A Gosnell Amendment? Jennifer Rubin Plays Doctor and Legislator—and Fails


There are two roles anti-choicers like to play for which they are ill-equipped. First, they like to play doctor. And second, they like to play God. In doing so, they spread outright lies about both abortion and contraception to mislead and whip the public into a frenzy about sex, pregnancy, and childbirth. And then, believing themselves to be the righteous ones, they seek to capitalize on their self-created panics to make public health and medical policy for the country based solely on emotion, facts be damned. Their end goal, as they make clear, is to outlaw abortion and contraception no matter the costs to public health, women’s lives, or society writ large.

The trial of Kermit Gosnell provides anti-choicers and their allies with a perfect platform for their efforts. In Gosnell, they have an unethical, unscrupulous criminal acting as a doctor. He preyed on women too poor to seek early, safe abortion care, ran a filthy “clinic,” and conducted illegal abortions during which, it is alleged, some infants were born alive and killed. In their quest to make safe, legal abortion care as inaccessible as possible, anti-choicers are now seeking to sway public policy by conflating safe abortion care with Gosnell’s atrocities, to tar all legitimate providers of safe abortion care as Gosnell clones, and to use a criminal case as a justification to drive legitimate providers out of business.

One recent example of this effort comes courtesy of Washington Post columnist Jennifer Rubin, who, in a column Wednesday, suggested several ways to further diminish access to safe, legal abortion care in the United States through what she calls a “Gosnell amendment.” If you read the piece, it is clear she has no idea what she is talking about.

Rubin, for example, calls for changes in Medicaid but appears not to understand how Medicaid works in the first place. She also calls for changes in federal funding of abortions, but appears not to understand that current law already severely restricts public funding of abortion.

She writes:

First, all Medicaid and other federal support for abortion services should come with caveats—health standards (of the type Pennsylvania refused to issue and enforce) and appropriate training for all personnel. Second, federal taxpayer dollars should not go for late-term abortions.

Let’s start out by making clear that this is the kind of grasping for irrelevant straws I described above (using the existence of a criminal to tar and feather an entire field of professionals who have no relationship to the criminal activity). For one thing, as confirmed in a phone call today to the Pennsylvania Department of Public Welfare, and notwithstanding the fact that what he did was illegal in the first place so the case illustrates nothing about safe abortion care, Gosnell was not receiving Medicaid payments for women seeking abortion. In fact, in 2010, there were only seven abortions in the entire state of Pennsylvania paid for by state tax funds, and no federally funded abortions anywhere in the state that year. As in zero. Zip.

But no mind: Rubin claims that Gosnell proves there are problems with federal Medicaid funding of abortion care, because eliminating Medicaid funding of abortions for any low-income woman under any circumstance is high on the anti-choice agenda and Gosnell gives them a platform for their arguments.

As for regulations and “health standards,” both the Centers for Medicaid and Medicare Services and state Medicaid agencies already work together both to certify and regulate Medicaid providers of all kinds, and both medical societies and advisory boards at the state and federal level set standards for care. Does this mean there is never any fraud? Of course not: Republican Rick Scott, the current governor of Florida, was implicated in one of the biggest Medicare frauds in the country in the late ’90s, showing that laws on the books are in fact broken until evidence is accumulated to bring a case. It was not lack of law or regulation, but rather lack of enforcement that allowed Gosnell to carry on for so long. Changes to Medicaid would therefore not have prevented and will not prevent past, current, or future quacks or criminals from operating in such a capacity until they are caught, just as homicide laws will never prevent all homicides and laws against arson won’t eliminate arsonists. Laws and regulations are meant both to define and to hopefully reduce criminal activity but will never eliminate it.

Rubin’s suggestion that federal taxpayer dollars should not go for abortions also is a head-scratcher, since the Hyde Amendment already forbids the use of federal funds for abortions except in cases of life endangerment, rape, or incest. This law has guided public funding for abortions for low-income women under joint federal and state programs since 1977. At a minimum, states must cover those abortions that meet the federal exceptions. States also are free to expand coverage of Medicaid funding of abortion for other reasons, using their own funds. Pennsylvania does not offer expanded Medicaid coverage for abortion.

Moreover, the system in Pennsylvania (as in many states) is such that even in cases of rape and incest it is virtually impossible to get reimbursed for a Medicaid-eligible abortion. As Claire Keyes, former director of a clinic in Pennsylvania, told RH Reality Check via email:

Although technically Medicaid in PA is supposed to cover rape and incest, in reality it did not. There were too many sub-carriers, if that is the right word, each with its own rules, own personnel. No matter how much time we as providers tried to “train” their employees for them in order that women whose pregnancies resulted from rape or incest would be covered, it was not worth it. No one from the top level of management ever cared enough to issue policy statements to their employees, so it was just a waste of time. We often had to submit 4-5 times for the same patient, then reaching the end of the eligible period for submission for reimbursement of the services. It was easier to not even try.

If one takes Rubin at her word, she would like to eliminate the exception in the Hyde amendment for Medicaid coverage for any “late-term” abortions, though she does not specify what she means by “late-term.” In the third trimester only, or both second and third trimesters? Is she saying that there should be no public funding whatsoever to cover an abortion for a poor woman whose life is quite literally in danger from a pregnancy gone terribly wrong? And if so, is she not then saying that the life of a woman living in poverty has less value than the life of a woman with a similar condition who can afford an abortion on her own? Does she mean to imply that a woman in the United States facing a situation similar to one now going on in El Salvador—where a woman now carrying a non-viable fetus and whose kidneys are failing due to pregnancy-related complications of uncontrolled lupus—should be left to die?

That gets us to the broader issue of late-term abortions. Every state should have an infant-born-alive statute, and those states that do not should have to justify why medical personnel should not have an affirmative duty to provide medical care to an infant who survives abortion. Do we really want any state to endorse by silence Gosnell’s practices?

Perhaps Jennifer Rubin was out of the country or not reading the papers in 2002 when President Bush signed into law the Born-Alive Infant Protection Act. This is federal law, as in it covers all the states. Since Kermit Gosnell is and was a criminal, he was not adhering to the law, as is the nature of the term “criminal.”

And exactly how far does Rubin want to go to eliminate late abortions? Under Roe v. Wade, states may not prohibit abortions even after fetal viability in cases where it is “necessary to preserve the life or health” of the woman. Third-trimester abortions, which make up an estimated 1.3 percent of abortions in the United States, happen when there are medical complications that compromise the life or health of the woman in question or fetal anomalies incompatible with life. In the Gosnell case, women who came for late abortions came for them because they didn’t have enough money to get early abortions, conditions created by the very policies Rubin advocates. 

If she wants a total ban on late abortions without exceptions for life and health, which women does Ms. Rubin suggest should be left to die? Which women should be left with lifelong health problems from a pregnancy gone horribly wrong? It’s a little harder when you have to face real people in need, so I ask, for which of these women does Rubin feel she or others are better equipped to decide what to do? Would she make the choice for Kate? For Gracie’s parents? For Autumn Elise’s parents? Why does Rubin or anyone else get to decide for these families what is best for them?

The inconvenient truth here is that the very policies anti-choicers espouse are the ones that create the conditions in which Gosnells thrive: limiting access to safe abortion care by closing clinics, driving up the costs, requiring women to go through innumerable unnecessary hoops to secure an abortion, and driving them later in the process—denying women living in poverty public support for safe abortion care. All of these and other policies espoused by anti-choicers drive women to desperate circumstances, as a trip to any number of countries with high rates of maternal mortality from complications of unsafe abortion will tell you.

Rubin’s column doesn’t prove any of the points she apparently set out to make, but it does prove a few things: She isn’t cut out to play doctor, God, or legislator. And given the inexcusable lack of factual accuracy in her piece, it is not clear to me she is cut out to be a columnist either. I know that the Washington Post got rid of its ombudsperson, but did it fire all the editors and fact-checkers too?

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  • Skulander

    Antichoice policies are directly responsible for Gosnell being around. They want to make safe, legal abortions as hard, expensive to obtain? They want to keep placing as many hurdles as they can in front of women seeking to end an unwanted pregnancy (which, it should be reminded, IS legal in the United States)?

    They should not be surprised when poor, desperate women turn to Gosnell. Do we really want to go back to the good, old days of unsafe illegal abortions (those that Gosnell performed)?

    • HeilMary1

      Imagine if the same anti-choice public shaming and expense regulations were placed on Viagra prescriptions, male cancer and STD treatments, and vasectomies?

      • Kristen

        I’ve said for a long time that if men were the ones to get pregnant there would be morning after pill vending machines on every street corner, and no rules restricting abortions.

  • Arachne646

    These criminals with horror movie clinics just don’t happen in Canada. I’m not saying reproductive health access is perfect–in some small Atlantic Island provinces there aren’t hospitals where you can get an abortion and you have to travel, or in remote parts of Canada, health care access is problematic.

    However, the combination of huge numbers of women without access to reproductive health care, and the inevitable presence of a lazy criminal quack, repeatedly creates in the US these abatoirs of women’s suffering that anti-choice campaigners relish. With reproductive healthcare, including abortion, as part of an universal medicare system, like Canada’s, there’s just no motive for Gosnell to run his “Clinic”. He would be limited to his pill-pushing, and probably be caught much more quickly.

    • HeilMary1

      The same hypocrite racist fetal idolators who rant about Gosnell’s non-sterile equipment that infected women with STDs have no problem with cheapskate Mother Teresa doing the same thing to already born and abandoned Indian kids with her non-sterile needles. Alternet has recently run an excellent expose on her medical malpractice “charities”.

      • ljean8080

        So you think Gosnell should get off?

        • http://twitter.com/JenGStarr Jennifer Starr

          Your reading comprehension is extremely poor. You know good and well that Mary said nothing of the kind.

        • HeilMary1

          I’d love to see pompous mother killers like VA George Mason U “family law” professor Helen Alvare, VA Del. Robert Marshall and VA AG Ken KKKookinelli go to jail any day over Gosnell because their ignored criminal Munchausen by Proxy attacks on even contraception and sterilization force desperate low income and immigrant women to Gosnell.

  • http://www.facebook.com/alfonso.taboadaportal Alfonso Taboada Portal

    Dr. Leroy Carhart opposed the Born-Alive Infant Protection Act prevented That will not be hailed as a hero until the outbreak prochoice Morbelli case.

    • HeilMary1

      Where is your outrage over the millions of women murdered by rotting fetuses and childbirth? The particular complication that killed Dr. Carhart’s patient normally kills women from childbirth itself, so she probably would have died anyway, and her fetus would have likely died anyway from its serious defect that prompted her to seek an abortion. You don’t give a hoot about the millions of childbirth deaths and the 100 million unwanted starving homeless kids already in this world!

      • http://www.facebook.com/alfonso.taboadaportal Alfonso Taboada Portal

        “That killed The complication particularly Dr. Carhart’s patient normally kills women from childbirth itself,” then recognize that Dr. Carhart practical delivery, not an abortion!.
        You’re right that the U.S. has a high maternal and infant mortality. But the solution is not abortion. Dr. Elard koch has been much research and obstetrical maternal mortality. . European The solution is: free and universal single payer health.

        • colleen2

          The solution is access to safe, legal abortion, effective contraception and a single payer system. Women will always need access to safe and legal abortions and contraception.

        • HeilMary1

          Only an abortion would have saved Savita in Ireland, and one can still save Beatriz in El Salvador, but you don’t care about them.

        • http://www.facebook.com/Feral.9.Hex Carla Clark

          Um, how is the solution practical delivery when you’ve just been TOLD that delivery causes the complication, moron?

          • HeilMary1

            Such morons think stuck rotting fetuses magically use Star Trek transporters to escape women’s bodies!

        • http://www.facebook.com/ingrid.heimark.5 Ingrid Heimark

          It is true that some pro-life countries have the lowest maternal death rates in the world, also in the US maternal mortality were almost at todays level BEFORE legal abortion. Of course that means the woman never must be prosecuted for an illegal abortion

        • cjvg

          And practically all single payer socialized health care systems cover abortion and each and every other reproductive choice needed or wanted by women.

          Of course the number of abortions in those countries is extremely low but no one wants to acknowledge that, however when needed they are freely and speedily available no shaming or preaching included!

  • conect2u

    Rubin belongs to the same ignorant mob ranting for the government to keep their hands off their Medicare during the heightened opposition to the passage of ACA. The fact she supposedly is a respectable journalists worsens the conveyance of misinformation or is it intentional lies to propagate her anti-choice beliefs? Hard to decipher..which is the goal & great cover

    • sophie

      Rubin is NOT a “respectable journalist.” She is a right wing corporate news sycophant, and her diatribes are nothing but anti-choice propaganda.

  • John H

    Does she mean to imply that a woman in the United States facing a situation similar to one now going on in El Salvador—where
    a woman now carrying a non-viable fetus and whose kidneys are failing
    due to pregnancy-related complications of uncontrolled lupus—should be
    left to die?

    Yes, yes she is. She hates women. Are we all clear on the fact that opposition to women’s bodily autonomy is misogyny yet? Sadly, probably not.

  • http://www.facebook.com/ingrid.heimark.5 Ingrid Heimark

    I just wonder, in which case of post-viability abortion is the mother’s life and health depending upon the fetus being delivered dead rather than during pre-term labor?
    I’m just curious

    • cjvg

      In general if the health complication id from the mother then a delivery puts to much stress on the compromises health of the mother to be save for her.
      Also, statistically seen labor induction methods have a significant increasing in morbidity/mortality as compared with that of D&E.

      Induced labor has a much higher rate of maternal health complications like cervical lacerations and uterine perforations.
      If the women’s health is already compromised this can be fatal.

      Women with a history of prior cesarean delivery are at particularly increased risk of morbidity/mortality when undergoing labor induction as a form of surgical abortion. Labor induction resulted in a 20-fold increased odds ratio of uterine rupture and 2-fold increased risk of blood transfusion in women with a history of prior cesarean delivery as compared with those without a uterine scar. Thus, women with a history of a prior cesarean delivery should undergo either D&E or D&X if the mothers health is of concern at all

      Some pregnancy complications that might require a late abortion are;

      -hypertenstion, if blood pressure is already that high that an abortion is required to save the mothers life, it is not advised to increase it by attempting a delivery

      _ preeclampsia, can cause sudden and abrupt bleeding, it is not always possible to save both and a choice must be made

      - severe diabetes with retinopathy (kidney failure) were an abortion is the only save way to avoid additional quite possibly fatal stress on the mothers system

      -hearth failure/ advanced cardiac disease, sickle cell disease, psychiatric disease.
      renal failure disease /complications , severe infections, cancer, autoimmune disease, pulmonary hypertension or embolism, hemorrhage
      All pretty self explanatory that actually attempting a delivery when the mothers health is that poor is not a medically sound idea and most certainly not the way to ensure the woman will survive!
      It is not as simple as you would like it to be, there are very good ethical and moral reasons to ensure that a woman suffering from any of these complications does not attempt delivery