Commentary Abortion

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

Jodi Jacobson

Washington Post columnist Jennifer Rubin used the Gosnell trial to suggest several ways to further diminish access to safe, legal abortion care in the United States through what she calls a "Gosnell amendment." She has no idea what she is talking about.

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

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

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

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

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She writes:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

News Abortion

Study: United States a ‘Stark Outlier’ in Countries With Legal Abortion, Thanks to Hyde Amendment

Nicole Knight Shine

The study's lead author said the United States' public-funding restriction makes it a "stark outlier among countries where abortion is legal—especially among high-income nations."

The vast majority of countries pay for abortion care, making the United States a global outlier and putting it on par with the former Soviet republic of Kyrgyzstan and a handful of Balkan States, a new study in the journal Contraception finds.

A team of researchers conducted two rounds of surveys between 2011 and 2014 in 80 countries where abortion care is legal. They found that 59 countries, or 74 percent of those surveyed, either fully or partially cover terminations using public funding. The United States was one of only ten countries that limits federal funding for abortion care to exceptional cases, such as rape, incest, or life endangerment.

Among the 40 “high-income” countries included in the survey, 31 provided full or partial funding for abortion care—something the United States does not do.

Dr. Daniel Grossman, lead author and director of Advancing New Standards in Reproductive Health (ANSIRH) at the University of California (UC) San Francisco, said in a statement announcing the findings that this country’s public-funding restriction makes it a “stark outlier among countries where abortion is legal—especially among high-income nations.”

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The researchers call on policymakers to make affordable health care a priority.

The federal Hyde Amendment (first passed in 1976 and reauthorized every year thereafter) bans the use of federal dollars for abortion care, except for cases of rape, incest, or life endangerment. Seventeen states, as the researchers note, bridge this gap by spending state money on terminations for low-income residents. Of the 14.1 million women enrolled in Medicaid, fewer than half, or 6.7 million, live in states that cover abortion services with state funds.

This funding gap delays abortion care for some people with limited means, who need time to raise money for the procedure, researchers note.

As Jamila Taylor and Yamani Hernandez wrote last year for Rewire, “We have heard first-person accounts of low-income women selling their belongings, going hungry for weeks as they save up their grocery money, or risking eviction by using their rent money to pay for an abortion, because of the Hyde Amendment.”

Public insurance coverage of abortion remains controversial in the United States despite “evidence that cost may create a barrier to access,” the authors observe.

“Women in the US, including those with low incomes, should have access to the highest quality of care, including the full range of reproductive health services,” Grossman said in the statement. “This research indicates there is a global consensus that abortion care should be covered like other health care.”

Earlier research indicated that U.S. women attempting to self-induce abortion cited high cost as a reason.

The team of ANSIRH researchers and Ibis Reproductive Health uncovered a bit of good news, finding that some countries are loosening abortion laws and paying for the procedures.

“Uruguay, as well as Mexico City,” as co-author Kate Grindlay from Ibis Reproductive Health noted in a press release, “legalized abortion in the first trimester in the past decade, and in both cases the service is available free of charge in public hospitals or covered by national insurance.”

Commentary Politics

Is Clinton a Progressive? Not If She Chooses Tim Kaine

Jodi Jacobson

The selection of Tim Kaine as vice president would be the first signal that Hillary Clinton intends to seek progressive votes but ignore progressive values and goals, likely at her peril, and ours.

During the 2016 presidential campaign, former secretary of state and presumptive Democratic presidential nominee Hillary Rodham Clinton has frequently claimed to be a progressive, though she often adds the unnecessary and bewildering caveat that she’s a “progressive who likes to get things done.” I’ve never been sure what that is supposed to mean, except as a possible prelude to or excuse for giving up progressive values to seal some unknown deal in the future; as a way of excusing herself from fighting for major changes after she is elected; or as a way of saying progressives are only important to her campaign until after they leave the voting booth.

One of the first signals of whether Clinton actually believes in a progressive agenda will be her choice of running mate. Reports are that Sen. Tim Kaine, former Virginia governor, is the top choice. The selection of Kaine would be the first signal that Clinton intends to seek progressive votes but ignore progressive values and goals, likely at her peril, and ours.

We’ve seen this happen before. In 2008, then-presidential candidate Barack Obama claimed to be a progressive. By virtue of having a vision for and promise of real change in government and society, and by espousing transparency and responsibility, he won by a landslide. In fact, Obama even called on his supporters, including the millions activated by the campaign’s Organizing for Action (OFA), to keep him accountable throughout his term. Immediately after the election, however, “progressives” were out and the right wing of the Democratic party was “in.”

Obama’s cabinet members in both foreign policy and the economy, for example, were drawn from the center and center-right of the party, leaving many progressives, as Mother Jones’ David Corn wrote in the Washington Post in 2009, “disappointed, irritated or fit to be tied.” Obama chose Rahm Emanuel as Chief of Staff, a man with a reputation from the days of Bill Clinton’s White House for a reluctance to move bold policies—lest they upset Wall Street or conservative Democrats—and a deep disdain for progressives. With Emanuel as gatekeeper of policies and Valerie Jarrett consumed with the “Obama Brand” (whatever that is), the White House suddenly saw “progressives” as the problem.

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It became clear that instead of “the change we were hoping for,” Obama had started on an impossible quest to “cooperate” and “compromise” on bad policies with the very party that set out to destroy him before he was even sworn in. Obama and Emanuel preempted efforts to push for a public option for health-care reform, despite very high public support at the time. Likewise, the White House failed to push for other progressive policies that would have been a slam dunk, such as the Employee Free Choice Act, a major goal of the labor movement that would have made it easier to enroll workers in unions. With a 60-vote Democratic Senate majority, this progressive legislation could easily have passed. Instead, the White House worked to support conservative Democrat then-Sen. Blanche Lincoln’s efforts to kill it, and even sent Vice President Joe Biden to Arkansas to campaign for her in her run for re-election. She lost anyway.

They also allowed conservatives to shelve plans for an aggressive stimulus package in favor of a much weaker one, for the sole sake of “bipartisanship,” a move that many economists have since criticized for not doing enough.  As I wrote years ago, these decisions were not only deeply disappointing on a fundamental level to those of us who’d put heart and soul into the Obama campaign, but also, I personally believe, one of the main reasons Obama later lost the midterms and had a hard time governing.  He was not elected to implement GOP lite, and there was no “there, there” for the change that was promised. Many people deeply devoted to making this country better for working people became fed up.

Standing up for progressive principles is not so hard, if you actually believe in them. Sen. Elizabeth Warren (D- MA) is a progressive who actually puts her principles into action, like the creation against all odds in 2011 of the Consumer Finance Protection Bureau, perhaps the single most important progressive achievement of the past 20 years. Among other things, the CFPB  shields consumers from the excesses of mortgage lenders, student loan servicers, and credit card companies that have caused so much economic chaos in the past decade. So unless you are more interested in protecting the status quo than addressing the root causes of the many problems we now face, a progressive politician would want a strong progressive running mate.

By choosing Tim Kaine as her vice president, Clinton will signal that she values progressives in name and vote only.

As Zach Carter wrote in the Huffington Post, Kaine is “setting himself up as a figure willing to do battle with the progressive wing of the party.” Kaine is in favor of the Trans-Pacific Partnership (TPP), a trade agreement largely negotiated in secret and by corporate lobbyists. Both Sen. Bernie Sanders, whose voters Clinton needs to win over, and Sen. Elizabeth Warren oppose the TPP because, in Warren’s words, it “would tilt the playing field even more in favor of … big multinational corporations and against working families.”

The progressive agenda includes strong emphasis on effective systems of governance and oversight of banks and financial institutions—the actors responsible, as a result of deregulation, for the major financial crises of the past 16 years, costing the United States trillions of dollars and gutting the financial security of many middle-class and low-income people.

As Warren has stated:

Washington turned a blind eye as risks were packaged and re-packaged, magnified, and then sold to unsuspecting pension funds, municipal governments, and many others who believed the markets were honest. Not long after the cops were blindfolded and the big banks were turned loose, the worst crash since the 1930s hit the American economy—a crash that the Dallas Fed estimates has cost a collective $14 trillion. The moral of this story is simple: Without basic government regulation, financial markets don’t work. That’s worth repeating: Without some basic rules and accountability, financial markets don’t work. People get ripped off, risk-taking explodes, and the markets blow up. That’s just an empirical fact—clearly observable in 1929 and again in 2008. The point is worth repeating because, for too long, the opponents of financial reform have cast this debate as an argument between the pro-regulation camp and the pro-market camp, generally putting Democrats in the first camp and Republicans in the second. But that so-called choice gets it wrong. Rules are not the enemy of markets. Rules are a necessary ingredient for healthy markets, for markets that create competition and innovation. And rolling back the rules or firing the cops can be profoundly anti-market.

If Hillary Clinton were actually a progressive, this would be key to her agenda. If so, Tim Kaine would be a curious choice as VP, and a middle finger of sorts to those who support financial regulations. In the past several weeks, Kaine has been publicly advocating for greater deregulation of banks. As Carter reported yesterday, “Kaine signed two letters on Monday urging federal regulators to go easy on banks―one to help big banks dodge risk management rules, and another to help small banks avoid consumer protection standards.”

Kaine is also trying to portray himself as “anti-choice lite.” For example, he recently signed onto the Women’s Health Protection Act. But as we’ve reported, as governor of Virginia, Kaine supported restrictions on abortion, such as Virginia’s parental consent law and a so-called informed consent law, which, he claimed in 2008, gave “women information about a whole series of things, the health consequences, et cetera, and information about adoption.” In truth, the information such laws mandate giving out is often “irrelevant or misleading,” according to the the Guttmacher Institute. In other words, like many others who let ideology rather than public health guide their policy decisions, Kaine put in place policies that are not supported by the evidence and that make it more difficult for women to gain access to abortion, steps he has not denounced. This is unacceptable. The very last thing we need is another person in the White House who further stigmatizes abortion, though it must be said Clinton herself seems chronically unable to speak about abortion without euphemism.

While there are many other reasons a Kaine pick would signal a less-than-secure and values-driven Clinton presidency, the fact also stands that he is a white male insider at a time when the rising electorate is decidedly not white and quite clearly looking for strong leadership and meaningful change. Kaine is not the change we seek.

The conventional wisdom these days is that platforms are merely for show and vice presidential picks don’t much matter. I call foul; that’s an absolutely cynical lens through which to view policies. What you say and with whom you affiliate yourself do indeed matter. And if Clinton chooses Kaine, we know from the outset that progressives have a fight on their hands, not only to avoid the election of an unapologetic fascist, but to ensure that the only person claiming the progressive mantle actually means what she says.