Was Money a Factor in the Losing Fight for Abortion Care in Health Reform?


In the past several months, the pro-choice movement has faced its toughest challenges during the Obama administration to date: the insertion of language into the House and Senate health reform bills that, if passed, would place the most onerous federal restrictions on women’s access to abortion since Roe v. Wade. Both threats came from Democrats, one set of restrictions placed in the House bill by Congressman Bart Stupak (D-MI) and the other in the Senate bill by Senator Ben Nelson (D-NE).

Throughout the process, pro-choice advocates and supporters tried desperately to reverse the restrictions: calling their members of Congress, donating to organizations that lobby for pro-choice policies, and more recently promoting the candidacy of a pro-choice female candidate—Connie Saltonstall—against Stupak.

But how did those restrictions get into the health reform bills of a Democratic Congress in the first place? There is obviously a range of factors, including what was and was not anticipated. 

The pro-choice movement’s support for health reform was supposed to have hinged on language, negotiated by Congresswoman Lois Capps, to preserve the status quo of the Hyde Amendment, as terrible as it is, a law that is attached to appropriations bills from year to year and which prevents federal funding of abortions except in cases of rape, incest or the life of the mother.  The presumption at the outset was that keeping things under the radar and putting forth the Capps Amendment would ensure passage of health reform without a fight over abortion.

The presumption proved completely wrong.

Instead, first Stupak and then Nelson amended their respective bills to dramatically restrict the rights of women even to purchase private insurance coverage for abortion care.  And this week the health reform bill passed with the Nelson language intact.

So how did anti-abortion advocates and a back-bench conservative Democrat manage to so successfully persuade a Democratically-controlled (and presumably pro-choice-led) Congress to allow a vote on such a restrictive bill — let alone how did it come to pass? One answer may be found in the lobbying disclosures of the pro-choice movement.

Between 2008 and 2009, pro-choice organizations actually reduced their lobbying expenditures from $1.8 to $1.3 million. Planned Parenthood alone accounted for $385,000 of that $500,000 reduction in lobbying expenses; the rest came mostly from reductions made by NARAL and the Reproductive Health Technologies Project (RHTP).

Planned Parenthood told RH Reality Check, “We think grassroots lobbying was one of the most effective tactics on healthcare reform. We wanted to invest more in [grassroots efforts] and make sure Congress heard from their constituents on this rather than from us.” PPFA in fact received grants from individual donors to conduct a grassroots lobbying campaign but not so much for lobbying Congress directly–though neither the grassroots strategy nor the DC-based lobbying effort was successful in the end in keeping abortion restrictions out of the final bill.

In the meantime, over the same period, specific anti-abortion lobbyists (represented mostly by the National Right to Life Committee and the American Life League) increased their spending from $600,000 to $710,000–a figure that does not include any of the official or unofficial lobbying undertaken by various religious groups, like the U.S. Conference of Catholic Bishops, or grassroots organizing conducted on the issue of health reform and abortion care such as through churches mobilized by the USCCB.

One question is why, with various reproductive health issues on the agenda, from the global gag rule to the provider “conscience” laws, were pro-choice groups drastically reducing their spending on lobbyists in 2009?  Because they finally had a full Democratic majority in power?

This can’t be the whole story: Even NARAL president Nancy Keenan told me in an interview before Stupak went to a vote that “A Democratic majority is not a pro-choice majority.”

Recognition that giving Democrats the reins did not necessarily mean success for a pro-choice agenda should have been clear early on in the Obama Administration. First on the pro-choice agenda was the global gag rule, with which Obama dispensed early on.  But while the end of the global gag rule was an important step, it shouldn’t have been allowed to mollify the pro-choice movement nor make them take a softer line on the administration.

Still, Democratic leaders asked the pro-choice movement to stay out of health reform debates initially to avoid politicizing the reform process, and rather than engaging the fight directly, both pro-choice Democrats and pro-choice groups accepted the Capps compromise language early on — apparently expecting that unilateral disarmament on healthcare reform would convince their opponents to remain out of the debate.

Bart Stupak and his backers in the United States Conference of Catholic Bishops and in the broader “pro-life” movement didn’t exactly take the pro-choice movement up on their olive-branch offering, choosing instead to do what it is that lobbyists normally do: push for as much as possible for the cause they represent. And push they did, introducing language in various committees, at first with little success–something for which Planned Parenthood takes due credit. 

But when push came to shove, House Speaker Nancy Pelosi announced that if putting the Stupak anti-choice language to a vote on the House floor and letting it pass was the cost of healthcare reform, so be it. In the end, pro-choice advocates were left with less than a week’s notice to marshal their massive but nascent grassroots campaign to defeat it.

Successful lobbying campaigns, like the one conducted by Stupak’s supporters, aren’t ginned up in a week or even a few months: they’re long, sustained sieges involving grassroots organization, lead time and constant pressure from lobbyists on members of Congress.

The pro-choice movement, having taken a pass on doing anything proactive to get a healthcare bill that recognized abortion as central to healthcare didn’t have the resources or sustained intelligence gathered to mount a last-minute reactive campaign either. And, in either case, they had already made the decision to support healthcare reform writ large, so they were stuck with a dual message: pass healthcare reform, but remove the abortion restrictions. Those kind of mixed messages make for a difficult grassroots campaign, and can make it sound like passing healthcare is of more importance that preserving women’s access to abortion services.

On the Friday before the final vote this weekend, Planned Parenthood spokesman Tait Sye told me: “Planned Parenthood is committed to fixing our broken healthcare system. Congress must fix the Nelson provision as part of healthcare reform and guarantee that reform will not result in women losing benefits they currently have.”

Of course, given the procedural maneuvers through which the House had to go to pass the Senate bill, and given the strength of the mobilization by an anti-choice minority, the only way to fix the Nelson provision now will be to go back at a later date and try to convince the very same Democrats who could not stand up for abortion care as health care during the process to now rescind those restrictions embedded in the bill. With the majority of the reform provisions, including the individual mandate, not set to go into full effect until 2014, Congress will likely wait a considerable amount of time before attempting any changes, and certainly with the 2010 elections so close at hand.

Meanwhile, coverage for abortion care will be eroded. There are certainly uninsured women who will eventually obtain coverage in a somewhat reformed market to the benefit of their health — including their reproductive health.  But there are also women that will likely lose access to their current coverage of abortion care because of this bill and this debate, and others, like the women who work for the Republican National Committee and the state of South Carolina who will lose their coverage more quickly as a result of political decisions.

Pro-choice women rely on (and donate to) groups like Planned Parenthood and NARAL Pro-Choice America to stand up and advocate for their access to abortion, first and foremost, and to hold the feet of supposedly pro-choice politicians to the fire on abortion access even when the going gets tough (and the tough go shopping for healthcare reform votes among rabidly anti-choice Democrats).

But, this time, at least, pro-choice advocates were not as willing as their pro-life counterparts to be the skunks at the garden party “just” to save access to abortion, or perhaps because they feared losing their own access to Democratic politicians who, unfortunately, too easily sacrificed the pro-choice movement for a political victory without putting up much of a fight on behalf of the pro-choice women who elected them. 

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  • waterjoe

    How about these facts?  First, the Capps Amendment did not really preserve the status quo and could not be viewed as a “compromise” if only one side agreed to it.  Second, the American public simply was not on the pro-choice side on this one.

  • saltyc

    So simply, the american public is so arrogant as to think it has the right to step in and block funding for routine and safe medical procedures that individual women choose. I wonder how you’d feel, joe, if the american public was simply able to interfere with your private organs too. Are Americans really that self-righteous and shallow? I don’t think so, because if you talk to most people who hold that view, it is very ill-formed and confused, and can easily be corrected to a more humanistic one that trusts individuals to make conscientious decisions, if more outreach and education were done. Even zealous christians change their minds too when they really examine the issue, and realize it’s not theirs to decide. I regularly talk to clinic protesters, and they are very narrow and ill-informed. It surprised me at first that none of them have spoken to women who have had abortions, it didn’t seem possible. But then I realize, that to hold an anti-choice position, requires a lot of ignorance.

  • offred

     

    “Are abortions still safe and legal (in case you might need one, God forbid)?”

     

    Yes.

     

    “Do you want to pay for someone else’s elective procedure, whether it’s a tummy tuck, penis enlargement, or abortion?”

     

    Not really, no.

     

    When PP calls me up for a donation based on my past giving, they always lay out a hysterical not-too-close-to-the-facts doomsday scenario that makes it easy to say, “no, thank you”.

     

    The most recent one was, “Did you know that the Stupak Amendment would make it impossible to get an abortion, even in the case of rape or incest”? Me: “No, I didn’t know that. Call me back when you won’t insult my intelligence. Bye.”

     

  • saltyc

    Actually, that’s true for many women who can’t afford an abortion, I have spoken to many women who had to delay or never have an abortion due to lack of funds. Unless you have lived in abject poverty, or near poverty, it’s hard to imagine, but it does happen.

     

    And comparing abortion to tummy tucks and penis enlargement? Whose intelligence is being insulted now??

  • offred

    So simply, the american public is so arrogant as to think it has the right to step in and block funding for routine and safe medical procedures that individual women choose.

     

    and

     

    And comparing abortion to tummy tucks and penis enlargement? Whose intelligence is being insulted now?

     

    So you would make a distinction between abortion and other “routine and safe medical procedures” that individuals choose? And if you would make a distinction, why begrudge “the american public” for also making a distinction?

     

    I’ll repeat my point: abortion is still legal. You don’t need the government to pay for it in order for that to be true.

  • jodi-jacobson

    Neither “penis enlargement” nor tummy tucks are “routine medical procedures.”

    Surely you know this and if you don’t well…I can’t help you.  You can look it up.

    But for the record, I don’t see legislation written into the health reform bill expressly forbidding these…do you?  Nor insurance coverage for Viagra?  Nor your prostate cancer exams? 

    And your comparisons are so insulting I am not sure how to best describe them.  A tummy tuck as compared to being forced by poverty or other conditions to bring a pregnancy to term and then bear a child you neither wanted in the first place nor can afford….for the rest of your life?  Seriously….don’t trivialize what for women is not a trivial issue.

    Finally, there are cases where a penile implant might be medically indicated as in surgery for transgender reassignment, then yes insurance would be covering it and by extension and your own analysis, you are subsidizing it now.

    Just like I am subsidizing polluters that get huge subsidies from the government, the Catholic Church and Evangelical groups that do political lobbying to deny people rights and blur if not obliterate the line between Church and State.  I could go on but I don’t have time.

    Abortion is in fact the most common outpatient procedure, is a safe medical procedure and in the case of an unwanted pregnancy or one that is due to rape or incest, or one that threatens the life or health of the mother or one that involves catastrophic fetal anomalies….in all of those cases it is essential health care for women whether you “believe” that or not.  It’s just fact.

     

     

     

  • saltyc

    Thank you, Jodi, it upsets me too to see the trivialization, like women could easily do without the procedure.

    People who don’t want to help should talk to the women I talk to who need an abortion but can’t afford it, who already have children, who have already given one up for adoption and know that they can’t go through with it again, women who have thought about it deeply and honestly and know what they need but can’t talk about it even with their closest relatives, let alone ask them for money. Many of these women have to wait and have a later abortion because of the lack of funding. It’s only through ignorance that people can be so callous.

     

  • crowepps

    It’s my understanding that somewhere in the health care bill is a specific provision in which insurance coverage will not be provided for Viagra prescribed to pedophiles.

     

    I agree with you that comments trivializing the physical and emotional toll pregnancy takes on women, and the necessity of abortion in addressing those needs, are just disheartening.  The belief that women’s lives don’t have any other purpose than producing babies and that they should be required to do just that whether they want to do or not reduces women to the level of breeding stock.

    “Man is willing to accept woman as an equal, as a man in skirts, as an angel, a devil, a baby-face, a machine, an instrument, a bosom, a womb, a pair of legs, a servant, an encyclopaedia, an ideal or an obscenity; the one thing he won’t accept her as is a human being, a real human being of the feminine sex.”

     D.H. Lawrence

  • sasu77

    Saying PP has given up on abortion rights is like saying Shell doesn’t care about the pipeline industry. PP has a long history to bringing reproductive health issues to light, even in a hostile environment. In the end their patients stand by them and their long reputation of being a shelter for people who need it. Maybe, one of the reasons, they want to go more grassroots. Congress does not have the type of stance on abortion because of the negative and controversial view, everyone knows that. No one wants to face the fact that we need abortions in our health care, it is human nature to avoid what is unpleasant until it smacks us in the head. So organizations like PP that have a strong reputation and clear stance are avoided in a “let’s all get along and make this easy” political environment. One organization and lobby group cannot compete with the religious and anti-abortion organizations that have been lobbying under cloaked disguise of human rights and stimulating the media in showing only the negative sides of this matter, posing as the public opinion. PP has always been there working hard, they would not have had the reputation and patients if they did not. The issue would have dropped long before this final vote, but it was not, it was a thorn in congresses side the whole way through and will continue to be because of organizations like PP.  It’s easy to say that things did not pass because you were counting on PP, but what have you done to help them, have you let your congress person know how you feel, or even your community.

  • sschoice

    sasu77, we’re not going to speak for Megan, but she’s certainly not saying Planned Parenthood has given up on abortion rights.  Also, while you probably know the difference, there is a big difference between Planned Parenthood clinics and Planned Parenthood Public Affairs and Planned Parenthood’s Political Action Committee (PAC) which does issue advocacy and political campaign work.  Planned Parenthood Public Affairs overall is not going to give up on supporting abortion rights any more than Planned Parenthood clinics which provide abortions or which refer to abortion providers are going to stop doing so.  

     

    What Megan said was that PP (meaning public affairs, one would assume) made decisions to reduce or change funding of grassroots organizing and lobbying in the recent battle for health care reform.  She gave some numbers:

    Between 2008 and 2009, pro-choice organizations actually reduced their lobbying expenditures from $1.8 to $1.3 million. Planned Parenthood alone accounted for $385,000 of that $500,000 reduction in lobbying expenses; the rest came mostly from reductions made by NARAL and the Reproductive Health Technologies Project (RHTP).

    Planned Parenthood told RH Reality Check, “We think grassroots lobbying was one of the most effective tactics on healthcare reform. We wanted to invest more in [grassroots efforts] and make sure Congress heard from their constituents on this rather than from us.” PPFA in fact received grants from individual donors to conduct a grassroots lobbying campaign but not so much for lobbying Congress directly–though neither the grassroots strategy nor the DC-based lobbying effort was successful in the end in keeping abortion restrictions out of the final bill.

     

    There’s probably more to the story than this, but this is useful information, and it’s hard to get this kind of insight into how a group chooses to budget it’s money and how money affects a group’s activities.  It may have made more sense for PP to spend money on grassroots organizing than lobbying if it felt that public education and local organizng was more important than lobbying politicians who may have already made their minds up or who were being influenced by say drug or insurance company interests which have a lot more money than pro-choice groups do.  It also would be interesting to see also how money might have been budgeted and spent differently by drug and insurance companies during this time, who might be expected to have a bigger influence than pro-choice groups, maybe even bigger than pro-choice and anti-choice group efforts combined.

     

    That’s purely our speculation, not Megan’s and certainly not Planned Parenthood’s, but that’s one way of looking at why these funding decisions and campaign choices by PP may have been made and how it might have related to others groups’ actions and efforts.  Others can add to this, but this is good to know about, so we can better encourage groups we might support like PP in the future to take stronger political stands on the issues, positions which one we can be sure their clinic staff and patients would support them on taking.

  • sschoice

     

     

    Megan wrote:

     

    One question is why, with various reproductive health issues on the agenda, from the global gag rule to the provider “conscience” laws, were pro-choice groups drastically reducing their spending on lobbyists in 2009? Because they finally had a full Democratic majority in power?

    This can’t be the whole story: Even NARAL president Nancy Keenan told me in an interview before Stupak went to a vote that “A Democratic majority is not a pro-choice majority.”

     

    Ok, so why did pro-choice groups “drastically reduce their spending on lobbyists in 2009?” (If not…)  “Because they finally had a full Democratic majority in power?”

     

    Part of the reason may be said to be the economic recession but that has been going on now for years and that alone can’t explain the difference in spending by pro-choice and anti-choice groups.  Simply having a Democratic majority in power may not explain all of the reasons, but it explains a good deal of that, because there simply is a lot more money going into partisan politics and to affect (and be affected by) partisan politics.  

     

    We doubt that pro-choice organizations chose on their own initiative to reduce funding, we think (if the information that Megan is reporting is accurate, and it makes sense) it’s more likely that they didn’t expect a great deal more money to come in to support them in this campaign — a campaign which as Megan observes lasted for well over a year just in this phase in the early couple years of the Obama administration — and based on that assumption they chose not to spend more of what they know are very limited resources on this. People, the battle over abortion coverage in health insurance — insurance, not government fundng — has been going on for a long time — this was an issue in the Clinton administration during their failed attempt at health care reform, and it’s been a not-well-known issue at the state level where a number of states have already put in place restrictions on what wholly private insurance companies can offer in the way of abortion coverage.  It’s not like any of us reasonably should claim ignorance this was coming.


    The choice to not put more resources into an issue which (once Democrats are in office) becomes a “wedge issue” is the best reason to explain why none of the youth-oriented GOTV (get out the vote) campaigns, nonpartisan and partisan alike, which engaged young people (or spent a lot of money claiming to) in 2008 and 2004 simply were either not engaged at all in significant voter education or mobilization during the health care reform struggle over the last year and a half, and when it was mentioned it did not include any serious discussion, much less advocacy, of abortion rights.  It’s not like any of these groups are officially neutral on the issue, or would have to be officially neutral to retain their funding sources.  Some may need to be nonpartisan, but they needn’t be officially neutral on choice, and even if they do they can choose to educate young people in depth on a given issue, but none did on this one. Nor did you see any significant numbers of young people to turn out to those “health care town hall” meeting — and there were no notable appeals from major groups even to participate in meetings which were subsequently in many cases overrun by disruptive protestors.


    I’m sure we can find numerous examples of national pro-choice groups with a c3, c4, a 527 or a PAC (various structures which allow for public education or advocacy) which engages young people (or wants to) or a public education group like the Women’s Media Center which does feminist media campaigns,  but we can expect that they’d exist and also that by defining themselves as (implicitly) feminist women’s groups they’d be engaging fewer people than one that didn’t explicitly define itself as a feminist women’s group and which has especially good connections with national music and entertainment media (like say Rock the Vote) or which specifically is designed to address youth access to health care in general (like Young Invincibles).  But neither of those groups nor any others like them, nonpartisan or partisan,  made a significant attempt at even an even-handed attempt at educating young people about the battle over abortion coverage in health care reform, much less engage in pro-choice advocacy on the issue.  That’s not to say that their supporters didn’t care about these issues or that there wasn’t some mention made, we did hear that Young Invincibles made some mention on their Facebook feed at one point somewhat supportive of opposing anti-choice restrictions and obstructions to reform passage, but it was the sort of mention that if you weren’t looking hard you’d have missed it.

     

    We did not spend effort trying to contact MTV and ask them to air information about this in-depth because we know by experience that they air very little information about birth control, much less abortion, and what they do requires a great deal of effort to produce and get broadcast on their network.  What information they do have on rare programming efforts like “It’s Your Sex Life” a few years ago is very good (and developed with help from the Kaiser Family Foundation) but it’s almost insignificant in effect compared to the overwhelming amount of sexualized, commercialized, and self-destructive behavior they air through music videos, reality shows, and other programs from the Jersey Shore to “Jackass“. The best we could likely get them to do is get (as we’ve gotten in the past when we’ve tried to get volunteers on programs they’ve solicited for through their press releases or other announcements) an irritated edit to a form letter explaining why they don’t air more “political” content.


    There are good professional resources on the web related to reproductive health care, RHRealityCheck is certainly one of them, and one that has now a very well developed blog community.  There’s now numerous progressive news sites and blogs which provide significant coverage to reproductive rights issues, and journalists / bloggers who potentially could more throughly research these issues.  It would be great to see some better explainations for what happened to cause so little support to be mobilized for this issue, especially in the face of an obvious mobilization of support by the opposition.  Unfortunatly, it’s not something we read much about, even here (explaining choices made to not push for certain pro-choice issues, for example), and if one don’t know what’s going on one can hardly be expected to come up with effective ideas for change.  We could do some of this research on our own, but our time is probably better spent reviewing professional journals in the library than trying to get answers out of organization leaders who probably themselves don’t have the answers.  

     

    Maybe the funding sources of these groups should be asked if they tried to specifically offer money to do this through these groups, but somehow I don’t think we’d get very far calling up the entities that have recently given these groups money, and we can’t hardly be expected to know who individual donors are to be able to call them and ask.  Maybe an online blog with a little of a name like RHRealityCheck could send a few emails to these groups and let us know you are waiting for a response. In any case, information like this is especially helpful, and we appreciate you trying to bring it to us.