Women's Health - Hearing of the House Democratic Steering and Policy Committee

Representative Nancy Pelosi
Women's Health

HON. NANCY PELOSI

OF CALIFORNIA IN THE HOUSE OF REPRESENTATIVES

Thursday, February 23, 2012

REPRESENTATIVE NANCY PELOSI (D-CA): 

Our meeting will come to order.

This is a hearing of the Steering and Policy Committee of the House Democrats. It is my honor to be here with our senior -- our ranking member on the Government Reform Committee of the House of Representatives, Congressman Elijah Cummings; a senior member of the committee, Congresswoman Carolyn Maloney; and congresswoman from the District of Columbia and long-term member of the committee Congresswoman Eleanor Holmes Norton.

We're gathered here today with a very special guest, Ms. Sandra Fluke, whom we'll hear from in a moment. But first I want to say that the purpose of this meeting is one that I wish didn't exist.

I wish that in the hearing that was held last week, the Republican majority on the House Oversight and Government Reform Committee would have heard from Sandra Fluke instead of just hearing a panel of five men. Seeing that panel before her, our colleague Congresswoman Maloney put it best, asking, where are the women?

Indeed, in this debate nothing could be more critical than hearing the voices of our nation's women, and Democrats are prepared to hear from a single witness today, Georgetown law student Sandra Fluke, to testify before the committee. She was invited by the Democrats to be at the panel that was called together last week. But the Republicans did not want to hear from her. And so we do today.

We are proud to bring Sandra before our Steering and Policy Committee to deliver the testimony she was denied last week, to stand firm in the cause of women's health, to no longer be held silent. Sandra is a bold and passionate leader for young women and all women, at Georgetown and across the country. She understands that this issue that we're discussing is a matter of women's health, plain and simple.

She has stood on the front lines in this debate at Georgetown University Law, dedicated her time and energy to the battle against -- in other issues, human trafficking and domestic violence, and served as the president and secretary of the Georgetown Law Students for Reproductive Justice. Sandra will continue to serve women -- (inaudible) -- as a leader in the field of public interest law.

I think it's important, as I yield to the distinguished ranking member of the committee, to inform you, Sandra, that following your rejection by the Republicans from the panel, which the Democrats had suggested you as their witness, that we've heard from over 300,000 people saying we want women's voices to be heard on the subject of women's health, and urging the Republican leadership to make sure that happens.

Having no reason to believe that they will, we're having our own hearing today. I know you will persuade them with your testimony.

And with that, I thank you for joining us this morning and yield to distinguished ranking member, Mr. Cummings, and thank him for his leadership and important role he played in last week's hearing. Mr. Cummings.

Representative Elijah Cummings


REPRESENTATIVE ELIJAH CUMMINGS: 

Thank you. Thank you very much, Madam Leader, for hosting today's event. And thank you, Ms. Fluke, for coming here today to share the testimony you were banned from giving last week.

When Chairman Issa rejected your testimony before the Oversight Committee, he argued that his hearing was not about contraceptives and was not about women's reproductive rights. He said, you are -- and I quote -- "a college student who appears to have become energized over this issue," end of quote, and that you are not, quote, "appropriate or qualified," end of quote, to testify, and that you did not have, quote, "the appropriate credentials," end of quote, to appear before the committee. Obviously, everyone on this panel disagrees with him.

As I sat there and listened to the chairman try to explain his position, I looked out on a panel of men. I could not help but wonder, what credentials did they have to talk about the importance of the pill to the lives of women?

In my opinion, the chairman committed a massive injustice by trying to pretend that the views of millions of women across the country are irrelevant to this debate, and that is what really offends people. Even if they did not agree with you, Ms. Fluke, that is no reason to silence you.

That is no reason to deny you a voice in the debate or, literally, a seat at the table.

So I thank you for coming here today to finally give the other side, the side of millions of women across the country who want safe and affordable coverage for basic preventive health care, including contraceptives. I look forward to hearing from you today.

Let me add that I fully understand the religious component of this debate. My mother's a strong and independent women who commands respect. She is also a woman of faith, and has been an independent pastor in a small Pentecostal church in Baltimore for all my life. I understand the importance of this issue to all women, including women of faith. That is why I commend the administration for the accommodation it made to allow women working at religiously affiliated organizations to obtain coverage for contraceptives directly through their health insurance companies.

Unfortunately, last week's completely one-sided hearing was not an isolated incident. Right now, a nationwide campaign is being conducted at both the state and federal levels to outlaw many forms of commonly used contraceptives. These efforts include legislation and ballot initiatives in multiple states, as well as legislation proposed right here in the House of Representatives and the Senate intended to outlaw the pill as well as other forms of contraceptives such as IUDs. The so-called morality legislation is intended to permit any employer, including for-profit sector companies, to deny insurance coverage for contraceptives that are contrary to their religious beliefs, or even broadly to any of their moral convictions.

Finally, under this legislation, a CEO could decide to ban coverage of the pill for unmarried women employees, he could deny coverage for routine prenatal care and testing, he could deny coverage for medically prescribed IUDs -- all in the name of undefined moral convictions.

Madam Leader, I am obviously not a woman, so I can -- I can never fully understand how central this issue is to the lives of millions of women across this country. But I am here today to support their right to exercise control over their lives and their bodies, and to make sure that they are never, ever -- never, ever -- denied a voice in this debate.

With that I yield back.

REP. PELOSI: Thank you. I thank you, Ranking -- (off mic) -- Cummings, for your very strong statement.

Now I'm pleased to yield to Representative Carolyn Maloney, with her words echoing, "Where are the women?" Well, Sandra Fluke is here today, and thank you for being here as well.

Representative Carolyn Maloney
REPRESENTATIVE CAROLYN MALONEY (D-NY): 

And thank you. Thank you, Leader Pelosi, for bringing Sandra to this hearing and for your commitment to these issues that are so important to tens of millions of women and men across our country.

When I took my seat at the hearing last week and I looked out at the panel, I couldn't help but ask: What is wrong with this picture? There was not one single woman on that first panel, not one. Even though we were there to talk about the needs of tens of millions of American women to have access to insurance for preventive health care, including reproductive rights, including contraception, the only freedom that was being debated was the freedom to tell women that they would not have access to family planning. What is wrong with that picture?

We should not need to remind our colleagues that a hundred percent of those who can have their health damaged by an unplanned pregnancy are women. A hundred percent of those who die from complications related to pregnancy are women. A hundred percent of those who give birth and plan their families are women. But 100 percent of those on that first panel, talking about the access to family planning, the ability to plan and space your children, and basic preventive health care -- there was not one single woman on that panel. What is wrong with this picture?

We see all too often in Congress, in state houses and in the super PACs that are now dominating the debate on the airwaves, that those who would take a woman's right to choose, those who compel a woman to undergo medical procedures she does not want or need, those who would introduce a bill on the House floor to allow hospitals to deny pregnant women lifesaving care, are men.

What is wrong with that picture? Everything.

REP. PELOSI: Thank you very much, Congresswoman Maloney.

Now I'm pleased to yield to a representative of the District of Columbia, who we are fighting to have a full vote on the floor of the House, but she has certainly a full voice on every subject she takes leadership on, Congressman Eleanor Holmes Norton, a senior and respected member of the committee.

Delegate Eleanor Holmes Norton
DELEGATE ELEANOR HOLMES NORTON (D-DC): 

Thank you very much, Leader Pelosi. And yes, I have a vote in this committee and -- I called for a vote when women -- when our witness, Sandra Fluke, was excluded.

It's important to remember how the hearing occurred in the first place. The hearing arose out of a controversy that had two sides, two compelling sides: religious liberty and reproductive freedom. By the time the hearing had been held -- had been called, we are fortunate that the administration had worked a compromise that in fact allows women to receive their contraceptive insurance, while at the same time recognizing the religious concerns of religiously affiliated institutions, such as universities and hospitals, who, under the accommodation, do not have to pay at all for contraceptives, which are now -- which are to be received through the insurance company and have no involvement with contraceptives.

This is very important to bear in mind, because in my more than 20 years in the House of Representatives, I have seldom seen a compromise that worked out a(n) issue of such importance to both sides as favorably as this compromise did.

The committee appeared to want to exploit the religious side of the issue by excluding the only witness that the Democrats -- that the Democrats requested. Sandra Fluke was essentially defined out of last week's hearing. In defining her out of the hearing, and having a hearing about only one side of a clearly two-sided issue, the majority managed to define out most American women.

The solid majority represented by Sandra Fluke was not at the table last week. I am very pleased, Madame Leader, that you have convened us here so that the concerns of women can be heard through their representative, Sandra Fluke, this morning.

REP. PELOSI: I thank you very much.

I know that -- and when we get to the Q&A, we'll have some other aspects of this to call attention to. For example, Congressman Cummings just mentioned that at the time -- you know, Democrats -- the minority is entitled to a witness at a hearing; and would you tell us, Mr. Cummings, as we lead into Sandra --

REP. CUMMINGS: What happened was we were -- we asked for two witnesses.

It was Ms. Fluke and a gentleman. And the majority -- Mr. Issa -- Chairman Issa said to us: You can only have one. And we said: We want Ms. Fluke. And they said no, and went on and invited the gentleman. We had already said that we would not accept him; we had to have her. And so what -- that's what happened. We -- so we were denied.

And then we appealed it, Madame Leader. After we were denied Ms. Fluke, we then wrote a letter saying: Would you please reconsider? And they said no.

REP. PELOSI: So here we are, gathered today -- and thank you for fighting the fight -- in this room -- which we're happy to have a room. But the leadership told us -- the Republican majority told us that we could not have the House recording studio, take this public. And so we thank the members of the press who are here for their resourcefulness with the technology to get the message from this room out, which has been barred by the Republican majority. It's amazing what lengths they will go to so that they don't have to listen to the voices of women.

We're honored that you're here. Thank you for your courage. Please proceed with your testimony as you wish, Ms. Sandra Fluke.

Testimony by Sandra Fluke




SANDRA FLUKE: 

Leader Pelosi, members of Congress, good morning, and thank you for calling this hearing on women's health and for allowing me to testify on behalf of the women who will benefit from the Affordable Care Act contraceptive coverage regulation.

My name is Sandra Fluke, and I'm a third-year student at Georgetown Law School. I'm also a past president of Georgetown Law Students for Reproductive Justice, or LSRJ. And I'd like to acknowledge my fellow LSRJ members and allies, and all of the student activists with us, and thank them so much for being here today. (Applause.)

We as Georgetown LSRJ are here today because we're so grateful that this regulation implements the nonpartisan medical advice of the Institute of Medicine. I attend a Jesuit law school that does not provide contraceptive coverage in its student health plan. And just as we students have faced financial, emotional and medical burdens as a result, employees at religiously affiliated hospitals and institutions and universities across the country have suffered similar burdens. We are all grateful for the new regulation that will meet the critical health care needs of so many women. Simultaneously, the recently announced adjustment addresses any potential conflict with the religious identity of Catholic and Jesuit institutions.

When I look around my campus, I see the faces of the women affected by this lack of contraceptive coverage. And especially in the last week, I have heard more and more of their stories. On a daily basis, I hear from yet another woman from Georgetown or from another school, or who works for a religiously affiliated employer, and they tell me that they have suffered financially, emotionally and medically, because of this lack of coverage. And so I'm here today to share their voices, and I want to thank you for allowing them -- them, not me -- to be heard.

Without insurance coverage, contraception, as you know, can cost a woman over $3,000 during law school. For a lot of students who, like me, are on public interest scholarships, that's practically an entire summer's salary. Forty percent of the female students at Georgetown Law reported to us that they've struggled financially as a result of this policy.

One told us of how embarrassed and just powerless she felt when she was standing at the pharmacy counter and learned for the first time that contraception was not covered on her insurance, and she had to turn and walk away because she couldn't afford that prescription. Women like her have no choice but to go without contraception.

Just last week, a married female student told me that she had to stop using contraception because she and her husband just couldn't fit it into their budget any more. Women employed in low-wage jobs without contraceptive coverage face this same choice.

And some might respond that contraception is accessible in lots of other ways. Unfortunately, that's just not true. Women's health clinics provide a vital medical service but, as the Guttmacher Institute has definitively documented, these clinics are unable to meet the crushing demand for these services. Clinics are closing, and women are being forced to go without the medical care they need.

How can Congress consider the Fortenberry, Rubio and Blunt legislation, that would allow even more employers and institutions to refuse contraception coverage, and then respond that the nonprofit clinics should step up to take care of the resulting medical crisis; particularly when so many legislators are attempting to defund those very same clinics?

These denials of contraceptive coverage impact real people. In the worst cases, women who need this medication for other medical reasons suffer very dire consequences. A friend of mine, for example, has polycystic ovarian syndrome, and she has to take prescription birth control to stop cysts from growing on her ovaries. Her prescription is technically covered by Georgetown's insurance, because it's not intended to prevent pregnancy. Unfortunately, under many religious institutions' insurance plans, it wouldn't be. There would be no exception for other medical needs. And under Senator Blunt's amendment, Senator Rubio's bill or Representative Fortenberry's bill, there's no requirement that such an exception be made for these medical needs.

When this exception does exist, these exceptions don't accomplish their well-intended goals, because when you let university administrators or other employers, rather than women and their doctors, dictate whose medical needs are legitimate and whose are not, a woman's health takes a backseat to a bureaucracy focused on policing her body. In 65 percent of the cases at our school, our female students were interrogated by insurance representatives and university medical staff about why they needed prescriptions and whether they were lying about their symptoms. For my friend, and 20 percent of the women in her situation, she never got the insurance company to cover her prescription. Despite verification of her illness from her doctor, her claim was denied repeatedly on the assumption that she really wanted birth control to prevent pregnancy. She's gay -- so clearly, polycystic ovarian syndrome was a much more urgent concern than accidental pregnancy for her.

After months of paying over $100 out of pocket, she just couldn't afford her medication anymore, and she had to stop taking it. I learned about all of this when I walked out of a test and got a message from her that, in the middle of the night in her final-exam period, she'd been in the emergency room. She'd been there all night in just terrible, excruciating pain. She wrote to me: It was so painful I woke up thinking I'd been shot. Without her taking the birth control, a massive cyst the size of a tennis ball had grown on her ovary. She had to have surgery to remove her entire ovary as a result. On the morning I was originally scheduled to give this testimony, she was sitting in a doctor's office trying to cope with the consequences of this medical catastrophe.

Since last year's surgery, she's been experiencing night sweats and awaking and other symptoms of early menopause as a result of the removal of her ovary. She's 32 years old. As she put it: If my body indeed does enter early menopause, no fertility specialist in the world will be able to help me have my own children. I will have no choice at giving my mother her desperately desired grandbabies, simply because the insurance policy -- that I paid for, totally unsubsidized by my school -- wouldn't cover my prescription for birth control when I needed it. Now, in addition to potentially facing the health complications that come with having menopause at such an early age -- increased risk of cancer, heart disease, osteoporosis -- she may never be able to conceive a child.

Some may say that my friend's tragic story is rare. It's not. I wish it were. One woman told us doctors believe she has endometriosis, but that can't be proven without surgery. So the insurance has not been willing to cover her medication, the contraception she needs to treat her endometriosis. Recently, another woman told me that she also has polycystic ovarian syndrome, and she's struggling to pay for her medication and is terrified not to have access to it. Due to the barriers erected by Georgetown's policy, she hasn't been reimbursed for her medication since last August. I sincerely pray that we don't have to wait until she loses an ovary or is diagnosed with cancer before her needs and the needs of all of these women are taken seriously, because this is the message that not requiring coverage of contraception sends: A woman's reproductive health care isn't a necessity, isn't a priority.

One women told us that she knew birth control wasn't covered on the insurance, and she assumed that that's how Georgetown's insurance handled all of women's reproductive and sexual health care. So when she was raped, she didn't go to the doctor, even to be examined or tested for sexually transmitted infections, because she thought insurance wasn't going to cover something like that, something that was related to a woman's reproductive health.

As one other student put it, this policy communicates to female students that our school doesn't understand our needs. These are not feelings that male fellow students experience, and they're not burdens that male students must shoulder.

In the media lately, some conservative Catholic organizations have been asking, what did we expect when we enrolled at a Catholic school? We can only answer that we expected women to be treated equally, to not have our school create untenable burdens that impede our academic success. We expected that our schools would live up the Jesuit creed of "cura personalis," to care for the whole person by meeting all of our medical needs. We expected that when we told our universities of the problems this policy created for us as students, they would help us. We expected that when 94 percent of students opposed the policy, the university would respect our choices regarding insurance students pay for completely unsubsidized by the university.

We did not expect that women would be told in the national media that we should have gone to school elsewhere and -- even if that meant going to a less prestigious university. We refuse to pick between a quality education and our health, and we resent that in the 21st century anyone thinks it's acceptable to ask us to make this choice simply because we are women.

Many of the women whose stories I've shared today are Catholic women. So ours is not a war against the church. It is a struggle for access to the health care we need. The president of the Association of Jesuit Colleges has shared that Jesuit colleges and universities appreciate the modification to the rule announced recently. Religious concerns are addressed, and women get the health care they need. And I sincerely hope that that is something we can all agree upon.

Thank you very much. (Applause.)

Representative Elijah Cummings
REP. CUMMINGS: Thank you very much, Miss Fluke. That was outstanding.

Let me say from the outset that there are a lot of us men who were insulted --

MS. FLUKE: Yeah.

REP. CUMMINGS: -- when we saw that. I just want to make it clear, and I do thank you for your testimony.

You know, you were -- you said something that was -- I guess a lot that was interesting. One of the things you talked about was the cost of contraceptives, and you said, I think, it could cost, over a law school career, $3,000.

MS. FLUKE: Yeah.

REP. CUMMINGS: And I think a lot of people assume that there are alternatives if you cannot get it through your insurance. Can you talk about that for a moment?

MS. FLUKE: Of course.

Yes, I think it's especially important in today's economy. Unfortunately many families are struggling with the cost of health care, and so many parts of the Affordable Care Act will help, especially this regulation.

As I discussed, the Guttmacher Institute recently did a study entitled "Recession Taking Its Toll: Family Planning Safety Net Stretched Thin as Service Demand Increases." And I encourage everyone to examine that because I think it really clearly demonstrates that these clinics are having to cut back their hours, lay off their staff, close their doors. And so the safety net that women have relied on in the past is not there, and I can tell you --

REP. CUMMINGS: And so I take it that they -- and so they end up doing without?

MS. FLUKE: They do, absolutely. That's what -- that's what many women have shared with me.

REP. CUMMINGS: Now, you know, Chairman Issa's said that you were merely a college student who appears to have become energized over this issue and that you were not appropriate or qualified to testify and that you do not have the appropriate good credentials to appear before the committee last Thursday. What was your reaction when you heard this statement about being -- not being qualified?

MS. FLUKE: Well, I will -- I will confirm that I was energized, yes. (Laughter, applause.) As you can see from the reaction behind me, many women in this country are energized about this issue. And so, yes, that part was correct.

In terms of whether or not I was an appropriate witness, I felt insulted not for myself but for the women I wanted to represent, the women whose stories I wanted to convey to the committee and the women whose voices were silenced that day. And I've heard some people point out that there were two women on the less primary panel that day, and that's correct, but they were not women who were there to represent the women affected by this policy, and that matters. This isn't just about demographics. It's about the voices of the women who are affected by this policy.

REP. CUMMINGS: The -- you certainly speak for millions, and I think Chairman Issa did not understand why we wanted you to appear, because we were looking for someone to speak for women who want safe and affordable coverage for their basic preventative health care, including contraceptives.

Now for the benefit of those who may not understand, can you describe your qualifications for testifying about the restrictions on insurance coverage for contraceptives?

MS. FLUKE: Sure. I'm an American woman who uses contraception, so let's start there. That makes me qualified to talk to my elected officials about my health care needs.

Beyond that, I will say that I, along with the other members of Law Students for Reproductive Justice at Georgetown and so many other of the activists who've been working on this, have been looking at this for years. We've followed the regulations very closely and the legislation, and we've done studies at our campus documenting the needs of women. So this is something we take very seriously, and we have studied for quite some time.

REP. CUMMINGS: As I noted in my opening, there is currently a nationwide campaign at both the state and federal levels not only to restrict insurance coverage but in some instances to outlaw many forms of commonly used contraceptives. If those efforts are successful and prohibit commonly used contraceptives like IUDs and some forms of the pill, it would roll back the clock for women across the country.

Can you describe what the impact would be on you and your classmates?

MS. FLUKE: Well, I think for millions of women, it would be an increase in the number of people who have the medical complications I've been talking about today. One woman came to me recently since this happened and described that she needs contraception to prevent seizures. So she has several seizures a month if she doesn't have contraception to balance her hormones, and that's just an incredible intrusion on her life, her ability to manage her daily affairs if she doesn't have access to that medical case -- medical prescription. So that's one of the huge impacts.

I think another impact that it's really important that we all think about is that contraception, when it first became available, was a revolution in this country. It allowed women to enter employment and educational opportunities that had previously not been accessible because they were unable to control their reproduction in the same way. And I just can't imagine rolling back the clock on that progress.

REP. CUMMINGS: Again -- I see my time is up, but thank you very much. I think you've done a great service for many, many women -- and men, by the way.

MS. FLUKE: I hope so. And I can tell you that my male partner is certainly one of those men who's very supportive of this policy, and I know there are many other men out there.

REP. CUMMINGS: Thank you.

REP. PELOSI: Thank you, Ranking Member -- (off mic). And thank you for bringing a picture worth a million words. Over 300,000, as a matter of fact, women -- (off mic) -- have responded to Congresswoman Maloney's -- (off mic).

Representative Carolyn Maloney
REP. MALONEY: First of all, thank you very much for being here today, and thank you for really being quite courageous in standing up, in speaking out.

This photograph -- you're in this photograph. Do you see yourself?

MS. FLUKE: I am. I'm right behind that man's head. (Laughter.)

REP. MALONEY: And you are waiting to testify.

I would like to underscore part of the statement that Ranking Member Cummings made, in that you were the selected Democratic witness for the panel, and according to the rules of the House of Representatives, we are entitled to selected our representative on the panel.

I was somewhat taken back (sic) by the fact that even when we -- Eleanor and Elijah and I were arguing that our witness should join the panel, that Chairman Issa said you were unqualified.

MORE I would venture to say that any woman is more qualified to talk about women's health needs across America than any man.

So again I say: What is wrong with that picture, as it pertains in the picture, the hearing and, I would say, in basic policy?

You're -- can you think of what was in his head when he said that? I know you're qualified. I know you're speaking for tens of millions of women across this country. Can you think of any reason why he would be so adamant that your voice should not be heard?

MS. FLUKE: I think, unfortunately, Chairman Issa's head is somewhere I -- I don't want to go. (Laughter.)

But what I have learned from this experience is that -- you know, they say knowledge is power. And evidently the knowledge of how this regulation will benefit millions of women's lives is very powerful, and I believe to some, unfortunately, it's evidently very threatening.

REP. MALONEY: Well, let's look at the rule. And I see it as very balanced, thoughtful and fair, both to religion, to women, to society as a whole. Under the administration's announced common-sense accommodation, churches do not have to provide insurance coverage for contraceptives for their church or their synagogue or their religious establishment. And women who work at nonprofit religious entities that serve the greater American public, such as hospitals and universities, can obtain coverage directly -- not from any religious institution but from insurance companies. So to me, the hearing was about women's rights and insurance companies and their right to obtain this coverage from insurance companies.

In your testimony, you touched about the fairness aspect of this and the equal opportunity aspect of it. Why should one woman working for one university have access to reproductive health care, but a woman working for another university not have it? It's a basic fairness and equality aspect.

I compliment you for bringing out the examples of young women and the multitude of ways that family planning, birth control medications help women with other medical challenges.

MS. FLUKE: Yes.

REP. MALONEY: And I appreciate your bringing that out.

I know that many people may be coming to you. The reaction that Speaker Pelosi -- excuse me -- Leader Pelosi gave to her letter, over 300,000 men and women responded across this country, saying that this commonsense approach is appropriate, it's fair, it's equal, and that women should have a voice at the table.

MS. FLUKE: Yes. And I -- I can't say that I've heard from over 300,000 women, as you have, but I've heard from many, many women thanking me for talking about this and just saying how important this regulation will be to them. And one woman who I spoke with on Sunday -- I actually spoke with both she and her husband -- told me about a need that she has for contraception. They recently had their first child, and it's just been a few months.

And since she gave birth, her obstetrician recommends that she take contraception following the birth of that child because, for her as a mother and for any potential child that she might carry in the future, it would be very medically dangerous for her to become pregnant too soon. And that spacing of children is an important medical concern.

So I think that really highlights something as well, because this woman is 30 years old, she's married and she's having children. We shouldn't be judging any of these women's choices about their health care needs, but in the case of this woman, she's doing everything that she's being asked to by some conservative voices, and yet she still can't get access to contraception because that's a purpose that prevents pregnancy. And even that woman is being denied the health care she needs.

So for me, it just really highlights that some of the issues that have been brought up are blurring what's really at stake here.

This is about -- for our opponents, this is about limiting women's access to health care, and that's why this just cannot occur.

REP. MALONEY: Thank you for your testimony. My time is expired. And thank you for pointing out the other needs for contraceptives. And one that is a basic need is the planning and spacing for your children to ensure your own health to be able to have future children. Thank you very much for your testimony.

MS. FLUKE: Thank you.

REP. PELOSI: Thank you very much, Congresswoman Maloney. Congresswoman Maloney came all the way down from -- came all the way -- (off mic). I thank you Congresswoman Maloney for her extraordinary leadership on the subject on the ongoing -- and for coming down during the break from her district in New York to be here, indicating the importance this issue has always been for her. Thank you, Congresswoman.

And to our local representative of national significance, Congresswoman Eleanor Holmes Norton.

Delegate Eleanor Holmes Norton
DEL. NORTON: Well, I'm certainly pleased to represent Ms. Fluke while she is in Washington.

MS. FLUKE: As am I that you do so.

DEL. NORTON: (Chuckles.)

What year are you at Georgetown?

MS. FLUKE: I'm a third-year student. I'll be graduating in May.

DEL. NORTON: You're about to graduate from law school.

First, let me put the questions I have for you, because I have some questions for you.

MS. FLUKE: OK.

DEL. NORTON: The information that your testimony reveals today made your appearance at the hearing we were -- we had last Thursday even more important because it was new information. I would wager that most Americans, when they think of contraceptives, they think about their own lives -- and their own lives are not typical of the lives that you have related -- but do not have the kind of information that you brought forward this morning. I want to thank you very much for putting that information at least on our record and on the record of American families who, I think, needed to hear it.

It's important to remember that we are accustomed to the fact that women live longer today. I wonder if we understand that that is a 20th century phenomenon. If you were to go into the graveyards of America, you would be quite amazed with the stones that speak of the lives of women who typically died earlier than men until the 20th century, and fairly along in the 20th century at that, from childbirth and its complications -- (to ?) understand what we are talking about here and how serious this issue is.

The Affordable Child (sic) Care Act, of course, now covers contraceptives. It's important also to understand that you -- before the Affordable Child (sic) Care Act, you could have a policy, and while every other part of -- every other -- you go to the -- if you go to the hospital or most things having to do with your health are covered, the insurance companies often did not cover contraceptive health care. Now, in case you think that is something that should be understood, the cost of health -- the cost of contraceptives, you had something to say about here.

But again, let me remind everyone that the notion of covering all of what attends to reproductive health is itself fairly new. I had two children. My two children were born in the 1970s. My family paid almost all of the costs of bearing those two children in the hospital. As recently as the 1970s, insurance companies paid a tiny portion of the cost a normal childbirth in an ordinary hospital. Not until regulations and law changed in fairly recent decades are we now even covering a process that was normal for most women.

Half of the births in the United States are unplanned. I want to discuss that issue with you.

What's the cost of tuition at Georgetown law school?

MS. FLUKE: We think it's $40,000-plus a year. I know that it's $60,000-some a year in loans for the cost of living and tuition. So it's -- it's quite a bill.

DEL. NORTON: Just for tuition. Of course, most of you, I take it, are not paying that in cash. (Laughter.)

MS. FLUKE: Well, I'm certainly not.

DEL. NORTON: Do you and most of your friends and colleagues in law school intend to practice law?

MS. FLUKE: We do. Yes. It's quite an investment, otherwise.

DEL. NORTON: In order to practice law or to use the law in other ways, would most young women of your age find it necessary to space your pregnancies?

MS. FLUKE: Yes, of course. I've talked with many women on our campus who, for them, the idea that they should go without contraception during law school and risk pregnancy while they're in law school, that's yet another way of asking them to put their education second, because -- I can't imagine -- I know a few women who have been pregnant during law school, but I just can't imagine how they do that. And I just think it's not a feasible option either economically or just in terms of their ability to balance everything, for most women.

DEL. NORTON: So you believe that the contraceptive is as necessary as any other health benefit provided by an insurance company?

MS. FLUKE: Absolutely. And especially for young women, it's one of the most commonly used health care needs that we have. One woman expressed to me, well, if my insurance doesn't cover this, then what am I paying my insurance for? These are young women who are in good health otherwise. This is what they need.

DEL. NORTON: That's a very important point. A young person doesn't go to the doctor very often, and if you're a young woman, it is probably -- it probably has a lot to do with reproductive health.

Now, were you and the other students asking for any subsidy from the university for insurance? Would Georgetown have itself had to pay anything for the insurance that you sought through the university?

MS. FLUKE: No. Our student insurance is entirely unsubsidized by the university. And my understanding is that that's true of most student insurance. And thankfully, I think, with the new accommodation to the -- the new adjustment to the regulation, even in situations of employers, they would not be contributing their money toward the contraceptive coverage.

DEL. NORTON: So let me ask what is the role, then, of the university? It doesn't pay anything, so what's the role of the university in this insurance that you are seeking?

MS. FLUKE: To restrict access to our health care needs. (Pause.) I could answer more completely if you like. (Laughs.) They arrange for the insurance and place the limits and controls on what type of coverage we can access, but they do not subsidize it.

DEL. NORTON: In your experience, are students who attend the university of many faiths or do they tend to be Catholic students?

MS. FLUKE: They're students of many, many faiths. And I think that's true at most Jesuit and Catholic universities. These universities provide a high-quality education, and students want to go there for many reasons. I'm proud to say that on our campus we have university-sponsored centers and student organizations that examine Jewish law or, you know, there are groups for Muslim students and students of all faiths. And thankfully, all of those students are welcome, but unfortunately, they're all affected by this lack of contraception coverage.

DEL. NORTON: Ms. Fluke, we learned also that the insurance companies who will be providing, through the affordable health care, contraceptive coverage for women do not incur extra cost for this. You notice that you have not heard insurance companies pipe up and say, what are you doing to us? It turns out that according to the actuarial tables, it costs an insurance company more if it does not provide contraceptive coverage, because of the costs of childbirth and of the conditions attending childbirth.

So this turns out to be not only a win-win, but if I may say so, a win-win-win. (Laughter.)

MS. FLUKE: Yes.

DEL. NORTON: Because, if anything, this is going to be a windfall for insurance companies in providing contraceptive insurance. It's a winner, certainly, in our country that we have this accommodation.

And if I might say so, as a -- as still a person who teaches law at Georgetown -- and I didn't have anything to do with the -- the ranking member will tell you, I didn't go finding you. It's the good work of the -- of the committee that found you. But I can say that Georgetown should be very proud of you. You are an -- you are illustrative of the very high quality of student that Georgetown is able to attract. And it's able to attract that quality because it welcomes students from many religions.

And your testimony here, it seems to me, has been an evidence of a young lawyer who's ready to practice and ready right now to offer any testimony we might need at any time in the Congress of the United States. Thank you for your testimony.

MS. FLUKE: Thank you so much, Congresswoman. And I would just add that there are many faculty members at Georgetown who, like yourself, have been very supportive of myself and of the Law Students for Reproductive Justice group. And we thank them so much for their support, because it is a frightening thing to speak against a university that provides your scholarships and that you're attending. So their support has meant a lot to us.

And as you were pointing out, Georgetown does have excellent preparation for -- especially for its public interest students, and that's why I chose that university. And so I think that just highlights that I should not have had to go without that in exchange for my health care. That should not have been a choice that I was faced with.

Representative Nancy Pelosi
REP. PELOSI: Thank you very much, Congresswoman Holmes Norton.

I will keep my questions brief, because I wish to associate myself with the questions raised by my colleagues and their very valuable statements, especially in light of thanking you and a full appreciation for what you brought to the table today. Clearly, a woman should always have a seat at the table -- unquestionably, when the subject is women's health.

As you were speaking, I was very moved by your statement and, again, by the questions of our colleagues. And I was reminded of a statement a very wise and respected Catholic leader in Washington, D.C., once said to me about Catholic education. He said: We educate young people not because they are Catholic, but because we are Catholic.

MS. FLUKE: Yes.

REP. PELOSI: And it was a stunning statement to me, and it flies in the face of what is going on here. The question of who is qualified to be a witness raises the question of who is qualified to have a hearing. Does that person, or that chairman of committee, have any judgment on what it means to a family to personally and religiously make decisions about the size and timing of their family?

Does that person have any knowledge, is he qualified to talk about the danger to women's health, and therefore the care of the family, to a mom if she and her husband, their doctor and their God cannot make those decisions?

Is that committee chairmanship and leadership of the Congress qualified to make a decision about how people exercise their God-given free will to take their responsibility and to answer for how they exercise that God-given free will?

It sounds to me, from their not wanting the public record of their hearing to show what this was all about, about women's health and how their decisions were impacting it, how they're not wanting to hear about it -- not wanting to hear about it -- when it came to women's view on women's health, and speaking for many women, I contend that the leadership of your committee, Mr. Cummings, was not qualified to hold a hearing on this subject, because their judgment is very, very poor as to what their obligation was to the public in the public record on this subject.

So I would like to take Sandra's testimony to the floor of the House, to be sure that we can read it into the record there, so the full Congress can be aware and not again barred from hearing what you so capably have presented to us.

It's a lack of respect. You know, it's a lack of respect, because when the president first put out his statement, there were those who said, well, we want our religious institutions beyond the church, which -- the waiver was present in the health care bill, and continued to be respected, the waiver for churches and places of worship -- and then the president said and the administration said that that -- that that did not extend to other activities of the church. And there was all the uproar. So the president then, as the congresswoman said, Congresswoman Maloney, in a very unprecedented way, moved quickly to remove all doubt of what the intention was. It's not about separation of church and state. It's about women's health.

But what was interesting about that progress of event -- the progression of events, I believe, is that following that, some of the leaders of the religious community said, oh, we don't want anybody, any insurance for any employer giving benefits to any employees to cover contraception.

MS. FLUKE (?): Yeah.

REP. PELOSI: And so I think that really showed their hand. It wasn't about church and state. It was about a(n) ideological point of view that flies in the face of the -- again, the respect that we need to have for women, the God-given free will that we have to have responsibility for, the role that women -- women's health plays in the lives of their families and of our country, and the strength of women.

And so I again thank you for your courage to come forward and with such clarity about this subject. And I hope it's a -- I won't say comfort to you --

MS. FLUKE: (Chuckles.)

REP. PELOSI: -- but a source of satisfaction to you that so many people, hundreds of thousands, more than we ever heard from, like that -- practically in 48 hours, over 300,000 people saying there shouldn't be a hearing without women's voices being heard.

MS. FLUKE: Well, it just demonstrates how many women and men care so deeply about this issue and how much it means to their lives.

REP. PELOSI: Well, it does, and it also speaks to the fact that this is what the practice is in our country. If an overwhelming number of Catholic women of childbearing age -- and make -- stretch that from 14 to 50 or however older or younger you want to go -- are practicing birth control, then there has -- that has to be some message to the church that please don't expect employers and insurance companies to enforce an attitude that you have that isn't even accepted by the laity, churchgoing people themselves.

So we have a problem here, which you have really clearly presented an answer to and a voice of a young woman in a -- an institution of higher learning that is Catholic, I always thought with a capital C and a small c. Let's hope that that is the case.

But in any case, I thank you. And I just invite you and my colleagues to say any closing statement they may wish to have or question they may wish to pose.

Representative Elijah Cummings
REP. CUMMINGS: The -- thank you very much, Madam Leader, and I'll be very brief.

As I sat in the hearing the other day, I asked myself the simple question, Ms. Fluke -- I asked a question: If this were a hearing on prostate cancer and there was a line-up of women and no men, I guarantee you, men would not have stuck around, because they would have said to themselves, you know, come on, give me a break.

And I just thank you for what you've done. And I was just listening, and one of the things that I've often said is that out of our pain comes our passion. And clearly you have felt the pain, you've seen it, you've empathized with it and tried to make sure that you change things.

And so, you know, I think this -- there's a story here. There's a big story. And that is that out of your desire and your classmates' desires, as students -- as students, as students -- to make a difference, now you have not only the Congress listening to you, but you have the country listening to you. And that is a powerful, powerful thing. And I just wanted to encourage you to continue to do what you're doing. We're going to work with you all and try to make sure that women have access to contraceptives and make sure that they have what they need to live the very, very best lives that they can.

And I thank you, Madam Leader, for calling this hearing.

REP. PELOSI: Thank you, Mr. Cummings.

Ms. Maloney, Congresswoman Maloney.

Representative Carolyn Maloney
REP. MALONEY: I would just like to add what's wrong with this picture. (Laughter.) A woman should have been at that table and, I would add, all the tables in America.

Thank you for your courage. Thank you for speaking out and for your testimony today.

MS. FLUKE: Thank you.

REP. PELOSI: Thank you -- (off mic).

Congresswoman Holmes Norton.

Delegate Eleanor Holmes Norton
DEL. NORTON: If we had gone to central casting (for ?) -- (laughter) -- to find a representative to speak for American women, we could not have done better than you here today.

And you have performed another service that is an unintended consequence of this hearing. For the first time, those who have paid attention to this issue now know that the affordable health care act covers contraceptives, so that women no longer have to pay extra for pills, devices or other means of contraception. Thank you for helping us to get that word out, Ms. Fluke. (Laughter.) Thank you very much.

MS. FLUKE: Well, thank you for --

Representative Nancy Pelosi
REP. PELOSI: Thank you. I do believe that the visibility -- we almost ought to thank the chairman for the, shall we say, lack of judgment that he had to arouse the -- to raise the awareness, because it's been very hard over the years to convince people that the fight here has been about contraception. For a generation that I've served in the Congress, 25 years now, we've tried to tell people it's about contraception, and they said it couldn't possibly be. Well, yes, it is. And I think there's a sisterhood that has been just around this issue quietly. It's not a subject that we like to go around talking about in public, about personal, very private matters, but apparently it is necessary, because these people who called this hearing don't seem to know what women know about women's health.

So I thank you and give the floor back to you for the last word, but thank you for your extraordinary leadership, your excellent statement, and with our commitment that we will take this, your words, to the floor of the House, if and ever these ill-conceived, to use a word -- (laughter) -- pieces of legislation ever reach the floor. But long before that, we will share your views on the floor of the House.

Please take the last word, Sandra, and thank you.

Sandra Fluke
MS. FLUKE: Thank you so much, Madam Leader, and thank you to all of you for supporting women in this important need.

And one thing I would just like to say is, while I appreciate the accolades for me as a spokeswoman, I would encourage all the members of Congress and all the members of the public to go online, because women have begun posting videos of what they would say if they had been asked to testify. They're posting about how this affects their lives.

And I just so hope that everyone can have a chance to look at that and hear from all of the women of America who are concerned about this issue. (Applause.)

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