Bush and SCHIP: It’s Also About Fetuses

Republican Senators Orrin Hatch and Chuck Grassley have "implored" George Bush not to follow through with his promised veto of the expansion of SCHIP, the State Children's Health Insurance Program.

Whether out of genuine compassionate conservatism and/or fear of the voters, two ordinarily reliable right wing Republican senators, Orrin Hatch and Chuck Grassley have "implored" George Bush not to follow through with his promised veto of the expansion of SCHIP, the State Children's Health Insurance Program that began in 1997. SCHIP, a hugely popular program across the political spectrum, provides health care for children whose parents make too much to be eligible for Medicaid but are too poor to purchase private insurance on their own. While the House and Senate bills are somewhat different, each would increase funding substantially more than the Bush administration is offering. (To put these increased costs in perspective, the Senate bill would cost less in the next five years than the government will spend in the next four months in Iraq).

Bush's Orwellian reason for opposing the expansion of SCHIP is that the program works too well! Namely, that people would get the idea that perhaps a proper role of government is to provide health care to its citizens. "My concern is that when you expand eligibility…you're really beginning to open up an avenue for people to switch from private insurance to the government."

But Bush's deplorable response to expanding SCHIP is not just about opposing government provided services. Like so much else in his presidency, his administration's record on SCHIP is also entangled in anti-abortion politics. In 2002, his Department of Health and Human Services issued a regulation that stipulated "unborn children" — but not the pregnant women carrying them! — were eligible for SCHIP funds. This move contradicted well established standards within the medical community. Both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have stated that the pregnant women and her fetus should be treated together.

Immediately after this regulation was issued, health care providers feared that funding for crucial pregnancy-related services that did not directly relate to the "unborn child" — such as pain medication during delivery and postpartum services — would be denied to women under SCHIP. However the twelve states that have elected to use SCHIP funds for pregnancy care have largely managed to get around this restriction through various maneuvers, and the worst fears of massive amounts of denied care did not materialize.

Some gaps remain however. For example, in Texas, the SCHIP program does not pay for certain services that could affect a woman during her pregnancy, such as cardiac care and asthma management (PDF). And although that state does pay for postpartum care, it does not provide for family planning services at that visit, which is the expected standard of care, according to medical guidelines.

Why did the Bush administration propose this cruel and absurd policy in the first place? The services that poor pregnant women could or could not get were not the point. The distinction that this SCHIP regulation drew between the "unborn child" and the pregnant woman can only be understood as part of a larger antiabortion strategy (enthusiastically supported by the Bush administration) to lay the groundwork for establishing a legal basis for "fetal personhood." The SCHIP measure is of a piece with the "Unborn Victims of Violence Act" passed by Congress and the "fetal pain" legislation that has been introduced at the federal level and passed in several states. Such legislation requires doctors to offer women getting abortions at various points in the second trimester of pregnancy anesthesia for the fetus, even though an exhaustive review of the literature by respected researchers that was published in the Journal of the American Medical Association concluded that fetuses were incapable of feeling pain until the 29th week of

In a similar vein, a number of states are pushing legislation which would require women to see an ultrasound before obtaining an abortion. SCHIP's privileging of the health needs of the fetus over that of the mother is echoed in the recent Supreme Court decision, Gonzales v Carhart. There the Court (with the help of Bush's two appointees) ruled that it was appropriate to override the medical community's judgment about patient safety, and ban a certain procedure "in order to promote respect for … the life of the unborn." And most stunning of all, for the first time since Roe v Wade, the Court held that considering the health of a pregnant woman is no longer constitutionally necessary in abortion law.

The saga of George Bush's treatment of SCHIP therefore represents a perfect marriage of two of the main pillars of his presidency: a full throttle opposition to effective government programs, and a relentless promotion of measures favored by his Religious Right base.

Check out Bush v. Choice for an article on last week's close call in the Senate — an anti-choice amendment to the children's health bill was narrowly defeated.