Hatch Attacks Essential Services for Low-Income Communities Under Health Care Reform

This article was updated with links at 11:22 am, Monday, July 13th, 2009.

The Republican Party, apparently bereft of viable ideas on how to solve pressing issues, is living up to its reputation as a one-trick pony: launching misleading attacks either on economic policies or on health policies, in the latter case consistently throwing around the word "abortion" whenever and whereever women’s health services are involved.

The most recent exercise in the party’s "don’t-let-the-facts-get-in-the-way" effort to obstruct progress on virtually any issue under consideration by Congress is an attack by Senator Orrin Hatch (R-UT) on a provision of a health reform bill–the Affordable Health Choices Act–known as the Women’s Health Amendment. Hatch is leading the charge falsely claiming that this amendment includes coverage for abortion services.

It does not.

The amendment, which would increase access to urgently needed preventive health care in low-income,
medically-underserved communities, was introduced last week by Senator Barbara Mikulski (D-MD) as the Senate HELP Committee (Health, Education, Labor and Pensions) considered amendments to the Act. It was supported by a wide range of groups, including, among others, Families USA, the Service Employees International Union (SEIU), Campaign for
America’s Future
, Health Care for America Now, the American Nurses
, the American Academy of Nursing, the American College of
Obstetricians and Gynecologists
, National Women’s Law Center, and the
National Partnership for Women and Families.

Yet despite the fact that the United States is facing an unprecedented shortage of health care providers, that more than 40 million Americans lack access to health care, and that low-income, medically underserved communities are hardest hit by the concurrent crises we are now facing, Republicans sought to block the amendment.

It passed.  Only one Democrat, Senator Bob Casey (D-PA), voted against the amendment. (As of the morning of July 13th, 2009, Senator Casey’s office has not yet returned calls inquiring about the reasons for his vote).

Efforts by Hatch and others to remove the amendment were strongly
opposed by advocates for gay, lesbian, and transgender communities, for HIV
and AIDS prevention and treatment, and for women’s health.  The Human Rights Campaign, which supports the rights of gay, lesbian, bisexual and transgender persons, favors the amendment because:

Many HIV/AIDS service providers and health facilities that focus on
LGBT people are [essential community providers] and serve as the primary source of health care for
these individuals.

The National Minority AIDS Council (NMAC) pointed to the critical need for  expanded access to the kinds of services offered by the Mikulski Amendment in a statement on its website:

Preventative care is particularly important for women of
color. Often the primary care takers of their families, they tend to put the
needs of their family members and children ahead of their own – to the
detriment of their health. Since 1992, HIV rates among women of color have
risen nearly 10%, with over 80% of all HIV cases among women in this country
occurring among Black and Hispanic women.

Undaunted by this first loss, Committee Republicans apparently see an
opportunity to complicate the health reform process by using abortion
as a wedge issue and perhaps try to poison the well in the next round
of votes on this bill by spreading misinformation. 

Again, the amendment does not include coverage for abortion care.

The amendment states:

A group health plan and health insurance issuer offering group or individual health insurance coverage shall provide coverage for, and shall not impose any cost sharing requirements (other than minimal cost sharing in accordance with guidelines developed by the Secretary) for, with respect to women (including pregnant women and individual of child-bearing age), such additional preventive care and screenings not covered under section 2708 as provided for in guidelines supported by the Health Resources and Services Administration.

It would:

include within health insurance plan networks those essential community providers, where available, that serve predominantly low-income, medically-under-served individuals, such as health care providers defined in section 340B (a)(4) of the Public Health Service Act and [in the relevant section of the] Social Security Act.

Expanding coverage to these populations is an urgent matter of public health.  First, women have higher health care costs than men to begin with.  Women of childbearing age spend 68 percent more
in out-of-pocket health care costs than men
, in part because of
reproductive health-related needs.

Yet the economic downturn, loss of jobs and health insurance and expansion of the numbers of people living in poverty have led a growing number of women to forego preventive health care.  Recent research shows that women are increasingly delaying or skipping preventive health care due the inability to pay for these services, thereby raising overall health costs in the long-run when treatment is required for originally preventable illness an disease.  A May 2009 report by the Commonwealth Foundation, for example, found that
more than half of women surveyed delayed or avoided preventive care because of
its cost. 

The Women’s Health Amendment
seeks to address these gaps, something to which the Republican Party apparently objects.

What would the Women’s Health Amendment actually do that is so scary? It would:

  • Increase access to basic primary preventive care.  This includes cancer screenings, well-women exams, pre-natal care, pap tests and other preventive care, including contraception and STI treatment and testing not covered in the prevention section of the Affordable Health Choices Act. 
  • Support "essential community providers (ESPs)."  ESPs expand access to medically under-served communities in part by relieving provider shortages.  By requiring that health plans include ESPs "in-network," the amendment would ensure patients’ access to the health care providers that are located in and have built trust in their communities.  Coverage would include migrant health centers; clinics providing HIV and AIDS prevention, treatment, and care; women’s health centers receiving grants under Title X; public hospitals and other hospitals serving low-income communities; and urban Indian organizations.

As NMAC noted, for example:

[The] Women’s Health Amendment would cover women of color’s access to services from
minority faith- and community-based organizations (MF/CBOs), which provide
culturally competent and easily accessible health and HIV/AIDS services in communities
of color throughout the country. Over 4,000 strong, MF/CBOs have saved
countless lives by providing their clients easily accessible health care

So what is the concern?

Because Planned Parenthood health centers are considered essential health providers, and because these providers would be supported by this amendment, Republicans are claiming that the amendment mandates abortion coverage.

Again: It does not.

It does however increase access to primary preventive health care, which constitutes more than 90% of the services provided by Planned Parenthood centersbasic prevention and primary
.  A recent study by the Guttmacher Institute found that
more than six in 10 patients who receive care at a women’s health
center like Planned Parenthood consider it their primary source of
health care
As we reported a few weeks ago, rates of cervical and breast cancer, sexually transmitted infections, and unintended pregnancies, among other health concerns, are highest in communities with the lowest access to essential reproductive and sexual health care.  Providing these services makes sense, whether you are considering this issue from the vantage point of public health, human rights, community well-being, health disparities, or financial savings to the country writ large.

It also increases access to basic contraceptive services which, by reducing unintended pregnancies, reduces the need for and by extension the number of abortions.  The very fact that the amendment does not fund abortion care, but reduces the need for abortion belies the Republicans real motives for opposing coverage for preventive care and essential service providers.

So Senator Hatch, and his comrades in the Senate and the anti-choice ocommunity (such as the Family Research Council) continue to attack health care reform by claiming that an amendment that will help ensure patients access to those health care providers they use and trust mandates abortion coverage.

Once again: It does not.

The Republicans, using fear as a motivator, continue to mislead on essential health debates, at the cost of the health and lives of millions of Americans.  As time goes on, it is increasingly clear that these tactics are used
as a foil for denying millions of Americans, primarily women and
children, the most basic of health care services.  In fact, the majority of people have turned on the lights, opened the closet door, looked under the bed and realized that neither women’s health issues writ large, nor Planned Parenthood specifically are the bogeymen they have been made out to be by a political party otherwise without a cause.  

As demonstrated by the votes of all but one Democrat on the HELP Committee in favor of keeping this amendment, the majority of Americans have left this bogeyman behind.  In the interest of public health and fiscal responsibilty alone, the Republicans should do the same.

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  • brianh

    HATCH: "…Would this include abortion providers? I mean, it looks to me like you’re expanding it to… for instance, Planned Parenthood. Would that put them into this system?"

    MIKULSKI: "It would include women’s health clinics that provide comprehensive services and under the definition of a woman’s health clinic, it would include, uh, it would include, uh, Planned, uh, Parenthood clinics. It would, um, it does not expand in any way expand a service. In other words, it does not expand, um, uh, or mandate abortion service."

    HATCH: "No, but it would provide for them."

    MIKULSKI: "It would provide for any service deemed medically necessary or medically appropriate."

    HATCH: "Well, I would have a rough time supporting it on that basis. I just wanted to get that clarified. Thank you."

    HATCH: "Madam Chairman, would you be willing to put some language in [about] not including abortion services? Then I think you would have more support."

    MIKULSKI: "…No, I would not, uh, be willing to do that at this time."

    Sounds like this covers abortion providers and thus abortions will be payed for by tax payers. This would mark the first time in US history that tax payers are required to fund an abortion.  That’s the complaint from pro-life organizations right? Am I missing something?

  • invalid-0

    You are right that the plan doesn’t “mandate” abortion coverage. I’m not even sure what that would mean. That any and every abortion must be covered? But I’m not sure I ever read/heard any Republicans asking about anything being mandated. That word seems to be coming from you and Sen. Mikulski.

    It seems pretty clear that Hatch’s questions about funding have to do with whether health institutions, and specifically ones like Planned Parenthood which, though they provide other services, are quite well known for providing abortions is are to be covered in the plan. The concern isn’t: “must abortion be covered?” but “will it be covered at all?” And the answer to that seems to be yes.

  • crowepps

    "At present, the federal Medicaid program mandates abortion funding in cases of rape or incest, as well as when a pregnant woman’s life is endangered by a physical disorder, illness, or injury."


    In addition, taxpayers paid for abortions before the Hyde amendment was passed in 1976, so this wouldn’t "the first time" at all.  There are lots of taxpayers who support the idea of medically necessary abortions and don’t mind paying for them.  Why should the negative opinion of 10% of the population be able to cut off that funding

  • jodi-jacobson

    The Mikulski amendment does not cover abortion care. Period. I am not clear what is confusing about this.

    The amendment–as described in detail above–ensures women have coverage for pap smears, breast exams, pre-natal and well-woman exams, contraception and so on.

    It does not cover abortion.  And I specifically stated this many times as I knew that those who would prefer to read it as such no matter what would do so.

    Medicaid pays for abortion under the conditions that Crowepps explains, and I would be lying if I did not think these conditions should be expanded. This amendment does not do that.

    What I explained in my article is that the amendment supports expanded access to essential health providers, a group in which Planned Parenthood health centers are included.  These centers provide the essential preventive services outlined above.  It is one thing if you don’t want women to have access to these services or for low-income communities to have expanded access to such coverage.  If that is the case, then please argue your case on its merits, as you see them and whatever these merits might possibly be.  But don’t change the subject because abortion coverage is not in this amendment.

    Finally, the misleading use of the term "mandated abortion coverage" shows up in several releases by Republican Senators and anti-choice groups.

    With best wishes, Jodi Jacobson

  • crowepps

    I’m not even sure what "mandated abortion coverage" means — are they going to drag women in and FORCE them to get abortions they don’t want?  The total disconnect between real women and their real problems and the real solutions that might help them and the myth of ‘abortion is never necessary’ is blatantly apparent.

  • jodi-jacobson

    The health care law to be passed will ostensibly mandate certain basic forms of coverage to create the even playing field and get the vast majority of Americans covered. it would, for example, mandate many things already in the Affordable Health Choices Act. Pap smears, well-woman exams, and so forth were not originally in the Act and therefore needed to be added as part of mandated coverage through the Mikulski Amendment or, shockingly i know, the health insurance programs to come out of this Act would not necessarily provide them OR would charge women premiums for basic preventive health care as per above.

    I hope that makes sense.

    Whatever happens now is not the final act, however. There is much work to do to ensure these things are not taken out. I can assure you I have been a part of processes of writing legislation based on the best evidence and the most basic human needs only to see these pieces be cut out in the end to mollify the far right, the US Council of Catholic Bishops, and so on.

    best, Jodi

  • crowepps

    Thank you for explaining, Jodi, I think I understand now.


    "Mandate" as in require the insurance companies/States to include payment for normal preventative care so that women can make their own choices.  Well, no wonder everyone’s having a cow.  After all, women living long and healthy lives so they can take care of their families is controversial!

  • jodi-jacobson