Personal Health

Child Health Care Tangled in Anti-abortion Politics

Bush's deplorable response to expanding child health care represents more than a fierce opposition to government-provided services.
A different version of this article originally appeared on RHRealityCheck.org.

Whether out of genuine compassionate conservatism or a fear of voter retaliation, 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. The Senate proposed a $35 billion boost over the next five years, compared to Bush's $5 billion increase. To put these increased costs into 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," Bush said in an interview with Washington Post reporters.

But Bush's deplorable response to expanding SCHIP is not just about opposing government-provided services. Like so much else in his presidency, the Bush 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 woman 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. The twelve states that have elected to use SCHIP funds for pregnancy care have largely managed to get around this restriction through various maneuvers; however, some gaps remain. In Texas, for example, the SCHIP program does not pay for certain services that could affect a woman during her pregnancy, such as cardiac care and asthma management. And although that state does pay for postpartum care, it does not provide for family planning services at that visit, which is an expected standard of care, according to medical guidelines.

Why did the Bush administration propose this cruel and absurd policy in the first place? The availability of services to poor pregnant women was 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 akin to 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 in the second trimester anesthesia for the fetus, even though an exhaustive review of the literature by respected researchers -- one that was published in the Journal of the American Medical Association -- concluded that fetuses were incapable of feeling pain until the 29th week of gestation.

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.



Carole Joffe is a professor of sociology at the U.of California, Davis, and a researcher at the Bixby Center for Reproductive Health Research and Policy at the U.of California, San Francisco.
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