THE BUSH administration has decided it's time to do something about the
millions of Americans who don't have health insurance. Just so long as they
aren't born yet.
The Health and Human Services Department wants states to insure the "unborn
children" of low-income pregnant women. Not necessarily the already-born
children of the very same women. Certainly not the women themselves.
The idea has been circulated in a draft policy letter from the
administration to state health officials. It seeks to allow states to insure
these "unborn children" - under the federal-state Child Health Insurance
This is one of the Band-Aids Congress has affixed to the oozing wound that
is the nation's collective refusal to afford basic health insurance to 43
million of its citizens. Of these, 11 million are children.
They are living, breathing, running, jumping, sweating - and suffering, at
any given time, everything from ear infections to AIDS. But these are not the
children to whom the administration offers its hand.
The child-health program began with much ado a few years ago. Its promise
was grander than has been its practice. Only 3.3 million of the eligible
children have been enrolled since 1997. The states have never used all the
The program covers pregnant girls under 18 but not pregnant women over 18,
a perversion. And so here is the idea: Why not give the fetus of an uninsured,
adult woman coverage the mother herself lacks?
"This is an attempt to expand access for prenatal care," said William
Pierce, a spokesman for HHS Secretary Tommy Thompson.
It is not - categorically not, Pierce insists - a sop to the anti-abortion
lobby. This is the lobby that believes an hours-old collection of cells has
rights equal to, if not greater than, the full-grown woman whose body makes
them. So why not make health insurance a new fetal right?
Because it's already available to their mothers. States currently can, and
do, insure pregnant women under Medicaid - up to any income level a state
decides upon. States currently can, and have, gotten federal waivers, initiated
by the Clinton administration, to cover the pregnant women under CHIP, which
offers greater reimbursement than Medicaid.
"It doesn't really end up expanding coverage," said Cindy Mann, senior
fellow at the Kaiser Commission on Medicaid and the Uninsured.
The administration, if it badly wants to speed and expand coverage, could
grant state waivers wholesale. Or it could back a bipartisan bill sponsored by
Sen. Jeff Bingaman (D-N.M.) that would simply add pregnant, adult women to the
list of those eligible for CHIP. This measure actually would provide funds to
pay for their care. The Bush budget does not.
Or the administration could push to reverse recent changes in Medicaid that
have thrown millions of young women off insurance. Women of childbearing age
were most likely to lose Medicaid and become uninsured between 1994 and 1998,
according to a study prepared for the Kaiser Family Foundation.
Welfare revision severed the link between public assistance and insurance.
When low-pay, no-benefit jobs came instead of a welfare check, the new workers
often lost Medicaid coverage, though most still qualify. And congressional
Republicans, who waged war on immigrants before President George W. Bush
decided they are key to his political future, pushed a Medicaid change that
makes legal immigrants wait five years for coverage. Bush did not happen to
mention this at Ellis Island the other day.
It does beg a question, though: "What's the immigration status of a fetus?"
The death rate among pregnant women in the United States is highest among
African-American and Latina women, with immigrants at greatest risk, according
to public health officials. U.S. maternal mortality is among the highest in the
industrialized world; the rate hasn't dropped since 1982. It is one more
disgrace atop the ignominy of being the nation most able to care for its
people, and least willing to do so.
Now the administration pretends to help by pushing poor mothers to the
front lines in the abortion wars. They are incubators, this policy says,
undeserving in and of themselves. That is a political message, however
chilling. It is not to be confused with a plan to save lives.
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