In a country where 40m people have no health insurance, the Bush administration is planning to offer publicly funded medical coverage to fetuses, in a move which pro-choice activists depict as a stealthy step towards outlawing abortions.
Under the plan, states would be allowed to redefine the fetus as "a targeted low-income child". As a result, pregnant women who do not, for any reason, qualify for Medicaid, the state-funded coverage offered to low-income families, could be provided with pre-natal care under the Children's Health Insurance Program (Chip).
That legal distinction is important, because the supreme court, in making its landmark Roe v Wade ruling in 1973 guaranteeing abortion, based its decision on the judgment that "the unborn have never been recognized in the law as persons in the whole sense".
Pro-choice advocates immediately denounced the Chip plan as a stealthy means of preparing the ground for an eventual ban on abortion.
Laurie Rubiner, vice president of the National Partnership for Women and Families, told the New York Times: "This is a backdoor attempt by the Bush administration to perpetuate its opposition to abortion rights. The real goal is to establish a legal precedent for granting personhood to fetuses"
The plan has been drawn up by the health secretary, Tommy Thompson, who is a longstanding opponent of abortion rights. However, his spokesman, Bill Pierce, denied that the measures concealed an anti-abortion agenda.
"They just give the states another tool to expand access to another population," he said yesterday. "States don't have to do this. This is simply another tool for them to use if they wish."
But he also confirmed that the plan would represent a step forward for those who believe that a fetus is a person with individual rights.
"If the question is, is the secretary pro-life? the answer is yes," Mr Pierce said. "So is the administration."
There are currently 43m Americans without any form of health insurance, and 10m of them are children under the age of 18. Medicaid provides basic services for the very poor, but many of the unemployed or low-income workers find that they are disqualified if they own an asset such as a car.
The Chip scheme was set up by President Bill Clinton to try to ensure that fewer children suffered as a result of this loophole, but when he was governor of Texas, George Bush attempted to block efforts to spread Chip coverage in poor Hispanic areas along the Mexican border, for budgetary reasons.
Chip is federally funded, but it was found that poor families who applied for Chip often found that they qualified for Medicaid, which is paid for out of state funds.
The plan currently being considered by Mr Thompson does not stipulate how old a fetus must be in order to qualify for insurance, but the New York Times reported yesterday that some officials wanted to make the qualification age as early as theoretically possible, soon after conception.
© Guardian Newspapers Limited 2001