The New Political Landscape for Reproductive Health Federal Legislative and Regulatory Action in 2009 January 2010 OVERVIEW The political landscape at the federal level changed dramatically as a result of the 2008 election. Having a pro-family planning, pro-choice president after eight years in the wilderness yielded many – but certainly not all – of the policy and personnel shifts that reproductive health supporters hoped would flow from an administration diametrically opposed to its predecessor on these issues. The new Administration‟s pro-reproductive health agenda was aided by the growth in the ranks of reproductive health supporters in both the House and Senate, although the absence of a solid pro-choice majority in either body meant that roadblocks to progress were still commonplace. And despite increasing numbers, the ranks of pro-choice public officials willing to vocally support services that comprise basic health care for women were painfully thin. Years of high-pitched political opposition have taken a toll, with even family planning attracting more than a whiff of controversy – despite near- universal use and support by Americans. And abortion – a service utilized by almost one-third of American women – is still viewed as a political problem of epic proportions by elected officials – including many who self-identify as pro-choice. Despite these considerable hurdles, the Obama administration and supporters in Congress made important strides toward restoring the role of the U.S. as a leader in sexual and reproductive health issues at home and abroad. During his first week in office, President Obama rescinded the Global Gag Rule, at last allowing U.S. aid to flow to international family planning organizations that use their own non-U.S. funds to offer abortion services or provide information or counseling about abortion. In March, he rescinded the so-called “conscience” regulation put in place in the final days of the Bush Administration that broadened the ability of health workers to refuse to provide care – including reproductive health services they find objectionable. The move was praised as a crucial victory for women's health and reproductive rights, while opponents condemned it as a devastating setback for freedom of religion. In May, the Obama administration took another critical step forward by allowing federal taxpayer dollars to fund significantly broader research on embryonic stem cells, stating that “medical miracles do not happen simply by accident.” The Administration promised to make up for the ground lost under his predecessor. Many of the President‟s budget priorities for 2010 reflected a welcome change by boosting funding for domestic and international family planning, eliminating ineffective federal abstinence-only grants, and redirecting funding to more robust teen pregnancy prevention programs which include information about contraception. There were incremental steps forward in the context of the annual appropriations process, but health insurance reform dominated the legislative landscape for the latter half of the year. Heath insurance reform was looked to as a way to expand affordable and accessible insurance coverage for millions of uninsured and underinsured Americans. Organizations that care about women‟s rights pursued reform as an important 1 opportunity to eliminate gender rating and to improve coverage of preventive health services such as family planning. For many national pro-choice groups like the National Partnership, who strongly supported efforts to reform our nation‟s health care system, abortion coverage was a sword of Damocles hanging over them throughout the process. The initial hope that abortion services would not be singled out for exclusion was dashed relatively early in the debate, leaving a bitter and ongoing fight to preserve the status quo on federal abortion policy to assume center stage. Unfortunately hyperbole, misinformation, and outright distortions characterized the public debate on abortion coverage. Confusion was bred in part by a contingent of anti- choice Democrats and Republicans who continued to rankle congressional leadership throughout the summer and fall with complaints that there was a so-called “hidden abortion mandate” in health care legislation. They were assisted by conservative organizations like the Family Research Council and the U.S. Conference of Catholic Bishops, and by radio talk show hosts such as Rush Limbaugh that incited their conservative base by claiming that the reform bills included “mandatory” coverage of abortion services. The House completed action on their version of health care reform before Thanksgiving. By Christmas Eve, when the Senate approved its version of the bill, it was abundantly clear that abortion would remain a sticking point until the bitter end. As Congress began to merge the House and Senate bills at the end of 2009, it was clear that pro-choice elected officials and organizations did not have much to work with. The House bill contains egregious language authored by Representative Bart Stupak (D-MI) that would effectively ban insurance coverage of abortion in the newly created exchanges – language that would take away coverage women now have. The Senate agreed to less restrictive, but still unacceptable, language requiring individuals in the exchange who purchase health coverage that includes abortion care to write two checks for every insurance payment – one for abortion coverage and one for all other services. This is an unworkable arrangement that advocates fear will lead insurers and individuals to opt out of plans with abortion coverage. And finally, the controversy surrounding abortion is punctuated by the tragic murder of Dr. George Tiller, a preeminent abortion practitioner. Dr. Tiller served patients from all over the United States in his Wichita, Kansas clinic. Dr. Tiller was shot to death by an anti-choice crusader on May 31 in the foyer of his church as he handed out the weekly church bulletin. His death serves as a horrific reminder of the danger abortion providers face each day in providing needed health care services to women. Pro-choice members of the House and Senate introduced resolutions acknowledging his death. 2 ADMINISTRATIVE ACTION Global Gag Lifted in First Week of New Administration On his third day in office, President Obama reversed the „Global Gag Rule,‟ his first important step toward dismantling the Bush-era policies on reproductive health. The Global Gag Rule had prohibited any U.S aid from going to HIV/AIDS clinics, birth- control providers, and other organizations around the world that used their own funds to advocate or provide abortion counseling and services. The rule was signed by President Ronald Reagan in 1984, overturned by President Bill Clinton in 1993, and reinstated by President Bush. The Gag Rule deprived the world's poor women of desperately needed medical care. The Executive Order rescinding the Global Gag Rule was issued one day after the 36th anniversary of the landmark Supreme Court decision Roe v Wade. President Obama issued a statement reaffirming his commitment “to protecting a woman's right to choose.” Obama said, “On the 36th anniversary of Roe v Wade, we are reminded that this decision not only protects women's health and reproductive freedom, but stands for a broader principle: that government should not intrude on our most private family matters.” Anti-Choice Groups Launch Postcard Campaign on FOCA at Beginning of Term With the election of Obama, anti-choice groups began the year on the attack. The U.S. Conference of Catholic Bishops and other anti-choice groups launched a nationwide postcard campaign against the Freedom of Choice Act (FOCA), legislation intended to codify Roe v. Wade's protections and guarantee the right to choose for future generations of women. They latched onto a statement Obama had made at a July 2007 Planned Parenthood event, during which he had said signing the bill would be “the first thing I'd do as president.” Despite this commitment and clear support for the measure by pro-choice groups, all parties agreed that the climate to pursue FOCA was not ideal. Understanding that the bill was unlikely to move and recognizing the bill as a political lightning rod, advocates did not even go so far as to press for introduction of the bill in the 111th Congress. On April 29, President Obama expressed a similar view at a press conference, clearly stating that FOCA was not an important legislative priority. White House Initiative to Reduce the Need for Abortion While FOCA quickly fell by wayside, the President consistently expressed his support for a “common ground” agenda throughout the campaign and at the beginning of his term – one that would bring together groups from across the ideological spectrum to talk about programs that work to prevent unintended pregnancies and support women who choose to carry their pregnancies to term. While this mantra offered some opportunities to promote a pro-family planning agenda, it also created some anxiety that abortion rights would take a back seat to less thorny political issues. 3 Speculation as to what support for a common ground agenda would look like in the new Administration heated up when President Obama issued an Executive Order on February 5, 2009 establishing the new White House Office of Faith-Based and Neighborhood Partnerships – an idea with its roots in the Bush administration. Obama's order gave the Office and its 11 satellites in federal agencies a policy role, although precisely what that role is remains unclear. Joshua DuBois, a former associate pastor in the Pentecostal church and adviser to Obama, became the Executive Director. However, it was the appointment of self-identified “pro-life” Alexia Kelley as Director of the Faith-Based Office at HHS, formerly the Executive Director of Catholics in Alliance for the Common Good that raised concerns in the reproductive rights community. The stated purpose of the Office is to form partnerships between all levels of government and non-profit organizations, both secular and faith-based, to better serve Americans in need.