States’ Role in Abortion Aid Reaffirmed : Health: Administration stands by its directive that spells out funding mechanism for poor women in cases of rape, incest. Issue stirs protests.

Despite protests from several state Medicaid directors, the Clinton Administration announced Thursday it would stand by its requirement that states help pay abortion costs for low-income women in cases of rape and incest.

While a dozen or more state laws allow such expenditures only when a pregnancy has endangered a woman’s life, Bruce C. Vladeck, administrator of the Health Care Financing Administration, insisted that under the Supremacy Clause of the U.S. Constitution, federal law supersedes all state statutes.

Last year, Congress passed a law loosening the 17-year-old ban on federal funding for abortions. The Hyde Amendment, named for its its author, Rep. Henry J. Hyde (R-Ill.), permits federal Medicaid money to be used to provide abortions in cases where pregnancies resulted from rape or incest. Before that, poor women served by the federal-state Medicaid program could receive government-financed abortions only in cases where their lives were threatened.

The Administration, which strongly supports abortion rights, had hoped to eliminate the federal funding ban altogether, but adding the exclusions for rape and incest was as far as Congress would go.

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The fight over the federal funding ban is being watched closely by both sides of the abortion issue. They consider it a preliminary bout in what promises to be a much larger struggle over the Administration’s proposal to include abortion coverage as one of the benefits guaranteed under its health care reform effort.

Under the Administration’s interpretation of the new law, abortions for rape and incest victims are considered “medically necessary,” meaning that both states and the federal government must fund them.

Vladeck gave a detailed explanation of the Administration’s interpretation of the law in a letter to Arkansas Medicaid Director Ray Hanley, who is also chairman of the State Medicaid Directors Assn. In an earlier letter, Hanley had protested the Administration directive, saying that Congress’ intent was to permit states to choose whether to fund abortion in rape and incest cases.

Yet Vladeck replied that if Congress had wished to make state funding of abortions discretionary, it would have added specific language to that effect, as it has in the past.

Without such language it is not an issue that can be decided by the states, the federal administrator wrote.

Hanley was far from satisfied with Vladeck’s response.

In an interview Thursday, he noted that before issuing the directive, Administration officials had indicated publicly on numerous occasions that they “would respect and try to reconcile state laws” on the issue.

Given the controversy that has surrounded the Administration directive, Hanley added, there is “an excellent chance that Congress will revisit this language” to make its intentions clearer.

Medicaid officials in at least two states--Utah and Louisiana--already have announced their intention to refuse to implement the order. The issue is moot in California, where Medi-Cal funds abortion without restriction.

Medicaid, a program that provides medical care to low-income people, operates primarily on federal funds. However, it is administered by the states, which also are required to pay for a portion of all services rendered under the program.

Vladeck also dismissed complaints by some state officials that the federal government was putting a major new financial burden on them without consulting them.

“The amount of state funds involved is negligible because the revision of the Hyde Amendment expands abortion coverage to a very small group of women,” Vladeck wrote. “Those who will now be served as a result of the Hyde Amendment of 1993 are poor women who have been the victims of rape or incest, who have suffered physical and mental abuse, and who, beyond that, have been made pregnant by those acts.”

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Although Hanley had warned that the federal order could leave states vulnerable to legal challenges, the legislative director of the nation’s largest anti-abortion group conceded that abortion opponents would find it difficult to overcome in court.

Douglas Johnson, legislative director of the National Right to Life Committee, said that judges traditionally have given “heavy deference” to federal agency interpretations of statutes in situations where Congress’ intent is questioned.

Meanwhile, abortion rights advocates in several states have mounted legal efforts to overturn laws that do not allow abortions in cases of rape and incest--efforts that, if successful, could leave those states without any restrictions on abortion.