Jessica Arons's blog

Senate Bill More Closely Preserves Abortion Status Quo

2009-11-24T07:00:00-05:00

Opponents and supporters of abortion rights agreed early on, in theory, to maintain the “status quo” with “abortion neutral” health care legislation. The idea was that health care reform is not the appropriate place to continue the fight over abortion and neither side should attempt to use health care reform as a vehicle to further expand or restrict access to abortion.

Click to view this PDF chart that explains the current law on abortion funding and shows how the House and Senate bills would maintain or change the status quo.

In pursuit of this objective, Rep. Lois Capps (D-CA) introduced an amendment in the House Energy & Commerce Committee that attempted to strike a balance and preserve the status quo on abortion funding. This proposal was adopted and ultimately included in the original House bill. The Senate Finance Committee also passed a bill that closely mirrored the Capps Amendment’s treatment of abortion funding.

Yet some abortion rights opponents refused to accept the Capps compromise and continued to lobby for further restrictions. Negotiations broke down and House Speaker Nancy Pelosi (D-CA) let Rep. Bart Stupak (D-MI) introduce an amendment that placed additional restrictions on abortion funding. In contrast, the merged Senate bill—released November 18—maintains most of the Capps compromise, but inserts additional provisions to ensure that no federal money will be used to pay for abortion services beyond those currently allowed by federal law. These provisions may go further toward addressing abortion rights opponents’ concerns, but they may also require new concessions from abortion rights advocates. Further analysis is necessary to determine the full ramifications of this new language on abortion coverage.

This chart explains the current law on abortion funding and shows how the House and Senate bills would maintain or change the status quo.

Bishops Originally Asked for "Abortion Neutral" Health Reform Package

2009-11-11T13:24:36-05:00

This article was originally published by Think Progress and is reprinted here with permission from the author.

On Monday, in an interview with ABC News, President Obama reminded Congress that “this is a health care bill, not an abortion bill.” When asked about the Stupak Amendment, he responded that “there needs to be some more work before we get to the point where we’re not changing the status quo,” implicitly acknowledging that the measure does not preserve the status quo on laws related to abortion funding. “I want to make sure that the provision that emerges meets that test — that we are not in some way sneaking in funding for abortions, but, on the other hand, that we’re not restricting women’s insurance choices,” he said.

Ironically, it was the U.S. Conference of Catholic Bishops that was among the first to call for an “abortion-neutral” health care bill back in July. It defined abortion-neutral as maintaining current policies on funding, mandates, and conscience protections:

Any legislation should reflect longstanding and widely supported current policies on abortion funding, mandates and conscience protections because they represent sound morality, wise policy and political reality. Making the legislation “abortion-neutral” in this sense will be essential for widely accepted reform.

The Capps Amendment, which was in the original House bill and is still in Senate legislation, meets all of these criteria:

- The Hyde Amendment ban on Medicaid funding for abortion would remain unchanged.

- The Hyde Amendment would be applied to all public and private plans in the Exchange by segregating private premiums and government subsidies and ensuring that only private premiums be used to pay for abortion.

- No abortions could be mandated as part of the minimum benefits package, even those allowed by Hyde.

- Evenhanded conscience provisions protect those willing and unwilling to provide abortion care, counseling, and referrals.

But the Bishops lobbied against this compromise and demanded that the far-reaching Stupak Amendment be adopted. This measure:

- Goes beyond the Hyde Amendment by preventing women from using their own money to buy an insurance plan that includes abortion, even though no public funding would be spent on abortion services.

- Gives insurance companies an incentive to discriminate against low- and moderate-income women.

- Limits insurance companies in deciding what benefits to offer their customers

- Provides for the purchase of flimsy abortion-only riders that are unlikely to be offered or purchased.

- Allows for discrimination against health care providers who are willing to offer abortion services

The Capps Amendment involved a number of concessions from abortion rights advocates and ought to satisfy the demands of abortion rights opponents. If the true goal is health reform and not to undermine that reform or advance an ideologically-rigid agenda, then we need both sides to meet in the middle.

Why The Stupak Amendment Is A Monumental Setback

2009-11-09T10:11:12-05:00

This article was originally published by ThinkProgress and is republished here with permission from the author and the Center for American Progress Action Fund.

If you thought that just because abortion is a constitutional right and part of basic reproductive health care it would be available in the reformed health insurance market known as the Exchange, think again. The Stupak Amendment, passed Saturday night by the House of Representatives after a compromise deal fell apart, potentially goes farther than any other federal law to restrict women’s access to abortion.

The claim that it only bars federal funding for abortions is simply false. Here’s what the Stupak Amendment does:

1. It effectively bans coverage for most abortions from all public and private health plans in the Exchange: In addition to prohibiting direct government funding for abortion, it also prohibits public money from being spent on any plan that covers abortion even if paid for entirely with private premiums. Therefore, no plan that covers abortion services can operate in the Exchange unless its subscribers can afford to pay 100% of their premiums with no assistance from government “affordability credits.” As the vast majority of Americans in the Exchange will need to use some of these credits, it is highly unlikely any plan will want to offer abortion coverage (unless they decide to use it as a convenient proxy to discriminate against low- and moderate-income Americans who tend to have more health care needs and incur higher costs).

2. It includes only extremely narrow exceptions: Plans in the Exchange can only cover abortions in the case of rape or incest or “where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death.” Given insurance companies’ dexterity in denying claims, we can predict what they’ll do with that language. Cases that are excluded: where the health but not the life of the woman is threatened by the pregnancy, severe fetal abnormalities, mental illness or anguish that will lead to suicide or self-harm, and the numerous other reasons women need to have an abortion.

3. It allows for a useless abortion “rider”: Stupak and his allies claim his Amendment doesn’t ban abortion from the Exchange because it allows plans to offer and women to purchase extra, stand-alone insurance known as a rider to cover abortion services. Hopefully the irony of this is immediately apparent: Stupak wants women to plan for a completely unexpected event.

4. It allows for discrimination against abortion providers: Previously, the health care bill included an evenhanded provision that prohibited discrimination against any health care provider or facility “because of its willingness or unwillingness to provide, pay for, provide coverage of, or refer for abortions.” Now, it only protects those who are unwilling to provide such services.

One in three women will have an abortion in their lifetime. Eighty-seven percent of employer plans offer abortion coverage. None of that will matter if the Senate takes its cues from the House. In every other way, this bill will expand access to health care. But for millions of women, they are about to lose coverage they currently have and often need.

Abortion Funding Fundamentals Under Health Reform

2009-10-01T07:00:00-04:00

Abortion has become a popular sideshow in the three-ring circus of the debate over health care reform. In particular, many questions about abortion funding have arisen—some genuine and some distorted.

Opponents and supporters of abortion rights agreed early on, in theory, to maintain the status quo with “abortion neutral” health care legislation. The idea was that health care reform is not the appropriate place to continue the fight over abortion and neither side should attempt to use health care reform as a vehicle to further expand or restrict access to abortion.

In pursuit of this objective, Rep. Lois Capps (D-CA) introduced an amendment in the House Energy and Commerce Committee that attempted to strike a balance and preserve the status quo on abortion funding. This proposal was adopted on July 30, 2009. On the Senate side, Finance Committee Chairman Max Baucus (D-MT) has proposed a bill that includes abortion funding provisions that closely mirror the Capps amendment.

Yet even finding agreement on the current state of play can be a challenge for an issue as controversial as abortion. This chart explains the current law on abortion funding and shows how the House and Senate bills would maintain or change the status quo.

Current law	Capps Amendment to House health care reform bill	Senate health care reform bill
The Hyde Amendment
The Hyde Amendment prohibits federal Medicaid and Medicare money from being spent on most types of abortion, including pregnancies that threaten the woman’s health or involve fetal anomalies. Federal money can only be used to pay for an abortion when the pregnancy threatens the life of the woman or results from rape or incest.	The Hyde Amendment restrictions would apply to all insurance plans that participate in the health insurance exchange, whether those plans are operated by private insurers or by the government’s “public option.” In other words, no federal funding, including affordability credits or other subsidies, would be used to pay for abortions beyond what is currently allowed. Private premiums would be segregated from public funds and only the private premiums could pay for abortion services beyond those allowed by the Hyde Amendment.	The Hyde Amendment restrictions would apply to all insurance plans that participate in the health insurance exchange, whether those plans are operated by private insurers or member-run co-ops. In other words, no federal funding, including affordability credits or other subsidies, would be used to pay for abortions beyond what is currently allowed. Private premiums would be segregated from public funds and only private premiums could pay for abortion services beyond those allowed by the Hyde Amendment.
Other government programs
Laws similar to the Hyde Amendment that restrict coverage of abortion services also apply to military employees and their dependents, federal employee health plans, members of the Peace Corps, women in federal prisons and detention centers, and Native Americans who receive health care through the Indian Health Services.	Current restrictions on federal spending for abortion services would not change.	Current restrictions on federal spending for abortion services would not change.
States
States have the option to use their own money to pay for abortion services beyond what is permitted under the Hyde Amendment, and 17 states currently do so. Federal money subsidizes these state Medicaid programs even though they cover abortion.	Federal money would subsidize plans that cover abortion—just like they currently do for state Medicaid plans and employer plans—but no public money would be used to pay for abortion services not allowed by the Hyde Amendment. Government money would only be used to help pay for the other medical services covered by those plans.	Federal money would subsidize plans that cover abortion—just like they currently do for state Medicaid plans and employer plans—but no public money would be used to pay for abortion services not allowed by the Hyde Amendment. Government money would only be used to help pay for the other medical services covered by those plans.
Private insurance
Private insurance companies are allowed to decide whether to cover abortion services, and 87 percent of typical employment plans currently provide such coverage. The federal government subsidizes these plans through an employer tax credit, even if the plans include abortion.	Each plan in the exchange could decide whether to cover abortion services beyond those allowed by the Hyde Amendment, provided that at least one plan in each market area offers such services and one plan does not. This provision goes well beyond current law to guarantee that consumers have the option to purchase a plan that suits their medical needs and their values. No abortion services—even those allowed by the Hyde Amendment for cases that threaten the woman’s life or result from rape or incest—can be mandated as part of a minimum benefits package.	Each plan in the exchange could decide whether to cover abortion services beyond those allowed by the Hyde Amendment, provided that at least one plan in each market area offers such services and one plan does not. This provision goes well beyond current law to guarantee that consumers have the option to purchase a plan that suits their medical needs and their values. No abortion services—even those allowed by the Hyde Amendment for cases that threaten the woman’s life or result from rape or incest—can be mandated as part of a minimum benefits package.

View this chart in PDF

The Abortion Distortion: Setting The Record--and John Boehner--Straight on the Capps Amendment

2009-08-26T08:00:00-04:00

Adding to the rampant mythmaking that health care reform will result in a mandate for taxpayer-funded abortions, Rep. John Boehner (R-OH) yesterday released a GOP Leader Alert with a tag line that reads “Despite Democrats’ Claims, the ‘Capps Compromise’ was Just for Political Cover” and asserting that “the legislation [in the House of Representatives] would in fact allow abortions to be subsidized by taxpayer funds.”

The only political cover being used here is by those who oppose health care reform.

The GOP Alert contains numerous distortions, using quotes that do not support the contentions made in the alert itself. For example, according to the alert:

The Associated Press has reported, for example, that “Health care legislation before Congress would allow a new government-sponsored insurance plan to cover abortions” and FactCheck.Org has stated that the “House bill would allow abortions to be covered by a federal plan and by federally subsidized private plans.

Note to Boehner: Neither of these quotations actually says that abortion coverage would be paid for with government money.

That’s because under the Capps Amendment (PDF), it wouldn’t.

In fact, a “federal plan” or a “federally-subsidized private plan” that covers abortion would be required, pursuant to the Capps Amendment, to use money from private premiums to pay for abortion care.

These facts notwithstanding, the alert concludes:

The bottom line? H.R. 3200 does not contain any limitation on federal funds authorized or appropriated in the bill from being used to pay for elective abortion or to subsidize the purchase of insurance coverage of elective abortion. (Emphasis in original.)

Oh if only that were true, abortion rights advocates could go home because their work would be done.

To reach this conclusion, Boehner cites Sections 115 and 122 of the bill, neither of which says anything about payment mechanisms. It is Sections 203 (SEGREGATION OF FUNDS) and 241(c) (PROHIBITION OF USE OF PUBLIC FUNDS FOR ABORTION COVERAGE) that ensure no public money will be spent on abortion.

To make his assertions, Mr. Boehner conveniently skips over the portion of Section 122 amended by Rep. Capps (D-CA) to prohibit the HHS Secretary or a Health Benefits Advisory Committee from requiring a health plan to include abortion coverage in order to participate in the Health Insurance Exchange.

Instead, he actually claims, in direct conflict with the plain reading of the bill, that abortion could be mandated as part of an essential benefits package. The alert reads:

Page 26; Section 122 – The bill defines what would be deemed an “essential benefits package,” or in other words what the government sets as benefits or services that must be covered by an insurance plan. This section, however, contains no explicit exclusion or prohibition from abortion being deemed part of an essential benefits package. Without such an exclusion, the bill leaves open the possibility of federally mandated coverage of abortion as an essential benefit.

It’s hard to imagine how he missed it, given that the new section is clearly labeled, “ABORTION COVERAGE PROHIBITED AS PART OF MINIMUM BENEFITS PACKAGE."

So, when you’re debating this topic at Town Hall meetings or around your kitchen table, here are two main points to keep in mind:

1) The Capps Amendment is meant to be a compromise, which means both sides must be willing to give some ground. Abortion-rights proponents in Congress are not trying to use health care reform as a vehicle to expand abortion access (although it would be appropriate for them to do so as reform is supposed to be about expanding access to health care). By the same token, abortion-rights opponents should not try to use health care reform as a vehicle to restrict access to abortion care.

2) This issue is a red herring. Most of the politicians and interest groups who protest abortion coverage in health care reform do not want reform to succeed at all. Among the few groups who want health reform but have a genuine objection to abortion coverage, even they cherry pick. For instance, the U.S. Conference of Catholic Bishops (who is cited in the Alert) also opposes contraception, sterilization, and end of life care, but they are only using their great lobbying power to oppose abortion coverage. The implication is that they will somehow learn to live with taxpayer money being used for these other services.

Assuming the person you’re debating isn’t holding a gun or calling you a Nazi, you could also try making these arguments:

1) The Capps Amendment applies to the public option as much as it applies to private plans in the exchange, so even if the HHS Secretary does allow the public option to include abortion services, under the current version of the bill they will only be paid for with private premiums. The same goes for federally subsidized private plans that choose to cover abortion - only private premiums would be used to pay for abortion care.

2) This is an entirely theoretical debate at this point. The bill neither mandates nor prohibits abortion coverage, nor any other health care service. Under the pending legislation, either the HHS Secretary or an independent commission of experts and citizens will determine what will be included in a minimum benefits package, and 75 percent of Americans want it that way. Congress is the wrong place to have this fight.

3) Abortion care is part of basic health care and should not be denied simply because the government wants to play a larger role in our health care system. Most employer-sponsored health plans cover abortion. Women should not lose this coverage in order to purchase insurance through a new health care exchange. Moreover, a recent poll showed that two-thirds of Americans want comprehensive reproductive health care, including abortion, to be part of any reform package and 6 out of 10 Americans would oppose a bill that excludes such coverage.

4) There is more than one view on this issue. A woman’s rights should not depend on her wallet, and if a woman needs assistance in order to obtain abortion care, the government ought to able to provide it, even if that means taxpayer money will be used for a purpose to which some citizens object. Currently, taxpayer money is used for the war in Iraq, stem cell research, the death penalty, and teaching evolution in our public schools - all activities to which some taxpayers object. Abortion opponents are not entitled to special treatment.

There has been a lot of intentional blurring of the lines in the debate over abortion in health care reform. Although many opponents of health care reform seem allergic to the facts (see the “death panels” debate), the public deserves more. Yes, this is a controversial topic and deserves vigorous debate, but let’s have a dialogue that is based on actual facts, not hyperbole, misinformation, and outright distortions.

Parenting with Dignity: Exploring Real Supports for Pregnant Women

2009-08-06T08:00:00-04:00

The Center for American Progress is publishing a series of policy briefs to help inform efforts at creating a common ground agenda. This introductory essay is the first in a series of articles from the Center for American Progress that RHrealityCheck will publish. Each will address various aspects of how to better support women and mothers, an area idenitfied as potentially rich in common ground.

In the debate over finding “common ground” on abortion, much has been made of the fact that, when asked why they chose to have an abortion, many women say, “I can’t afford another child right now.” Given this response, some have suggested that providing additional supports to pregnant women might help reduce the abortion rate. The thinking goes that if women feel the economic obstacles are too great to carry a pregnancy to term—especially an unintended pregnancy—then policies that ease those burdens may help a woman ultimately have a child that she wants to have. An alternative line of thinking suggests that if a woman is trying to decide between abortion and carrying to term, additional supports may tip the balance and lead her to choose having the child.

The Center for American Progress continues to believe that, per the public health data, widespread access to contraception is the most effective method available for reducing unintended pregnancy, especially when coupled with medically accurate sex education. Unintended pregnancy is, after all, the proximate cause of the vast majority of abortions. We also believe that the government should not be in the business of promoting one moral viewpoint over another, nor should it try to persuade individuals to make particular health care decisions that have no bearing on public health outcomes.

Nevertheless, we do believe in taking a comprehensive approach to addressing reproductive health needs and we feel that it is an important policy objective in its own right to provide better supports to pregnant women, regardless of any potential subsequent effect on the abortion rate. We will therefore be examining, through a series of issue briefs, a variety of meaningful ways in which we can better address the needs of pregnant women.

When a woman says she can’t afford a child, she is not just thinking of the nine months of pregnancy, the first few months after the child is born, or even the first few years of life. She is most likely thinking about the next 18 years—or beyond—and how she will clothe, bathe, feed, house, nurture, and educate another human being for that entire period of time.

She may already have one or more children to care for—indeed 6 out of every 10 women who have abortions are already mothers. She may be the primary caretaker for a disabled or elderly member of her family. She may want a family one day but feel economically or emotionally unprepared to start one now. She may have a partner who is willing to help raise a child or not. She may be working, unemployed, or trying to finish her education so she can better support herself and her loved ones. If working, she may have secure employment, or she may be one sick day away from a pink slip. She may be in perfect health, have a chronic illness, struggle with addiction, or suffer intimate partner violence. She may have health insurance, or she may be uninsured. She might consider adoption or think it is out of the question.

In short, a multitude of factors may affect her decision to continue or terminate a pregnancy. And “I can’t afford a child right now” can encompass a number of these factors. Diapers and formula are clearly not sufficient. Systematic changes to health care, the workplace, the adoption system, and others are necessary to have a real effect on the lives of pregnant women.

Parenting with Dignity: Part One in a Series

2009-08-05T08:00:00-04:00

RH Reality Check is partnering with the Center for American Progress (CAP) to promote a series of policy briefs created by CAP on the economic and social supports required to ensure women can engage in "parenting with dignity." This introductory essay will be followed by a series of articles addressing various aspects of how to better support women and mothers, and with efforts to share these analyses widely with both the mainstream and new media communities.

Click here to read more from the series.

A Taxing Problem: Abortion and Health Reform

2009-07-30T16:30:00-04:00

This article was originally posted on Huffington Post.

Last week, five pro-life Democrats, headed by Rep. Tim Ryan (D-OH), sent Speaker Pelosi a letter suggesting a "common ground" solution to the abortion "roadblock" in health care reform. They proposed that insurance companies neither be required to nor prohibited from paying for abortion and that no federal subsidies be used to pay for the procedure.

Ryan and his co-signers should be applauded for placing primary importance on the need to provide health care coverage to the more than 50 million Americans who currently go without insurance and for being unwilling to sacrifice health care reform on the altar of abortion politics. This is in welcome contrast to the stonewalling and ultimatums coming from Rep. Bart Stupak (D-MI) and his allies. But Ryan's proposal is based on a misguided and attenuated definition of government spending, and it conflicts with what Americans want and expect from health care reform.

Health care reform legislation does not contemplate taxpayer-subsidized abortion. The bills under discussion essentially propose a sliding scale premium to individuals and families based on their income. Rather than offering a tax credit, voucher, or other form of direct cash payment to help families purchase health care, the government would offset lower premiums by paying the remainder directly to the insurance company. By analogy, we're talking farm subsidies, not food stamps.

What's more, when people purchase insurance, they buy a comprehensive package of services they hope they will never have to use. The whole purpose of insurance pooling is to offset risk, knowing that not everyone will utilize every service covered.

The suggestion that a health plan might offer abortion coverage and it might be used by someone who might have paid a lower premium than someone else because the government might have helped pay their premium is a horrible reason for Congress to carve out an explicit exception to a bill that is otherwise entirely silent on coverage options.

Understood in this light, the arguments about taxpayer-funded abortions are simply too tangential to withstand scrutiny.

Even if you share Ryan's overly expansive definition of government spending, whether we like it or not, taxpayers do not have the right to specify how their tax money should be spent. I understand why people would want to withhold their taxes from purposes they oppose, but our system does not -- nor should it -- work that way.

The Constitution authorizes Congress to collect taxes to provide for the common defense and general welfare. There is no footnote that says, "unless some of us disagree." All Americans can surely think of at least one use of their taxes to which they object -- for some liberals, it might be the death penalty; for some conservatives, the teaching of evolution in public school. There are proper channels for disputing such policies, but attacking government funding is not one of them.

The "common ground" solution here is to let the experts -- not politicians -- decide what services should be covered. A recent poll shows that Americans are extremely wary of having Congress or the president pick and choose which medical services will be covered or excluded in a new health care system. Seventy-five percent of voters would rather have an independent commission of medical experts and citizens decide these critical issues--Republicans are the strongest supporters of this approach, with 78 percent in favor.

And contrary to the prevailing conventional wisdom, strong majorities of voters recognize the full range of reproductive health services--including prenatal and maternity care, contraception, screening for cancer and sexually transmitted infections, and, yes, abortion -- as basic health care. They want those services to be covered and would oppose any health care reform plan that does not include comprehensive reproductive health services.

Americans do not want politics to drive coverage decisions. In other words, they object precisely to the type of food fight brewing on Capitol Hill right now. A recent report finds that the Millennial generation finds culture war issues such as abortion much less salient to their lives than previous generations. It is high time that Congress moves on from the culture wars too.

HHS "Provider Conscience" Rule Puts Public Health in Danger

2008-12-24T08:00:00-05:00

As expected, the Bush administration finalized its proposed "provider conscience" rule last week. Despite opposition from leading medical groups like the American Medical Association, the American College of Obstetricians and Gynecologists, and the American Hospital Association; from Senators, House members, and state attorneys general; from officials at the Equal Employment Opportunity Commission; and from over 200,000 individual commentators, the Health and Human Services Department pushed through a rule that expands the right of health care workers to refuse to provide medical care, counseling, referrals, and even information to an unprecedented level.

The rule is pernicious in many ways. It allows all employees, and even volunteers, of most institutions receiving HHS dollars to deny access to a wide variety of medical services. The rule ostensibly protects only employees who object to abortion and sterilization, but it is written so broadly that it could also apply to contraception, fertility treatments, HIV/AIDS services, gender reassignment, end-of-life care, or any other medical practice to which someone might have a personal moral (not even religious) objection.

This rule is not "just a woman's issue," though the more than 17 million women who depend on our public health system and who are disproportionately low-income and women of color will certainly bear the largest brunt of this politically-motivated regulation. The rule also provides a striking example of how the stigmatization of one medical service-specifically, abortion-can quickly creep into other areas and erode well-established medical standards of care. Allowing medical services to be ranked on a scale of moral superiority is a public health problem.

The right of conscience is an important and time-honored value in our society and one that should not be tread upon lightly. But it is not only health providers who have rights; so do patients. Standards of care and codes of conduct exist to balance the rights of them both. Instead of pitting the rights of providers and patients against one another, perhaps there are a few tenets upon which we as a society can agree:

Withholding relevant, medical information from patients is never good medical practice nor ethical;
In emergency situations, the patient's medical needs must always come first;
Providers who are unwilling to provide certain services must give their patients timely notice of their refusal to do so and must refer those patients to a provider who can supply the needed health care.

Despite the fact that professional medical associations have consistently endorsed these precepts, the new HHS rule ignores all three of these basic yet essential codes. Fortunately, it is likely that the new administration and the new Congress will work to reverse this rule as quickly as possible. But this debate will not end with the demise of this rule, and we must not countenance some very dangerous concepts that have been advanced in support of the rule.

Requiring a health care provider to do his or her job is not discrimination. Employers are required to accommodate an employee's religious beliefs when doing so does not present an undue hardship on the employer. However, refusal or withdrawal of health care in a manner that neglects a patient's needs is an undue hardship and should not be entitled to accommodation.

Providing a referral for a service is not morally equivalent to providing that service yourself. There are varying degrees to which one's conscience may be burdened by certain actions. Supplying information about where to find appropriate medical care ought not to tax one's conscience to the same extent as performing a procedure or dispensing medication. Moral beliefs exist along a continuum and the protections afforded for such beliefs must be proportionate as well.

A refusal to provide care can harm patients. In our current health care system, we face a shortage of primary care physicians, a nursing shortage, a vast population of uninsured and underinsured patients, hospitals that cannot afford to stay open, and rural communities with few health care resources like clinics and pharmacies. Health care providers should not assume that just because they say no, a patient will be able to find another provider who will say yes who is also affordable and accessible.

The so-called "provider conscience" rule disrupts the careful balance established by medical codes of conduct and standards of care, placing the health, well-being, and dignity of patients at risk. We must work to ensure the proper balance is restored quickly, so that we can continue to protect the right of conscience while also protecting access to all health care services for every patient who needs them.

This article was first posted at Science Progress.

Not All Politics Is Local: Connecting the Dots on Anti-Abortion Initiatives

2008-11-01T09:00:00-04:00

Advocates and politicians who oppose legal abortion often claim they only want to "send the issue of abortion back to the states," and the current round of state ballot initiatives reinforces the impression that this is the case. But this position is a bait-and-switch tactic that should not be trusted.

Abortion opponents' unabashed goal is to ban abortion throughout the country. Their initiatives at the state level are just one part of that plan. In fact, two of the three measures voters will decide this Election Day are intended to provide a direct challenge to Roe v. Wade and open the door for a national ban on abortion.

South Dakota's Measure 11 would ban abortion except in narrow circumstances, and Colorado's Amendment 48 would define a fertilized egg as a person, which would severely restrict access to abortion, contraception, fertility treatments, and scientific research. In contrast, California's Proposition 4 attempts to limit but not ban abortion by requiring parental notification for minors.

On the surface, these initiatives seem quite different. But while they represent different strategies--an absolutist versus an incrementalist approach--they are all linked by a common agenda: to end legal abortion across America.

California Proposition 4 is endorsed by Americans United for Life, among others. This is an organization that has worked to slowly erode women's access to abortion care with bills that limit available abortion methods after 12 to 13 weeks of pregnancy; require waiting periods, biased counseling, and ultrasound viewings prior to an abortion; create burdensome and medically unnecessary regulations for abortion clinics; assert that fetuses feel pain during an abortion; and allow health care employees to refuse to counsel, refer, or treat patients for any service to which they object.

In other words, Americans United for Life and its allies favor laws that make it exceptionally hard to get an abortion--through cost, distance, stigma, and delay--but do not explicitly ban abortion. It is largely due to such efforts that Mississippi, North Dakota, and South Dakota now have only one remaining abortion clinic each, that 87 percent of U.S. counties do not have an abortion provider, and that approximately one-third of low-income women who want an abortion find themselves forced to carry their pregnancies to term.

Proponents of Colorado Amendment 48 and South Dakota Measure 11, in contrast, hope that if one of these measures passes, it will be immediately challenged in court. Their calculation is that by the time the case reaches the Supreme Court, there will be a majority of justices willing to overturn Roe.

With the current balance on the Court, that is a somewhat risky strategy, but nevertheless a real threat. Four justices are firmly against Roe, but it is not clear if they are all willing to expressly undo the settled precedent. Four justices are firmly in support of Roe, but some of them may retire soon, and whether their successors agree or differ with them will largely depend on who the next president is.

The ninth vote--Justice Anthony Kennedy--currently represents the ideological center of the Court, and it is not easy to predict how he would rule. Based on the decision he authored in the 2007 case Gonzalez v. Carhart, it is clear that he harbors significant misgivings about abortion rights. On the other hand, he did concur in the landmark Planned Parenthood v. Casey decision, a case that both sides thought would mark the end of Roe but instead strongly reaffirmed its core principles.

For these reasons, not all abortion-rights opponents are on board with the absolutist plan. Many fear it is too soon for the all-or-nothing approach. They are concerned that if the gamble does not pay off, the result will be another precedent that affirms the central holding of Roe, which might make it harder to eventually overturn.

What voters should understand is that, regardless of their various strategic determinations, the leaders behind these initiatives are all working with the common goal of undermining Roe in the short term and reversing it in the long term. They have already achieved too much of this plan and we should not allow them to go any farther.

Do not be deceived by the promise that the abortion debate will finally quiet down with Roe's demise. Rather than turning attention, for instance, to providing families with the supports they need to raise healthy children, the antiabortion movement would launch a 50-state referendum on abortion coupled with a national campaign to ban it in the U.S. Constitution or with federal legislation.

The leaders of the movement to outlaw abortion are fully dedicated to the idea that the right to life--or, more accurately, the right to birth--is a fundamental right that should be the law of the land, not just the law in some of the land.

Passing one state initiative will most certainly pave the way for other rollbacks in the states and eventually nationwide. Unless voters in South Dakota, Colorado, and California defeat these measures this Election Day, an abortion ban may be coming soon to a place near you.

This article was first featured on The Huffington Post.

Proposed HHS Regulation Could Still Block Access to Contraception, Other Health Services

2008-08-22T10:52:14-04:00

HHS has released its proposed regulation to “help protect health care providers from [religious] discrimination.” The good news is it no longer attempts to re-define abortion to include birth control. But don’t breathe a sigh of relief just yet. The regulation no longer defines pregnancy or abortion at all. But Sec. Mike Leavitt indicated in the press conference that individuals might be able to define those terms for themselves in determining what they find morally objectionable, which means they still may be able to deny women access to oral contraceptives, emergency contraception, and the IUD, among other commonly used methods of birth control.

And that’s just the beginning.

While most of the regulation limits the scope of allowable moral objections to training, performing, counseling, or referring for abortion and sterilization, some sections are not so restricted.

Entities to whom this subsection 88.4(d) applies shall not require any individual to perform or assist in the performance of any part of a health service program or research activity funded by the Department if such service or activity would be contrary to his religious beliefs or moral convictions.

That seems to be an exception you could drive a truck through.

Also note the objections can be based not only on religious beliefs but on any personal moral convictions. This is much broader than the traditional conscience clauses, including those that allowed for conscientious objectors during the Vietnam War.

Finally, the proposed regulation would extend protection from doctors and nurses to just about anyone who might come into contact with a patient, and even some who might not.

[A]n employee whose task it is to clean the instruments used in a particular procedure would be considered to assist in the performance of the particular procedure.

By that logic, an ambulance driver, a receptionist, and even the person who processes health insurance forms might be able to refuse to perform their jobs if related to a health care service they find morally objectionable. Volunteers are explicitly protected too.

The public may submit comments on the regulation during the next 30 days to http://www.Regulations.gov or via email to consciencecomment@hhs.gov.

This post was first published at ThinkProgress.

Putting an End to the Albatross Myth

2007-06-25T09:00:00-04:00

In her June 22nd New York Times op-ed, "Why Pro-Choice Is a Bad Choice for Democrats," Melinda Henneberger sends a mixed message to pro-choice politicians. She criticizes them for failing to address the complexity of the abortion issue, but she tells them instead of giving up on voters who consider themselves pro-life, they should give up on defending abortion rights. I don't think they have to give up on either.

As Shira Saperstein and I wrote in January 2005:

Instead of retreating from the perceived albatross of abortion (and further demoralizing steadfast supporters), the way for progressives and moderates to broaden their appeal and strengthen their ranks is to show leadership in this controversial area. Leadership requires grappling with difficult issues—not ignoring them. The divide this country faces regarding difficult issues like abortion presents an opportunity for those on the left to demonstrate leadership, not to show how well they can follow. Progressives must ask—and strive to answer—the hard questions, such as what is the proper balance to be struck between respect for fetal life and respect for women as moral decision makers? How can the government best support women in their decisions to have or not have children? How can we reduce the frequency of abortion in ways that preserve rather than compromise women's autonomy?

We agree with Henneberger that abortion discussed in isolation is a winning issue for conservatives. But if progressives and moderates can put abortion back in context and link it to a larger agenda, they may be able to get into some of that complexity that Henneberger rightfully notes is missing from the current debate:

Leadership also involves articulating a vision. Progressives need to acknowledge that the conflict over abortion cannot be solved with simple solutions. Instead, a comprehensive plan to improve women's health and lives and give them real choices is necessary. Such an agenda would include not only legal abortion but also access to contraception, medically accurate sex education, pre- and post-natal care, child care, health care, paid family leave, job training, job protection, and a living wage. For until we as a society create a climate in which women have the social and economic means to prevent unwanted pregnancies and to raise the children they want to bear, we are all responsible for every abortion that occurs.

However, Henneberger herself falls into the trap of oversimplifying the debate—criticizing the Presidential candidates who were dismayed by the Supreme Court's abandonment of a health exception requirement in abortion jurisprudence. Her characterization of their positions ignores the history of abortion in this country:

The public needs to be reminded that support for legal abortion and other reproductive rights comes from a specific and tragic history. Roe did not mark the beginning of abortion in this country. Illegal and unsafe abortions resulted in death, serious illness, and infertility for thousands of women, which provided much of the impetus for making abortion legal. When challenged by those who would criminalize abortion, progressives must remember this history and explain what they are about: protecting women's health and lives, ensuring that children are born into families that can care for them, and keeping women and their doctors out of jail. They must seek to fill, not create, a void in the current political landscape.

Rather than becoming silent on abortion, pro-choice leaders must struggle in this sound-bite-driven world to speak more clearly about the reasons in favor of legal abortion. And it would be nice if the media tried to do the same.

The Pro-Choice Continuum

2007-01-24T08:00:00-05:00

Jessica Arons is the Director of the Women's Health and Rights Program at the Center for American Progress and the author of More than a Choice: A Progressive Vision for Reproductive Health & Rights.

In the pro-choice community, we spend most of our time debating the options women should have when they are thinking about terminating a pregnancy. We rarely spend time, however, discussing what options women should have when giving birth. By the same token, maternal and birthing rights activists often do not address issues surrounding abortion in their own work.

The National Advocates for Pregnant Women (NAPW) has set out to change that. This past weekend in Atlanta, GA, pro-choice activists and maternal rights supporters came together—for the first time to my knowledge—for a National Summit to Ensure the Health and Humanity of Pregnant and Birthing Women.

Abortion rights supporters are familiar with waiting periods, funding bans, biased counseling requirements, procedure restrictions, and other obstacles that women must endure when they want to access abortion care in the United States. But how many of us know that the Cesarean section rate in our country (30.2%) is twice as high as that recommended by the World Health Organization (10-15%)? And who knew that over 300 hospitals in this country have an outright ban on letting women even try to have a vaginal birth if they have previously had a C-section despite mounting evidence that it often is safe?

From debates over delivery in a hospital versus at birthing centers or home to attempts to secure health insurance coverage for midwives and doulas (trained birth attendants), birthing rights advocates work to ensure that women get the final say about the circumstances under which they birth and the medical care they receive during the delivery of their children. Through their efforts, they aspire to guarantee that women are truly informed about their delivery options and empowered to have their decisions honored.

The links between their work and that of conventional reproductive rights activists should be obvious. We both seek heightened respect for women's decisions regarding their pregnancies. We both attempt to defend women from unwanted, and often harmful, government intrusion into their reproductive lives. And we both want women to have better access to quality reproductive health care.

When a young mother is denied the childcare she needs in order to pursue her education; when a woman is prosecuted rather than treated for using drugs while pregnant; when a woman cannot afford to pay for an abortion she needs; when a court orders a woman to undergo a C-section against her will; when midwives are denied a state license to practice; and when a prison sterilizes a woman without her knowledge; we all should raise our voices in collective outrage over the denial of women's reproductive and human rights.

Lynn Paltrow, founder of NAPW, noted at the Summit that we as women are all connected by our potential capacity to bear children. Accordingly, when any pregnant woman is treated with disrespect and indignity, when her wishes are undermined or outright ignored, when her life is devalued, we all suffer the consequences.

As we mark the 34th anniversary of Roe v. Wade this week, it is fitting that we expand the notion of what it means to be pro-choice and join with new allies to ensure that all pregnant women have genuine and meaningful choices and that their decisions—and they themselves—will be respected.