Hospital visitation, latest step in delicate dance on gay rights

Gay rights activists cheered Obama's memo on hospital visitation rights, but the president faces increasing tension with constituencies who helped elect him and expected faster results.

President Obama’s directive to give same-sex couples visitation rights in hospitals represents the latest effort by the administration to advance the agenda of an interest group that worked hard for his election – and has expressed frustration over the pace of change.

The president’s memorandum, released Thursday night, directs the Department of Health and Human Services to draft rules requiring hospitals that accept Medicaid and Medicare funding to “respect the rights of patients to designate visitors” and representatives authorized to take part in medical decisionmaking. The directive’s central focus is same-sex couples, though other categories of people would also be covered, including widows and widowers who choose to designate friends.

Gay rights activists praised Mr. Obama over the move, perhaps the biggest expansion yet of gay rights since his election. But they also made clear that their agenda remains long, and includes the repeal of a federal law barring recognition of same-sex marriage and a ban on military service by openly gay people. Obama opposes gay marriage, but supports civil unions that afford the rights of full marriage.

The president's tensions with the gay community are similar to those between him and other constituencies – including blacks, Hispanics, women, and labor – that supported his campaign and expected big things after eight years of the Bush administration. Analysts see two factors at play: one, Obama’s deliberative style, and two, the immense issue agenda he has taken on, a combination of his own goals and inherited problems, including two wars and an economic crisis.

“Look at how he prepared for his decision on Afghanistan; he took months,” says Bruce Buchanan, a presidential scholar at the University of Texas, Austin. “Also, he’s got to be careful over how he times things, and how he portrays them, given the huge [number of] balls that he has in the air at any given time.”

Healthcare reform dominated Obama's first year-plus in office, and he is now tackling financial reform. In addition, if he is seen as putting any of his constituencies ahead of the others, he could alienate important supporters.

Obama seems aware of the juggling act he faces, and of the frustrations it creates. Last June, at an event in the East Room of the White House honoring the gay rights movement, the president acknowledged that “many in this room don’t believe that progress has come fast enough,” drawing parallels with civil rights leaders petitioning for equality a half century ago. But, he added, “I suspect that by the time this administration is over, I think you guys will have pretty good feelings about the Obama administration."

Since that statement, the administration has taken steps toward repealing the military’s “don’t ask, don’t tell” policy and signed a law that makes it a federal crime to assault an individual because of sexual orientation or gender identity. The administration has also been working quietly with gay rights leaders on areas of common concern, as it did on the hospital visitation memorandum.

“Obama is a proven ally, with a record going back to his days in the Illinois state Senate,” says Rick Rosendall, vice president for political affairs at the Gay and Lesbian Activists Alliance of Washington. “He is not a perfect ally. We don’t agree on the marriage issue, but he has helped us move forward.”

One striking feature of the visitation memo is its emotional language in expressing sympathy for the gay and lesbian couples that have been barred from hospital bedsides because they are not related by blood or marriage.

“There are few moments in our lives that call for greater compassion and companionship than when a loved one is admitted to the hospital,” the directive begins. “In these hours of need and moments of pain and anxiety, all of us would hope to have a hand to hold, a shoulder on which to lean – a loved one to be there for us, as we would be there for them.”

Some conservative leaders expressed chagrin that Obama was “pandering” to an interest group and that his directive undermined the definition of marriage.

But the Catholic Health Association (CHA), which represents the nation’s extensive network of Catholic hospitals, agreed with the goal of Obama’s memorandum.

“All persons of goodwill can understand and agree that when a person is sick, they deserve to decide who they want to visit them,” CHA president and chief executive officer Carol Keehan said in a statement Friday.