The Abortion Distortion: Setting The Record–and John Boehner–Straight on the Capps Amendment

Jessica Arons

The intentional blurring of the lines in the debate over abortion in health care reform now includes a misinformation campaign by the GOP House leadership.

Adding to the rampant mythmaking that health care reform will result in a mandate for taxpayer-funded abortions, Rep. John Boehner (R-OH) yesterday released a GOP Leader Alert with a tag line that reads “Despite Democrats’ Claims, the ‘Capps Compromise’ was Just for Political Cover” and asserting that “the legislation [in the House of Representatives] would in fact allow abortions to be subsidized by taxpayer funds.”

The only political cover being used here is by those who oppose health care reform.

The GOP Alert contains numerous distortions, using quotes that do not support the contentions made in the alert itself.   For example, according to the alert:

The Associated Press has reported, for example, that “Health care legislation before Congress would allow a new government-sponsored insurance plan to cover abortions” and FactCheck.Org has stated that the “House bill would allow abortions to be covered by a federal plan and by federally subsidized private plans.

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Note to Boehner: Neither of these quotations actually says that abortion coverage would be paid for with government money.  

That’s because under the Capps Amendment (PDF), it wouldn’t.

In fact, a “federal plan” or a “federally-subsidized private plan” that covers abortion would be required, pursuant to the Capps Amendment, to use money from private premiums to pay for abortion care.

These facts notwithstanding, the alert concludes:

The bottom line? H.R. 3200 does not contain any limitation on federal funds authorized or appropriated in the bill from being used to pay for elective abortion or to subsidize the purchase of insurance coverage of elective abortion. (Emphasis in original.)

Oh if only that were true, abortion rights advocates could go home because their work would be done.

To reach this conclusion, Boehner cites Sections 115 and 122 of the bill, neither of which says anything about payment mechanisms.  It is Sections 203 (SEGREGATION OF FUNDS) and 241(c) (PROHIBITION OF USE OF PUBLIC FUNDS FOR ABORTION COVERAGE) that ensure no public money will be spent on abortion.

To make his assertions, Mr. Boehner conveniently skips over the portion of Section 122 amended by Rep. Capps (D-CA) to prohibit the HHS Secretary or a Health Benefits Advisory Committee from requiring a health plan to include abortion coverage in order to participate in the Health Insurance Exchange.

Instead, he actually claims, in direct conflict with the plain reading of the bill, that abortion could be mandated as part of an essential benefits package.  The alert reads:

Page 26; Section 122 – The bill defines what would be deemed an “essential benefits package,” or in other words what the government sets as benefits or services that must be covered by an insurance plan. This section, however, contains no explicit exclusion or prohibition from abortion being deemed part of an essential benefits package. Without such an exclusion, the bill leaves open the possibility of federally mandated coverage of abortion as an essential benefit.

It’s
hard to imagine how he missed it, given that the new section is clearly
labeled, “ABORTION COVERAGE PROHIBITED AS PART OF MINIMUM BENEFITS
PACKAGE."

So, when you’re debating this topic at Town Hall meetings or around your kitchen table, here are two main points to keep in mind:

1) The Capps Amendment is meant to be a compromise, which means both sides must be willing to give some ground.  Abortion-rights proponents in Congress are not trying to use health care reform as a vehicle to expand abortion access (although it would be appropriate for them to do so as reform is supposed to be about expanding access to health care).  By the same token, abortion-rights opponents should not try to use health care reform as a vehicle to restrict access to abortion care.

2) This issue is a red herring.  Most of the politicians and interest groups who protest abortion coverage in health care reform do not want reform to succeed at all. Among the few groups who want health reform but have a genuine objection to abortion coverage, even they cherry pick.  For instance, the U.S. Conference of Catholic Bishops (who is cited in the Alert) also opposes contraception, sterilization, and end of life care, but they are only using their great lobbying power to oppose abortion coverage.  The implication is that they will somehow learn to live with taxpayer money being used for these other services.

Assuming the person you’re debating isn’t holding a gun or calling you a Nazi, you could also try making these arguments:

1) The Capps Amendment applies to the public option as much as it applies to private plans in the exchange, so even if the HHS Secretary does allow the public option to include abortion services, under the current version of the bill they will only be paid for with private premiums.  The same goes for federally subsidized private plans that choose to cover abortion – only private premiums would be used to pay for abortion care.

2) This is an entirely theoretical debate at this point.  The bill neither mandates nor prohibits abortion coverage, nor any other health care service.  Under the pending legislation, either the HHS Secretary or an independent commission of experts and citizens will determine what will be included in a minimum benefits package, and 75 percent of Americans want it that way.  Congress is the wrong place to have this fight.

3) Abortion care is part of basic health care and should not be denied simply because the government wants to play a larger role in our health care system.  Most employer-sponsored health plans cover abortion.  Women should not lose this coverage in order to purchase insurance through a new health care exchange. Moreover, a recent poll showed that two-thirds of Americans want comprehensive reproductive health care, including abortion, to be part of any reform package and 6 out of 10 Americans would oppose a bill that excludes such coverage.

4) There is more than one view on this issue.  A woman’s rights should not depend on her wallet, and if a woman needs assistance in order to obtain abortion care, the government ought to able to provide it, even if that means taxpayer money will be used for a purpose to which some citizens object.  Currently, taxpayer money is used for the war in Iraq, stem cell research, the death penalty, and teaching evolution in our public schools – all activities to which some taxpayers object. Abortion opponents are not entitled to special treatment.

There has been a lot of intentional blurring of the lines in the debate over abortion in health care reform.  Although many opponents of health care reform seem allergic to the facts (see the “death panels” debate), the public deserves more.  Yes, this is a controversial topic and deserves vigorous debate, but let’s have a dialogue that is based on actual facts, not hyperbole, misinformation, and outright distortions.

Commentary Contraception

Hillary Clinton Played a Critical Role in Making Emergency Contraception More Accessible

Susan Wood

Today, women are able to access emergency contraception, a safe, second-chance option for preventing unintended pregnancy in a timely manner without a prescription. Clinton helped make this happen, and I can tell the story from having watched it unfold.

In the midst of election-year talk and debates about political controversies, we often forget examples of candidates’ past leadership. But we must not overlook the ways in which Hillary Clinton demonstrated her commitment to women’s health before she became the Democratic presidential nominee. In early 2008, I wrote the following article for Rewirewhich has been lightly edited—from my perspective as a former official at the U.S. Food and Drug Administration (FDA) about the critical role that Clinton, then a senator, had played in making the emergency contraception method Plan B available over the counter. She demanded that reproductive health benefits and the best available science drive decisions at the FDA, not politics. She challenged the Bush administration and pushed the Democratic-controlled Senate to protect the FDA’s decision making from political interference in order to help women get access to EC.

Since that time, Plan B and other emergency contraception pills have become fully over the counter with no age or ID requirements. Despite all the controversy, women at risk of unintended pregnancy finally can get timely access to another method of contraception if they need it—such as in cases of condom failure or sexual assault. By 2010, according to National Center for Health Statistics data, 11 percent of all sexually experienced women ages 15 to 44 had ever used EC, compared with only 4 percent in 2002. Indeed, nearly one-quarter of all women ages 20 to 24 had used emergency contraception by 2010.

As I stated in 2008, “All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.”

Now, there are new emergency contraceptive pills (Ella) available by prescription, women have access to insurance coverage of contraception without cost-sharing, and there is progress in making some regular contraceptive pills available over the counter, without prescription. Yet extreme calls for defunding Planned Parenthood, the costs and lack of coverage of over-the-counter EC, and refusals by some pharmacies to stock emergency contraception clearly demonstrate that politicization of science and limits to our access to contraception remain a serious problem.

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Today, women are able to access emergency contraception, a safe, second chance option for preventing unintended pregnancy in a timely manner without a prescription. Sen. Hillary Clinton (D-NY) helped make this happen, and I can tell the story from having watched it unfold.

Although stories about reproductive health and politicization of science have made headlines recently, stories of how these problems are solved are less often told. On August 31, 2005 I resigned my position as assistant commissioner for women’s health at the Food and Drug Administration (FDA) because the agency was not allowed to make its decisions based on the science or in the best interests of the public’s health. While my resignation was widely covered by the media, it would have been a hollow gesture were there not leaders in Congress who stepped in and demanded more accountability from the FDA.

I have been working to improve health care for women and families in the United States for nearly 20 years. In 2000, I became the director of women’s health for the FDA. I was rather quietly doing my job when the debate began in 2003 over whether or not emergency contraception should be provided over the counter (OTC). As a scientist, I knew the facts showed that this medication, which can be used after a rape or other emergency situations, prevents an unwanted pregnancy. It does not cause an abortion, but can help prevent the need for one. But it only works if used within 72 hours, and sooner is even better. Since it is completely safe, and many women find it impossible to get a doctor’s appointment within two to three days, making emergency contraception available to women without a prescription was simply the right thing to do. As an FDA employee, I knew it should have been a routine approval within the agency.

Plan B emergency contraception is just like birth control pills—it is not the “abortion pill,” RU-486, and most people in the United States don’t think access to safe and effective contraception is controversial. Sadly, in Congress and in the White House, there are many people who do oppose birth control. And although this may surprise you, this false “controversy” not only has affected emergency contraception, but also caused the recent dramatic increase in the cost of birth control pills on college campuses, and limited family planning services across the country.  The reality is that having more options for contraception helps each of us make our own decisions in planning our families and preventing unwanted pregnancies. This is something we can all agree on.

Meanwhile, inside the walls of the FDA in 2003 and 2004, the Bush administration continued to throw roadblocks at efforts to approve emergency contraception over the counter. When this struggle became public, I was struck by the leadership that Hillary Clinton displayed. She used the tools of a U.S. senator and fought ardently to preserve the FDA’s independent scientific decision-making authority. Many other senators and congressmen agreed, but she was the one who took the lead, saying she simply wanted the FDA to be able to make decisions based on its public health mission and on the medical evidence.

When it became clear that FDA scientists would continue to be overruled for non-scientific reasons, I resigned in protest in late 2005. I was interviewed by news media for months and traveled around the country hoping that many would stand up and demand that FDA do its job properly. But, although it can help, all the media in the world can’t make Congress or a president do the right thing.

Sen. Clinton made the difference. The FDA suddenly announced it would approve emergency contraception for use without a prescription for women ages 18 and older—one day before FDA officials were to face a determined Sen. Clinton and her colleague Sen. Murray (D-WA) at a Senate hearing in 2006. No one was more surprised than I was. All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.

Sometimes these success stories get lost in the “horse-race stories” about political campaigns and the exposes of taxpayer-funded bridges to nowhere, and who said what to whom. This story of emergency contraception at the FDA is just one story of many. Sen. Clinton saw a problem that affected people’s lives. She then stood up to the challenge and worked to solve it.

The challenges we face in health care, our economy, global climate change, and issues of war and peace, need to be tackled with experience, skills and the commitment to using the best available science and evidence to make the best possible policy.  This will benefit us all.

Commentary Contraception

The Promotion of Long-Acting Contraceptives Must Confront History and Center Patient Autonomy

Jamila Taylor

While some long-acting reversible contraceptive methods were used to undermine women of color's reproductive freedom, those methods still hold the promise of reducing unintended pregnancy among those most at risk.

Since long-acting reversible contraceptives (LARCs), including intrauterine devices and hormonal contraceptive implants, are among the most effective means of pregnancy prevention, many family planning and reproductive health providers are increasingly promoting them, especially among low-income populations.

But the promotion of LARCs must come with an acknowledgment of historical discriminatory practices and public policy related to birth control. To improve contraceptive access for low-income women and girls of color—who bear the disproportionate effects of unplanned pregnancy—providers and advocates must work to ensure that the reproductive autonomy of this population is respected now, precisely because it hasn’t been in the past.

For Black women particularly, the reproductive coercion that began during slavery took a different form with the development of modern contraceptive methods. According to Dorothy Roberts, author of Killing the Black Body, “The movement to expand women’s reproductive options was marked with racism from its very inception in the early part of [the 20th] century.” Decades later, government-funded family planning programs encouraged Black women to use birth control; in some cases, Black women were coerced into being sterilized.

In the 1990s, the contraceptive implant Norplant was marketed specifically to low-income women, especially Black adults and teenage girls. After a series of public statements about the benefits of Norplant in reducing pregnancy among this population, policy proposals soon focused on ensuring usage of the contraceptive method. Federal and state governments began paying for Norplant and incentivizing its use among low-income women while budgets for social support programs were cut. Without assistance, Norplant was not an affordable option, with the capsules costing more than $300 and separate, expensive costs for implantation and removal.

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Soon, Norplant was available through the Medicaid program. Some states introduced (ultimately unsuccessful) bills that would give cash rewards to entice low-income women on public assistance into using it; a few, such as Tennessee and Washington state, required that women receiving various forms of public assistance get information about Norplant. After proposing a bill to promote the use of Norplant in his state in 1994, a Connecticut legislator made the comment, “It’s far cheaper to give you money not to have kids than to give you money to have kids.” By that year, as Roberts writes, states had spent $34 million on Norplant-related care, much of it for women on Medicaid. Policymakers thought it was completely legitimate and cost-effective to control the reproduction of low-income women.

However, promoting this method among low-income Black women and adolescents was problematic. Racist, classist ideology dictating that this particular population of women shouldn’t have children became the basis for public policy. Even though coercive practices in reproductive health were later condemned, these practices still went on to shape cultural norms around race and gender, as well as medical practice.

This history has made it difficult to move beyond negative perceptions, and even fear, of LARCs, health care, and the medical establishment among some women of color. And that’s why it’s so important to ensure informed consent when advocating for effective contraceptive methods, with choice always at the center.

But how can policies and health-care facilities promote reproductive autonomy?

Health-care providers must deal head on with the fact that many contemporary women have concerns about LARCs being recommended specifically to low-income women and women of color. And while this is part of the broader effort to make LARCs more affordable and increasingly available to communities that don’t have access to them, mechanisms should be put in place to address this underlying issue. Requiring cultural competency training that includes information on the history of coercive practices affecting women of color could help family planning providers understand this concern for their patients.

Then, providers and health systems must address other barriers that make it difficult for women to access LARCs in particular. LARCs can be expensive in the short term, and complicated billing and reimbursement practices in both public and private insurance confuse women and providers. Also, the full cost associated with LARC usage isn’t always covered by insurance.

But the process shouldn’t end at eliminating barriers. Low-income Black women and teens must receive comprehensive counseling for contraception to ensure informed choice—meaning they should be given information on the full array of methods. This will help them choose the method that best meets their needs, while also promoting reproductive autonomy—not a specific contraceptive method.

Clinical guidelines for contraception must include detailed information on informed consent, and choice and reproductive autonomy should be clearly outlined when family planning providers are trained.

It’s crucial we implement these changes now because recent investments and advocacy are expanding access to LARCs. States are thinking creatively about how to reduce unintended pregnancy and in turn reduce Medicaid costs through use of LARCs. The Colorado Family Planning Initiative has been heralded as one of the most effective in helping women access LARCs. Since 2008, more than 30,000 women in Colorado have chosen LARCs as the result of the program. Provider education, training, and contraceptive counseling have also been increased, and women can access LARCs at reduced costs.

The commitment to LARCs has apparently yielded major returns for Colorado. Between 2009 and 2013, the abortion rate among teenagers older than 15 in Colorado dropped by 42 percent. Additionally, the birth rate for young women eligible for Medicaid dropped—resulting in cost savings of up to an estimated $111 million in Medicaid-covered births. LARCs have been critical to these successes. Public-private partnerships have helped keep the program going since 2015, and states including Delaware and Iowa have followed suit in efforts to experience the same outcomes.

Recognizing that prevention is a key component to any strategy addressing a public health concern, those strategies must be rooted in ensuring access to education and comprehensive counseling so that women and teens can make the informed choices that are best for them. When women and girls are given the tools to empower themselves in decision making, the results are positive—not just for what the government spends or does not spend on social programs, but also for the greater good of all of us.

The history of coercion undermining reproductive freedom among women and girls of color in this country is an ugly one. But this certainly doesn’t have to dictate how we move forward.

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