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01-07-1994
SPOTLIGHT STORY - MEDICAID DIRECTIVE: CLINTON DEFENDS ABORTION ORDER
L.A. TIMES' Tumulty: "Despite protests from several state
Medicaid directors, the Clinton Administration announced Thursday
that it would stand by its requirement that states help pay
abortion costs for low-income women in cases of rape and incest"
(See REPORT 1/5 #1). Health Care Financing Administration's
Bruce Vladeck "insisted" that although a many states have laws or
constitutional amendments that only allow such funding to save
the life of the mother, under the Supremacy Clause of the U.S.
Constitution, "federal law supersedes all state statutes." And
under the Clinton admin.'s interpretation of the new Hyde
Amendment, abortions for rape and incest victims are considered
"medically necessary," meaning that both states and the federal
government fund them. Vladeck gave a "detailed explanation" of
that interpretation in a letter to State Medicaid Directors Assn
chair Ray Hanley, who is also the AR Medicaid Dir. Hanley had
"protested" the directive, contending that Congress' intent in
the Hyde Amendment was to permit states to choose whether to fund
abortions in rape and incest cases. But Vladeck replied that if
allowing states to choose was Congress' intent, "it would have
added specific language to that effect." Hanley was "far from
satisfied" with Vladeck's response. In a 1/7 interview, Hanley
pointed out that before issuing the directive, admin. officials
had indicated they would "respect and try to reconcile state
laws" on the issue. He added that there is an "excellent chance
that Congress will revisit the language" to make its intentions
clearer (1/7). Hanley: "It's an intolerable position to put the
states in" (Hall, USA TODAY, 1/7).
ACTIVISTS REACT: NRLC legislative director Douglas Johnson:
"Thirty-seven states have laws or policies in conflict with the
new Federal directive. The directive is carefully drafted to
provide maximum assistance to pro-abortion groups challenging
these laws. The likely effect is that some of the states would
then be forced to pay for unrestricted abortions." Planned
Parenthood on 1/6 announced that it would file suit against any
state that refused to comply with the directive (See REPORT 1/6).
The Center for Reproductive Law and Policy VP Kathryn Kolbert: "A
long history of Federal court decision supports the Clinton
Administration's position that states must cover all abortions
for which Federal money is available. That's also good policy.
Survivors of rape and incest have suffered enough. They should
not be forced to carry pregnancies against their will" (Pear,
N.Y. TIMES, 1/7). Johnson agreed that judges traditionally have
given "heavy deference" to federal agency interpretations of
statutes in situations where Congress' intent is questioned (L.A.
TIMES, 1/7). A federal government atty said that under the
Medicaid law, "what is not prohibited is required if it is
medically necessary." She said that since Medcaid coverage for
abortions in cases of rape and incest is no longer prohibited,
"it is therefore required." Kolbert: "In general, the Federal
Medicaid law required states to pay for doctors' services that
are medically necessary. Congress has prohibited the use of
Medicaid money for abortion generally but permitted use of money
when a women's life is in danger or the woman is a survivor of
rape or incest. In those three situations, abortion coverage is
mandatory, and states are not free to impose more restrictions
than the federal statute imposes" (N.Y. TIMES, 1/7).
PUBLIC FUNDING LAWS AS OF 1993: According to NARAL, states
that have laws restricting public funding unless to save the life
of the mother include AL, AZ, AR, CO, DE, DC, FL, GA, IL, IN, KS,
KY, LA, ME, MI, MO, MS, MT, NE, NH, NV, NM, ND, OH, OK, SC, SD,
TN, TX and UT. States that provide funding in certain additional
circumstances, such as rape or incest include ID, IA, MD, MN, PA,
VA, WI, and WY. States that fund all or most abortions include
AK, CA, CT, HI, MA, NJ, NY, NC, OR, VT, WA and WV (NARAL review).
STATES THAT WON'T COMPLY: So far, Medicaid officials in UT
and LA have said that they will not comply with Clinton's
directive (See REPORT 1/6). LA Dept. of Health and Hospitals
spokesperson Joe Wagner: "We can't pay because it would be a
violation of state law" (AP/ARKANSAS DEMOCRAT-GAZETTE, 1/6). LA
Dept. of Health and Hospitals deputy dir. John Futrell: "We could
risk the entire Medicaid program by not following federal rules."
At risk is about $2.8B annually in Medicaid funding. The LA
Legislature cannot change the abortion law during the regular
1994 session because of a new constitutional amendment "limiting
discussions to fiscal matters during even-numbered years." A
special session would have to be called to make that change,
according to Futrell (Myers, Baton Rouge MORNING ADVOCATE, 1/6).
STATES THAT MAY HAVE TROUBLE COMPLYING: The Associated
Press has pointed to certain states that may have "trouble"
complying with the new requirement. Those states include: MO,
NH, VA and AR. A spokesperson for pro-choice AR Gov. Jim Tucker
(D) said that his state is taking a "wait and see attitude." SD
officials have said they were not sure whether the state would
comply (AP/ARKANSAS DEMOCRAT-GAZETTE, 1/6). In VA, funding also
is restricted to life/health of the mother, rape or incest, or if
the fetus will be born with a gross and incapacitating physical
deformity (REPORT sources).
STATES THAT WILL COMPLY: So far, states that have laws
restricting funding unless to save the life of the mother, but
nonetheless will comply with the Medicaid directive are AZ, OH
and RI. RI Gov. Bruce Sundlun (D) spokesperson Barbara Cottam:
"We're in the process of reviewing those guidelines and
implementing the regulations (Mills, AP/PROVIDENCE JOURNAL-
BULLETIN).
The Abortion Report
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