Reproductive Health-Care Fights Roil Washington

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Reproductive Health-Care Fights Roil Washington

Christine Grimaldi

Planned Parenthood Federation of America’s Dana Singiser called the GOP's omnibus bill “more extreme than the Trump Administration’s own budget."

Radically different visions for reproductive health care, from helping people with low incomes access family planning services to preventing teen pregnancies, are splitting Capitol Hill and pitting some Republicans against the White House.

Lawmakers in the U.S. House of Representatives and the U.S. Senate have each proposed separate fiscal year 2018 Labor, Health and Human Services, and Education (Labor-HHS) bills that essentially cancel each other out in how they do, or don’t, value health care for women. Transgender and gender nonconforming people, people with low incomes, and people of color stand to lose even more from the House’s cuts to programs geared toward ending the disproportionate disparities and negative outcomes they face in a health-care system that values those who are cisgender, wealthy, able-bodied, and white.

President Trump is already giving the majority of congressional Republicans who want to undermine those programs, along with avowedly anti-choice administration officials with the same goals, wide latitude to do so.

Trump’s Centers for Medicare and Medicaid Services chief, Seema Verma, stood by his side as he signed off on congressional Republicans’ plan to undermine Obama-era Title X safeguards intended to stop state-level interference in the federal funding stream for family planning clinics. By July, Trump’s U.S. Department of Health and Human Services (HHS) suddenly pulled the plug on $213.6 million funding for 81 teen pregnancy prevention programs, even though the programs had two more years of funding left in their cycles, according to a report from the Center for Investigative Reporting’s Reveal news.

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The same day that the Senate’s friendlier Labor-HHS bill took a key legislative step, the public health agency’s media relations shop, under anti-choice extremist Charmaine Yoest’s leadership, went as far as to retweet a wildly misleading Wall Street Journal editorial falsely claiming that the federal teen pregnancy prevention program doesn’t work.

The House and Senate have some time to reconcile the vast differences between their spending bills, most likely in backroom discussions. Congress just passed a continuing resolution (CR) to fund the government after the September 30 end of fiscal year 2017, through early December, after Trump struck a deal with top Democrats. A CR keeps the federal government running in the absence of annual appropriations bills that are supposed to pass both the House and the Senate and, with the president’s signature, become law. The government operated extensively through CRs during Barack Obama’s presidency thanks to partisan gridlock.

CRs can set the stage for potentially dramatic showdowns while funding for the federal government hangs in the balance. Remember when Sen. Ted Cruz (R-TX) in 2015 tried and failed to shut down the government over “defunding” Planned Parenthood? Through their appropriations bills, House and Senate Republicans are revealing their potential targets, if not for the next CR, then for other anti-choice legislative pushes while they have a friendly White House. And House and Senate Democrats, along with some Senate Republicans, are letting their counterparts know that sundry attacks on women’s health won’t stand.

House Versus Senate

A short primer on the appropriations process: The House last Thursday passed 12 fiscal year 2018 spending bills collected into a $1.23 trillion “omnibus” package (HR 3354). House Speaker Paul Ryan (R-WI) and his brethren’s wish list is dead on arrival in the Senate for a couple of reasons—first and foremost because no Democrat in the upper chamber is likely to support it. Most controversial bills in the Senate need at least some Democrats on board to reach the 60-vote threshold to advance without a potential derailment in the form of a filibuster. Moreover, the House omnibus bill’s massive price tag violates pre-existing budget caps and therefore would trigger what’s known as sequestration, or mandatory cuts to defense and domestic spending. Lawmakers would have to agree to lift those caps—again, a heavy lift.

As part of the House-passed omnibus, the Labor-HHS bill zeroes out federal Title X family planning funding to health-care providers that serve people with low incomes, Rewire reported in July. At the same time, the administration is using the endangered program to justify rescinding Obamacare’s birth control benefit, claiming that women with low incomes can go through Title X providers to obtain “free or subsidized contraceptives.”

Targeting Title X is only the start of a Labor-HHS bill that House Appropriations Committee Democrats in a release called “a multi-faceted assault on women’s health”: 

It prohibits federal reimbursement to Planned Parenthood for health care services, including contraceptive services, for women covered by Medicaid. It eliminates funding for Title X family planning and Teen Pregnancy Prevention grants and includes the text of the Conscience Protection Act, threatening a woman’s access to care in life-endangering emergencies. It expands the “Global Gag Rule,” prohibiting organizations that provide or counsel women on abortion services from receiving any global health funding, prohibits funding for UNFPA [United Nations Population Fund], and caps reproductive health funding at the 2008 level.

The Conscience Protection Act allows a broadened swath of health-care providers to sue if they’re supposedly coerced into providing abortion care, or if they face discrimination for refusing to provide such care. The House passed the legislation last year, but it would almost certainly fail to meet the Senate’s 60-vote threshold. Trump, however, has repeatedly called on Senate Majority Leader Mitch McConnell (R-KY) to change the chamber’s rules and lower the threshold to a simple 51-vote majority.

McConnell has so far shot down that idea.

Trump already reinstated the global gag rule, an anti-choice policy prohibiting U.S. foreign aid to organizations that provide abortion care abroad with their own funds. Although every Republican president since Ronald Reagan has implemented the policy, Trump’s dramatically expanded version received icy reviews from reproductive health advocates and even from a former George W. Bush administration official.

House Republicans presumably wrote the global gag rule into the Labor-HHS bill in an attempt to codify, or enshrine, the policy in the law. Their strategy would prevent a future Democrat in the White House from rescinding it via an executive order, à la Bill Clinton and Obama.

Republicans attached a rider to the omnibus’ fiscal year 2018 Financial Services and General Government bill ending the Johnson Amendment, a 1954 provision barring tax-exempt organizations like churches from making political endorsements or electioneering on behalf of a candidate. More than 20 groups, including the nonpartisan Campaign Legal Center and the Brennan Center for Justice, called the move “a backdoor effort to get rid of the Johnson Amendment without allowing House members to vote on this important question.” Trump already undermined the Johnson Amendment months ago via executive action that’s still subject to legal scrutiny.

Planned Parenthood Federation of America’s Dana Singiser in a statement called the omnibus “more extreme than the Trump Administration’s own budget”—a budget, Rewire reported, that amounts to a “pro-life” wish list restricting access to reproductive health care while bludgeoning social safety nets that sustain life for people with nowhere else to turn.

Singiser, the health-care organization’s vice president of public policy and government affairs, pointed to other anti-choice areas in the omnibus.

The fiscal year 2018 Financial Services and General Government spending bill would ban abortion coverage under Obamacare’s multi-state insurance plans “and continue harmful provisions to restrict abortion access, including banning the District of Columbia from using its own own funds to pay for abortion services for low-income women and prohibiting federal employees from receiving abortion insurance coverage,” according to the statement. Rep. Gary Palmer (R-AL) then doubled down against the people of the District of Columbia through a successful amendment to repeal local law protecting employees from retaliation over their reproductive health-care choices. (The House passed the same amendment as part of last year’s financial services spending bill.)

Meanwhile, the fiscal year 2018 Homeland Security bill, in addition to funding a border wall, would block people in U.S. Immigration and Customs Enforcement custody “from needed health care by banning abortion coverage except in cases of rape, incest, and to protect the woman’s life.

Senate Versus White House

The Senate’s Labor-HHS bill is the opposite of the House’s in almost every way, attempting to at least preserve the status quo on reproductive health programs already under attack from the Trump administration.

The full Senate Appropriations Committee last Thursday voted 29 to 2 to advance a bipartisan Labor-HHS bill that would not only maintain Title X and teen pregnancy prevention funding levels, but also administer the programs as they operated under Obama’s presidency—in effect, ordering the Trump administration not to take the money and use it for its own ends.

Sen. Patty Murray (WA), the top Democrat on the Labor-HHS appropriations subcommittee, praised the full committee’s bipartisan vote on the bill for standing up to Trump.

“I’m pleased that this bill ties the Trump administration’s hands as it tries to undermine family planning efforts and gut evidence-based research on teen pregnancy prevention, and I hope that Democrats and Republicans can continue to show President Trump that Congress won’t rubber-stamp his extreme, harmful agenda on women’s health,” Murray said in a statement.

Tying the administration’s hands matters given the top HHS officials who tout failed abstinence-only education and distort or deny the scientifically proven efficacy of birth control. Teresa Manning, the notorious birth control foe nevertheless charged with administering Title X funds to ensure people with low incomes can access family planning services, claims that “family planning is something that occurs between a husband and a wife and God” and isn’t a matter for the federal government.

The anti-choice Susan B. Anthony (SBA) List, in statements to Politico and the white nationalist publication Breitbart News, criticized the typically anti-choice Labor-HHS Chair Roy Blunt (R-MO) for working with Murray to craft a bill “that continues Obama administration policy to protect the abortion industry.”

Spending for fiscal year 2018 State, Foreign Operations, and Related Programs (State-Foreign Operations), under the full committee’s consideration the same day as the Labor-HHS bill, likely registers a similar disappointment to SBA List.

Initially, the State-Foreign Operations bill included House-type provisions to codify the global gag rule and prohibit UNFPA funding. By the time the bill landed in the full committee, typically the last step before consideration on the floor, Sen. Jeanne Shaheen (D-NH) delivered a counterpunch in the form of an amendment to rescind the global gag rule in the vein of her legislation challenging the policy in the first days of Trump’s presidency.

GOP Sens. Susan Collins (ME) and Lisa Murkowski (AK), who have mixed records on reproductive rights, crossed party lines to vote for Shaheen’s amendment, as they did with her Global Health, Empowerment, and Rights (HER) Act in January. Anti-choice Democrat Joe Manchin, the West Virginia senator who met earlier this year with Planned Parenthood smear campaign architect David Daleiden, voted against it.

The full committee ultimately adopted the amendment to the bill, 16-15. And the amendment wasn’t enough to sink the overall bill, which advanced on an even stronger 31-0 vote.

Anti-choice Republicans could attempt to strike the global gag rule amendment with an amendment of their own if and when the State-Foreign Operations bill comes to the Senate floor for a vote. Sen. Lindsey Graham (R-SC), chair of the subcommittee that oversees that bill, expects the point to be moot, given House Republicans’ nearly uniform support for the global gag rule. Alternatively, if the bill gets rolled into a CR or an omnibus, the language could get struck behind closed doors as lawmakers work on a compromise.

GOP Sens. Steve Daines (MT) and James Lankford (OK) intend to push for Planned Parenthood’s exclusion from Title X funds during floor consideration of the Labor-HHS bill, according to a paywall-only CQ report. Lankford is a former Bible camp director behind perennial congressional GOP-led efforts to criminalize a common medical procedure used after miscarriages and during second-trimester abortions.

Advocates Provide Context

House Republicans’ omnibus may be, in the words of a top Democratic aide, a “complete waste of time because it cannot be enacted.” But it reveals the dramatic extent to which they want to cut reproductive health care, with the full support of the Trump administration.

That the Senate even attempted to maintain the status quo for reproductive health care is a testament to lingering echoes of bipartisanship, despite repeated Obamacare repeal bills.

“Given the recent shortening of existing TPP Program grants by HHS, the Senate language is a powerful bipartisan endorsement of continuing the current funding and approach in this gold-standard evidence-based program,”  The National Campaign to Prevent Teen and Unplanned Pregnancy’s Ginny Ehrlich said in a statement.

A senior Senate Democratic aide echoed that sentiment more broadly.

“It’s certainly promising to see Democrats and Republicans coming together to reject some of the most extreme proposals we’ve seen so far on women’s health as it relates to the appropriations process,” the aide told Rewire.

In working together to defy Trump, the aide said Democrats and Republicans showed that they can bridge the partisan divide and find “some spaces for agreement.”

“It’s always heartening to see and certainly speaks to hope that there can be further work on issues like this,” the aide said.

Advocates have hope, too—hope that the appropriations process may even improve on reproductive health care in an eventual CR or omnibus.

The National Family Planning & Reproductive Health Association (NFPRHA), for one, “is calling on Congress to increase funding for family planning as the fiscal year 2018 appropriations process continues,” according to president and CEO Clare Coleman.

NFPRHA criticized House appropriators for gutting Title X and Senate appropriators for flat-funding it, “translat[ing] to an even deeper deficit of resources for the family planning safety net and mak[ing] it harder for millions to seek the education and care they need to stay healthy.”

The National Partnership for Women and Families wants Congress “to fund the government in a way that helps all families achieve economic security,” Vice President Sarah Lipton-Lubet told Rewire in an email.

“That means protecting the safety net on which struggling women and families rely for health care, food, housing and other essential supports,” she said. “And it means protecting women’s access to affordable, quality contraception and abortion care. As Congress considers what programs and initiatives to fund, we want members to know that women are watching and we won’t stand for any funding cuts that would undermine the health, well-being and economic security of this nation’s women and families.”