Response to claims made by Matthew Boudway of Commonweal:

1. Boudway:  Anyone who follows the arrows can see that no tax money is used to pay for abortions.

AUL:  The chart as a whole demonstrates how tax dollars will be used to pay for plans that cover abortions under the Senate/Obama health care reform bill.  Using tax dollars to subsidize insurance plans that cover abortions is a radical departure from existing law — the Hyde amendment explicitly prohibits the use of federal funds to support plans that provide abortion.  The language of the Hyde amendment underscores the long-held understanding that subsidizing plans that provide abortion is tantamount to supporting abortion with federal funds.  This is explained in more detail below.

1. Boudway:  Nor is anyone forced by the Senate Bill to enroll in a plan that covers abortion. Those who do enroll in such a plan will have to pay a separate premium that goes into a segregated fund for abortion payments . . . According to the chart, enrollees would be required to pay the surcharge “even if [they] object or never plan to have an abortion.” This is true, just as it’s true that many who object to abortion and/or never plan to have an abortion (who does?) already pay for abortions through their health-insurance premiums. If people now want to avoid this, they can — but then, so could anyone under the system . . .

AUL:  No individual should have to pay for another person’s abortion in violation of his/her own conscience.  However, that is exactly what happens when pro-life individuals must pay into an insurance plan that covers abortions.  It is disingenuous to claim that individuals who do not want to pay for abortion coverage can choose an insurance plan that does not include it.  If John Doe works for XYZ, a small business, and XYZ decides to enroll John and the rest of its employees in an insurance plan that includes abortion coverage in an exchange, John and his coworkers will be forced to pay the surcharge.  It would be prohibitively expensive for them to do otherwise.

It is true that some individuals who object to abortion currently pay for abortions through their insurance premiums.  Some are just as trapped in the current system as John Doe would be trapped in the new system, and that is a tragedy.  However, it is fundamentally offensive for the government to institute a system in which pro-life Americans, or their employers on their behalf, would have to write a separate premium check to cover elective abortions.

1. Boudway:  The Senate Bill would not allow insurance exchanges to offer only plans that cover abortion.

AUL:  Our concern is not simply that prolife insurance companies might be shut out of insurance exchanges – our concern is that under mandate authorities in the bill, all private insurance companies could be required to cover abortion, regardless of whether they participate in the exchanges.  Specifically, an amendment added to the Senate health care reform bill on December 3, 2009 (sponsored by Sen. Mikulski (D-MD)) in pertinent part, requires group health plans and health insurance issuers offering group or individual health insurance to provide coverage for and not impose cost sharing requirements on “preventive care” for women “as provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA).”

While this amendment does not explicitly require abortion coverage, it also fails to exclude it.  This concern was raised during the debate over the amendment, and Senator Murkowski (R-AK) offered an amendment that would have prevented the inclusion of abortion; however, her amendment was defeated.  The HRSA could categorize abortion as “preventive care,” and would therefore recommend coverage for abortion by all private plans.  The recommendation would force private plans to offer abortion coverage.

The Stupak Amendment would prohibit this, and the failure to include that prohibition in the Senate bill is another reason why the language is defective.

1. Boudway:  The double asterisks tell us that “if the Hyde Amendment is removed from LHHS approps, affordability credits could be used to directly pay for abortions,” but there is no reason to suppose that the Hyde Amendment will be removed from LHHS appropriations…

AUL:  It is incredible to claim that “there is no reason to suppose that the Hyde Amendment will be removed from LHHS appropriations.”  Pro-abortion organizations are bent on eliminating the Hyde Amendment, and many of the politicians they support are equally committed to the goal.  It is not cynical to see the carefully written abortion language in the Senate bill as the first step in a plan to eliminate any restrictions on federal funding for abortion.

The authors of the Senate/Obama language could have explicitly stated that affordability credits (and other funds in the bill, for that matter) cannot be used to pay for elective abortions.  That is how the abortion funding ban is written in the Stupak amendment to the House bill.  Instead, the Senate bill provides that affordability credits cannot be used to pay for those abortions that are currently prohibited by the Hyde Amendment. In other words, if the Hyde Amendment – an appropriations rider that must be renewed annually – were not included yearly, abortion would be covered by the affordability credits under the Senate/Obama bill (which would by then be law).

One must remember that Democratic leadership and the media claimed at the beginning of this debate that the Hyde Amendment would not be affected by health care reform, surely knowing that this fact was irrelevant since the funding mechanisms in the bills circumvented the Hyde Amendment (and do so to this day).

1. Boudway:  Finally, the triple asterisks inform us that “federal funding of insurance plans that cover abortions is a radical change from existing law.” . . . One reason the federal government has never before funded insurance plans that cover elective abortion is that it has never had to fund insurance for as many people as would receive affordability credits under the Senate Bill. You cannot just extend the Hyde Amendment to the new private-insurance exchanges without also translating it into a new legal structure. The Stupak Amendment does this rather nicely.

AUL:  We agree that a new structure is needed to incorporate the principles of Hyde into the new system, which is why we support the Stupak language and oppose the Senate bill that does not include Stupak.  The Stupak amendment and our position is reflected in current federal law.  The Federal Employees Health Benefits Program (FEHBP), under which federal employees choose benefits, is modeled on the Hyde Amendment and does not permit one of those choices to be insurance plans that cover abortions.

1. Boudway:  Groups like Americans United for Life scare us with claims about what the Democrats’ health-insurance reform will do, and then, when asked for an explanation, fall back on hedged predictions about what it could do if this or that also happened – even when this and that seem quite unlikely.

AUL:  It is indisputable that when legislation relating to health care does not explicitly exclude abortion coverage or funding, administrative agencies and courts will include it.

Congress has passed the Hyde Amendment in LHHS appropriations each year since 1976, because the administrative agency administering Medicaid began paying for over 300,000 abortions a year.

In 1996, in Planned Parenthood v. Engler, the Sixth Circuit held that abortion “fall[s] within several of Medicaid’s mandatory categories of care” (family planning, outpatient services, inpatient services, and physician services) and that a state law that restricted funding for abortion to those necessary to save the mother’s life conflicts with the “mandate.”[1] Therefore, if Congress does not explicitly prohibit states from funding certain abortions with Medicaid (as Congress does through Hyde), states must fund them.

UPDATE: Boudway responds.

 On Monday February 22, 2010, following the release of President Obama’s new health care reform proposal, Nancy Ann Deparle, Director of the White House Office of Health Care Reform,   made the following statement on a conference call about how the Obama proposal addresses abortion: 

The starting point is the Senate bill with the Nelson language.  It’s not a perfect proposal, but it was crafted in a bipartisan manner.  It’s different from the House, but our effort was to not change the status quo on abortion.  I know it’s not ideal, but that’s the starting point we’re working from.

Her statement that the Senate abortion language was “crafted in a bipartisan manner” is inexplicable.   In fact, the Senate abortion language was crafted behind closed doors without a Republican in the room, which was evidenced by the fact that no Republican Senators voted in favor of it (as part of the manager’s amendment to the bill).  Instead of modeling the Senate abortion language after the House abortion language (the Stupak-Pitts Amendment, with its bipartisan nature demonstrated by the political diversity of its cosponsors as well as the 64 Democratic members who voted for it), Majority Leader Reid decided to model the language after the pro-abortion Capps Amendment that was included in an early version of the House bill and in the Senate Finance Committee Bill.  Reid was able to tighten the language just enough to win over Senator Ben Nelson from Nebraska, who was holding the key 60^th vote. 

However, no rewording can hide what the Senate language does.  The genesis of the language aside, Ms. Deparle grossly misrepresents how it compares to existing law or the “status quo on abortion.” 

The most well known embodiment of the “status quo on abortion” is the Hyde Amendment, a funding limitation added annually to the Labor, Health and Human Services Appropriations Bill.  However, there are numerous other laws that adopt the same principles in the Hyde Amendment – that no federal funds may be used to pay for abortions (except in cases of rape, incest, or the life of the mother) or to subsidize insurance plans that cover abortions. 

The Senate bill does not adopt the comprehensive approach to prohibiting federal funding of abortion found in the Hyde Amendment (and the House health care reform bill).  Instead, the Senate bill:

• Only prohibits the use of certain funds to pay for abortions, leaving open the possibility that other authorized funds – such as the 11 billion dollars provided for Community Health Centers –  will be used to pay for abortions.  Furthermore, even the paltry limitation in the bill is not built on solid ground – it is tied to the existence of the Hyde Amendment which is subject to elimination every year.  So, if the Hyde amendment is ever removed from LHHS appropriations, the limited prohibition on federal funding for abortion in the Senate health care reform bill will disappear as well.  Pro-abortion lawmakers are committed to getting rid of the Hyde Amendment, and it is perhaps not cynical to see this as the first step in a two-step plan to do that. 

• Allows federal dollars to directly subsidize insurance plans that cover abortions. Again, this contravenes existing law.  The most well-known example of the prohibition on the use of federal dollars to subsidize insurance plans that cover abortions is the Federal Employee Health Benefits Program (FEHBP).

The Senate bill also fails to maintain the “status quo” on abortion in other ways.  The bill creates new broad mandate authorities for federal agencies and officials that could allow them to require private insurance companies to provide abortion coverage.  For example, under the Mikulski Amendment to the Senate bill, an administrative agency may determine that abortion is “preventive care” and then require all insurance companies to cover abortion.  If that happens, all Americans will be forced to pay for abortions through their insurance premiums, even in violation of their conscience. 

Speaking of conscience, while the Hyde-Weldon conscience amendment (added annually to LHHS appropriations) prohibits government entities from discriminating against health care entities that refuse to participate in abortions, the Senate bill only prohibits discrimination against health care entities by insurance plans participating in the new government exchanges.

Clearly, the Obama Administration is not trying to maintain the “status quo” on abortion with health care reform.  Health care reform is another weapon in the Administration’s arsenal to mainstream abortion in the United States.

For a detailed comparison of the Hyde Amendment, the House bill, and the Senate bill, including citations, please click here.

On Monday morning, February 22, 2010, President Obama unveiled a “new” health care reform proposal, purporting to combine ideas from the Senate-passed bill, the House-passed bill, and Republican proposals.  However, a careful examination of the White House proposal (which lacks actual legislative language) and statements made by members of the Obama Administration during a health care conference call on Monday reveal the truth – the “new” proposal is simply a modified version of the anti-life bill that passed the Senate on Christmas Eve. 

Unfortunately, while the White House was crafting modifications to the Senate bill, they failed to remove the anti-life language.  Therefore, all of AUL’s concerns about the bill’s abortion-related provisions, conscience provision, and end-of-life provisions remain.  Further, the White House proposal dramatically increases funding – by 11 billion dollars – for “community health centers” which will include Planned Parenthood abortion centers.  Because the proposal lacks a blanket prohibition on the use of federal funds for abortions, these new funds could be used to directly pay for abortions.

For detailed analyses of the anti-life provisions in the Senate health care reform bill, please see the following posts:

Legal Analysis of Life Concerns in President’s Proposal (Same as the Senate Health Care Reform Bill)

Abortion Tax and other Problems in President’s Proposal (Same as the Senate Health Care Reform Bill)

Abortion Funding Chart (In President’s Proposal and Senate Health Care Reform Bill)

Comparison Chart of Hyde Amendment, Senate Bill/President’s Proposal, and House Bill

Also, please see the letter which AUL’s sister organization, AUL Action, sent to President Obama on July 21, 2009.

Statement of Americans United for Life President and CEO Dr. Charmaine Yoest on new Senator Scott Brown:

“Americans United for Life would like to congratulate Senator Scott Brown on his swearing-in today and welcome him to Washington. Although the Senator’s support for Roe v. Wade has been widely reported, Senator Brown also opposes federal funding for abortion, supports strong parental consent rules for minors, supports a ban on partial birth abortion and supports promoting adoption as an alternative to abortion. On these and on many other issues, we can find common ground with the new Senator and we look forward to working with him.”

And maybe closer than you think

In a stunning reversal of fortunes, Senator Ben Nelson’s popularity is in a nosedive at home in Nebraska after he threw away his pro-life credentials for a few Medicaid dollars.

After standing firm for weeks insisting that there be no expansion of abortion through the government health care bill, Nelson abandoned that pledge once he secured millions in payments to Nebraska’s Medicaid program.  In response to the deal’s details becoming public, Senator Coburn stated in a press release that voters “will hold accountable anyone who defends sacrificing the unborn on the altar of political expediency.”

Well, Senator Coburn looks like a prophet in Nebraska.  According to a December 28 Rassmussen poll, if the election were held today between Democratic Senator Nelson and Republican Nebraska Governor Dave Heineman, Nelson would lose by a shocking 31 points.  By contrast, Nelson won his last election in 2006 with 64% of the vote.

And health care reform is the overriding reason for Nelson’s stark decline.  65% of Nebraskans say they oppose any health care reform that provides coverage for abortion while only 6% support mandated abortion coverage.  What would happen if he switched his vote?  Rasmussen asked and found that 20% of those voters backing Heineman would immediately come his way.

And if that wasn’t enough, Nelson’s special deal for free Medicaid money has only 17% support back home.  So much for buying votes.

While some are predicting health care passage later this month, these poll numbers offer a sobering reality check to which both Senators and Representatives should pay close heed.

Statement of Dr. Charmaine Yoest, President of Americans United for Life

“60 U.S. Senators just made history by voting to move forward with a bill that imposes a first-ever mandatory abortion tax on the American people. Majority Leader Reid held this vote in the middle of the night because he knows that the vast majority of Americans don’t want this new tax and don’t want tax dollars bankrolling insurance plans that cover abortion. A ‘yes’ vote is a solid ‘yes’ to the expansion of federal funding for abortion. We will be making this tragic decision clear to those constituents who have been misinformed that their Senator is pro-life.”

- Dr. Charmaine Yoest, President of AUL Action

For more on the abortion tax and the bill itself, click here: http://blog.aul.org/

For more information or to schedule an interview please email press@aul.org

Buried in an Associated Press story last week on President Obama’s health care reform agenda was a fact that counters misleading statements from the White House: The Hyde Amendment does not protect American taxpayers from funding abortions through ObamaCare.

The AP reports:

The main point of contention is the proposed new federal subsidies that would help lower-income people purchase health care coverage from private plans — and potentially from a new government-sponsored plan — within a new purchasing exchange.

Currently a law called the Hyde amendment bars federal funding for abortion — except in cases of rape and incest or if the mother’s life would be endangered — and applies those restrictions to Medicaid, forcing states that cover abortion for low-income women to do so with their own money. Separate laws apply the restrictions to the federal employee health plan and military and other programs.

But the Democrats’ health overhaul bill would create a new stream of federal funding not covered by the restrictions.

As blogger Ed Morrissey notes, “It only took the Associated Press six weeks after Rep. Joe Wilson’s ‘You lie!’, but they finally have reported that Barack Obama told a whopper in his joint speech to Congress — and that Democrats have lied all along about abortion and ObamaCare.” But the misinformation from the White House didn’t end with Obama’s speech.  Twice in recent weeks, White House Press Secretary Robert Gibbs has insisted to reporters that the Hyde Amendment is sufficient to prevent federal funds from subsidizing abortion.

Morrissey adds:

Democrats have used the Hyde Amendment as a big red herring during this debate.They have repeatedly argued that their ObamaCare bills do not repeal the Hyde Amendment, which is at once both true and irrelevant.  The funding for ObamaCare bypassed the Hyde amendment, which allows most Democrats to pose dishonestly on the issue.

That was most true when Barack Obama told Congress and the American people that no federal dollars would go for abortions.  He knew, or at least he should have known, that the Hyde Amendment did not cover the funding his own party proposed for coverage.  He also knew that his party had blocked efforts to close that loophole in the bill.  Obama either lied or showed a dismaying ignorance of the facts in the debate, and given his endorsement of Planned Parenthood and theirs in return, I’m betting he isn’t ignorant on this issue at all.

Indeed, while on the campaign trail, Obama vowed to Planned Parenthood that abortion funding would be the “center and heart” of his health care plan. The current bill is on track to keep that promise–unless Americans call on the President and Congress to keep his promise to America–that of an abortion-free health care bill–and not his promise to Planned Parenthood.

TAKE ACTION: Join Team Life via AUL Action’s RealHealthCareRespectsLife.com and make your voice heard in Washington.

HERE are the Facts

Media Matters stated:  “In a new anti-choice ad, the conservative Americans United for Life presents several nuggets of misinformation regarding how abortion is being treated in Democratic proposals for health care reform.  Because they lack any factual grounds for their argument, the group resorts to ominous music, sarcasm, and misdirection.”

Our Response:  All of the statements in the advertisement are facts.  If Media Matters truly wishes to dispute the accuracy of our statements, they should do that – not just paste in statements made by other sources about health care reform.  Nonetheless, below is the background information on our statements. 

Our assertions in the ad:

1.     “Senator Max Baucus’ health care bill requires the taxpayers to spend $6 billion establishing co-ops that could cover abortion.”

The Senate Finance (Baucus) Bill authorizes $6 billion in funding to create a Consumer Operated and Oriented Plan (CO-OP) program, which is described on pages 43-45 of the Redline, the most recent version of the bill (note – the bill is still only written in conceptual language, not statutory language).  The purpose of the CO-OP is “to foster the creation of non-profit, member-run health insurance companies that serve individuals in one or more states.”  The Federal funds (i.e. tax dollars) will be distributed as loans and grants.

Nothing in the Senate Finance Bill states whether or not these federally-funded health insurance companies will cover abortion; however, if they do, $6 billion in federal (taxpayer) funds will be used to set up insurance companies that cover abortion.  If members of the Finance Committee did not intend for these companies to include abortion coverage in their health care plans, why did they defeat Senator Hatch’s amendment during the Finance Committee’s mark-up that would have prohibited the authorization or appropriation of federal funds for “elective abortions and plans that cover such abortions”?  (Amendment #C14, failed 13-10).

Without the inclusion of explicit language excluding abortion coverage, like the amendment offered by Senator Hatch, there is no guarantee that abortion coverage will be excluded.

2.     The Capps Amendment routes federal dollars to private health insurance plans that cover abortion. 

The Capps Amendment to the House health care bill, H.R. 3200, provides the following:  “In the case of a qualified health benefits plan, the plan is not required (or prohibited) under this Act from providing coverage of services described in paragraph (4)(A) or (4)(B). . . .” (Subsection (d)(2), page 1, line 12 through page 2, line 5, emphasis added).  The referenced “services” in (4)(A) and (4)(B) are all abortions (those for which federal funding is allowed under the Hyde Amendment (rape, incest and the life of the mother) and those for which federal funding is prohibited under the Hyde Amendment).

In other words, private health care plans that cover abortion are allowed to participate in the “health insurance exchange” created by H.R. 3200.  Individuals who qualify to receive “affordability credits” (federal dollars) to help pay their insurance premiums may then select health care plans that cover abortion.  The end result – federal dollars subsidize health care plans that cover abortion.

Supporters of the Capps Amendment argue that this is not problematic, because the amendment establishes an accounting mechanism designed to separate the federal funds flowing into a health insurance plan that covers abortion from the portion of the premium paid by an individual.  In theory, only the portion paid by the individual may be used to pay for abortions, while the federal dollars are used to pay for non-abortion related services. The mechanism creates “silos” of money in an attempt to claim that no federal taxpayer dollars will fund abortion.

The Capps accounting mechanism is flawed because it is a restriction in name only. It will not work because money is fungible. Funds are funds, and money is freely exchangeable or replaceable, in whole or in part. Corporations, households, and small business all have one bottom line, and funding diverted away from abortion simply allows “unearmarked” money that a health plan would otherwise have used to pay for other types of care to flow towards abortion services. For instance, if your household received a tax credit to pay for child care, that would free up the money you had budgeted for child care expenses, allowing you to spend those dollars on other household expenses. Your household realizes a net gain of the amount of the child care tax credit.

Under Capps, even if certain funds have restrictions on use for abortion, an abortion-providing health care entity can simply substitute unrestricted funding in its place. In this way, federal taxpayers are supporting plans which offer abortion coverage and contributing funds towards the provision of abortion.   

3.     The Capps Amendment will include abortion in the public option . . .

The Capps Amendment provides that “[t]he public health insurance option shall provide coverage for services described in paragraph (4)(B) [“abortions for which funding is allowed” under the Hyde Amendment – currently in cases of rape, incest, and the life of the mother].  Nothing in this Act shall be construed as preventing the public health insurance option from providing for or prohibiting coverage of services described in paragraph (4)(A) [“abortions for which public funding is prohibited” under the Hyde Amendment]” (Subsection (d)(3), page 2, line 6 through 12, emphasis and brackets added).

In other words, the Capps amendment requires the public option to cover any abortions for which federal funding is currently allowed under the Hyde Amendment (rape, incest, and the life of the mother).  Therefore, in the event that the Hyde Amendment is ever eliminated or its exceptions are broadened, coverage of more or all abortions would be required. 

Furthermore, the amendment permits the Secretary of the Department of Health and Human Services (HHS) to include elective abortion (Sec. (4)(A)) as a mandatory minimum benefit in the public option.  There is little doubt that abortion will be included in the public option, given the proabortion stance of the current Secretary of HHS, Kathleen Sebelius, and President Obama’s statement at a Planned Parenthood conference on July 17, 2007:  “In my mind, reproductive care [i.e. abortion] is essential care, it is basic care . . . so it is at the center and at the heart of the plan that I proposed . . . .”

4.     . . . and ensures that every area of the country will have at least one health insurance plan that covers abortion.

The Capps Amendment provides that “[t]he Commissioner shall assure that, of Exchange participating health benefits plans offered in each premium rating area of the Health Insurance Exchange—there is at least one such plan that provides coverage of services described in subparagraphs (A) and (B) of section 122(d)(4) . . .” (Subsection (e), page 3, line 5 through page 4, line 14).

In other words, for the first time in history, the federal government will ensure that every area of the country has access to a private health insurance plan that includes abortion coverage. 

5.     All five committees defeated amendments that would have stopped an abortion mandate in health care reform. 

Below are the amendments defeated in the five committees of jurisdiction (three in the House and two in the Senate) that would have prohibited abortion coverage and funding:

House Ways and Means Committee

            The amendment offered by Rep. Sam Johnson (R-TX) to prohibit abortion coverage failed by a vote of 18-23. 

The amendment offered by Rep. Eric Cantor (R-VA) to prohibit abortion funding failed by a vote of 19-22.

House Education and Labor Committee

            The two amendments offered by Rep. Mark Souder (R-IN) to prohibit abortion coverage and funding failed by votes of 19-29. 

House Energy and Commerce Committee

The two amendments offered by Rep. Stupak (D-MI) and Pitts (R-PA) to prohibit abortion coverage and funding failed by a vote of 30-29 and 27-31, respectively.

Senate Health, Education, Labor, & Pensions

An amendment offered by Sen. Hatch (R-UT) to prohibit abortions funding failed. (amdt. 227).

An amendment offered by Sen. Mike Enzi (R-WY) to prohibit abortion coverage failed (amdt. 276).

Senate Finance Committee

An amendment by Senator Hatch (R-UT) (#C14) to prohibit the authorization or appropriation of federal funds for “elective abortions and plans that cover such abortions,” with an exception for rape, incest, or the life of the mother failed 13-10.

6.     The pro-abortion legislators are telling you that the Hyde Amendment will stop federally funded abortions in health care reform.  Don’t be fooled. The Hyde Amendment does not apply to the current health care reform proposals. 

The Hyde Amendment is a spending limitation added to the yearly Labor, Health & Human Services (LHHS) Appropriations bill to prohibit federal funding from being used to pay for abortions, except in the cases of rape, incest or life of the mother.  Spending falls under Hyde if:

1)      The money is appropriated yearly through the Appropriations process, AND

2)      The money flows through HHS (as with Medicaid).

Both 1 & 2 are required for Hyde to apply.  The Hyde Amendment is used to prevent Medicaid funds from being used to pay for abortion. 

None of the new benefits discussed above meet both of these criteria.  Therefore, the Hyde Amendment will not apply to them.

• H.R. 3200 establishes a separate funding mechanism for the affordability credits (it bypasses the Appropriations process).  The credits are routed through a newly established Trust Fund financed through taxes on, among other sources, individuals and small businesses who do not meet health insurance coverage mandates. (See Sec. 207 (c)(2)).  Funding for the affordability credits neither runs through HHS nor depends upon the yearly Appropriations process; therefore, Hyde does not apply. 

• In the Senate HELP Bill, the Hyde Amendment will not apply toward the tax credits because the HELP bill bypasses the Appropriations process (See Sec. 3111). Funding for the tax credits will not depend upon the yearly Appropriations process; therefore, Hyde does not apply. 

• In the Senate Finance Bill, the Hyde Amendment will not apply toward the tax credits because the Baucus bill bypasses the Appropriations process.  Funding for the tax credits will not depend upon the yearly Appropriations process; therefore, Hyde does not apply. 

7.     President Obama and congress, when will you write explicit language excluding abortion from health care reform? America wants to know.  Don’t let your tax dollars go to abortion.

The detailed explanations above demonstrate that the health care reform proposals under consideration provide for federal coverage and funding for abortion.  All are changes in the status quo on abortion.  Without explicit language excluding abortion coverage and funding, these proposals will lead America down the road to paying for the destruction of innocent human life.

There have been many promises made during the health care debate in Congress, from President Obama, Speaker of the House Nancy Pelosi and many others that no federal funding will go to abortion in health care reform. They claim they are merely maintaining the “status quo.” Yesterday, in The Wall Street Journal, AUL President and CEO Dr. Charmaine Yoest argues in her op-ed “Tax Dollars Shouldn’t Fund Abortion” that the current proposals aren’t the status quo and in fact, they would “take us toward an era of unprecedented federal abortion funding.”

As Dr. Yoest writes,

“The Capps Amendment would side step the Hyde Amendment and other provisions in federal law. If it becomes law as part of health-care reform it would make abortion coverage a part of the public option, funnel tax dollars to private health plans that cover abortion, and ensure that every area of the country will have at least one health insurance plan that covers elective abortion. If this should happen, for the first time in more than 30 years the federal government would be in the business of funding the destruction of unborn human life.”

Updated October 12, 2009

The U.S. House of Representatives

The three committees of jurisdiction marked up and reported out versions of the House health care reform bill, H.R. 3200.  The House Democratic leadership is currently reconciling the different versions of the bill behind closed doors. In some cases, they will also need to reconcile different versions of amendments from the same committee.   For instance, the Energy and Commerce Committee adopted two different conscience clause amendments: a clear and comprehensive amendment from Rep. Stupak [D-MI], and an insufficient amendment from Rep. Capps [D-CA].

After this process is finished, but before the Republicans in the House will likely have much time to review the finalized language, the Rules Committee will determine the rules under which H.R. 3200 may be considered by the full House.  Rules generally govern the number of amendments which can be offered, how much debate will be allowed on the bill, and what procedures will govern the voting process. 

After the Rules Committee completes its work, the bill will move to the full House for consideration.[1]  The House Democratic Leadership has said that this could happen in mid-October.  At that point, members of the House may offer amendments to the bill to be voted on by the whole House.  However, it is possible that the Rules Committee, at the behest of the Democratic leadership, may prohibit pro-life amendments from receiving a vote.  Congressmen Stupak and Joe Pitts (R-PA) sent a letter on behalf of 183 members of Congress to Speaker Pelosi urging her to allow floor consideration of an amendment that would exclude abortion funding and coverage.

When and if the bill passes the full House, and if a bill passes the Senate, the House leadership will choose conferees.  These are House members who will represent the House in a conference with the Senate during which the two bodies try to reconcile the versions of the bills that each body has passed.

Two Senate Bills — Normal Process

The Senate Health, Education, Labor, and Pensions (HELP) Committee bill was marked up and reported out of Committee before the August recess.  The Senate Finance Committee is expected to report out its bill on Tuesday, October 13^th.  Staff members for both the Senate Finance Committee and the Senate HELP Committee are already working to reconcile their bills. Ultimately, however, Majority Leader Harry Reid and other members of the Democratic Party will determine the content of the final Senate Bill.

Once there is a unified Senate health care reform bill, the full Senate will consider the bill on the Senate floor, likely in mid-October.  At that point, all Senators, including those who may have already offered unsuccessful amendments in Committee, may offer amendments to the bill to be voted on by the whole Senate.  Eventually, Senate Majority Leader Reid or another senator will offer a cloture motion to limit debate and the number of amendments.  If that motion receives 60 votes, an exact date will be set for the final vote on the bill. 

When and if the bill passes the full Senate, and if a bill passes the House, the Senate leadership will choose conferees.  These are senators who will represent the Senate in a conference with the House during which the two bodies try to reconcile the differing versions of the bills that each body has passed.

Two Senate Bills — Alternative Process

In the event that the Senate Democratic leadership does not believe that they have 60 votes to invoke cloture, or if they fear that the amendment process may significantly alter the bill, they may decide to use an alternative process available in the Senate for floor consideration.  This process is called “reconciliation.”  Reconciliation is a fast-track procedure reserved for bills relating to taxes, spending, and debt.

This is how the reconciliation would likely work in this case:

·         The Senate Budget Committee would essentially staple the two bills (HELP and Finance) together without considering how the provisions complement or conflict with each other.

·         The Senate Democratic leadership would then offer a “substitute amendment” on the Floor that includes everything they want from the two bills, and removes everything else.

·         Under Reconciliation rules, only 51 votes are needed to add amendments (including the substitute amendment) and for final passage (unlike the normal process that requires 60 votes to get cloture and prevent a filibuster).

·         Amendments are subject to strict rules.  All amendments must be “germane” (on topic) and are subject to the “Byrd Rule” (explained below).  The Senate Parliamentarian decides whether amendments meet these two tests.

·         Debate is severely limited, ensuring a final vote.

Under the “Byrd Rule,” any Senator can raise a Budget Point of Order challenging a provision of the bill.  Once the provision is challenged, it must pass six tests.  Failing any one of the tests will result in the provision’s removal from the bill.  A provision would fail this point of order if it is considered extraneous; that is, if it has no effect on spending or revenues, it is not a “necessary term or condition” of another provision that does affect spending or revenues, or if its small budget effect is “merely incidental” to its larger non-budgetary purpose.

Even if a provision is likely to violate one of these tests, a supporter of the provision can ask that the Byrd Rule be waived before the parliamentarian rules on the point of order.  60 votes are needed to waive the point of order. 

The Byrd Rule is significant because it could lead to the removal of several key provisions in the health care bill.  For instance, the exchanges / gateways would likely be considered extraneous.  This could make this procedure unattractive to the Senate Democratic leadership.

Once the limited consideration time expires, the bill will receive a vote.  If the bill passes, the Senate leadership will choose conferees. These are senators who will represent the Senate in a conference with the House during which the two bodies try to reconcile the differing versions of the bills that each body has passed.

It is important to note that Democratic Leadership will be confronted with considerable opposition if they use the Reconciliation process.  The Senate prides itself on being the greatest deliberative body in the world, and the Reconciliation process largely circumvents traditional Senate procedure.

Conference

The House and Senate conferees will work together to try to reconcile the House version of the bill with the Senate version of the bill.  A conference can go smoothly and move quickly, or can require long periods of deliberation and compromise.  Senate and House leadership may choose conferees without diverse beliefs, which would enable them to remove provisions in the bill that they do not like without resistance.  For example, if there are no pro-life conferees, the conscience protection added to H.R. 3200 will certainly be removed.  The White House will also weigh in heavily at this time, urging the conferees to make changes to the bill that fit their agenda.  We expect this process to take many weeks, consuming November and December.

Final Passage

Once a bill is agreed upon in conference, the conference bill is sent back to both the House and Senate for final passage.  The House and Senate will each have to conduct another vote on the bill in order to pass the bill along to the President to sign into law.  The earliest this is likely to occur is late December.

President’s Signature

In order to the bill to become a law, President Obama would need to sign the finalized health care legislation.

Revised October 12, 2009

Introduction

In this Memorandum, we review provisions of the health care reform bills before Congress that implicate four areas:  (I) abortion funding and coverage, (II) freedom of conscience, (III) the curtailment, withdrawal, or denial of effective life-sustaining treatment, and (IV) end of life issues.  Our examination includes an analysis of such provisions in H.R. 3200, the Senate Health, Education, Labor and Pensions (HELP) bill, and the Senate Finance bill, the three bills before Congress as of October 12, 2009. 

I.                   Abortion Funding and Coverage

All three versions of health care reform currently before Congress mandate abortion funding and coverage through express provisions in the bills.  This mandate was magnified by the rejection of key pro-life amendments in all five of the committees of jurisdiction (House Ways and Means Committee, House Labor and Pensions Committee, House Energy and Commerce Committee, Senate Health Education, Labor and Pensions (HELP) Committee, and the Senate Finance Committee).  Furthermore, without express language prohibiting abortion funding and coverage, courts and administrative agencies will interpret health care reform to include it, based on prior interpretations of Medicaid’s “Mandatory Categories of Care.”  In addition, the Hyde Amendment, as added yearly to HHS Appropriations, is insufficient to prevent abortion funding and coverage under the health care bills.  Therefore, abortion funding and coverage must be explicitly excluded.

A.     Express Abortion Funding and Coverage in Health Care Reform Bills

1.      H.R. 3200

The House bill, H.R. 3200, delegates to the Health Benefits Advisory Committee the task of determining mandatory minimum benefits that any private or public health care plan must offer to participate in the Health Insurance Exchange (See Division A, Title I, Subtitle C). The House Energy and Commerce Committee approved an amendment offered by Rep. Lois Capps (D-Calif.) which prohibits the Health Benefits Advisory Committee, the Secretary of HHS, and the Commissioner from mandating coverage of abortion.  However, the Capps amendment itself mandates abortion coverage.

The Capps amendment permits the Secretary of the Department of Health and Human Services (HHS) to include abortion as a mandatory minimum benefit in the new public health care plan, and requires taxpayer funded abortion through the provision of affordability credits for plans that cover abortion (an accounting system is supposed to prevent federal dollars from paying for abortion itself; however, the government is still subsidizing insurance plans that cover abortion). The current Secretary of HHS, Kathleen Sebelius, is pro-abortion and would certainly include abortion in the plan, allowing for immediate federal funding of elective abortion coverage. The provision also requires that all areas of the country contain one private plan that covers abortion.[1]

In addition, H.R. 3200 allows states to cover “family planning services” under Medicaid. (See Sec. 1714). The definition of “family planning” in the bill comes from Sec. 1905(a)(4)(C) of the Social Security Act which defines “family planning” services as those “family planning services and supplies furnished (directly or under arrangements with others) to individuals of child-bearing age (including minors who can be considered to be sexually active) who are eligible under the State plan and who desire such services and supplies.” Given prior court and administrative interpretations of “family planning” to include abortion, this is another means by which an abortion mandate will be read into H.R. 3200.

2.      Senate HELP Bill

The Senate HELP bill delegates to a “Medical Advisory Committee” (see Sec. 3103) the role of determining which minimum benefits any private or public health care plan must offer.  It is expected that this unelected administrative committee, which will be appointed by President Obama’s administration, will decide that abortion merits mandatory inclusion in any health care plan offered.[2] Were this to occur, private plans would be forced to offer coverage for abortion in order to participate in the Health Insurance Exchange that is established by the bill.  Further, taxpayers may be forced to subsidize abortions under a possible public health care plan.

An amendment by Sen. Mikulski (D-Md.) that was accepted by the Senate HELP Committee will require insurers to cover “essential community providers…that serve predominantly low-income, medically under-served individuals.” Sen. Mikulski explained the amendment as providing for “any service deemed medically necessary or medically appropriate.” She acknowledged that Planned Parenthood will fall into this category of “community providers” and will therefore be included in health insurance networks under the bill.  Planned Parenthood’s inclusion will certainly lead to additional federal funding of abortion, as was evidenced by Sen. Mikulski’s refusal, at Sen. Hatch’s request, to include specific language in the bill excluding “abortion services” from “medically necessary or medically appropriate” care.[3]

3.      Senate Finance Bill

Senator Max Baucus’ (D-MT) Finance Bill does not include a public plan, but provides six billion dollars for the establishment of health insurance cooperatives which are not prohibited from covering abortion or subsidizing plans that cover abortion.   Also, at least one private plan in each premium rating area must provide coverage for abortion.  The Baucus bill allows tax-credits and cost-sharing credits to be applied to plans that pay for abortion, provided an accounting system is employed to label the funds used to pay for abortion as “private premium dollars,” preventing the use of government subsidies to pay directly for abortions.[4]   However, as with the Capps Amendment, this system does not alter the fact that the government will be funding insurance plans that cover abortion, in a departure from current practice.

B.     Pro-Life Amendments Rejected

1.      H.R. 3200

Members of the three House committees of jurisdiction offered amendments (1) to prohibit the inclusion of abortion coverage from the required basic benefits that any government or private plan must offer, and (2) to prohibit federal funding of abortion. However, all these amendments were defeated.

House Ways and Means Committee

            The amendment offered by Rep. Sam Johnson (R-TX) to prohibit abortion coverage failed by a vote of 18-23. 

The amendment offered by Rep. Eric Cantor (R-VA) to prohibit abortion funding failed by a vote of 19-22.

House Education and Labor Committee

            The two amendments offered by Rep. Mark Souder (R-IN) to prohibit abortion coverage and funding failed by votes of 19-29. 

House Energy and Commerce Committee

The amendment offered by Rep. Stupak (D-MI) and Pitts (R-PA) to prohibit abortion funding failed by a vote of 27-31. 

Perhaps the clearest example that Congressional leadership intends these bills to mandate abortion coverage occurred on July 30.  Rep. Pitts and Rep. Stupak offered an amendment to prohibit abortion coverage. On the initial vote, the amendment passed by a vote of 31-27. However, because he did not have the votes present to defeat the amendment, Chairman Henry Waxman (D-Calif.) voted in favor of this amendment on the initial vote so that a re-vote would be possible. (House rules allow the chair to reconsider an amendment if the chair originally voted in favor.) When the amendment was subject to a re-vote, Chairman Waxman and Rep. Bart Gordon (D-Tenn.) changed their votes to No, defeating the amendment 30-29. In addition, Rep. Zack Space (D-Ohio), who was not present for the initial vote, voted no on the amendment for the revote.

2.      Senate HELP Bill            

In the Senate HELP Committee, pro-life amendments were universally defeated as well, with only Senator Bob Casey (D-PA) crossing party lines to support them.  These included amendments offered by:

Sen. Mike Enzi (R-Wyo.), that would have prevented taxpayer funding of abortion (see amdts. 276 and 277) and an amendment which would prevent abortion clinics from being eligible for federally qualified health center grants(amdt. 275, See sec 172 of the bill).

Sen. Hatch (R-Utah), that would prevent tax-funded abortions unless the life of the mother is endangered (amdt. 210), or unless the pregnancy is the result of rape or incest (amdt. 227).

Sen. Coburn (R-OK), that would have ensured no abortion mandates (amdt. 270), prevented abortion clinics from being eligible for federally qualified health center grants (amdt. 273) and prevented the invalidation of state laws that regulate abortions (amdt. 272). His amendments failed 12-11.

Sen. Pat Roberts (R-Kan.), that would have prevented the invalidation of state laws regulating abortion (amdt. 204). It likewise failed 12-11.

3.      Senate Finance Bill

The Senate Finance Committee also defeated an amendment that would have added explicit language prohibiting federal funding and coverage of abortion.  Senator Hatch (R-UT) offered an amendment (#C14) that would have prohibited the authorization or appropriation of federal funds for “elective abortions and plans that cover such abortions,” with an exception for rape, incest, or the life of the mother.  The amendment also clarified that insurance companies could choose to offer separate, supplemental policies to cover elective abortions.  Such policy would need to be completely separate and paid for entirely by the individual choosing the policy.

The amendment failed 13-10, with Senator Snowe (R-ME) crossing party lines to vote against the amendment, and Senator Conrad (D-ND) crossing party lines to support the amendment.

C.     Courts Interpret “Mandatory Categories” of Care to Include Abortion

In Planned Parenthood v. Engler, 73 F.3d 634 (6th Cir. 1996), a U.S. Court of Appeals held that abortion “fall[s] within several of Medicaid’s mandatory categories of care” and that a state law that restricted funding for abortion to those necessary to save the mother’s life conflicts with the “mandate” of Medicaid. Id. at 637. The court held that “under Medicaid, certain categories of medical care are mandatory and therefore must be provided by participating states when a physician certifies that the care is medically necessary to the patient…” The court concluded that “the mandatory categories of care” included “inpatient hospital services,” “outpatient hospital services,” “other laboratory and X-ray services,” “nursing facility services” “early and periodic screening and diagnosis for individuals under the age of 21,” “family planning services” and “physician services furnished by a physician.” Though “abortion” is not explicitly named in any of those services, the court broadly concluded, “abortion fits within many of the mandatory care categories, including ‘family planning,’ ‘outpatient services,’ ‘inpatient services,’ and ‘physician services.” See also Hope Medical Clinic v. Edwards, 63 F.3d 418 (5th Cir 1995); Little Rock Family Planning Services v. Dalton, 60 F.3d 497 (8th Cir. 1995), cert. denied, 116 S.Ct. 777 (1996); Hern v. Beye, 57 F.3d 906, 910 (10th Cir. 1995), cert. denied, 116 S.Ct. 569 (1995).

The above referenced judicial interpretation of Medicaid — whereby abortion is included within broad categories of “medically necessary” services — will certainly be applied to any federal statute involving health care reform.

D.    Bypassing the Hyde Amendment Through Back Door Spending Authority

The Hyde Amendment, a yearly “rider” to the Labor, Health and Human Services (LHHS) Appropriations bill, prohibits the use of taxpayer money for abortion through the Medicaid program. The Hyde Amendment is not permanent law; it must be introduced and approved each year in order to prohibit taxpayer money from financing abortion.

However, even if the Hyde Amendment were to remain intact legislatively, the funding mechanism employed by Congress to pay for the trillion dollar health care reform effort circumvents the Hyde Amendment, rendering it inapplicable.

Instead of following the normal path that authorization bills follow, in which the authorizers present completed legislation to the appropriators in order to fund the project, H.R. 3200 self-appropriates by funding new programs through a Trust Fund created specifically for that purpose. See H.R. 3200, Sec. 207 (c)(2). Referred to as “back door spending authority”, this tactic bypasses the appropriations committee in order to obtain funding for its new spending. 

The Senate Finance Committee bill provides a refundable tax credit to be used for purchase of health insurance through the state exchanges for individuals up to 300% of the federal poverty level. The premium tax credit will be refundable and payable in advance directly to the insurer. The Treasury will pay the premium credit amount to the insurance plan in which the individual is enrolled.[5]  The Hyde Amendment will not apply toward the tax credits because the Baucus bill bypasses the Appropriations process.  Funding for the tax credits will not depend upon the yearly Appropriations process; therefore, Hyde does not apply.

II.                Freedom of Conscience in Health Care Reform Bills

A.     H.R. 3200

H.R. 3200 currently contains two conscience clauses. Reps. Pitts, Stupak, and Lee Terry (R-Neb.) drafted a conscience clause which the Energy and Commerce Committee passed by voice vote, and Rep. Capps also included a conscience clause in the amendment she successfully offered on July 30.

The Stuapak-Pitts Amendment mirrors existing law, i.e., the clear protections for those who oppose abortion which are provided annually through the Hyde/Weldon conscience amendment (that must be added to an appropriations bill annually).  It prohibits federal, state, or local governments that receive funds under H.R. 3200 from subjecting any health care entity to discrimination “on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.” 

By contrast, the Capps Amendment prohibits health insurance plans participating in the Exchange (not government entities) from discriminating “against any individual health care providers or health care facility because of its willingness or unwillingness to provide, pay for, provide coverage of, or refer for abortions.”  In other words, this provision protects the right of conscience for abortion providers, and would therefore require pro-life insurance companies to contract, against their conscience, with abortion providers.

B.     Senate HELP Bill

The late Sen. Ted Kennedy (D-MA) offered an amendment on July 13 to the HELP bill (amdt. 205) which would ensure that no health care provider or entity is excluded from contracting with an insurance plan participating in “the Gateway” (the HELP bill’s health care exchange framework) on the basis that the provider or entity refuses to perform abortions if performing abortions would be contrary to the religious or moral beliefs of the individual or entity. This amendment was accepted. The scope of the Kennedy amendment is limited however. It does not cover providers who refuse to pay for or refer patients for abortion services. In addition, the amendment provides an exception for “cases of emergency,” which is undefined and can be stretched to fit almost any situation, effectively stripping providers of any protection the amendment may have offered them. Medical providers need true rights of conscience protection and an ability meaningfully to object to performing abortions.

Sen. Coburn offered an amendment (a codification of the Hyde/Weldon conscience amendment that must be added to an appropriations bill annually) to ensure that health care providers are not forced to participate in abortions or discriminated against because they choose not to do abortions (amdt. 246). The Coburn amendment was defeated.

C.     Senate Finance Bill

The Senate Finance Bill includes a conscience provision that mirrors the Capps Amendment in H.R. 3200.  Like the Capps Amendment, the Senate Finance Bill would also protect abortionists from discrimination, thereby forcing pro-life insurance companies to contract with the abortionists. 

Senator Orrin Hatch offered an amendment (#C13) that would have mirrored the Hyde/Weldon conscience amendment (that must be added to an appropriations bill annually).  However, it was defeated 13-10, with Senator Snowe (R-ME) crossing party lines to vote against the amendment, and Senator Conrad (D-ND) crossing party lines to support the amendment.

III.             Curtailment, Withdrawal, or Denial of Effective Life-Sustaining Treatment

All of the versions of health care reform expand upon the use of Comparative Effectiveness Research (CER), which is used to compare the benefits and harms of methods to prevent, diagnose, treat, and monitor a clinical condition and improve delivery of health care, without including language that sufficiently ensures that the results of CER will not be used to mandate or encourage the withdrawal or curtailment of effective life-sustaining treatment for the terminally ill, the chronically ill, or the permanently disabled.

CER could become a means of advocating for the least expensive treatment at the expense of respect for life. With cost as the only driver, the elderly, sick, and disabled may find their options for care severely limited.

A.     H.R. 3200

Section 1401 of H.R. 3200 establishes its own version of a CER entity, the Center for Comparative Effectiveness Research, within the Agency for Healthcare Research and Quality (AHRQ). The entity is funded by a CER Trust fund, a combination of appropriations and a per-capita fee on Medicare and private insurers, described in Sec. 1802 of the bill. The Center would conduct, support, and synthesize research on outcomes, effectiveness, and appropriateness of health care services and procedures. An independent CER Commission would oversee the activities of the Center.

B.     The Senate HELP Bill

The Senate HELP bill also establishes a comparative effectiveness entity in Sec. 937 called the Center for Health Outcomes Research and Evaluation. The bill states in Sec. 937 (h)(1) that “Center reports and recommendations shall not be construed as mandates for payment, coverage, or treatment.” However, nothing in the current bill prevents the results of comparative effectiveness research (CER) from being used to deny treatment.

Likewise, Sec. 2707 of the HELP bill requires that insurers develop and implement a reimbursement structure for making payments to health care providers that provides incentives for use of evidence-based medicine and best clinical practices. (See Sec. 2707 (1)(C)).

Also, the Senate HELP bill permits a Medical Advisory Council to determine a minimum set of health care benefits that will be required under all public and private plans. The Council will report to the Secretary of Health and Human Services.

C.     Senate Finance Bill

The Senate Finance Committee bill establishes the Patient-Centered Outcomes Research Institute (the “Institute”) as a private, non-profit corporation which would conduct research and evidence synthesis and disseminate their research findings. In addition, the Institute would, among other things, identify and carry out research priorities, appoint advisory panels, provide for a peer-review process for primary research, and submit annual reports to the Congress, the President, and the public.

Importantly, the Senate Finance Committee bill does not tie the results of the CER studies to reimbursement.  Even so, concerns remain because three amendments that would have explicitly prevented CER from being used to mandate or encourage the withdrawal or curtailment of effective life-sustaining treatment to the elderly, terminally ill, chronically ill, or permanently disabled were defeated (see Memo Sec. D(3) below).

Also, the Senate Finance Committee bill actually amends the American Recovery and Reinvestment Act (ARRA) and its CER framework by incorporating the ARRA’s CER Coordinating Council into the new Institute’s governance and requiring the Coordinating Council of the ARRA to coordinate its activities with the Senate Finance Committee’s CER Institute.

To fund the CER Institute, the Senate Finance Committee bill establishes a CER Trust fund, funded by general monies from the treasury and a tax on health insurance policies. $1.27 billion would be transferred to the Trust Fund through FY2019. Also, the bill would impose a fee of $1 in FY2013 and $2 in FY2014 through FY2019, on each health insurance policy in the United States multiplied by the number of lives covered under that policy. This fee would sunset after FY2019.

D.    Pro-life Amendments

1.      H.R. 3200

While several pro-life amendments to the CER provision in H.R. 3200 were accepted in the Energy and Commerce Committee mark-up, others were defeated, as were all of the pro-life amendments to the CER provisions offered in the other House and Senate Committees.  Because five, distinct versions of health care reform were reported out of the five committees of jurisdiction, there is no guarantee that the final bill will include the pro-life provisions added in Energy and Commerce.

Energy and Commerce Committee

An amendment offered by Representatives Donna Christensen (D-VI), Jay Inslee (D-WA), Greg Walden (R-OR), and Fred Upton (R-MI) during the Energy and Commerce Committee markup would have made it explicit that the CER research would not be used in ways that interfere with the treatment decisions made by doctors and their patients. It would have created an independent Institute to oversee a patient-centered research program–unlike the current House version which establishes the CER entity as part of HHS’ AHRQ. It would also have ensured appropriate use of results by requiring the research Institute to recognize differences in patients (including differences based on race, ethnicity and gender), separating the research Institute from policy decision-makers, and protecting the ability of physicians to tailor their use of the CER results to the needs of individual patients.

The amendment was slated to be considered by the Committee when Congress returned from August recess; however, the amendment was not among the group that the Committee ultimately considered.  Therefore, the amendment was effectively defeated.

Rep. Phil Gingrey (R-GA) offered three amendments concerning CER. Two of Gingrey’s amendments passed by voice vote, while the third was rejected by a vote of 33-24.

Gingrey’s first amendment prevents the House CER entity from developing “quality-adjusted life year measures” or any other methodologies that can be used to deny benefits to a beneficiary against the beneficiary’s wishes on the basis of the beneficiary’s age, life expectancy, present or predicted disability, or expected quality of life.

Gingrey’s second amendment prevents the results of CER from determining health coverage decisions.

Rep. Gingrey’s third amendment, which failed by a vote of 33-24, likely failed as a result of being overly broad. The text of Rep. Gingrey’s amendment is here:

“Nothing in this section shall be construed to allow any federal employee or political appointee to dictate how a medical provider practices medicine.”

Rep. Mike Rogers (R-MI) also offered a CER-related amendment which was accepted by voice vote. Rep. Rogers’ amendment prevents the Federal government and private insurers from using Federal comparative effectiveness research for care rationing or limiting reimbursement levels.

However, another amendment offered by Rep. Mike Rogers on CER was rejected by the Committee by a vote of 35-23. This amendment would have prevented the use of comparative effectiveness research from being used to decide whether to offer or withhold coverage or to reduce reimbursements for healthcare providers for offering treatments.

Finally, Rep. Tim Murphy (R-PA) also offered an amendment which passed by voice vote. Rep. Murphy’s amendment requires the new Center for Comparative Effectiveness Research and the new Health Choices Commission to consult with the specialty colleges and academies of medicine in determining any official recommendation or standards for best practices.

Ways and Means Committee

Rep. Wally Herger (R-CA) offered an amendment at the Ways and Means Committee mark up of H.R. 3200 which would have prohibited the use of CER to make coverage determinations on the basis of cost. This amendment was defeated by a vote of 26-15.

Education and Labor Committee

No amendments on CER were considered during the Education and Labor Committee mark up.

2.      Senate HELP Bill

All amendments to prohibit cost-driven curtailment, withdrawal or denial of care were rejected.  On June 22, 2009, Sen. Enzi offered two amendments to the HELP Committee bill which would have prevented the denial of end of life care and prohibit rationing on the basis of patient age, disability, medical dependency or quality of life. (amdts. 278 and 280).[6] These amendments were rejected on a party line 13-10 vote. Opposition was lead by Sen. Mikulski.

Sen. Hatch also offered amendments to the bill which would have prevented the rationing of health care available to patients (amdts. 232 and 233) and ensured that taxpayers were not forced to fund assisted suicide (amdt. 228). The Hatch amendments were rejected by a vote of 13-10 on June 18, 2009.

Sen. Roberts offered three amendments which would have prevented private health insurers from being prohibited from covering treatments (because of the Medicare payment policy tie-in language.), which would have ensured that all individuals have access (if they wish for such access) to essential health benefits” (as defined by the Secretary under this title) regardless of their age, expected length of life, disability, etc., and one which would have required the Gateway (Exchange) to certify that participating plans do not have a pattern or practice of denying coverage to individuals based on their age, expected length of life, disability (amdts. 209, 210, and 211). The Roberts amendments were defeated by a 13-10 vote.

3.      Senate Finance Bill

Three amendments relating to CER were defeated in Committee.  These amendments would have addressed concerns that CER could be used to mandate or encourage the withdrawal or curtailment of effective life-sustaining treatment to the elderly, terminally ill, chronically ill, or permanently disabled.

Senator Pat Roberts (R-KS) offered an amendment (D5) that would have prohibited cost from being a factor in any comparative clinical effectiveness research conducted using federal funds under this bill and existing law. Failed 8-14.

Senator Roberts also offered an amendment (D4) that would have removed the comparative effectiveness provisions in the bill (the Patient-Centered Outcomes Research Act of 2009).  Failed 9-14.

Senator Jon Kyl offered an amendment (D8) that would have added the “Preserving Access to Targeted, Individualized, and Effective New Treatments and Services (PATIENTS) Act of 2009” (S.1259).  The PATIENTS Act would have ensured that data obtained from CER would not be used to deny coverage of an item or service under a federal health care program.  It would have also ensured that CER would account for factors contributing to differences in the treatment response and treatment preferences of patients.  Failed 10-13.

IV.              End of Life Care

In H.R. 3200, section 1233 addresses end of life care. The section leaves unclear whether the government or a health care provider could counsel or encourage a patient to choose physician-assisted suicide as a solution to terminal illness. While section 1233 remains in the bill, an amendment offered by the “Blue Dog Democrats” and accepted by the Energy and Commerce Committee, Sec. 138, prevents the “promotion” of assisted suicide (though not the practice of it), and makes it clear that material distributed by Qualifying Health Benefits Plans (QHBPs) “shall not include advanced directives or other planning tools that list or describe as an option suicide, assisted suicide or the intentional hastening of death regardless of legality.” (However, there is an exception to this for states which already require this information to be listed.)  However, it is unclear how the potentially conflicting Section 1233 and Section 138 relate to one another.

In the Senate Finance Committee, a modification was added to the bill that included Senator Hatch’s amendment to prohibit federal funding for assisted suicide and provide conscience protection for those who refuse to participate in assisted suicide.  (#C12, Page 17).

Conclusion

In order to move forward, the health care reform legislation before Congress must ensure that life at all stages is protected.  This requires:

·        The inclusion of language that explicitly prohibits abortion funding or coverage.

·        The permanent codification of the Hyde Amendment.

·        The removal of the Capps Amendment and Mikulski Amendment.

·        The inclusion of broad, explicit language that codifies the right of conscience (such as the Pitts/Stupak conscience amendment to H.R. 3200, rather than the Kennedy Amendment to the Senate HELP Bill).

·        The exclusion of government-defined end-of-life counseling.

·        Language that ensures that Comparative Effectiveness Research included in the bill and in existing law will not be used to mandate or encourage the withdrawal or curtailment of effective life-sustaining treatment to the terminally ill, the chronically ill, or the permanently disabled.

This week, the Senate Finance Committee is expected to report (vote) out of Committee Chairman Baucus’ version of health care reform.  Like the other four Committees (three in the House and one in the Senate) that have reported out health care reform bills, the Senate Finance Committee failed to include in the legislation language that would adequately prevent federal funding and coverage of abortion.

Recent intelligence from the Hill indicates that a purported “compromise” on abortion funding and coverage in health care reform is in the works.  Rumor has it that the template for the language will be Rep. Lois Capps’ (D-CA) amendment that was added to the House version of the bill (H.R. 3200) during the Energy and Commerce Committee mark-up.

In response to the backlash against her amendment, Rep. Capps sent a letter to Speaker Pelosi, arguing that her amendment “was carefully written to preserve the status quo regarding the ban on federal funding for abortion services.”  In reality, the Capps Amendment, and the similar language in the Senate Finance Committee Bill, is a radical departure from the status quo.  Here are Rep. Capps’ arguments in support of her amendment, followed by AULA’s responses.

Rep. Capps:  “The Capps compromise applies the current Hyde amendment to health care reform.  It prohibits federal funding for abortion beyond the cases of rape, incest or life of the woman.  If a health plan chooses to offer abortion coverage beyond these exceptions, it cannot use federal funds to do so.”

AULA:  This statement is inaccurate.  Hyde does not apply since reform would be funded outside of HHS (to which Hyde applies).  Nor, is anything like Hyde part of the Capps Amendment.  While the Hyde Amendment prevents any federal funds from paying for elective abortions through Medicaid, the Capps Amendment explicitly allows the Secretary of HHS to require funding for elective abortions in the public option.  Furthermore, the Capps Amendment permits government subsidies to go to private health care plans that cover elective abortion.  While participating health care plans are supposed to “provide assurances” that no federal funds are used directly to pay for abortions, that does not change the fact that federal dollars are going to plans that cover elective abortions. 

Rep. Capps:  “[N]o money from the Treasury will be directed to abortion services . . . [because] money is transmitted to a private contractor who then reimburses physicians. . . .”

AULA:  The fact that the U.S. Treasury will transmit funds to private contractors, who then pay physicians (i.e. abortionists), does not magically transform the money from federal money to private money!  Furthermore, as previously stated, a private plan’s “assurances” that they are not using federal subsidies to pay for abortions is not enough – no private plans that cover abortions should receive federal subsidies.  Contrast this with current law under the Hyde Amendment.  Under the Hyde Amendment, the Federal Employees Health Benefits Program (FEHBP) cannot include any plans that cover elective abortion.  In other words, no federal subsidies go to health care plans that include abortion coverage.  That is the status quo –the federal government does not subsidize elective abortion coverage.

Rep. Capps:  “[I]n 17 states Medicaid provides coverage for abortions beyond the Hyde exceptions.” 

AULA:  The truth is that under the current version of the Hyde Amendment to Medicaid, states MAY NOT use federal funds or their matching funds to pay for abortions.  If states want to pay for elective abortions, they must use their own revenues that are completely separate from the Medicaid program.  In other words, states must appropriate additional funds, not Medicaid-matching funds, to pay for abortions. In the same way, any states that wish to pay for elective abortions for women who qualify for subsidized health care under the health reform bills may choose to set up their own programs – nothing is stopping them.  However, in order for health care reform to remain consistent with the status quo, no federal dollars can go to insurance plans that cover abortion.

Rep. Capps:  “[T]here is also a requirement in my amendment that in each region, there must be at least one health plan available that does not cover abortion services.”

AULA:  Rep. Capps fails to mention that there is also a requirement that every region include at least one health plan that covers elective abortion.  In other words, under her amendment, for the first time, the Federal government will ensure that there is a private insurance plan within everyone’s reach that covers abortion. 

Rep. Capps closes the letter stating that she “worked with great diligence to craft a common ground solution.”  However, there is no “common ground” in the “status quo” on federal funding and coverage of abortion.  Today, elective abortion is not covered or funded under federal law.  Make no mistake — the Capps amendment will change the status quo to embrace federal funding and coverage of abortion.

It was reported last week that, for the first time, surgeons in the U.K. have successfully treated an extremely ill heart patient with a combination of an artificial heart and his own stem cells.  The patient was fitted with a mechanical pump and then injected with 6 million of his own stem cells, in hope that those cells would repair damage in the patient’s heart.

This success raises questions for us in the United States.  First, why are embryonic stem cell advocates—and the President and his administration—still pushing for destructive research that has yet to successfully treat a single human person, while ignoring the need for substantial funding of adult stem cell research?  Once again, AUL is here to point out that adult stem cells have been used to treat or cure patients with over 70 different diseases and conditions, while there have been absolutely no successes with embryonic stem cell research.  We’re starting to feel like a broken record.

Yet the message is still not getting across.  To date, only sixteen states promote or encourage the use of umbilical cord cells and/or other forms of adult stem cells for research.

But an underlying question is also raised, one that is timely as we wait to find out what kind of health care we will be left with once the federal government takes over. 

In relaying the patient’s story, Sky News reported that NHS in the U.K. will not pay for this life-saving treatment.  Instead, the patient said he “relies on charity funding—or travels abroad to implant pumps in countries where governments are prepared to fund the £60,000 devices.” 

Interesting.  This patient—in a country with nationalized healthcare that is the predecessor to what President Obama is seeking for the United States—has to travel outside of the U.K. to other countries that are willing to pay for his treatment.

The surgeon himself stated, “I am very frustrated that all the work that I have done back home in the UK has to be translated into patient care in other countries,” and “”[w]e have helped to develop implantation programmes in France, Greece and Japan. It’s time we did it in the UK.”

He believes that this treatment protocol for heart patients could save 12,000 patients each year.

The article continues:

The Greek government has recently agreed to fund pumps for some patients with serious heart failure.

Professor Papakonstantinou [a heart surgeon at the Ahepa University Hospital in Thessaloniki] said they offer good value for money because patients are able to leave hospital and do not need drug treatment.

But in Britain, the NHS will only fund pumps in transplant patients who are waiting for a donor heart. Around 100 a year are implanted.

In a statement, the Department of Health said: “Before making such technology more widely available as an indefinite long-term treatment in end-stage heart failure, the NHS needs to ensure there is clear evidence of benefit.

Apparently 11,900 extra lives saved isn’t a clear enough benefit.
I’m not sure this is what most Americans have in mind when they think “health reform.”

The article from Sky News can be viewed at http://news.sky.com/skynews/Home/Health/Artificial-Heart-And-Stem-Cells-Save-Mans-Life-In-Pioneering-Surgery-By-British-Surgeon/Article/200909415387553?lpos=Health_Second_UK_News_Article_Teaser_Region_0&lid=ARTICLE_15387553_Artificial_Heart_And_Stem_Cells_Save_Mans_Life_In_Pioneering_Surgery_By_British_Surgeon

Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee (SFC), released his Committee’s health care reform bill on September 16, 2009.  The SFC bill, America’s Healthy Future Act of 2009, provides the spending cuts which will offset the costs of health care reform.  The SFC and the Senate HELP Committee share jurisdiction over health care reform in the Senate, but only the SFC can determine the funding offsets.

The SFC is scheduled to mark up its bill this week.  For daily updates on life-related amendments in the SFC mark-up, click here.  The SFC marks up “in concept” as opposed to amending specific statutory language.  In other words, the process works like this:  First, a member of the Committee offers an amendment to change a provision of the bill.  After debating the amendment, the Committee members vote on it.  If a majority of the members vote in favor of the amendment, the bill’s language will reflect the change made by the amendment.  Three Senators, Orrin Hatch (R-UT), Michael Enzi (R-WY) and Jay Rockefeller (D-WV) plan to offer amendments during the mark up concerning abortion.

Currently, the SFC bill addresses abortion in a way that closely parallels the abortion provisions in the House health care reform bill, H.R. 3200, America’s Affordable Health Choices Act of 2009, as added by the Capps amendment. One key difference in the SFC bill, however, is its rejection of the public health insurance option. Where the Capps amendment assures abortion will be a mandatory public plan benefit, the SFC bill does not raise this same concern because it does not include a public plan option.

Pro-life Provisions

On abortion the SFC bill:

Leaves intact state laws regarding the prohibition or requirement of coverage or funding for abortions, and state laws involving abortion-related procedural requirements (see pg. 25); and

Ensures that at least one insurance plan in each state exchange does not provide coverage for abortion (except for abortions in cases of rape, incest or life of the mother) (see pg. 27).  

On conscience protection:

Maintains Federal conscience protections and abortion-related antidiscrimination laws (see pg. 25).

Pro-abortion Provisions

However, the SFC bill also:

Allows qualified health plans to provide coverage for all abortions (see pg. 26) and mandates that at least one plan in each state exchange provide coverage of all abortions (see pg. 27);

Permits “cost-sharing credits” to go to private plans that cover abortion services provided that the plans “segregate” the funds and use only premium dollars to pay for the abortion services (however, this accounting mechanism does not hide the fact that the government is allowing the plans that cover abortions to receive the credits) (see pg. 26);

Would allow the federal government to mandate abortion coverage for abortions in private health insurance if the Hyde amendment ever fails (see pg. 26).

Is not funded through the Labor, Health and Human Services (LHHS) Appropriations Bill, so the Hyde Amendment (which prohibits the use of taxpayer money for abortion through the Medicaid program) does not apply to the bill. 

AUL Action urges the SFC to accept the pro-life amendments offered by Senators Hatch and Enzi in the upcoming days and to respect life through this important reform.

End of Life Provision

There are no provisions addressing end-of-life issues in the Bill.

Physician Quality Reporting / Rationing Provision

The SFC bill would require the Secretary of HHS “to provide reports to physicians that compare their resource use with that of other physicians or groups of physicians caring for patients with similar conditions.”  Beginning in 2015, “payment would be reduced by five percent if an aggregation of the physician‘s resource use is at or above the 90th percentile of national utilization.”  In other words, doctors who fall in the top 10% of expenditures, compared to doctors treating similar patients and conditions, would be penalized.  This could lead doctors to make decisions based on reimbursement concerns rather than concerns for their patients.

In today’s Washington Times, three days after AUL’s meeting with White House officials failed to give adequate reassurances that abortion funding would not be in the health care bill, an op-ed by AUL President & CEO Dr. Charmaine Yoest strikes to the core of the current debate: “Is Abortion Health Care, or Is it Not?”

The truth is that the health care packages under consideration do include abortion funding. Without a specific statutory amendment that includes an explicit ban on federal funding and coverage, we face health care reform that includes abortion.

Lost in the debate over whether or not abortion is “in there” – whether or not you can flip to a certain page and point to a particular clause related to abortion funding – is an understanding among political elites that this is a watershed battle over definition. It’s existential, if you will, and comes down to a very straightforward question: Is abortion health care, or is it not? …

Planned Parenthood and the abortion lobby define abortion as health care, as being morally equivalent to a tonsillectomy, and health care reform is their vehicle for imposing that view definitively with the full force of the federal government.

Learn more:

• Watch the recent TV appearances of Dr. Charmaine Yoest on Fox News and AUL Staff Counsel Mary Harned on CBN, each giving the inside story on their meeting last week at the White House.
• Read coverage of AUL’s White House meeting at FoxNews.com, the Washington Examiner, LifeSite, CBN.com’s Brody File, and LifeNews.

This week, Americans United for Life’s legislative arm AUL Action met with senior White House officials Melody Barnes, Tina Tchen and Joshua DuBois.  AUL Action President and CEO Dr. Charmaine Yoest called on the White House to clarify President Obama’s recent statement of support for keeping abortion funding out of health care reform.  After the meeting, Dr. Yoest stated that the White House remained noncommittal on explicit language excluding abortion from the health care bill. 

“After the meeting, we remain deeply concerned about abortion funding and the abortion mandate in health care reform.  Ms. Barnes reiterated the President’s statement about opposing abortion funding in his address before Congress last week but the White House would not commit to language that explicitly excludes abortion from health care reform.  The reality on the Hill right now is that the health care bills do include abortion funding. 

Without a specific statutory amendment that includes an explicit ban on federal funding and coverage, taxpayers will be paying for abortion.  Including abortion in health care is something the pro-life movement will oppose vigorously.”  

Dr. Yoest provided the White House with a brief from the Americans United for Life legal team that documents why anything less than a explicit ban on abortion funding and coverage will allow government-funded abortion.     

Dr. Yoest also delivered a petition with over 39,000 signatures from pro-life Americans telling President Obama that they urge him to veto any bill that does not specifically forbid mandating insurance companies to cover abortion.  The petition also urges the President to veto any bill that could make taxpayers responsible for directly or indirectly paying for abortion.  

For further information, please visit AUL’s health care website: www.RealHealthCareRespectsLife.com

CBN Story: Pro-Lifers Suspicious of New Health Care Bill

Americans United for Life’s sister organization Americans United for Life Action will relay the pro-life community’s deep concerns about health care reform directly to the White House this Thursday, September 17, when AUL Action meets at the White House with Melody Barnes, President Obama’s Domestic Policy Advisor, Tina Tchen, who directs White House’s Office of Public Engagement and Joshua Dubois, director of the White House’s Office of Faith Based and Neighborhood Partnerships.

Americans United for Life Action President and CEO Dr. Charmaine Yoest said, “We plan to take the message to the White House that real health care respects life. Abortion is not health care, but without an explicit, proactive exclusion of abortion, the courts will impose an abortion mandate just as they did with Medicaid. The abortion lobby is using health care reform to try to end-run around the Hyde Amendment which has been a thorn in their side. Their ultimate objective is to define abortion as basic health care which Americans do not support. We have a petition to the President protesting the abortion mandate on www.realhealthcarerespectslife.com that we intend to hand deliver at our meeting.”

The White House made the invitation in response to AULA’s open letter to President Obama, and Dr. Yoest’s agenda items for it include the concerns outlined in that letter: the current health care reform bills’ mandating government coverage and funding of abortion, their insufficient provisions for conscience protection, and the risk the bills carry of denial of care for the elderly and very ill.

          AULA Staff Counsel Mary Harned asks: “If pro-abortion members of Congress do not intend for the health care reform bills to fund and mandate abortion coverage, why did they vote against all amendments that would have included explicit language excluding abortion funding and coverage?

These Pro-life Amendments Explicitly Excluding Abortion in the Health Care Bills Were Defeated:

U.S. Senate

• (1) Senator Mike Enzi’s (R-WY) amendments that would have prevented taxpayer funding of abortion and would prevent abortion clinics from being eligible for federally qualified health center grants;
• (2) Senator Orin Hatch’s (R-UT) amendments that would have prevented tax-funded abortions unless the life of the mother is endangered or unless the pregnancy is the result of rape or incest (making the Hyde Amendment permanent);
• (3) Senator Tom Coburn’s (R-OK) amendments that would have ensured no abortion mandates, prevented abortion clinics from being eligible for federally qualified health center grants, prevented the invalidation of state laws that regulate abortion, codified the Hyde/Weldon conscience protection law, and ensured that Americans have professional ethicists informing any Government-funded medical decisions; and
• (4) Senator Pat Roberts’ (R-KS) amendment which would have prevented the invalidation of state laws regulating abortion.

U.S. House of Representatives

In the Education and Labor Committee:

• • Amendment to prohibit the abortion coverage mandate (Rep. Souder) failed (19-29).
  • Amendment to prohibit the abortion funding mandate (Rep. Souder) failed (19-29).

 In the Ways and Means Committee:

• • Amendment to prohibit the abortion coverage mandate (Rep. Johnson) (failed 18-23).
  • Amendment to prohibit the abortion funding mandate (Rep. Cantor) (failed 19-22).

 House Energy and Commerce Committee:

• • Amendment to prohibit the abortion coverage mandate (Reps. Pitts, Stupak, and Blunt) (failed  29-30).
  • Amendment to prohibit the abortion funding mandate (Reps. Stupak and Pitts) (failed 27-31).

For further information, please visit AUL’s health care website:

www.RealHealthCareRespectsLife.com

Sen. Max Baucus (D-MT) has released his proposal for “America’s Health Future Act.”  This bill has been said to address the pro-life community’s concerns about abortion funding and coverage and freedom of conscience. The proposal deals with the issue of abortion by incorporating similar language to the Capps amendment to H.R. 3200, which does not explicitly exclude abortion coverage and funding; in fact, the Capps Amendment mandates abortion funding. 

Americans United for Life’s President and CEO Dr. Charmaine Yoest said, “This bill provides $6 billion for the establishment of health insurance cooperatives which would be permitted to cover abortion.  Under the Baucus bill, abortions permitted under the Hyde amendment (currently in cases of rape, incest or to save the life of the mother) can be mandated in the minimum benefits package. If the Hyde Amendment is ever eliminated, the Baucus bill would mandate coverage for all abortions.  Real health care respects life and the pro-life community will never support any bill that does not explicitly say that abortion funding and coverage is not allowed. ”

Americans United for Life’s sister organization, Americans United for Life Action, is meeting with the White House tomorrow to discuss concerns regarding abortion funding and coverage, conscience protection and end of life issues in the current health care reform proposals. 

Mary Harned, Americans United for Life’s Staff Counsel cautions that there is still a long road ahead in the health care fight: “The mark-up of the Baucus bill will begin next Tuesday.  Even if language expressly excluding abortion funding and coverage is added to the bill, it will then need to be reconciled with the bill reported from the Senate Health, Education, Labor and Pensions Committee.  After that process, the bill will then: (1) go through an amendment process on the Senate Floor; (2) go to conference where it will be reconciled with whatever bill the House produces.”

 For further information, please visit AUL’s health care website: www.RealHealthCareRespectsLife.com

In his address to a Joint Session of Congress this evening, President Obama repeated his claim that “no federal dollars will be used to fund abortion.”  However, he failed to commit to supporting language that explicitly prohibits the use of taxpayer dollars for abortion.

AUL’s President and CEO, Dr. Charmaine Yoest, expressed disappointment in the President’s address, stating, “President Obama has previously articulated a desire to see a decrease in the number of abortions performed in the United States.  Yet he is throwing his support behind legislation that will equate abortion with basic health care.”  Dr. Yoest further explained that “Americans understand that abortion is not health care, and that the women and unborn children in our country deserve better.” 

AUL’s Staff Counsel, Mary Harned, said, “No matter how President Obama and Congress change the structure of the health care reform proposals — whether there is a public option, co-op, exchange, or the like — any legislation that provides government funding for health care must contain explicit language that excludes abortion.  Abortion is not health care; however, based on how courts have interpreted Medicaid, we know that courts will interpret any legislation relating to government-funded health care as requiring abortion coverage unless there is an explicit prohibition (like Hyde).”

In their legal memoranda, AUL’s legal team has carefully explained how existing law will not prevent the health care bills from mandating taxpayer funding of abortion.  They also documented how seven circuit courts have held that abortion is covered under Medicaid, necessitating an explicit prohibition on the inclusion of abortion.  Dr. Yoest stated that “courts will certainly interpret any legislation that provides federal funding for health care as they have interpreted Medicaid in the past.  So, any health care reform must include an explicit prohibition on abortion funding and coverage.”

Current proposals mandate abortion coverage and funding in a number of ways, including:

1. An amendment to H.R. 3200 permits and may require abortion coverage in the public health insurance plan, and permits taxpayer funding of private plans that cover elective abortion through the provision of affordability credits
2. The Senate HELP bill delegates to a “Medical Advisory Committee” the role of deciding what benefits any private or public health care plan must offer. This Committee is expected to include abortion as a required minimum benefit.
3. Prior court holdings that state that abortion is included within several of Medicaid’s mandatory categories of care (inpatient services, outpatient services, and preventative care) will certainly apply to any federal statute revising Medicaid and involving health care reform.
4. The rejection of several key pro-life amendments in the House and Senate Committees, which would have ensured that abortion was not funded in the bills, demonstrates that the bills are intended to mandate abortion.

8:10 p.m. – As we await the President’s appearance, some words from AUL Staff Counsel Mary Harned, who has seen an advance copy of part of Obama’s speech: “No matter how President Obama and Congress change the structure of the health care reform proposals — whether there is a public option, co-op, exchange, etc. — any legislation that provides government funding for health care must contain explicit language that excludes abortion.  Abortion is not health care; however, based on how courts have interpreted Medicaid, we know that courts will interpret any legislation relating to government-funded health care as requiring abortion coverage unless there is an explicit prohibition (like Hyde).”

8:12 p.m. – The President is introduced.

8:17 p.m. – Obama starts by recounting America’s economic woes. “I will not let up until Americans who seek jobs can find them.” Applause.

8:18 p.m. – Claims that his “bold and decisive action” since January has “pulled the economy back from the brink.”

8:19 p.m. – “I am not the first President to take up this cause [health care], but I am determined to be the last.” Applause.

8:20 p.m. – “Our collective failure to meet this challenge … has led us to the breaking point.” He is trying to highlight a sense of urgency.

8:21 p.m. – “We are the only democracy, the only advanced democracy” [perhaps correcting himself due to speed-reading his Teleprompter] that “allows such hardship” (as being uninsured) for millions of its people.

8:22 p.m. – He’s now running down a list of horror stories about problems of uninsured people in America.

8:25 p.m. – “Our health care system is putting an unsustainable burden on taxpayers.” And YOUR agenda will cost us HOW much, Mr. President? Have you looked at your own CBO’s figures?

8:26 p.m. – Obama says that some think the only way to fix the system is to have a single-payer system like that in Canada. Someone in the hall thinks it’s an applause line. He goes on to say that he’d rather “build on what works and fix what doesn’t rather than building an entirely new system from scratch.” But the current House plan would in fact build an entirely new system.

8:28 p.m. – Starts complaining about “scare tactics” by opponents of Obamacare. “The time for bickering is over.” He’s raising his voice. “NOW IS THE SEASON FOR ACTION!” Applause.

8:29 p.m. – Claims his plan would “slow the growth of health care costs.” But is it a new plan — his own? He’s not specifying that he is in fact offering a plan.

8:29 p.m. – “Nothing in our plan requires you to change what you have.” But what is “our” plan? He’s implying he has his own plan, but hasn’t actually said he’s offering one. As Michael Steele said in Politico (will link the article shortly), there is NO plan currently in Congress that has all the things the Prez claims “our plan” has.

8:32 p.m. – He’s running down a long list of what his plan will offer. It’s much like RNC Chairman Michael Steele wrote earlier today:

Here’s what we know for sure – the president will give a good speech Wednesday night. He always does. We also know that he will say a lot of things that the American public likes and agrees with when it comes to health care reform. He always does.

But there is one small problem. Speaker Pelosi’s bill, a bill that the president has endorsed, doesn’t have anything in common with the president’s eloquent, poll-tested rhetoric. In fact, no Democrat proposal exists from the president or any of his congressmen that has anything in common with the president’s rhetoric.

8:35 p.m. – Says his plan will REQUIRE individuals to carry basic health insurance, just like drivers are required to carry auto insurance.

8:36 p.m. – “While there remain some significant aspects of the plan to be ironed out” — this line is met with laughter.

8:38 p.m. – Anger erupts from the crowd as Obama insists his reform would not cover illegal immigrants.

8:38 p.m. – “No federal dollars will be used to fund abortions, and federal conscience laws will remain in place.” WHAT conscience laws — the regulations he put on ice when he took office? And to say that federal dollars will not be used to fund abortions is misleading, as every plan in Congress right now would mandate abortion funding. Unless the President plans to immediately demand that abortion be explicitly excluded from any health care plan, the courts, under existing laws, will be required to read abortion into any plan passed by Congress. See AUL’s RealHealthCareRespectsLife.com for details on this.

Liveblogging will continue presently in a new post.

Today, Americans United for Life, the nation’s oldest national pro-life organization, launched its “Back to the Hill” campaign to educate lawmakers and Americans on the current health care proposals’ threats to the lives of the elderly, ill, and unborn. 

AUL’s sister organization AUL Action (AULA) sent a letter today to Speaker Nancy Pelosi to protest recent disinformation on her Web site about abortion in health care.  AULA is also meeting with the White House on September 17 to discuss the problem of taxpayer-funded abortion in the proposed health care reform.

Americans United for Life will be paying close attention to President Obama’s address this evening before a joint session of Congress.   President Obama has stated that claims that abortion was in the health care proposals were a “fabrication,” and has claimed that he aims to reduce the “need” for abortions.   However, on the campaign trail in 2007, Obama assured a Planned Parenthood Action Fund conference that abortion would be “at the center and the heart” of his health care reform, and the current health care proposals reflect that priority. AUL’s legal team has detailed the elements in the proposals that would mandate taxpayer-funded abortion coverage.

Dr. Charmaine Yoest, President and CEO of AUL, said, “Tonight, President Obama needs to address the abortion mandate in the health care reform proposals currently before Congress.  History has shown that where abortion is not explicitly excluded, courts will interpret legislative language to mandate it.” 

William Saunders, AUL Sr. Vice President of Legal Affairs, added, “An explicit and permanent prohibition on abortion coverage and funding is essential to prevent Congress, or an activist court, from mandating coverage and taxpayer funding of all elective abortions under the guise of health care.” 

AUL will be tweeting and liveblogging President Obama’s speech tonight. 

AUL’s Health Care Information Hub: Real Health Care Respects Life.com:

• Back to the Hill Guide: What to Expect Next
• FAQ about Health Care Reform
• Talking Points
• Video: Obama on Abortion in Health Care
• Health Care Bills in Congress
• End-of-Life Issues in Bills
• Federal Courts on Abortion in Current Bills
• Federal Courts on Abortion and Medicaid Coverage
• Status of the Hyde Amendment

Since the 1970s, federal courts have regularly interpreted the “mandatory categories of care” within Medicaid to include abortion and thus mandate abortion coverage. That judicial interpretation of Medicaid will be adopted by courts in interpreting federal health care legislation, unless abortion is expressly excluded.

In addition to the leading case of Planned Parenthood Affiliates of Michigan v. Engler—where the Sixth Circuit held that “abortion fits within many of the mandatory care categories, including ‘family planning,’ ‘outpatient services,’ ‘inpatient services,’ and ‘physicians’ services.’ 73 F.3d 634, 636 (6th Cir. 1996)—at least six other circuit courts (the First, Third, Fifth, Seventh, Eighth, and Tenth) have held that abortion is covered under Medicaid (unless there is a specific statutory exclusion like the Hyde Amendment). Some, like the Sixth Circuit, have specifically held that abortion is covered under the broad “mandatory categories of care” including “family planning” within Medicaid (Title XIX of the Social Security Act, 42 USC 1396d(a)).

The First Circuit, in Preterm, Inc. v. Dukakis held that abortion is covered by Medicaid and implicitly concluded within the mandatory Medicaid categories. 591 F.2d 121, 125 (1st Cir. 1979).

The Third Circuit, in Roe v. Casey, noted with agreement that “[t]he district court took note of the fact that standard abortion procedures ‘involve most, if not all’ of the types or classes of services which are to be furnished to the categorically needy” within Medicaid. Roe v. Casey, 623 F.2d 829, 832 (3rd Cir. 1980).

The Fifth Circuit, in Hope Medical Group for Women v. Edwards, held that a state statute limiting Medicaid-funded abortion procedures was “inconsistent with the broad objective of Title XIX to provide needed medical care to qualified recipients.” 63 F.3d 418, 428 (5th Cir. 1995). The court stated, “[a]lthough Title XIX does not specifically include abortion as a mandatory service, the parties concede that abortion services fall under several of the eight broad categories of medical services mandated by the Act, including inpatient hospital services, outpatient hospital services, physician’s services, and family planning services.” Id. at 425.

The Seventh Circuit, in Zbaraz v. Quern, agreed with the First Circuit’s decision in Preterm “that limiting Medicaid assistance to life-threatening abortions “violate[s] the purposes of the Act and discriminate[s] in a proscribed fashion” 596 F.2d 196, 199 (7th Cir. 1979).

The Eighth Circuit in 1980 held that “[the Medicaid mandatory categories] include medical procedures to induce abortions.” Hodgson v. Board of County Com’rs, Hennepin County, 614 F.2d 601, 607 (8th Cir. 1980). And in Little Rock Family Planning Services, P.A. v. Dalton, the court held that “[a] state plan must cover medical services that a person’s physician certifies are “medically necessary.” 60 F.3d 497, 499 (8th Cir. 1995). Though the Dalton court admitted that “[Title XIX] does not identify any specific medical procedures, whether they are Caesarean sections, transfusions, bypass surgery, or abortions.” Id. at 499, it concluded that “[b]ecause abortion falls within several of these mandated categories [of medical service], a medically necessary abortion is a mandatory covered service.” Id.

The Tenth Circuit, in Hern v. Beye, held that “[a]bortion falls under several … ‘mandatory coverage’ categories, including ‘inpatient hospital services,’ 42 U.S.C. § 1396d(a)(1), ‘outpatient hospital services,’ id. § 1396d(a)(2)(A), ‘family planning services,’ id. § 1396d(a)(4)(C), and ‘physicians’ services furnished by a physician,’ id. § 1396d(a)(5)(A).” 57 F.3d 906, 911 (10th Cir. 1995).

In addition, several federal district courts have read abortion into Medicaid.

In Doe v. Busbee, the court concluded that “[i]t is clear that an abortion is a medical procedure which falls within the five general categories set out in Title XIX.” 471 F.Supp. 1326, 1331 (N.D. Ga. 1979).

In Smith v. Rasmussen, the court held that “[a]bortions . . . fall within several of Medicaid’s mandatory categories of care.” 57 F.Supp.2d 736, 755 (N.D. Iowa, 1999).

In Planned Parenthood Affiliates of Ohio v. Rhodes, the court broadly held that “[t]he ‘promotion’ of abortion, whether it consist of counseling, encouraging, referring, assisting or even performing medically necessary abortions is included in the five general categories.” Planned Parenthood Affiliates of Ohio v. Rhodes, 477 F.Supp. 529, 540 (E.D.Ohio, 1979).

Finally, in reading these decisions, it must be understood that a “medically necessary” abortion is—under the Supreme Court’s abortion doctrine—whatever an abortion provider, in his/her personal, subjective judgment, determines it to be. The terms “necessary” and “medically necessary” are virtually synonymous, because both vest the abortion provider, in his or her subjective judgment, with complete discretion to determine their meaning. As the lower federal courts have applied the terms, an abortion is “necessary” because a woman requests it, and it becomes “medically” necessary when the doctor agrees to it. Consequently, when these two terms are combined—“medically necessary” to preserve the “health” of the woman”—a “medically necessary” abortion means any abortion a provider agrees to perform for any reason.

Health care reform must respect life, and not contain provisions that mandate or encourage the withdrawal or curtailment of effective life-sustaining treatment to the terminally ill, the chronically ill, or the permanently disabled. Therefore, the provisions that address end-of-life issues must be amended to leave no room for an interpretation that would pressure healthcare providers to make decisions based on cost rather than best medical care.

Section 1233 of the House bill includes vague, federally defined end-of-life counseling. We are concerned that such counseling might put subtle pressure on patients to make decisions not on sound medical bases but in order to conserve costs. Additionally, the bill does not define terms such as “palliative care” and “end-of-life services,” raising the question of whether a discussion about euthanasia might even be mandated.

Section 2707 of the Senate HELP bill requires that insurers develop and implement a reimbursement structure for making payments to healthcare providers that includes incentives for use of evidence based medicine and best clinical practices. This and other provisions in the bill create the possibility that health care coverage determinations could be based on a patient’s health status, age, and/or quality of life. The resulting structure could become a means of advocating for the least expensive treatment at the expense of respect for life. With cost as a primary driver, the elderly, sick, and disabled may find their options for care severely limited.

Supporters of the healthcare reform bills claim that the legislation will not lead to the withdrawal or curtailment of life-sustaining healthcare, or put pressure on doctors and patients to hasten death. However, amendments offered in the Senate HELP Committee to address these concerns were defeated, including the following: (1) amendments to prevent the denial of end of life care and prohibit rationing on the basis of patient age, disability, medical dependency, or quality of life; (2) an amendment to ensure that taxpayers were not forced to fund assisted suicide; (3) an amendment that would have prevented private health insurers from being prohibited from covering treatment; (4) an amendment that would have ensured all individuals have access to essential health benefits; and (5) an amendment that would have required certification that participating plans do not have a pattern of practice or denying coverage based on their age, expected length of life, and disability.

If the supporters of these healthcare reform measures do not intend to withdraw or curtail life-sustaining healthcare for many patients, why are they unwilling to include clarifying language in the bills? We urge members of Congress to clarify these provisions before a bill is brought to the House and Senate floors.

• What do the health care reform plans currently in Congress say about the unborn?
• You say the plans would mandate abortion coverage. How would they do that?
• Doesn’t the Hyde Amendment protect taxpayers from having to fund abortions?
• I heard that the health care reform plans would enable people to choose which insurance plan they want. Those plans would then be funded by individuals’ premiums. Wouldn’t that ensure that taxpayer money would not pay for abortions?
• I get my reproductive-health check-ups from Planned Parenthood, but I would never consider getting an abortion. If Congress followed Americans United for Life’s principles for health care reform, wouldn’t that force me to find another provider?
• Is it true that the health care reform plans would encourage doctors to perform euthanasia?
• Do the plans really contain provisions for “death panels”?

What do the health care reform plans currently in Congress say about the unborn?

Very little. In fact, despite the Democratic Congress’ insistence that any health care reform considered must provide some form of health insurance for all children, the current health care reform bills do not explicitly cover unborn children under Medicaid. However, the bills would require taxpayer funded abortion. Health care for children begins before birth, and health care reform must recognize this by providing health insurance coverage for unborn children as well. [top]

You say the plans would mandate abortion coverage. How would they do that?

H.R. 3200, the Senate HELP bill, and the Senate Finance (Baucus) bill mandate abortion funding and coverage in a number of ways, including but not limited to:

1. The Capps amendment to H.R. 3200 permits and may require abortion coverage in the public health insurance plan.
2. Both the Capps amendment to H.R. 3200 and the Baucus bill permit taxpayer funding of private plans that cover elective abortion and mandate that one private insurance plan in every coverage area includes abortion.
3. The Senate HELP bill delegates to a “Medical Advisory Committee” the role of deciding what benefits any private or public health care plan must offer. This Committee is expected to include abortion as a required minimum benefit.
4. Prior court holdings that state that abortion is included within several of Medicaid’s mandatory categories of care (inpatient services, outpatient services, and preventative care) will certainly apply to any federal statute  involving health care reform.
5. The rejection of several key pro-life amendments in the House and Senate Committees, which would have ensured that abortion was not funded or covered in the bills, demonstrates that the bills are intended to mandate abortion. [top]

Doesn’t the Hyde Amendment protect taxpayers from having to fund abortions?

Not necessarily. The Hyde Amendment is not a statute, but is an appropriations “rider” that requires Congressional approval each year. Therefore, it can be eliminated at the whim of Congress. Furthermore, even if the Hyde Amendment continues to be added to the Health and Human Services (HHS) appropriations bill each year, the Hyde amendment may prevent only the funds appropriated in that bill from being used for abortions. The health care reform bills currently before Congress would bypass the annual appropriations process by self appropriating. In other words, the Appropriations Committee may have no jurisdiction over the health care bills; therefore, the health care reform bills themselves must include an explicit prohibition on taxpayer funded abortion. [top]

I heard that the health care reform plans would enable people to choose which insurance plan they want. Those plans would then be funded by individuals’ premiums. Wouldn’t that ensure that taxpayer money would not pay for abortions?

No. Under the health care reform bills before Congress, individuals will continue to choose their health insurance plans. The federal government will cover the cost of insurance for individuals at certain income levels.  However, the federal government will be using everyone’s tax dollars to cover the costs associated with the public plan and the subsidies provided to private health insurance plans. Therefore, because the public plan and many private plans will cover abortions, everyone’s tax dollars will pay for abortions. [top]

I get my reproductive-health check-ups from Planned Parenthood, but I would never consider getting an abortion. If Congress followed Americans United for Life’s principles for health care reform, wouldn’t that force me to find another provider?

No. There is nothing in the health care bills before Congress that would adversely affect the ability of Planned Parenthood to continue its operations as it does today. Neither is AUL proposing any changes that would adversely affect Planned Parenthood’s ability to continue operations as it currently does today. [top]

Is it true that the health care reform plans would encourage doctors to perform euthanasia?

The word “euthanasia” is not in the proposals currently being considered by Congress. However, H.R. 3200, section 1233 addresses end of life care. The section leaves unclear whether the government or a health care provider could counsel or encourage a patient to choose physician-assisted suicide as a solution to terminal illness. While section 1233 remains in the bill, an amendment offered by the “Blue Dog Democrats” and accepted by the Energy and Commerce Committee, Sec. 138, prevents the “promotion” of assisted suicide (though not the practice of it), and makes it clear that material distributed by Qualifying Health Benefits Plans (QHBPs) “shall not include advanced directives or other planning tools that list or describe as an option suicide, assisted suicide or the intentional hastening of death regardless of legality.” (However, there is an exception to this for states which already require this information to be listed.)  However, it is unclear how the potentially conflicting Section 1233 and Section 138 relate to one another.

Furthermore, when health care providers are forced to go over a list of government-mandated questions regarding end-of-life with elderly patients, in order to receive reimbursement, this process could subtly pressure the patients to make decisions based on cost-saving rather than best medicine. [top]

Do the plans really contain provisions for “death panels”?

Not exactly. As discussed in the previous answer, H.R. 3200 allows health care providers to receive reimbursement for end-of-life counseling as long as the providers adhere to specific requirements. This provision is troubling because it allows the government to control a very private conversation between a doctor and patient, and could subtly pressure patients to make end-of-life decisions they would not otherwise make. [top]

On the editorial page of today’s Wall Street Journal, the editors offer a primer in rationing: what it is, and why it is key to President Obama’s plans for health care reform. They observe:

While claims about euthanasia and ‘death panels’ are over the top, senior fears have exposed a fundamental truth about what Mr. Obama is proposing: Namely, once health care is nationalized, or mostly nationalized, rationing care is inevitable, and those who have lived the longest will find their care the most restricted. [Read the full article.]

AUL Senior Counsel Clarke Forsythe says the article clarifies a distinction that supporters of ObamaCare ignore when they claim that the President’s reform plan would be no different than the rationing of goods and services that already exists. “In a practical manner, the limits and constraints in this world result in goods being rationed,” Forsythe says. “We don’t have all the time or money or material goods we might like or need.  But there’s an important distinction between rationing according to prices and limits in the marketplace and rationing by government budget and government officials.”

TAKE ACTION: Get the facts on the health care reform plans currently under consideration and sign the “Keep Abortion Out of Health Care” petition at AUL’s RealHealthCareRespectsLife.com.

We’ve got inside information: Yesterday a media-relations executive from the Planned Parenthood Federation of America, giving a talk here in Washington on Planned Parenthood’s health care reform strategy, made a comment that revealed the impact we’ve been making in thwarting the abortion industry’s agenda. She lamented that because the “anti-choice” movement — meaning pro-lifers like you and me — had attracted so much attention to her organization’s efforts to mandate abortion funding in health care reform, Planned Parenthood was being forced onto the defensive.

Bad news for abortion advocates is great news for champions of life! But Planned Parenthood has an extremely well-financed public-relations department. Planned Parenthood — enabled by the more than 350 million of your tax dollars each year — and its president, Cecile Richards, don’t stay on the defensive for long.

Perfect example: Planned Parenthood’s spin machine has issued a “Reality Check,” attacking what Richards says are “myths” spread by pro-lifers — and twisting the truth so much it made my head feel like it was in a spin machine. I showed it to our legal team, and they responded with some masterful mythbusting of their own. Here’s their take on the abortion industry’s three biggest myths about health care reform:

• MYTH: Pro-life groups want to strip reproductive health from health care reform.

Reality: Pro-life groups want to protect women’s reproductive health. And we do not want to deny women insurance coverage. However AUL, along with the vast majority of Americans, believes that “Real health care respects life!” No matter what Planned Parenthood says, abortion does not equal reproductive health. And health coverage should not include the destruction of unborn children. Furthermore, no one should be forced to violate their conscience by performing, referring for, paying for, or providing coverage for abortion. And make no mistake, that’s what the bills under consideration would do.

• MYTH: The health care reform bills before Congress will not change the “status quo” regarding insurance coverage of abortion.

Reality: An amendment added to H.R. 3200 permits the Secretary of the Department of Health and Human Services (HHS) to include abortion in the public health insurance plan, and requires abortion coverage if the Hyde amendment is ever reversed. The current Secretary of HHS, Kathleen Sebelius, is staunchly pro-abortion and would certainly include abortion, allowing for immediate federal funding of elective abortion coverage. The provision also requires that all areas of the country contain one private plan that covers abortion and permits taxpayer funding of private plans that cover elective abortion.

The Senate HELP bill delegates to a “Medical Advisory Committee” the role of deciding what benefits any private or public health care plan must offer. This Committee is expected to include abortion as a required minimum benefit. Further, based on court precedent, private plans would be forced by the government to include coverage of abortion — this is a drastic change from the status quo in which private plans may elect to cover abortion and individuals may choose whether or not to purchase health insurance that offers coverage of abortion. Ironically, “pro-choice” activists are trying to take consumer choice out of health care.

• MYTH: The health care reform bills before Congress do not mandate abortion coverage.

Reality: Both H.R. 3200 and the Senate HELP bill mandate abortion in several ways:

1. an amendment to H.R. 3200 permits and may require abortion coverage in the public health insurance plan, and permits taxpayer funding of private plans that cover elective abortion;
2. prior court holdings which state that abortion is included within several of Medicaid’s mandatory categories of care (inpatient services, outpatient services, and preventative care) will certainly apply to any federal statute revising Medicaid and involving health care reform, and;
3. the rejection of several key pro-life amendments in the House and Senate Committees, where the inclusion would have ensured that abortion was not funded in the bills, demonstrates that the bills are intended to mandate abortion.

If you’re trying to sort out the myths from facts on health care reform, the best place to start is AUL Action’s RealHealthCareRespectsLife.com. The site features in-depth analysis from our legal team, showing how the health care reform plans currently under consideration by Congress would mandate abortion coverage, strip providers of their rights of conscience, and threaten the ill and elderly with denial of care. Also, if you’re going to a town hall meeting this month, download our special town-hall flyer and distribute it to show your friends and neighbors to show that Real Health Care Respects Life.

Thank you for joining me in working to protect and defend life!

Yours For Life, Charmaine Yoest, Ph.D. President & CEO

AUL Senior Counsel William Saunders Addresses World Congress of Families This week in Amsterdam, AUL Senior Counsel William Saunders is among the distinguished speakers addressing the World Congress of Families, the preeminent gathering of individuals and organizations from around the world who promote the natural family. Watch the proceedings on the WCF’s Web site.

We’re All A-Twitter at the White House If you follow AUL on Twitter, then you received on-the-spot updates from the East Room of the White House yesterday as AUL Senior Fellow Dawn Eden attended the Presidential Medal of Freedom ceremony. Sign up for our Twitter feed to get the latest pro-life news as it happens.

Learn How Obama Is Imposing FOCA by Stealth When the outcry of pro-lifers — including the more than 700,000 who signed AUL Action’s “Fight FOCA” petition — made it inexpedient for Obama to fulfill his vow to Planned Parenthood to sign the Freedom of Choice act, his administration changed tactics. Read our new FOCA by Stealth Timeline to see how the White House is systematically working behind the scenes to implement the goals of FOCA, which include removing all regulations on abortion.

Jill Stanek observes in her World Net Daily column that something is missing from the “Reality Check” Web site that the White House set up to defend ObamaCare: “the A-word.”

The White House is going to great lengths to refute accusations that its health care reform plan would promote euthanasia and rationing, but makes no attempt to counter claims that it would mandate government funding of abortion. There’s a reason for that. As Stanek notes, this July 2007 video of the then-candidate Obama addressing the Planned Parenthood Action Fund conference shows that the President believes abortion should be the “center and heart” of any health care reform.

TAKE ACTION: Get the facts about the health care reform bills currently under consideration and sign AUL’s “Keep Abortion Out of Health Care” petition at RealHealthCareRespectsLife.com.

MORE: Sarah Palin today backs up her claim that ObamaCare would promote “death panels” with quotes from liberal opponents of the President’s health care reform plan, including Democratic New York State Senator Ruben Diaz, Chairman of the New York State Senate Aging Committee, who writes:

Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives. … It is egregious to consider that any senior citizen … should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign.

Washington, DC — Americans United for Life, the oldest national pro-life organization, denounced the Ryan-DeLauro bill’s unprecedented mandate that states cover abortion in state medical assistance programs.

Tucked into the Ryan-DeLauro bill (HR 3312) is a little-noticed provision that mandates that states provide abortion in state medical assistance programs. The paragraph in Title VII, section 701 of the bill says that these state programs must cover “family planning” services. Since the 1970s, several federal appeals courts have read “family planning” in the Medicaid statute to include elective abortion, unless the bill contains an express exclusion of abortion, such as the Hyde Amendment. Because the Ryan-DeLauro bill contains no such exclusion, it mandates abortion coverage in state medical assistance programs.

“Planned Parenthood and NARAL wouldn’t back a so-called ‘common ground’ bill unless it included abortion services,” said AUL President & CEO Dr. Charmaine Yoest. “Efforts to paint this bill as ‘pro-life’ are deceptive.”

Up to now, states have had the option to provide different “benefit packages” to certain populations, and the coverage could be modeled on “benchmark” or “benchmark equivalent” plans. The Ryan-DeLauro Bill would mandate, for the first time, that states include abortion within the “benchmark” or “benchmark equivalent” plans. This would be a radical extension of federally mandated taxpayer funding of abortion and an unprecedented mandate that states cover abortion in state medical assistance programs.

AUL Senior Counsel Clarke Forsythe said, “The bill takes away the flexibility that the states have had in designing their plans, by mandating that ‘family planning’ — which federal courts read to include elective abortion — be included. Under Ryan-DeLauro, states can no longer opt out from paying for elective abortion.”

For detailed background on the Ryan-DeLauro bill from AUL’s legal experts, as well as information on how current health care reform efforts in Congress threaten the right to life and rights of conscience, visit KeepAbortionOutOfHealthCare.com.

Media Contact:

Heather Smith

202-270-9962

heather.smith@aul.org

Washington, DC — As lawmakers move to take health care out of Washington and into townhalls, Americans United for Life (AUL), the oldest national pro-life organization, called a House Committee’s vote last week “outrageous” for defeating an amendment that would have ensured that taxpayers would not be forced to pay for abortion under the House’s health care bill.

House Energy & Commerce Committee Chairman Henry Waxman (D-Calif.), a longtime beneficiary of Planned Parenthood donations who has a 100% favorable voting record from NARAL Pro-Choice America, engineered a series of late-night shenanigans to kill the pro-life amendment by Reps. Bart Stupak (D-Mich.), Joe Pitts (R-Pa.), and Roy Blunt (R-Mo.).

First, Waxman voted for the amendment, which would have prohibited the federal government from requiring any insurance plan — including the “public option” — to provide coverage for abortion (with exceptions in cases of rape, incest, and danger to the life of the mother). Then, just minutes after the amendment passed 31-27, Waxman took advantage of a House rule that allows supporters to bring an amendment back for consideration later. This time, Waxman managed to strong-arm others on the committee to join him in defeating the amendment, 30-29.

AUL President & CEO Dr. Charmaine Yoest said of the Waxman move, “This outrageous vote shows the desperation of those members of Congress who are beholden to the abortion industry. They know that polls show American taxpayers do not want to be forced to pay for abortion. So they are resorting to parliamentary shenanigans, under cover of night, hoping to rush through an abortion-funding health care plan without the public’s noticing.”

Dr. Yoest urged those who want to know details of the health care plans under consideration – including how each of them would mandate abortion coverage – to visit AUL’s new Web site KeepAbortionOutOfHealthCare.com, which features expert analysis from AUL’s legal team.

Full Senate to Vote on Judge Sonia Sotomayor This Week

AUL’s legal experts have also been supplying information on the troubling judicial philosophy of Supreme Court nominee Judge Sonia Sotomayor to Capitol Hill and the American public, in advance of this week’s vote by the full Senate on her confirmation. Their latest informational release, “What Judge Sotomayor Said — and Should Have Said,” demonstrates how Sotomayor’s answers before the Senate Judiciary Committee revealed flaws in her understanding and judgment. AUL’s expertise was recognized by Congress before the American public when President & CEO Dr. Charmaine Yoest was invited to testify before the Judiciary Committee on the Sotomayor nomination.

Media Contact:
Heather Smith
202-270-9962
heather.smith@aul.org