Op-Eds, Editorials Roll In on Bush Plan to Extend CHIP Coverage to Fetuses

A draft policy from the Bush administration that would permit states to make fetuses eligible for medical coverage under their CHIP programs has drawn public reaction in recent days. The policy is laid out in an undated draft letter to state officials from Dennis Smith, who supervises the CHIP program at the Centers for Medicare and Medicaid Services (formerly HCFA). The letter states that HHS Secretary Tommy Thompson intends to propose that "an unborn child" may qualify as a "targeted low- income child" eligible for the CHIP program. Smith writes, "This would mean that regardless of the age of the mother, eligibility for the unborn child may be established, thereby making services including prenatal care and delivery available." Currently, the CHIP program only covers pregnant girls under the age of 18, though New Jersey and Rhode Island have received federal waivers to cover older pregnant women. And while Medicaid covers pregnant women of all ages, the federal government only requires states to cover women up to 133% of the federal poverty level; state CHIP programs often have higher income ceilings. The letter does not indicate how old a fetus must be to qualify for state coverage, and some officials "want to specify" that a fetus could qualify soon after conception (Kaiser Daily Reproductive Health Report, 7/6). Outlined below are the summaries of all the public opinion pieces and editorials uncovered by the Kaiser Daily Health Policy Report since the decision was announced last week, the majority of which oppose the proposal.

Op-Eds and Statements

• Donald Powell, columnist: In a Philadelphia Inquirer op-ed, Donald Powell writes that "Bush and company are right" to try to provide medical coverage for fetuses because any medical procedures performed on a fetus will "directly affec[t] the life and health of that unborn child." Powell writes that some have argued that a fetus' "total dependency" on the woman carrying it means that it "should not be considered a separate human life." However, he states that "[t]here can hardly be more direct evidence that a fetus is a human life than our ability to photograph it, medically treat it and even perform corrective and/or lifesaving surgery on it." He adds that even if some people do classify the fetus as a dependent being, they should not oppose Bush's proposal because "in a civilized society, dependency is neither a crime nor a reason to ignore constitutional rights and protection." Although abortion-rights advocates are "right to worry" that Bush's plan may "create a new means of undermining Roe v. Wade," they should be able to draw "distinctions when it comes to government health allocations," Powell writes. He concludes, "This laudable initiative merely exposes the old semantics, makes clear who is being treated and why -- and declares that we no longer will base our criteria for being 'human' on whether a particular life is wanted or not" (Powell, Philadelphia Inquirer, 7/16).
• Robert Best, president, Culture of Life Foundation: The Culture of Life Foundation "lauds" the proposal to extend CHIP eligibility to fetuses, calling it a "bold and compassionate step that would pay big dividends for the health of children and their mothers." In a statement, Culture of Life Foundation President Robert Best states, "Including the unborn in CHIP would be completely appropriate. The unborn are in fact children, and with good prenatal care we would be better able to assure a safe delivery and a healthy future for them and their mothers." Best adds that "to provide low-income mothers with access to the health care that will make them and their babies healthier doesn't take away choice, it adds real choice --the choice of being the healthy mother of a healthy baby, even when money is a problem" (Culture of Life statement, 7/6).
• Judie Brown, president, American Life League: In an ALL statement, President Judie Brown states that the Bush administration's proposal to cover fetuses is only a "camouflag[e]" for its "real agenda" to promote embryonic stem cell research. "By tossing this meatless bone to pro-life apologists for the Bush administration, the president can proceed with his desire to reach a compromise on destructive, embryonic stem cell research," Brown writes. The statement continues, "Reports suggest that the Bush proposal for [the program] would provide each state with the option of providing prenatal care specifically to 'unborn children.' Reports do not reveal, however, that CHIP programs already provide funding for chemical abortions, thereby making it possible for each state to protect only those preborn children who survive chemical assault." Brown concludes that the administration will "not succeed in its attempt to ignore all those dead bodies caused by aborting embryonic persons for their stem cells" (ALL statement, 7/6).
• Marie Coco, Newsday columnist: In her Newsday column, Marie Coco writes that the proposal to cover fetuses through government insurance programs "is one of the Band-Aids Congress has affixed to the oozing wound that is the nation's collective refusal to afford basic health insurance" to those who lack it. Coco writes that if the Bush administration wants to "speed and expand coverage," it could instead grant state waivers of CHIP requirements "wholesale" or back a bill ( S 1016) that would expand CHIP coverage to low-income pregnant women. This bill, Coco notes, "actually would provide funds to pay for [women's] care," whereas the Bush budget "does not." She concludes, "Now the administration pretends to help by pushing poor mothers to the front lines in the abortion wards. They are incubators, this policy says, undeserving in and of themselves. That is a political message, however chilling. It is not to be confused with a plan to save lives" (Coco, Newsday, 7/12).
• Gloria Feldt, president, Planned Parenthood Federation of America: In a statement, PPFA President Gloria Feldt says that although every woman "should have prenatal care coverage," Bush's proposal "devalues women, inflames the [abortion] debate and carves women and their health right out of the picture." Feldt states that states can currently provide coverage to pregnant women over 18 through Medicaid or state CHIP programs if they obtain a waiver from the federal government. She writes, "If the administration is really interested in expanding access to prenatal care, it should simply streamline or eliminate the waiver process." Bush's proposal to cover fetuses through CHIP programs "ignore[s] ... the real health needs of low-income women and families," who she says should receive prenatal care "with no political baggage attached." Feldt concludes, "This should be a wake-up call for anyone who believes that the global gag rule and other attacks on reproductive rights would stop outside our borders" (PPFA statement, 7/6).

Editorials

• Cedar Rapids Gazette: "It's unsettling to give an embryo the kind of legal status being considered" by the Bush administration's CHIP proposal, a Cedar Rapids Gazette editorial states, adding that "[f]ortunately" the proposal is only a draft. "Making an embryo eligible for health coverage seems to ignore the status of the person -- someone with a clearly defined name, gender, identity and all the baggage that comes with it -- carrying that embryo. It's like saying, 'Never mind the woman. Pay attention to the embryo,'" the editorial continues. The administration says that the move is "simply an effort to improve prenatal care for the working poor," but abortion-rights supporters say that the move is a "step to banning abortion." The editorial concludes, "Maybe CHIP isn't the right mechanism to accomplish improved prenatal care for the working poor, if that is what the administration is truly concerned about. Leave the abortion argument to another arena" (Cedar Rapids Gazette, 7/10).
• Newsday: "Under the guise of providing government-funded medical care for uninsured pregnant women, administration officials are weighing a proposal that would allow states to define fetuses as unborn children. That's unnecessary and disingenuous: Women who need care shouldn't be pawns in a strategy sure to roil the legal waters on abortion," a Newsday editorial states. The proposal is unnecessary because states can already cover pregnant women under the program by requesting waivers, the editorial states, adding that Congress could "amend the law to cover expectant mothers and eliminate the need for cumbersome waiver applications -- without redefining fetuses." Defining "fetuses as children, even as unborn children, would hand the abortion opponents legal leverage they have long sought in their fight to outlaw abortion," it continues, adding that the argument that abortion is "murder" would "gain currency, fundamentally altering the legal landscape in the nation's long, painful battle over abortion rights." Coming when the announcement does, as Bush is deliberating over the fate of embryonic stem cell research funding, "it is difficult to ignore the possibility that Bush may be searching for a way to approve the funding while defusing the reaction from the abortion foes by handing them a win as well. He shouldn't stoop to that," the editorial concludes (Newsday, 7/10).
• New York Times: Bush's plan to expand prenatal care by including a fetus in the definition of a qualifying CHIP beneficiary is a "backdoor effort to undermine abortion rights," a New York Times editorial states. The proposal "looks to be designed primarily to advance the right-to-life movement's longstanding goal of establishing a legal precedent for recognizing the fetus as a person," the editorial states, adding that HHS Secretary Tommy Thompson "need not take this approach" as he can encourage the use of federal waivers to cover these women under CHIP. "Instead he is pandering to antiabortion groups with a proposal designed to further their political agenda," the editorial concludes (New York Times, 7/7).
• Philadelphia Inquirer: A Philadelphia Inquirer editorial says, "Everyone wins when poor women are given the best possible opportunity to have healthy babies," but by redefining the fetus as a "targeted low-income child ... [h]ypocritically, the Bush administration is attempting to take advantage of the appeal of good prenatal care and exploit it for political gain." The editorial adds, "a closer look at the proposed measure exposes it as nothing more than a political sham. ... It is a thinly veiled attempt ... to insert blatantly antiabortion language into state and federal law." If Bush "truly wanted to promote healthy babies," he could encourage states to seek a CHIP waiver to cover care for low-income pregnant women or could encourage them to expand Medicaid eligibility requirements. The editorial concludes, "People on both sides of the abortion debate can readily agree that giving the best possible medical care to poor pregnant women is one of the most important things the government can do. This should indeed be about healthy pregnant women who give birth to healthy babies -- not about politics" (Philadelphia Inquirer, 7/16).
• Seattle Post-Intelligencer: "Skepticism of Bush's motives is warranted because of the other obvious ways the goal -- healthier babies -- could be, and, in fact, is already being achieved," a Seattle Post-Intelligencer editorial states. Increasing prenatal care coverage would be "as simple as adding women as beneficiaries of CHIP" by changing the law or by granting states waivers allowing them to expand coverage to pregnant women as they chose, the editorial continues. Washington state already offers prenatal care through its First Steps program, a "progressive" model Bush should investigate, the editorial continues. "Regrettably though not surprisingly, the Bush administration has opted for a circuitous route that happens to run through a legal and political minefield," it concludes (Seattle Post-Intelligencer, 7/11).