide.

The Dobbs court did not set forth the parameters for applying the rational basis test, but plainly, ignoring the dimension of risk in cases of maternal autism and developmental disability would be highly irrational. Indeed, the Mississippi statute at issue in the case allowed for post 15-week abortions in the case of medical emergency or severe fetal abnormality.

Should you have any questions or concerns about abortion access for girls and women in your state who are disabled by autism and related disorders, please do not hesitate to contact us at info@ncsautism.org.

Signed,

Board of Directors
National Council on Severe Autism

Michigan Ballot Proposal 3: "Right to Reproductive Freedom"

On November 8, 2022, Michigan will vote on a ballot initiative, Proposal 3, the "Right to Reproductive Freedom", that restores rights and protections that Michigan women were afforded for five decades under Roe v. Wade.

The issue of abortion rights weighs heavily on people who are disabled and their families. Depending on the disability,  many disabled women of child bearing age face increased risks of harm to their health with pregnancy and increased vulnerability to sexual assault resulting in unwanted pregnancy. Women who have given birth to children with disabilities or have suffered miscarriages, depending on the underlying cause, may be at increased risk of significant problems in subsequent pregnancies. Having access to a full spectrum of medical care, including abortion and contraception, gives them more control over decisions affecting their lives and those of their families. 

The Detroit Free Press published an opinion piece on the subject on 10/29/2022, "I’m an OBGYN in Michigan. This is what I worry about when treating a patient." by Lisa Harris. Near the beginning of her article, she says this: "Many of you see the complexities in abortion, and are carrying two opposite ideas in your hearts at the same time: that abortion means a potential human won’t be born, and that a ban on abortion means that women may not be able to determine the course of their lives and their family’s lives. Both things are true, and that is what can make abortion such a hard issue. 

"I want to offer a window into abortion care here in Michigan." 

This is worth reading for its exploration of the complexities of abortion care and what Proposal 3 is intended to do. 

Rather than relying on campaign ads to form an opinion on Prop. 3, reading the exact wording of the proposal amending Michigan's state constitution goes a long way to dispelling misinformation about it and its affect: 

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Article 1, Section 28 Right to Reproductive Freedom

(1) Every individual has a fundamental right to reproductive freedom, which entails the right to make and effectuate decisions about all matters relating to pregnancy, including but not limited to prenatal care, childbirth, postpartum care, contraception, sterilization, abortion care, miscarriage management, and infertility care. An individual's right to reproductive freedom shall not be denied, burdened, nor infringed upon unless justified by a compelling state interest achieved by the least restrictive means. 

Notwithstanding the above, the state may regulate the provision of abortion care after fetal viability, provided that in no circumstance shall the state prohibit an abortion that, in the professional judgment of an attending health care professional, is medically indicated to protect the life or physical or mental health of the pregnant individual.

(2) The state shall not discriminate in the protection or enforcement of this fundamental right. 

(3) The state shall not penalize, prosecute, or otherwise take adverse action against an individual based on their actual, potential, perceived, or alleged pregnancy outcomes, including but not limited to miscarriage, stillbirth, or abortion, nor shall the state penalize, prosecute, or otherwise take adverse action against someone for aiding or assisting a pregnant individual in exercising their right to reproductive freedom with their voluntary consent. 

(4) For the purposes of this section:

  • A state interest is "compelling" only if it is for the limited purpose of protecting the health of an individual seeking care, consistent with accepted clinical standards of practice and evidence-based medicine, and does not infringe on that individual's autonomous decision-making.
  • "Fetal viability" means: the point in pregnancy when, in the professional judgment of an attending health care professional and based on the particular facts of the case, there is a significant likelihood of the fetus's sustained survival outside the uterus without the application of extraordinary medical measures. 
(5) This section shall be self-executing. Any provision of this section held invalid shall be severable from the remaining portions of this section.[11] 

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The proposal does not automatically change any laws regarding parental consent for abortion for a minor child, nor does it change restrictions on who can perform abortions and safety concerns for the mother.

Whether you agree or disagree with Prop. 3, the wording is not confusing. It may lead to court challenges and proposed legislative changes over specific issues, but that can occur at any time, with or without Prop. 3 and with or without Roe V. Wade.

The default position for reproductive rights in Michigan

Without Prop. 3, Michigan could revert to a 1931 law that bans abortion in all cases except to preserve the life of the woman. It also bans any attempt to procure a miscarriage for a woman except to preserve the life of the woman. This law has been challenged in court on whether it violates rights already protected by the Michigan constitution, but a decision on this issue is still pending.

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THE MICHIGAN PENAL CODE (EXCERPT)
Act 328 of 1931
CHAPTER III
ABORTION

750.14 Miscarriage; administering with intent to procure; felony, penalty. 

Sec. 14. Administering drugs, etc., with intent to procure miscarriage—Any person who shall wilfully administer to any pregnant woman any medicine, drug, substance or thing whatever, or shall employ any instrument or other means whatever, with intent thereby to procure the miscarriage of any such woman, unless the same shall have been necessary to preserve the life of such woman, shall be guilty of a felony, and in case the death of such pregnant woman be thereby produced, the offense shall be deemed manslaughter.

In any prosecution under this section, it shall not be necessary for the prosecution to prove that no such necessity existed.
... 

750.15 Abortion, drugs or medicine; advertising or sale to procure; misdemeanor.

Sec. 15. Selling drugs, etc., to produce abortion—Any person who shall in any manner, except as hereinafter provided, advertise, publish, sell or publicly expose for sale any pills, powder, drugs or combination of drugs, designed expressly for the use of females for the purpose of procuring an abortion, shall be guilty of a misdemeanor.

Any drug or medicine known to be designed and expressly prepared for producing an abortion, shall only be sold upon the written prescription of an established practicing physician of the city, village, or township in which the sale is made; and the druggist or dealer selling the same shall, in a book provided for that purpose register the name of the purchaser, the date of the sale, the kind and quantity of the medicine sold, and the name and residence of the physician prescribing the same.

...

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and more... 

NPR: "Supreme Court overturns Roe v. Wade, ending right to abortion upheld for decades" by Nina Totenberg and Sarah McCammon, 6/24/2

NPR: "The Sexual Assault Epidemic No One Talks About" by Joseph Shapiro, 1/8/2018 on "All Things Considered"

Friday, October 14, 2022

Social Security and Supplemental Security Income (SSI) will be increased by 8.7% in 2023

Most people with developmental disabilities in Michigan qualify for Supplemental Security Income (SSI) based on their disability and limited income. Social Security Disability Insurance (SSDI) is usually available to people with DD based on a parent qualifying for Social Security retirement benefits or SS disability benefits. Check out the Social Security web page to learn more. Talk to someone who knows about how to qualify to make sure the person with DD is categorized correctly and that they are applying for all the benefits they are entitled to.

As an example, my sons both received SSI benefits from the age of 18 and then received SSA benefits after my husband retired. Their combined SSI and SSA benefit does not exceed what they would receive with only SSI benefits. SSA qualifies them to receive Medicare benefits as well as Medicaid health insurance.

These are excerpts from a press release from the US Social Security Administration:

Thursday, October 13, 2022
For Immediate Release
Mark Hinkle, Press Officer
press.office@ssa.gov

Social Security Announces 8.7 Percent Benefit Increase for 2023


Social Security and Supplemental Security Income (SSI) benefits for approximately 70 million Americans will increase 8.7 percent in 2023, the Social Security Administration announced today. On average, Social Security benefits will increase by more than $140 per month starting in January.

The 8.7 percent cost-of-living adjustment (COLA) will begin with benefits payable to more than 65 million Social Security beneficiaries in January 2023. Increased payments to more than 7 million SSI beneficiaries will begin on December 30, 2022. (Note: some people receive both Social Security and SSI benefits). The Social Security Act ties the annual COLA to the increase in the Consumer Price Index as determined by the Department of Labor’s Bureau of Labor Statistics.

“Medicare premiums are going down and Social Security benefits are going up in 2023, which will give seniors more peace of mind and breathing room. This year’s substantial Social Security cost-of-living adjustment is the first time in over a decade that Medicare premiums are not rising and shows that we can provide more support to older Americans who count on the benefits they have earned,” Acting Commissioner Kilolo Kijakazi said.

...

Social Security and SSI beneficiaries are normally notified by mail starting in early December about their new benefit amount. The fastest way to find out their new benefit amount is to access their personal my Social Security account to view the COLA notice online. It’s secure, easy, and people find out before the mail arrives. People can also opt to receive a text or email alert when there is a new message from Social Security--such as their COLA notice--waiting for them, rather than receiving a letter in the mail. People may create or access their my Social Security account online at www.ssa.gov/myaccount.

...

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See the full press release here.

Tuesday, October 4, 2022

Big Win for University of Michigan Nurses

From the Detroit Free Press:

University of Michigan nurses approve contract with $5K bonuses, 22.5% raises over 4 years

By Christina Hall and Kristen Jordan Shamus

10/3/22

Michigan Medicine nurses have approved a four-year, $273 million contract with University of Michigan Health after months of working without a new agreement in place.

Nurses represented by the University of Michigan Professional Nurse Council, a local bargaining unit of the Michigan Nurses Association, approved the new contract that includes:

  • A 22.5% raise during the four years of the contract.
  • A $5,000 bonus for each nurse this year. Current nurses still employed at Michigan Medicine will receive a $2,000 retention bonus March 31, 2026.
  • Elimination of mandatory overtime for most units, except for defined emergency situations.
  • Expanded staffing guidelines.

Nurse practitioners will be in a new salary step model. All other nurses will receive a 7.5% pay raise in the first year. All bargaining unit members will receive a 6% pay increase in the second year, 5% increase in the third year and 4% in the fourth year, according to a release from the university.....

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I'm always glad to see "essential workers" getting well-deserved pay hikes and improvements in working conditions. Something like this needs to happen for Direct Service Providers who care for people with disabilities.

Monday, October 3, 2022

The emergency preparedness project from the National Council on Severe Autism

This is from the National Council on Severe Autism with suggestions to get families thinking about emergency preparedness before it is too late:

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The Annual September 26th Project for 2022 Has Launched — Watch and Share 

September 13, 2022

Dear friends in the autism and special needs community, 

Last year we launched The September 26th Project, the annual emergency preparedness reminder for our families, created in commemoration of Feda Almaliti, founding VP of NCSA, and her son Muhammed, who died senselessly in a house fire on September 26, 2020, and embracing all who have faced such tragedies.

This September we again urge all autism and special needs families to take just 10 minutes on or around September 26th, to take steps to prepare for crisis and emergency. We are not asking for perfection, but for just one or two things that may help avert disaster. Don’t have a fire extinguisher? Now is the time to buy one. Haven’t checked your smoke/CO alarms? September is the perfect time to do it. Haven’t created a family emergency and exit plan? Go for it. Install a keypad lock where it would be helpful and safe. Or register with your local first responders, or create an emergency kit, charge back-up batteries, or attend a CPR class. Just one or two things, each step when taken year after year will make a big difference.

To get started, please watch (and share!) our 2022 September 26th Project video, where autism families who have suffered horrific tragedy share their stories — but also inspire you to take action, just 10 minutes, this September.

With best wishes,

The September 26th Project Committee

Maysoon Salah, Jill Escher, Kelly Bermingham, Lubna Salah