Federal Refusal Clause Signed Into Law
On December 8, 2004, President Bush signed the FY 2005 Consolidated Appropriations Act into law (HR 4818), which includes the FY 2005 Labor, Health and Human Services, and Education (Labor-HHS) spending bill. The Labor-HHS section of the bill contains a sweeping new federal "refusal clause" which goes well beyond normal "conscience clause" protections. The new language, authored by Representative Dave Weldon (R-FL), could have a dramatic impact on access to reproductive health care information and services.
The Federal Refusal Clause is intended to prohibit a federal agency or program, or State or local government, from enforcing any abortion-related laws or regulations as they apply to health care entities. According to the provision, health care entities include physicians or other health care professionals, hospitals, provider-sponsored organizations, HMOs, insurance plans, or "any kind of health care facility, organization, or plan." Essentially, any "health care entity," would be allowed to refuse to perform, pay for, provide coverage of, or refer for abortions regardless of federal, state, or local laws to the contrary. Any law or regulation that required such action could be considered discrimination and violators would lose all federal funds under the Labor-HHS-Education bill.
This provision has major ramifications across the health care spectrum in that among other things, it effectively nullifies state Medicaid requirements in regard to abortion referrals and coverage and it could prohibit state and local governments from enforcing a wide range of their own laws and constitutional mandates that ensure access to abortion services and referrals. In addition, the provision is at odds with Title X's federal regulations that require clinics receiving Title X funds to provide abortion referrals to clients upon request. In addition to the Federal Refusal Clause, the bill contains a number of provisions that harm women’s ability to control their own reproductive decisions: Under-Funding Family Planning: Title X, the nation's cornerstone family-planning program for low-income women, continues to be inadequately funded. Each year, approximately 4.5 million low-income women and men receive basic health care through the 4,600 clinics nationwide, but far more eligible people do not receive these critical services. This program reduces unintended pregnancies and makes abortion less necessary. Increase Funding for Unproven “Abstinence-Only” Programs: Scientifically unproven “abstinence only” programs received a $30 million increase; three times that of Title X. These programs censor discussion of contraception’s health benefits leaving teens ill equipped to protect themselves against pregnancy and disease. Once Again Canceling Family Planning for World’s Poorest Women: Language that would have restored previously canceled funds to the United Nations Fund for Population Assistance (UNFPA) was stripped from the omnibus. UNFPA provides reproductive-health care, including family-planning services but NOT abortion, to the world's poorest women. For each of the last three years, President Bush has cancelled all funding for this vital program. The loss of EACH year's funding, $34 million, could prevent 2 million unintended pregnancies; nearly 800,000 abortions; 4,700 maternal deaths; nearly 60,000 cases of serious maternal illness; and more than 77,000 infant and child deaths. Enforcing the “Global Gag Rule”: Senate language that would have repealed the “global gag rule” was stripped from the omnibus legislation. This harmful policy, imposed by President Bush on his first business day in office, prohibits the US Agency for International Development (USAID) from granting family-planning funds to any overseas health clinic unless it agrees not to use its own, private, non-U.S. funds for abortion services, advocacy, or counseling.
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