Health care experts and abortion rights advocates expressed doubts Friday about a Bush administration proposal to define a fetus as an "unborn child" so state insurance programs can pay for prenatal care for some low-income women.
Specialists in health care financing said the administration doesn't need to revise fundamental legal definitions to expand insurance coverage for prenatal care. Instead, they said, it could approve waivers that would allow states to cover these women without provoking another controversy over abortion rights.
"If the administration wants to provide prenatal and other health services to pregnant women through [the Children's Health Insurance Program] so they can have healthier babies, that's great," said Rep. Henry A. Waxman (D-Los Angeles). "They can easily do it under the current law."
The administration is considering a rule change that would classify a fetus as an unborn child to allow low-income women who lack health insurance, but earn too much to qualify for Medicaid, to receive coverage under a federal-state insurance program limited to children.
"This would be a tool for the states to give them greater flexibility in offering more access to prenatal services to these women, with the obvious goal being healthy babies and children," said William A. Pierce, a spokesman for the Department of Health and Human Services.
Some abortion rights advocates have said they fear the proposal is a "back-door" attempt to create a legal precedent for recognizing a fetus as a person.
But Pierce denied that HHS Secretary Tommy G. Thompson, an abortion foe, is seeking the change as part of an anti-abortion political agenda. "We think this will make the process swifter and less cumbersome for the states than having to apply for waivers," Pierce said.
Under Medicaid, states are required to cover prenatal care and childbirth for women with incomes up to 133% of the federal poverty level. They have the option to go as high as 185% of the poverty level, currently defined as $17,050 a year for a family of four.
The children's insurance program, or CHIP, was designed to cover children who lack health insurance but whose family incomes are higher than those set for Medicaid recipients. About 3.3 million children participated in the program last year, according to HHS.
"This administration has an option: It can announce that it will give a waiver to any state to allow the state to cover any first-time pregnant woman with CHIP money," said one congressional source familiar with health care financing rules.
"Secretary Thompson has been very outspoken, saying he's willing to let states use CHIP money to cover prenatal care--and there's nothing that would keep him from giving a waiver to any state to do that," said the source, who requested anonymity. "It isn't a complicated waiver. The administration can extend the funds to the pregnant mothers of those children who will be eligible once they're born."
Abortion rights activists called the administration's efforts a sleight-of-hand maneuver to alter the legal status of a fetus. They compared the action to similar efforts to hold criminals responsible for harming a fetus during an act of violence against a pregnant woman or to punish a drug-using pregnant woman for harming her fetus.
"There are lots of parallels," said Roger Evans, director of litigation and law for Planned Parenthood Federation of America.
Gloria Feldt, president of the organization, said Planned Parenthood "has been working for many years so that all women can get access to prenatal care, but this is not the way to do it. This policy has ulterior motives, and I suspect this sort of thing will be popping up everywhere in this administration--and we will be looking for it."
But abortion opponents applauded the concept. Robert A. Best, president of the Washington-based Culture of Life Foundation, called it a "bold and compassionate step that would pay big dividends for the health of children and their mothers."
Best said he was surprised that "pro-choice" groups were angered by the idea, saying that "it doesn't take away choice, it adds real choice--the choice of being the healthy mother of a healthy baby, even when money is a problem."
Pierce, of HHS, who said the plan originated "in the secretary's office," stressed that the proposal is "still under consideration" and that no final decision has been made. "It's not by any measure complete," he said.