What’s Wrong with the World

As is the case with FEHB plans currently, and with the Affordable Care Act and the President's related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIP) except in the cases of rape or incest, or where the life of the woman would be endangered.

Our policy is the same for both state and federally-run PCIP programs. We will reiterate this policy in guidance to those running the Pre-existing Condition Insurance Plan at both the state and federal levels. The contracts to operate the Pre-existing Condition Insurance Plan include a requirement to follow all federal laws and guidance.

Wouldn't it be prudent to post based on primary souces?

Oops, sources.

The thinking here is based on this line of reasoning. The PA plan states the following on abortion:

Abortions: Includes only abortions and contraceptives that satisfy the requirements of
18 Pa.C.S. § 3204-3206 and 35 P.S. §§10101, 10103-10105.
1. Elective abortions are not covered. Services rendered to treat illness or injuries
resulting from an elective abortion are covered.
2. The Program and its Subcontractors will respect the conscience rights of
individual providers and provider organizations and comply with the
Pennsylvania law prohibiting discrimination on the basis of the refusal or
willingness to participate in certain abortion and sterilization-related activities as
outlined in 43 P.S. §955.2 and 18 Pa. C.S.A. §3213(d).http://www.nrlc.org/AHC/PennsylvaniaHighRiskPoolPlan.pdf

Now 18 Pa.C.S 3204-3206 states that an abortion can only be performed, except in emergency situations, after consultation with a doctor who determines that the abortion is a medical necessity. http://www.health.state.pa.us/abortion/mifnotice.htm

In a practical sense, 3204 means that there on no elective abortions performed in PA. All abortions are a medical necessity. Therefore, the provision list in the plan and the HHS denials are smokescreens.

If you think that is incorrect, why then does 3204 specifically mention that abortions for the purpose of gender selection are banned? It would seem logical that a gender selection abortion is not a medical necessity. However, it is obvious that a medical necessity in PA law is anything a doctor and patient can agree to. Or does PA have an abortion law that violates Supreme Court rulings?

Isn't it interesting to see the pro-choicers (yeah, MZ, I don't care what you call yourself, I'm talking about you, too) running to the definition of a "health" exception thing here? Chris is completely right. I mean, this is particularly striking coming from people who want to call themselves "pro-life" in some sense, given that pro-lifers have known for over thirty years what a "medical necessity" exception means in law.

Suppose that Barack Obama, in signing his infamous executive order, had told us all, "Now, please understand, this still allows abortion coverage for all abortions that a doctor determines to be medically necessary." We would have had a chance to tear that nonsense to shreds then.

Please recall that the previous status quo named only a narrow set of highly specific exceptions under which federal law covered abortions. Now it covers all the ones that aren't "elective" based on the word of some doctor considering a huge range of considerations including psychological and familial. If you can't see that as a major change, you are being willfully blind.

Notice, too, that my main post was pretty brief. I simply said that Stupak & co. should be repenting in dust and ashes. If, MZ, you think Stupak shouldn't be repenting in dust and ashes because he can tell himself, "Oh, it's okay, only the abortions in PA that some doctor says are necessary based on a woman's whole life and familial situation would be covered," then you can share Stupak's millstone. That wasn't what he pretended he was doing.

This is the exact Hyde language like I and everyone else have been saying all along would govern. Why don't you just admit you're wrong? Instead you think that if you call me pro-choice you have buttressed your argument. You may be the most dishonest person I've encountered online.

M.Z.,

If Lydia is the most dishonest person you've encountered online, please allow me to welcome you to the first webpage you've ever been to on the internet. Because clearly you must have had no contact with anyone else, ever. Unless you're just using hyperbole. If that's the case, you're just using rhetoric to buttress your argument—in which case this would be a case of rampant hypocrisy and make you the one being dishonest.

No, MZ, you are wrong, it is not. The Hyde Amendment (as most recently amended) had the following exceptions, and only the following exceptions:

life of the mother
rape
incest

Where in that list do you see the following exception?

in determining whether an abortion is necessary the physician’s best clinical judgment may be exercised in light of all factors relevant to the well-being of the woman

That is from here:

http://www.health.state.pa.us/abortion/mifnotice.htm

See, why don't you just admit that you are wrong, MZ? This is _not_ the Hyde Amendment language. The Hyde Amendment did _not_ include an "any abortion which is necessary in the physician's best clinical judgment" exception. It never did, and of course we would have had a lot more controversy a lot sooner if someone had tried to amend the Hyde amendment to include so broad an exception. And the Hyde Amendment would not have been so hated by pro-choicers had it included so broad an exception.

http://www.aclu.org/reproductive-freedom/public-funding-abortion

Now, I ask you, even under the exceptions of the Hyde Ammendment, is an innocent human life extinguished? What do you call that, I ask? And, under the HA, are federal funds used? Just asking?

As is the case with FEHB plans currently, and with the Affordable Care Act and the President's related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIP) except in the cases of rape or incest, or where the life of the woman would be endangered.

That was the first sentence of the HHS release I quoted above. In case you're still too lazy the read the whole thing, I've placed the relevant section in bold.

MZ, the HHS secretary can release all the press statements she wants, but here is the actual plan:

http://www.nrlc.org/AHC/PennsylvaniaHighRiskPoolPlan.pdf

See p. 14. NRLC didn't just make this up. The statement on abortion coverage there simply references state law and excludes "elective" abortions, and the definitions in that case follow what I have already quoted concerning a physician's determination that an abortion is necessary.

If a woman has this proposed plan as her plan and has a doctor who states that an abortion is "necessary" in his clinical judgment and the plan will not pay for it, she will have grounds for a complaint that the plan is not covering what it would be prima facie taken to cover. Notice that, if we're talking about press releases, according to a PA press release the HHS _did_ approve that very proposal:

http://www.portal.state.pa.us/portal/server.pt?open=512&objID=17319&PageID=502655&mode=2&contentid=http://pubcontent.state.pa.us/publishedcontent/publish/cop_hhs/insurance/news_and_media/news___media/articles/june_28__2010.html

The HHS secretary's press release is, as far as I can see, not worth the pixels it is written on. The plan itself covers all "non-elective" abortions as defined under existing PA law, which is far broader than the Hyde Amendment coverage.

TonyC, that is wandering from the point. Of course I'm not happy about those exceptions. I was not bringing them up to endorse them but to show the _expansion_ of federal health care coverage under Obamacare so that pro-Obama people like MZ shall be "without excuse."

The federal government should stick to protecting snail darters and financing unemployable street thugs, and raising esteem levels of some muslims somewhere in the world based on something Avicenna said sometime ago.

Reading through the PA plan, it looks like PA's and HHS' out is that the PA plan says it will comply with the forthcoming HHS regulations. If the HHS regulations follow the Hyde Amendment rules, then PA would be required to follow them.

The problem is that this is all slap-dash like everything else this administration does. They approve proposals for running a health care plan that they don't even have the regulations written for yet. On the other side, PA is accepting contracts without knowing all of the rules they will be forced to follow. This doesn't make any sense to a normal person. It's like buying a car but letting the dealer decide what accessories you'll get later on.

Either we have incompetence here with things being agreed to without all of the rules and regulations in place. Or, HHS was going to see if they could let it slide by "not having all of the rules in place" yet.

Oh, clearly, HHS would never have released that press release at all had it not been for the outcry from the pro-life side. The timing makes that evident. Even if PA "follows" the pulled-out-of-the-hat HHS "guidance" ("oops, say something, quick") this would itself be the result of the pro-life objections rather than some sort of refutation of them, as the pro-Obama so-called "pro-lifers" want us to believe.

But I have real doubts about even that. Patients and doctors use the provisions of a plan as written to decide what is going to be covered. The only way that this won't be saying to patients that all their "deemed necessary by a physician" abortions will be covered will be if it's rewritten.

I wonder what new spin we'd get from the pro-Obama Catholic crowd if we had in the future a documented case of a non-Hyde abortion covered by this plan?

Notice, for example, that the certification (p. 4) that mentions the HHS contract says that the state of PA will abide by the requirements in the contract _and_ provide the services outlined in the proposal. No faintest hint that the services outlined in the proposal might be _forbidden_ by the HHS contract.

The reactions of left-leaning Catholics every time something like this comes up are very revealing. Do they treat it as a "teaching moment", first in line to criticize the evils of the Obama policies, and then tie in issues upon which right-leaning partisans are in fact deafeningly silent (e.g. widespread funding of abortions through private insurance)?

No, of course not.

Left-leaning Catholics might have a shred of credibility if they were consistently first in line to warn about and criticize the specific wickednesses of their guy. After all, they supposedly supported him under a rubric of remote material cooperation with evil, which means that they are supposedly adamantly opposed to the evil elements of his policies.

Supposedly. But I almost never see that in their actual behavior, in the actual things they write. There is no "paleoish-leftism" which is ruthlessly critical of the Obama administration on abortion while supporting public funding of health care. There is only lip service.

This is news? Really, it would be news if this hadn't happened. The hymns of glory are being transformed into the dirges of damnation within our earshot.

The Chicken

No, it didn't surprise me, MC. That's why I almost didn't blog it. But then I thought about Stupak and his enablers and wondered whether perhaps this would prompt, "I was wrong" to pass their lips. I'm afraid we now have data on this.

It would be interesting to get some sort of commitment from the pro-Obama types who claim that Obamacare is not going to fund expanded abortion coverage. What _would_ they say if we had specific, documented instances in which it had done so? Would they _then_ admit that they had been wrong?

By the way, contrary to what I have read being said elsewhere, there is no slightest contradiction between saying a) that the HHS press release is an obvious after-the-fact attempt at PR damage control and b) that it is doubtful that such statements will actually be "controlling" or any of those other impressive=sounding words in preventing the abortion coverage prima facie contained in the PA plan. This is a PR battle. Obviously, the HHS statement is a PR move. They hoped for exactly the reaction they are getting: "I told you so" yelled at pro-lifers. Staunch ignoring of the fact that it was issued only _after_ the NRLC's successful gotcha moment in the news. Hoping that everyone will ignore the fact that NRLC's interpretation of the PA plan is wholly reasonable. And so forth. It hardly follows from the PR value of this press release that it has any legal force, that the infamous "executive order" is legally enforceable, or that non-Hyde abortions will actually not be covered in the PA plan.

This is news? Really, it would be news if this hadn't happened.

Sure. This post could have easily been titled "And to the surprise of no one..."

A study out this week as reported at the Slashdot blog shows that for some, correcting a false fact makes them cling to their original opinion even more strongly, like an antibacterially-resistant bacteria. Even providing first-hand testimony might not be enough. One can always pray for a miracle of repentence on the legislators, but one wonders what it will take. Do these people pray? Do they think God is telling them to make these laws? It seems that some have made God merely an extension of their own egos.

Sometimes, you can't win for losing.

The Chicken

Hey, mendacious Lydia. Pro-choice MZ didn't deny the accusation, but merely confirmed that you had called him a name.

An Obama political appointee issues a completely non-binding statement that is a self-evident attempt to spin some very damaging pre-November-election news, and that's supposed to somehow negate the text of every real, controlling policy document relevant to the issue? Well, I know I'm convinced.

MC, you are absolutely right. It almost seems as if the so-called non-abortion-supporting Obama-care lovers are reacting to the pro-life movement's AHA! with a knee-jerk defense. The AHA! sounds like an attack, so they jerk into defense mode, even before they know any of the facts about what they are defending. Once they are in defense mode, admitting that the facts don't support their case is almost impossible as a psychological act, because the defense mode includes adjusting the lens you use for looking at the facts.

Should be a lesson to us all on being extremely careful to form both our ideas and our consciences with careful attention to the real truth, instead of the little lies we all prefer to be true. Once you get used to accepting the little lies, you undermine your ability to tell the difference between a clear lens and a rose-colored lens.

Sage, you always put things so pithily!

"But then I thought about Stupak and his enablers and wondered whether perhaps this would prompt, "I was wrong" to pass their lips. I'm afraid we now have data on this."

The lack of concern and the assumption of GOP pro-life malice or political exploitation is difficult to excuse. Why not a comment like "let's look into this further and see if the NRLC charges hold up, then fix it"?

However, it's clear Stupak feels betrayed by the way pro-life groups appeared to build him up only to turn on him and throw millions of dollars to his GOP opponent. He's claimed that the GOP's strict insistence on the Byrd Rule prevented his amendment from ever being added to the bill during reconciliation. If that's true, pro-lifers certainly dropped that ball by not considering whether the GOP tactics would result in a worse bill.

If they were so concerned about this outcome, a Stupak supporter might wonder, why weren't they critical of the GOP then?

I disagree, Kevin, if I'm understanding you correctly. The whole "deeming and passing" thing had serious problems. Moreover, it appeared to be a trick, and there was no guarantee that the Stupak amendment would in fact be added later if the bill were passed without it. One reason to doubt it was Senate Democrat desire or will, not merely Republican insistence on the Byrd rule! If what you are implying is that Stupak was excused for completely caving in the end on the abortion funding issue because he was annoyed about the resistance to "deeming and passing and adding stuff later," then I couldn't disagree more. This was a matter of serious principle which he had promised to stand firm on. What possible excuse could there be in his wanting the Republicans to agree with him on a different procedure for him to have caved in completely?

Finally, of course I'm going to refuse to agree that somehow Republicans had a duty to be _in favor_ of the bill overall and not fight it because this _might have_ made it possible (though there are legitimate doubts about this) to block adding abortion coverage. Again, if that is what you are implying, I could not disagree more.

Stupak completely caved on an issue where he had been a standard-bearer. Nothing you are mentioning there ("Hey, Republicans should have just thrown out the Byrd rule, even if they thougt that this was legally unprincipled and even though this would have made it easier to pass Obamacare overall, because then maybe Stupak's amendment would have been added at reconciliation") shows a picture of the Republicans doing anything similar. Stop trying with the weak tu quoques, already.

Here's a point for you to consider, Kevin J: It was theoretically possible that a doomsday scenario would have developed in which the House "deemed" the Senate bill passed and then the Stupak amendment was to be added in the Senate in reconciliation, which would have been a highly legally questionable use of reconciliation. Had the House done that, a question would have arisen as to whether the Senate Republicans would invoke the Byrd rule actually to _oppose_ the adding of the Stupak amendment at reconciliation, where the Senate Democrats indicated a full willingness to do so. I'm inclined to say of this latter willingness, "When pigs fly," but we're just supposing. _Then_ the whole strategic question would have arisen--were these Republicans wrong to oppose this, because the Democrats were genuinely offering them an opportunity to improve the bill but they chose to stand on the legal point of principle, etc.

Frankly, I think that would have been an interesting argument and that it _certainly_ would not have been obvious that Republicans were obligated to throw the Byrd rule out the window even in that case. Had they resisted under those circumstances, they certainly would not have been doing the same thing that Stupak did.

But as it was, it didn't even come to such a doomsday scenario. Stupak simply gave in on the basis of a totally worthless Executive Order, which the Bishops themselves _explained_ was worthless. He led the former Democrat opponents in the House in voting for the bill as it was without his amendment, and that was the end of that.

The idea of somehow asking, "Why didn't pro-lifers criticize Senate Republicans?" on the basis of something they didn't actually do in a messy situation that didn't actually arise and that plausibly would never have arisen anyway (because of the probable lack of interest by Senate Democrats in adding the Stupak Amendment at any point) and of somehow bringing this up in response to a call for Stupak to repent for the unconscionable thing he _did_ do in a completely clearcut situation which _did_ arise is really quite ridiculous. I'm afraid that it bespeaks a desire to appear detached and objective by finding some reason, however strained, to shake one's finger under the nose of both parties.

this would prompt, "I was wrong" to pass their lips

That would be a shocker.

As all this seems to be based on a bid proposal and absent the final rules; what would it take to bring it into line with what you want?

I was annoyed with the first story as it seemed to simply parrot Republican talking points with no follow up with HHS, etc. as one would expect with a real news outlet.

Oh, Al, don't ask what I _want_. That's asking way too much. I don't expect that. But what would it take for the NRLC not to have made the claims they make or to say that they are now satisfied that the PA plan has been modified so that abortion coverage by the federal government is not expanded? It would take the plan's being rewritten to say _in the plan's list of benefits_, something like, "Abortion in this plan will be covered only in cases of rape, incest, or to save the life of the mother." You know, all insurance plans list their benefits. But under the explication of abortion benefits in the *bid that was accepted* (you left that bit out in your summary, Al), the actual implication is that what will be covered is all abortions that are deemed "necessary" rather than "elective," with a reference to PA law which defines that very broadly. This isn't really rocket science, especially not for a lawyer.

And by the way, if the plan were _changed_ in that way _in the explication of benefits_, it would be because of the NRLC's publicity and not a refutation of their claims. When a watchdog group blows the whistle and people snatch their hand out of the cookie jar, that shows the importance of the watchdog group, not that it's full of liars.

Ok, but how does this differ from Medicaid coverage in which state plans can cover abortion with state funds?

http://www.statehealthfacts.org/comparetable.jsp?cat=10&ind=458

"When a watchdog group blows the whistle and people snatch their hand out of the cookie jar, that shows the importance of the watchdog group, not that it's full of liars."

My position is a little more nuanced than that; besides lying we also can have incompetence, gullibility, or laziness. in this case the groups may have caught an honest oversight that would have been corrected or it may have been more then that. My complaint still stands. Lifesite News seems have have done a more workmanlike job.

Depending on and merely repeating a partisan source without any other follow up is simply poor form and that goes for using Democratic sources as well as Republican. It is certainly a problem when the source is a not too bright Congressman with a record for serial lying.

How does what differ from it? The state proposal? It differs in that the state proposal was for federal funding for the plan, period. Nothing to do with the state's covering abortions with state funds. Are you seriously implying that the Hyde amendment in no way limited federal funding of abortion? Tell that to all the pro-choice groups who opposed it.

or it may have been more then that.

Can't you be a little clearer, Al? As in "or it may be that they were really just going to fund all those abortions by this plan if nobody had said anything, just as NRLC said they were." Surely you can bring yourself to consider that possibility and say that in so many words, can't you? After all, you pride yourself on being so objective. Why should "laziness, gullibility, incompetence" on the part of pro-lifers be the only options you talk about in clear language?

By the way, Al: This is a blog. I do not consider myself in honor bound to obtain primary source documents for everything I blog before I blog it. I make judgment calls as to whether stories are credible or not, and I choose to blog them or not based on those judgment calls. You are always free to cite primary sources that you believe contradict the story as I recap or state it, and I will respond as I see fit. That's the way the blogosphere works. I have the freedom to blog stories based on news stories on the web, and you have the freedom as a commentator to contradict me if you think I've overlooked or misstated something. In this case, I think the original sources involved support the NRLC's reading, and the HHS memo is obviously a face-saving ex post facto move with no binding authority in itself. You may disagree. Whatever. But please stop implying that there is something intrinsically irresponsible about putting up a blog post based on news links without finding PDFs of all the laws, proposals, etc., etc., for every story individually ahead of time, as one might do for an original research article.