Commentary Abortion

Stoking Fire: Anti-Choice Groups Resurrect ‘Death Panel’ Claims

Eleanor J. Bader

Anti-choice groups recently charged that the imposition of the Affordable Care Act has brought death panels to U.S. soil. It’s not the first time the right wing has imagined this lurking menace.

Since the dawn of the anti-choice movement more than 40 years ago, its leaders have linked abortion, euthanasia, and infanticide. As Human Life International (HLI) and other anti-choice groups see it, abortion leads to euthanasia as day leads to night. Furthermore, they see infanticide as a form of euthanasia, and have called it the bridge between the two.

Meanwhile, LifeNews.com, a go-to information source for many antis, recently tapped an emotional nerve among opponents of reproductive rights by invoking the notion of non-voluntary euthanasia, wherein doctors have the power to decide who lives, who dies, and when. “Euthanasia is no longer voluntary in the Netherlands, one of the first countries to embrace it,” the site reports. “Today, they have what’s called kryptonasia, where doctors make the decision of when a patient’s life should be taken, without input from the family.”

Lest LifeNews.com readers think this merely an example of European permissiveness or unbridled liberalism, the website’s editors quickly made the story relevant to readers in the United States, charging that the imposition of the Affordable Care Act (ACA) has brought “death panels” to U.S. soil. Reportorial emotions run high as LifeNews.com and the National Review, among other media outlets, conjure the Godlike powers of the ACA’s Independent Payment Advisory Board (IPAB), an oversight panel that the antis consider an Obama-crafted vehicle for life-and-death decision making.

It’s not the first time the right wing has imagined this lurking menace.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

In its initial incarnation, the ACA included funding so doctors could be paid for providing end-of-life counseling to Medicare beneficiaries, Karen Davenport, director of health policy at the National Women’s Law Center, told Rewire. The goal was to ascertain people’s end-of-life preferences before those decisions needed to be made. For example, might they opt for palliative care over medical intervention if they become terminally ill? Have they considered signing a Do Not Resuscitate Order to prevent being hooked up to machines and force fed? Conversely, do they want doctors to do everything possible to keep them alive?

Davenport notes that the end-of-life counseling provision never made it into the final version of the ACA, in large part because Republican lawmakers erroneously labeled the proposed discussion a “death panel” and railed that it was a bold-faced attempt to push grandparents and people with disabilities into a cost-saving, humanly orchestrated demise. But its defeat did not signal the end of “death panel” malarkey, and conservatives have continued to shout the phrase wherever and whenever possible. “The idea of having a board that decides if people will get services or not fits into a pervasive right-wing narrative,” Davenport said. “It’s great rhetoric. Presenting an imminent threat to people who already distrust Obama and the government revs up supporters.”

Who cares if the allegations are true?

Indeed, when Congress created the IPAB, the right quickly moved in to attack this new, presumably assailable target as a threat to medical autonomy. That it has absolutely nothing to do with medical decision making was irrelevant. So what is the board’s function, you ask?

“The board is a backstop to make sure that Medicare, a really important source of health care for elders and the disabled, realizes cost savings,” said Davenport. “The law explicitly prohibits rationing care or doing anything to propose changes to the program. Among other things, it can’t impose higher cost-sharing for recipients or raise premiums.”

Once it is convened, the non-partisan board will be composed of 15 congressionally vetted people, all recommended by party leaders. As of today, no one has been nominated to serve. Still, once appointments are made, their job will be to make recommendations to the House, Senate, and president. Congress will then vote these recommendations up or down. “Their exclusive focus will be on the fees that are paid to providers with an eye toward controlling Medicare reimbursement rates to physicians,” Davenport said.

This reality, of course, has done nothing to assuage the antis. The specter of euthanasia—and physician-assisted suicide—continues to loom large, claim HLI and other anti-choice groups. In fact, as increasing numbers of lawmakers and the general public express their support for allowing the terminally ill to end their lives on their own terms, their panic is escalating. In addition, their fear-mongering about the United States’ moral decline is ramping up. To make its point, the right routinely trucks out the death-with-dignity legislation that is gathering steam throughout the world. Closer to home, they raised a ruckus over Vermont’s decision in May to become the fourth U.S. state to allow physicians to provide medication to dying patients so they can end their lives. The Center for Bioethics and Culture Network expresses the views of most death-with-dignity opponents when it argues that “a society that permits or legalizes euthanasia and assisted suicide for the few, embarks on a path leading inexorably to permissive mercy killing of the many.”

This stance leaves supporters shaking their heads and asking why.

“If someone wants to commit suicide, it’s most often an impulsive act that comes from mental illness,” Barbara Coombs Lee, president of Compassion & Choices, a Washington, D.C.-based advocacy group that champions expanded options for terminally-ill people, told Rewire. “Assisting them is illegal. This is very different from aid in dying, which is a rational decision that comes at the end of life. We are talking about offering people who are dying a peaceful exit at a time of their own choosing. It’s very different from assisting in a suicide or coaxing depressed people to jump from ledges.”

It comes down to choices, Coombs Lee says, and who has them and who doesn’t. Furthermore, she calls conservative grumblings about “death panels” and death-with-dignity legislation “a bunch of heat and political posturing.” What’s more, she said, “the extremism that drives these scare tactics does not represent mainstream America. People are overwhelmingly in favor of having end-of-life options.”

Not surprisingly, they are similarly in favor of the ACA and reproductive justice.

Analysis Abortion

‘Pro-Life’ Pence Transfers Money Intended for Vulnerable Households to Anti-Choice Crisis Pregnancy Centers

Jenn Stanley

Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.

Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.

Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.

Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.

This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.

Where Funding Comes From

The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.

This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.

As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.

Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.

“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”

Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.

According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.

Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.

Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazette reported in April that at least some of the money appears to have been designated for programs outside the state.

Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.

“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”

 

“Every Other Baby … Starts With Women’s Care Center”

Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.

Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.

In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.

The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.

“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.

Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.

Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.

“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.

Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”

In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.

Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”

Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.

Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.

In a 2011 interview with Philadelphia City Paper, Kevin Bagatta said that Real Alternatives counselors were not required to have a degree.

“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.

There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.

Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.

“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”

“Life Is Winning in Indiana”

Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.

These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.

Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.

A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”

Hunsberger denies any deceit on the part of Women’s Care Center.

“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”

Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”

“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.

Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.

“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.

If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.

In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.

Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.

News Abortion

Health Insurer Kaiser Distances Itself From Employees’ Anti-Choice Activities

Nicole Knight Shine

Active since 2014, if not earlier, Kaiser for Life appears to oppose what it describes as "late-term" abortions performed at Kaiser Permanente facilities in California.

Kaiser Permanente is disavowing an anti-choice group called Kaiser for Life, telling Rewire that the $60-billion company wasn’t aware of the group, apparently comprised of Kaiser Permanente doctors and patients, and that the company is “not lending our name to it.”

The group Kaiser for Life is taking part in the July 23 summit for Californians for Life, which opposes abortion rights. Appearing on a list of “Pro-Life Doctors, Nurses, and Medical Clinics,” Kaiser for Life is described as being made up of “doctors, nurses, patients, staff, and administrators who want to end abortion, helping both women and babies THRIVE.”

Kaiser Permanente has used the word “thrive” to market itself for more than a decade.

Active since 2014, if not earlier, Kaiser for Life appears to oppose what it describes as “late-term” abortions performed at Kaiser Permanente facilities in Sacramento and elsewhere, according to Sacramento Pro-Life News.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

A representative from Kaiser for Life didn’t respond to an inquiry about the group by press time.

A Kaiser Permanente spokesperson told Rewire that the Oakland-based health-care provider’s policies permit employees to take part in political activities, as long as workers are off the clock, off premises, and avoid the appearance of representing their employer.

Asked whether participating in Kaiser for Life might violate company policy, the spokesperson would only say that the nonprofit has no immediate knowledge of the organization or contact with it.

A Kaiser Permanente logo can be seen accompanying a brief 2014 story about Kaiser for Life by Sacramento Pro-Life News.

“Kaiser Permanente is committed to providing the full range of comprehensive, integrated women’s health services for our members,” the spokesperson noted in an email.

The spokesperson said “elective” pregnancy terminations are performed at some Kaiser Permanente facilities, “usually as a result of complications or multiple fetal anomalies,” while other abortion services are provided through Planned Parenthood and Family Planning Associates.

Anti-choice advocacy by doctors and nurses isn’t unheard of, and the Californians for Life website lists participating groups like the Association of Pro-Life Physicians and California Nurses for Ethical Standards, which “promotes respect” for the “preborn.”

Conversely, anti-choice groups routinely target companies that, among other things, allow voluntary employee-donation programs to Planned Parenthood. Bank of America, as Rewire reported, was subject to an anti-choice boycott late last year.