Abortion Battle Casualties: Bargaining Away Health Care for America’s Most Vulnerable Women

The Indianapolis Star reported on Monday that Planned Parenthood of Indiana (PPIN) is being forced to cut off all services to Medicaid patients, lay off staff, and furlough workers as they shut down all clinics in the state one day a week to save money.  Public donations that had sustained PPIN since May 10^th, when the defunding law went into effect, have now run out.  The Indianapolis Star article noted the all too familiar response from anti-abortion activists, “…Planned Parenthood has ‘made it clear what their priority is…They wouldn't stop providing abortions even in the interim to keep the women's health services…”  We have heard this refrain time and again from anti-choice politicians and anti-abortion activists – if Planned Parenthood really cared about poor women’s health care services they would just stop performing abortions – then all of their problems would magically disappear. 

Of course, for Planned Parenthood this is not an option; to stop performing abortions would not only cede the argument that abortion is not health care and endanger women’s health and lives, but it would also not stop the war on women or the war on reproductive rights.  One only needs to see the writing on the wall with the increasing “personhood” movement that is moving through Alabama, Montana, North Dakota, Oklahoma, and Virginia.  This legislation, which would provide personhood rights to fertilized eggs, would not only outlaw abortions but also potentially ban contraception by defining life “…from the moment of fertilization and implantation into the womb.”  Anti-choice politicians and anti-abortion activists are not only seeking to outlaw abortion but they also want to outlaw contraception.  And shutting down Planned Parenthood eliminates one of the most critical ways low-income women access contraceptive services. 

NPR recently explained that while “[l]ast year's GOP takeover of the U.S. House and statehouses across the country has dramatically changed the shape of the nation's abortion debate.  It has also given a boost to an even more far-reaching effort: the push to legally redefine when life itself begins.”  This personhood redefinition movement “…could threaten the use of a long list of commonly used contraceptives…” 

Last week at Netroots Nation conference, RH Reality Check’s Amanda Marcotte detailed her participation on a panel discussing the war on contraception.  The panel discussed “…the escalating attacks on contraception access from the religious right.”  Marcotte noted that while the war on contraception “…can also be viewed as an opportunity…[to] highlight the distance between anti-choice claims to be ‘pro-life’ and their actual demands, which are focused on sex and gender,”  she remains concerned that “…the response to the anti-choice movement’s bolder attacks on contraception will not be to use this to highlight the anti-sex, anti-woman ideology underlying the opposition to abortion but instead, pro-choicers will simply de-prioritize defending abortion rights in order to protect contraception.” 

Trying to compromise with anti-choice forces that believe contraceptive access actually increases the incidence of abortion; that believe using birth control puts women’s health at risk; and that believe Planned Parenthood is a front for prostitution, the sex trafficking of young girls, and exploits the Hyde Amendment’s rape and incest exceptions to provide abortions to teenage girls regardless of their age, seems increasingly futile.  These anti-choice extremists will never be convinced that “[i]n 2006, publicly funded family planning services helped women avoid 1.94 million unintended pregnancies, which would likely have resulted in about 860,000 unintended births and 810,000 abortions.” 

Slate’s Dahlia Lithwick recently noted a 2002 Guttmacher Institute report indicating that “…efforts to deny family planning funding to any agency that also provides abortions go way back: The ‘campaign—to ban both direct and 'indirect' government support for abortion—was conceived almost before the ink was fully dry on the 1973 Roe v. Wade decision’.”  The Planned Parenthood fight is not going away with the abortion messaging war in high gear for the 2012 elections; and with GOP presidential candidates all trying to outdo each other in proving their anti-abortion bona fides for extreme anti-abortion activists. 

Back in December 2007 then candidate Obama responded to a RH Reality Check questionnaire regarding sexual and reproductive health and rights.  Then Senator Obama’s staff responded to this question: Does Sen. Obama support the Hyde amendment?  Under what circumstances does he believe that Medicaid should cover abortions (all pregnancies, life- or health-threatening pregnancies, pregnancies that are a result of rape or incest, extreme fetal malformation)?

Obama does not support the Hyde amendment.  He believes that the federal government should not use its dollars to intrude on a poor woman's decision whether to carry to term or to terminate her pregnancy and selectively withhold benefits because she seeks to exercise her right of reproductive choice in a manner the government disfavors.

But now, when Obama administration officials call the Hyde Amendment “settled law” and Health and Human Services Secretary Kathleen Sebelius says, “[f]ederal funds have never supported abortion, do not support abortion, will not support abortion,” hasn’t the administration already compromised too far and lost the messaging war altogether?  And are they simply bargaining away the reproductive rights of women who do not have the political power to fight back?  Arguably, some of the most politically powerless women in the U.S. are the low-income and vulnerable women in the District of Columbia; their abortion rights are once again being marginalized. 

Back in April, I detailed the deal struck by the President Obama and Senate Majority Leader Harry Reid during the April budget showdown that bargained away D.C.’s abortion rights in order to avert a government shutdown.  In that RH Reality Check article, I asked:

When the budget negotiations ramp up for FY 2012, what other reproductive rights will be sacrificed for the sake of compromise?  How far will the President be willing to stretch the definition of preventing the budget debate from being overtaken by ‘unrelated disagreements on social issues?’

And now, predictably, D.C. abortion rights are once again on the FY 2012 negotiating table. 

According to the Guttmacher Institute, currently 17 states use their own state Medicaid funds to “…provide all or most medically necessary abortions” for low-income women.  And until the April budget compromise, D.C. was also permitted to use their own local funds to provide abortion services for Medicaid patients.  But last week, the House Appropriations Committee revealed a first draft of its 2012 spending bill for the District of Columbia which includes a “…ban on the District using its own funds to pay for abortions for low-income women.  That prohibition, which Republicans imposed during their last tenure in the House majority, was also included in the short-term spending deal agreed to in April by President Obama and the GOP.”  Since those April negotiations, when President Obama “…reportedly said to House Speaker John Boehner (R-Ohio), ‘John, I will give you D.C. abortion’ – local officials and activists have scrambled to prevent history from repeating itself.” 

The DC Abortion Fund said, “…anti-choice members have included the D.C. abortion ban in their funding bill once again.  Not only is this policy dangerous for women but it also usurps the District’s own local governance, undermines the city’s self-rule, and makes a mockery of the democratic process in the nation’s capital.”  Del. Eleanor Holmes Norton (D-D.C.) said, "[w]e are deeply disappointed that the bill retains the 2011 abortion rider, and we will insist that the Senate and the administration oppose it…the bill…is scheduled to reach the floor in early July.”  

The Kaiser Family Foundation estimates 60,500 nonelderly Medicaid enrolled women may be affected by the reinstated ban; this is indeed "...a cruel blow to the poor and largely African-American women who need those services."  And the National Women’s Law Center explains:

[p]oor women denied abortion coverage may have to postpone paying for other basic needs like food, rent, heating, and utilities in order to save the money needed for an abortion…Restrictions on public funding for abortion disproportionately affect minority women as they are more likely to rely on public funding for medical care.  In D.C., 26.1% of minority women are living in poverty compared to just 8.6% of white, non-Hispanic women…The time needed to save money often results in poor women experiencing delays in obtaining an abortion.  The greater the delay in obtaining an abortion, the more expensive, and less safe the procedure becomes.

Abortion is health care – and as pro-choice politicians continue to cede ground, delegitimize, and stigmatize abortion, women’s health and lives are increasingly put at risk.  And anti-choice politicians that have been emboldened by their successes at constraining abortion rights across the country are now ready to ramp up the war on contraception. 

How can women’s health care advocates negotiate with a Republican leadership that responds directly to the U.S. Conference of Catholic Bishops regarding whether contraceptive services should be provided to women at no cost under the Affordable Care Act (ACA), which requires insurers to provide all preventive health services at no cost to the insured person? 

Scientific evidence has clearly established that access to contraception and family planning services not only improves a woman’s overall health but increases her life span.  Consequently, contraception should be covered under ACA.  Nonetheless, the U.S. Conference of Catholic Bishops, along with other conservative organizations, objects to science based reasoning telling the New York Times “[p]regnancy is not a disease to be prevented, nor is fertility a pathological condition…So birth control is not preventive care, and it should not be mandated.”

Trying to reason and compromise with this extreme conservative and political narrative that ignores facts is an exercise in futility.  Anti-choice politicians that continue to demonize Planned Parenthood cannot be convinced that family planning services constitute:

…a gateway into the U.S. health care system for women who would otherwise only have a tenuous connection to medical care, or none at all; a source of urgently needed contraceptive services and other sexual health care for young women in foster care, who are at high risk of unintended pregnancy; and a highly successful public health program that boosts maternal and newborn health, saves billions in taxpayer dollars, and averts significant numbers of unintended pregnancies, unplanned births and abortions.

It is an incontrovertible fact that access to contraception reduces the rate of abortion. 

Guttmacher Institute research shows that the two-thirds of U.S. women at risk of unintended pregnancy who use contraception consistently and correctly throughout the course of any given year account for only 5% of all unintended pregnancies.  The 19% of women at risk who use contraception but do so inconsistently account for 44% of all unintended pregnancies, while the 16% of women at risk who do not use contraception at all for a month or more during the year account for 52% of all unintended pregnancies.

It is also a fact that women, regardless of their religious backgrounds, believe in contraceptive rights and have come to recognize that “…contraceptive use and the prevention of unintended pregnancy improves the health and social and economic well-being of women and their families…”  Moreover, the data presented in the Guttmacher Institute’s report, Countering Conventional Wisdom: New Evidence on Religion and Contraceptive Use, “…shows that opposition to contraception by the Catholic hierarchy and other socially conservative organizations is not reflected in the actual behaviors and health care needs of Catholic and Evangelical women.”

Planned Parenthood has been defunded in Indiana, Kansas, Minnesota, and North Carolina.  Wisconsin Governor Scott Walker (R) is expected to sign a bill defunding nine of the state’s Planned Parenthood clinics any day now and Louisiana’s Planned Parenthood clinics may soon be defunded as well.  In fact, the Times-Picayune editorial board explains that the argument that funding Planned Parenthood in Louisiana indirectly funds abortion services is “…nonsensical…In Louisiana, Planned Parenthood doesn't perform any abortions at all…In fact, making it harder for women to get contraceptive services is likely to result in more women terminating unplanned pregnancies.” 

Clearly, regardless of whether the particular Planned Parenthood centers under attack actually perform abortions, anti-choice politicians will continue to see Planned Parenthood as nothing more than a government funded abortion mill. 

PPIN is currently waging a legal battle to restore its Medicaid funding because the Indiana defunding law directly violates federal Medicaid law.  PPIN is being supported by the Justice Department in their lawsuit.  The Justice Department filed a brief with the federal district court on June 16^th in support of the PPIN lawsuit challenging the law.  The Justice Department brief states, “[b]ecause the Indiana law violates the Medicaid statute’s freedom of choice provision and because the public interest strongly supports preserving the freedom of choice that Congress conferred, this Court should enjoin further implementation of the Indiana law with respect to the provision of Medicaid services.” 

But sadly, while PPIN is now forced to cut off their Medicaid patients there is of course no guarantee that the federal court ruling expected on July 1^st will restore that funding; PPIN may be forced into a protracted legal battle that will leave all of their Medicaid patients out in the cold with eight of the Indiana’s 28 centers on the ultimate chopping block. 

On June 9th, 28 Senate Republicans sent a letter to the Centers for Medicare and Medicaid Services saying that “Indiana's new law cutting Medicaid funding to Planned Parenthood does not violate Medicaid rules…”  The Senators also wrote, “Indiana's proposal should not only be approved, we believe it serves as an important model for every state…Unfortunately, your decision is simply the latest example of this administration's alarming pattern of usurping states' authority to manage their Medicaid programs in ways that best meet the needs of their citizens.”  The GOP leadership clearly has no intention of backing down from the Planned Parenthood battle.  Planned Parenthood has become the bogeyman in the abortion wars and the easy scapegoat that the extreme political right can use to fire up their political base for the 2012 election cycle. 

Notably, the defunding of Planned Parenthood in Kansas, North Carolina, and soon Wisconsin cannot be challenged as violations of federal Medicaid law.  And the Planned Parenthood closings in Minnesota are a direct result of Title X budget cuts.  These other states may have very limited legal options available to them to restore that funding beyond hoping for changes in the state legislature during the next election cycle.  However, Planned Parenthood leaders in North Carolina and in Kansas are both considering litigation. 

When we continue to provide politicians with the ammunition to isolate abortion rights from other reproductive health care rights, we also provide anti-women extremists with the weapon they need to further delegitimize abortion as health care.  And then pro-choice politicians only end up empowering and goading the anti-abortion argument providing further opportunities to chip away at abortion access for those women who can least afford the burden. 

Some pro-choice activists and pro-choice politicians underestimate and misread the extreme nature of the newly emboldened anti-choice, anti-women movement if they believe that bargaining away abortion rights for the poorest and most vulnerable women can salvage the critical health care services provided by Planned Parenthood.  Segregating Planned Parenthood and contraceptive rights from abortion rights will not preserve health care for poor women, it will only embolden this extreme movement to further constrain reproductive rights – only setting up contraception as the next political target.