Bridging the Divide on Health Care for Women

This article first appeared in Daily Kos.

There have been some whoppers this summer. Nothing like an effort to make health insurance more affordable and available to all Americans to bring out the conspiracy theorists. Among my "favorite" whoppers:

(1) Grandma is going to go before a government death panel (I wonder if the government death panel will be modeled on the death panels of profit-motivated insurance bureaucrats that deny people lifesaving treatments every day in this country?);

(2) According to a recent Republican National Committee mailer, the Democratic government is going to check your political party registration, and if you’re a Republican you’ll be denied health care;

(3) Catholic bishops are persuading their parishioners that health care reform will mean that every single American is going to have to pay for their neighbors’ abortion.  Perhaps the most egregious of all in this debate has been New York Times columnist Ross Douthat, who decided to start a sibling rivalry in heaven between the late Senator Ted Kennedy and his late sister Eunice Shriver over their respective views on abortion. Let’s hope that in time, Mr. Douthat will look back on this most inhumane column and regret what he wrote.

With all this hyperbole, we have lost sight of the original goal of health reform: to expand access to health care, improve quality, and reduce costs — not to litigate abortion rights, no matter how much anti-choice groups may want to use it for that purpose. And Planned Parenthood knows firsthand that women in particular need access to more health care, better quality health care, and more affordable health care. After all, women are affected far more than men by the costs of our health care system — they pay more for health care, use the health care system more, and make the health care decisions for their families.

Abortion is a legal medical procedure in this country, and therefore Planned Parenthood believes it should be part of the health care system. That said, we acknowledge that there are some compromises that need to be made to move health care reform forward. For many years there has been a ban on the use of federal funds to pay for abortions. While we vehemently disagree with this policy because it denies care to the lowest-income women who need affordable health care access, we understand that this is the law of the land and until we have the political ability to change it, we have to compromise. We are willing to do that if it means more women can access the affordable, quality health care they deserve.

In late August, Rep. Lois Capps (D-CA) offered an amendment as a straightforward response to concerns raised by anti-choice groups. While no other medical procedure is singled out for exclusion in any of the bills, in order to move reform forward, anti-choice organizations needed an assurance that the medical commission cannot guarantee abortion coverage in every Exchange plan. That’s why we did not oppose the Capps amendment that provides them with that assurance. It explicitly states that abortion will neither be mandated nor prohibited. It also mandates that every region will have at least one insurance plan that offers abortion coverage and one that does not, so people have a choice.

But fair compromise is not enough for opponents of women’s health. They now insist that if there is a public option that there be a strict and total ban on abortion coverage.

Their argument? First, they mislead. They argue that the public option is just like Medicaid — financed by public dollars and, therefore, should be prohibited from offering any abortion coverage at all. The public option will be just like a private plan, financed by private premiums.

Their second argument — even if it’s financed with private dollars it’s administered by government employees so, therefore, it is government run. Following that line of reasoning, we are going to have to reexamine a lot of government programs that touch the line between church and state. Pell grants — administered by government employees and that allow students to take the government money to religious educational institutions — will need to be reexamined for eligibility.

Their third argument — if the public option allows abortion coverage, people cannot choose the public option without having their own personal funds go toward a plan that pays for abortion coverage. That is exactly why the Capps amendment allows you to choose another plan and guarantees that there will always be a plan that does not include abortion. Imagine if we went down the road of individuals being able to dictate which health care services their private insurer offers other customers, of every individual being able to tell their employer that they don’t want their premiums going toward individuals or health care they object to — gays and lesbians, obesity, smoking…you name it. Insurance would be discriminatory and simply unworkable.

For true advocates of the public plan, there is another reason why we should not ban abortion in the public plan. Defenders of the public plan have cried foul, arguing that it will follow the same rules as the private plans and that the private plans simply don’t want fair competition.  If we start to impose separate rules on the public plan, different from the private plans, then it really is like government run health insurance, isn’t it? So, is it really going to be fair competition or not?  You can’t have it both ways.

I am trying really hard to understand what it is anti-choice hard-liners want, other than to simply kill health care reform. I wish someone would explain to me where their middle ground really is, and stop shifting it every time I think I’m standing still.  I really want to understand what they want for the women we serve everyday at Planned Parenthood — because our more than 850 health centers provide care every year to more than three million people, most of whom are below 150 percent of the poverty line. As a matter of fact, more than 90 percent of it is preventive and primary care.

I truly believe that if we share the goal of expanding access to affordable, quality health care, then we should find a way to make that goal a reality. Planned Parenthood is at the table ready to work, and we invite others to join us so that America can stop suffering under a broken health care system and start benefiting from the health care options we deserve.

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  • douglasjohnson

    Speaker of whoppers, my favorite whopper of the summer is the notion that the Capps Amendment is a "compromise." A meeting of the minds between Congressman Henry Waxman (D-W. Hollywood) and Planned Parenthood can hardly be fairly termed a "compromise." A more objective analysis might conclude that the Capps-Waxman Amendment would put the federal government in the abortion-funding business in a very big way, breaking with decades of federal policy consensus under which federal funds do not flow to health plans that cover elective abortions.


    The biggest abortion-related concerns of pro-life groups regarding H.R. 3200 pertain to (1) a proposed insurance program that would be run entirely by the federal government (the "public option"); and (2) a proposed new premium-subsidy program ("affordability credits") to help tens of millions of people buy health insurance. The Capps-Waxman Amendment, it has been conceded, would: (1) authorize the Secretary of Health and Human Services (HHS) to pay for elective abortions under the proposed "public plan" (and she would do so — Obama explicitly promised this to Planned Parenthood); and (2) allow the proposed "affordability credits" (premium subsidy) program to subsidize private insurance plans that cover elective abortions, as well as the public plan.


    Some supporters of the bill, like Laurie Rubiner, have claimed that any elective abortions subsidized by these two programs would occur with "private" funds, but this claim is beyond misleading — it is truly absurd. All of the types of funds that would be expended by both the public option and the premium subsidy program would be federal government funds and public funds. This is true as a matter of law, and it is reflects the usage of those terms by and about federal agencies across the board. With few exceptions, funds under the control of and expended by an agency of the federal government cannot accurately be described as "private funds."


    For example, the funds in a citizen’s bank account are private, but once he or she writes a check to the IRS to pay income taxes, the funds become federal government funds, public funds, deposited in a U.S. Treasury account. The same is true here. Once an enrollee makes a "premium" payment to DHHS, the funds are no longer "private" — they are federal government funds, as truly and completely as the funds that the government gathers from incomes taxes, user fees, fines, and other sources. Under the Capps-Waxman Amendment, abortion providers would send their bills to DHHS. They would receive in payment checks drawn on a federal Treasury account, an account under the control of a senior official of the Executive Branch. This would be direct federal government funding of elective abortion.


    Some of the people who are engaged in the ludicrous exercise of attempting to label these federal funds as "private" are doing so for a transparently political purpose: To conceal the reality that H.R. 3200 would establish direct federal government funding of elective abortion by the government insurance plan, and would also result in large-scale federal subsidies for private health plans that pay for elective abortions. Both of those effects would be sharp departures from longstanding federal policy.


    Those in the news media who adopt the inaccurate characterization that the expended funds would be "private," or who embrace the inaccurate claim that "federal funds" will not be spent on abortions, are allowing themselves to be manipulated in a way that misleads the public regarding the important public policy issues that are at stake.


    Ms. Rubiner’s odd mention of Pell grants actually underscores my point. Back in the 1980s, there was an institution called Grove College that badly wanted to stay clear of various federal regulations, so this college accepted no direct federal aid. But some Grove College students had received Pell grants. The federal Department of Education held, and the U.S. Supreme Court agreed, that enrolling these students constituted "federal financial assistance" to Grove College. [Grove City College v. Bell, 465 U.S. 555 (1984)]. But in the case of the public option, no such two-step analysis is required, because the public option would be an arm of the federal government and nothing else, and all of its funds would be public funds.


    A memorandum demonstrating that all of the funds that would be expended by the "public option," and all of the funds that will flow to the premium-subsidy program, are in fact "federal funds," is posted here:


    The memo contains links to primary documents from the CBO, GAO, and the nonpartisan Congressional Research Service.


    I wonder how many of those who are currently trying to snooker the public into believing that the Department of Health and Human Services would be expending "private funds" for abortions, through the public option, would also embrace the notion that other federal agencies — say, the CIA, or the Pentagon — could expend federal Treasury funds in transactions that would be considered "private."


    Douglas Johnson

    Legislative Director

    National Right to Life Committee

    Washington, D.C.

    More documentation here

  • noworsethanusual

    What you see below is not a real press release. It is a parody. It is offered to make a point about the policy issue under discussion. There really is no "Congressman Louis Capped," and there is no California 54th district.   Congresswoman Capps is the object of the parody, but she is a big girl and she can take it.



    Representing California’s 54th District



    September 17, 2009 5:20 p.m.


    In Speech, Congressman Capped Laments "Blatant Misinformation" and "Fabrications"Regarding His "Handguns for Hikers" Fund for National Parks; He Explains That No "Public Funds" Will Be Used, Only Mandatory Surcharges on All National Parks Admissions Fees


    WASHINGTON, D.C. — In remarks today on the floor of the U.S. House of Representatives, Congressman Louis Capped (R-Ca.) lamented "blatant misinformation" and "fabrications" regarding his "National Parks Optional Handguns for Hikers Act of 2010," a bill that he introduced on August 19, 2009. 

    "My bill is a good faith, common ground solution to the very challenging, very sensitive policy issues surrounding the carrying of loaded handguns in national parks," Congressman Capped told the House. "It is unfortunate that my bill has been greeted with a fusillade of blatant misinformation and outright fabrications. It is time to set the record straight. My critics do not have license to distort the facts at hand."


    In May, 2009, Congress enacted a new law (the Coburn Amendment) that allows citizens to carry loaded handguns for self-defense in national parks, if they meet certain state-determined qualifications. The new law, which has engendered some ill-founded controversy, takes effect on February 22, 2010.  Congressman Capped explained that he is a strong supporter of the Coburn law, but he thinks that more needs to be done. 


    In his floor remarks today, Congressman Capped said, "Many handgun owners would like to visit our beautiful national parks, but they are reluctant to subject themselves to the hassle and complicated rules involved in traveling by commercial airline with a handgun. Others arrive at a national park only to discover that they have simply forgotten their handguns at home. Moreover, in these tough economic times, some citizens even have been forced to sell their handguns to pay for utilities and groceries. My National Parks Optional Handguns for Hikers Act of 2010 addresses all these problems in a way that reflects a spirit of compromise and that fully respects all points of view on this sensitive subject."  

    The bill would require the National Parks Service to add a $12 surcharge on every "America the Beautiful – National Parks and Federal Recreational Lands Annual Pass," and to add a $3 surcharge to the cost of any daily pass to any national park. These surcharges will go exclusively into a "Handgun for Hikers Segregated Fund" in the U.S. Treasury.

    "The Handguns for Hikers segregated fund will be used for the exclusive purpose of providing handguns of high quality and adequate caliber to those who visit the national parks and who need a handgun to carry while they are in the park," Congressman Capped told the House. 

    Congressman Capped said that some critics had "distorted the facts at hand" by "suggesting that my bill is actually a scheme to provide government funding for handguns, and therefore a significant departure from current law. But nothing could be further from the truth. My bill specifically prohibits any regular Interior Department appropriations from going into the Handguns for Hikers Fund. The handguns will be paid for entirely by the strictly private mandatory contributions required by my bill from every national park visitor. Those who say that these are federal funds engage in an outrageous distortion, because all of these funds will originally be in the possession of private citizens, before the Interior Department collects the money from park visitors at the gates. After that, the federal government will keep these strictly private funds in the special federal government account in the U.S. Treasury until the money is actually spent on the handguns.

    "So you see, under my bill, the federal government will offer every park visitor the means to go armed with a government-provided handgun, drawing on the contributions of his fellow park visitors, and all without spending anything that we will call federal funds," Congressman Capped explained.

    Mr. Capped added, "Certainly, I know that there are some people who may object to paying a surcharge that will be used for handguns, and I respect their viewpoint — under my bill, such people have every right to avoid the national parks system. After all, there are many fine private campgrounds and state parks, and my staff assures me that in every state there is at least one non-federal park or private campground that has a no-handguns policy, for now at least. So anybody who wants to enjoy the great outdoors but has a hangup about subsidizing handgun purchases will have other options. My bill applies the handgun surcharge only to the National Parks option."


    Congressman Capped took issue with those who have charged that the bill is not truly "neutral" on the question of carrying handguns in national parks. "It is true that every visitor to a national park would be required to pay the handgun surcharge," he said. "However, no park visitor will be required to actually claim a handgun. That will be purely a matter of personal choice, and there will be absolutely no discrimination against park visitors who choose not to take advantage of the benefit. So this is truly a handgun neutral policy." 

    Congressman Capped concluded, "I only hope that we can move forward with this legislation without being further sidetracked by the distortions and fabrications of those who, in the face of these facts, continue to insist that my bill is nothing but a thinly veiled scheme to put the federal government into the business of purchasing and disseminating handguns."