November 21, 2004
WASHINGTON - Long before it ended up attached to a budget bill being voted on by Congress, the effort to ease legal requirements to provide abortion services was underway in community hospitals across the country.
The omnibus spending bill approved Saturday by the House and Senate contains a provision that will allow hospitals and health maintenance organizations to refrain from providing abortions and related services. President Bush is expected to sign it into law.
Forty-five states and the federal government already give individual doctors the right to refuse as a matter of conscience to perform abortions.
The measure, sponsored by Rep. Dave Weldon (R-Fla.), extends the right of refusal to hospitals and HMOs. They could choose not to pay for, perform or even refer patients for abortions.
On both sides of the contentious debate, lawmakers and activists have predicted far-reaching consequences.
"Federal dollars should not be used to deny the federally protected right to choose," House Minority Leader Nancy Pelosi (D-San Francisco) said. She called the Weldon amendment "an extraordinary sneak attack on women's rights."
Sen. Barbara Boxer (D-California) said Weldon's proposal "treats women worse than criminals" because it makes it easier for providers to refuse to refer women for abortions. "We make sure criminal suspects have to be told their constitutional rights."
The provision was pushed by National Right to Life and several Catholic organizations, and was seen as a display of political strength by antiabortion organizations.
Douglas Johnson, legislative director of National Right to Life, called the 108th Congress "the most successful yet" for antiabortion forces.
The Weldon amendment was a reaction to abortion rights victories in courtrooms across the country, Johnson said. "Ten different courts said that no matter what the state constitution says, you have to provide abortions," he said.
Under the Weldon measure, "it's really pretty simple," Johnson said, noting that "nobody loses their funds" whether they provide abortion services or limit them.
One of the earliest efforts to impose restrictions occurred several years ago in the small Alaska town of Palmer. Religious conservatives elected to the Valley Hospital Assn.'s board voted to end abortions except in cases of rape, incest or danger to the mother's life, contending that the policy change reflected residents' sentiments.
An obstetrician-gynecologist who performed abortions at the hospital, along with a local abortion rights group, filed suit. The state Supreme Court ruled that because the hospital accepted public funds, it had to allow abortions.
This year, in Las Cruces, N.M., a Dona Ana County commissioner inserted language in a long-term public hospital lease that would have limited abortion as a "method of birth control." Though public hearings were held on the lease, the language did not attract notice.
"Knowing that this is a conservative community, I believed that was the will of the general public," said Paul B. Curry, who chaired a joint city-county negotiating panel and wrote the abortion-limits clause.
He said he was concerned that, because the nonprofit organization that had been running Memorial Medical Center had struggled financially, the new operator might someday decide that abortions should be marketed to make money.
When the restrictions on abortion came to light, the state finance board refused to approve the contract, saying the clause was unconstitutional. Rather than imperil the lease, the city and county dropped the prohibition.
The Rev. Howard Bess, an American Baptist pastor who was president of the Mat-Su Coalition for Choice in the Alaska case, predicted Weldon's action would reenergize activists like those in Palmer and Las Cruces who had lost their fights.
"They cut us off at the knees," he said. "There'll be more suits filed."
Curry agreed with the assessment, though not with the sentiment. "I think it's very appropriate," he said. Healthcare providers "should have the option of refusing to perform elective abortions in their communities."
Boxer said Senate Republican leaders promised Saturday to bring up the Weldon amendment on its own in a few months. "Because there's no way I can win right now, all I can do is delay," she said in a telephone interview after speaking against the proposal on the Senate floor.
But Johnson, of National Right to Life, noted that antiabortion forces would gain strength once the 109th Congress is seated in January. He called Boxer's effort "thrice doomed."
Abortion-rights advocates were particularly infuriated by Weldon's championing of the right of a hospital or healthcare center to refuse to refer a patient for an abortion.
"This is about HMOs and hospitals dictating to a doctor what they can tell a patient about access to services," said David Seldin, a spokesman for the abortion rights group NARAL Pro-Choice America. "This is about the sanctity of the doctor-patient relationship."
"An employer can set its policies," said Johnson, "and that means that a doctor can go work elsewhere if he doesn't like that policy."