Before the Arizona House of Representatives
Committee on Health and Human Services
February 15, 2012
Chairman Ash, Ranking Member Gonzales, and members of the committee, my name is Charles A. Donovan and I am president of the Charlotte Lozier Institute in Washington, D.C. The Lozier Institute is a new entity, founded in 2011, that is dedicated to examining public policy and amassing and assessing data on issues of women’s health and child well-being. We support and affirm the dignity and value of every human life. Thank you for this opportunity to present testimony to your committee in support of H.B. 2800, which could rightly be called a Whole Women’s Health Prioritization Act of 2012.
The legislation before you today is reasonable, moderate, and focused on improving both the quality and coherence of health care for women in Arizona. It follows the requirements of existing law while ensuring that expenditures of federal and state matching funds under a number of federal statutes are made with a view to ensuring women and girls access providers capable of providing them with a range of coordinated care that serves their medical needs.
H.B. 2800 does not reduce appropriated family planning funds by a single penny; it does, however, ensure that those funds are provided on a priority basis to health care entities that offer the full range of primary health care services for women. The bill will ensure that the care women receive in the area of reproductive health is integrated, as it should be, with their other health care needs, including such services as mental health counseling, dental care, cancer screenings and prenatal care by the most experienced providers.
In addition, while the focus of the bill is on integrated, or whole-woman, care, the legislation carries out the historic intention of Congress in enacting legislation in this area that family planning be understood as contra-distinct from elective abortion. As a result, H.B. 2800 includes a provision that would harmonize Arizona’s policy priorities with the requirements of the legislation known as the Hyde Amendment, which has, since 1976, limited the circumstances under which taxpayer dollars can be used to pay for abortions.
The Whole Woman Approach
Limited federal and state public funding exists for family planning and preventive health services for women generally, and for maternal and fetal patients in particular. Federal deficits continue to exceed $1 trillion annually and the White House projection for Fiscal Year 2013 is just below that level. These fiscal constraints mandate that the State allocate available funding efficiently. The principal means by which the state may fulfill its duty to steward these funds is to ensure that funds are distributed by priority to the most efficient point-of-service health care providers. Public and private providers of primary and preventive care utilize public funds more effectively than providers of health care services that are specialized to particular medical services or discrete patient populations. Consequently, it is sensible for the Arizona legislature to adopt H.B. 2800 in order to prioritize the distribution to and utilization of public funds for family planning, reproductive health care and maternal/fetal care by such public and private primary and preventive care providers.
Prioritization of public health care funding to primary and preventive care also reflects sound health care policy. Individuals who have a primary care clinician are more likely to access health care services, leading to more favorable long-term outcomes. Health care costs are lowered when primary and preventive care is provided by such primary care clinicians in a setting that addresses the whole person by emphasizing counseling, screening and early detection of leading causes of morbidity and mortality – including diabetes, hypertension, obesity, cardiovascular and renal diseases, and asthma. Indirect costs such as lost worker productivity and employer health care costs are also reduced. Most importantly, individual citizens will lead longer, healthier and happier lives as a result of having less fragmented health care.
It is also sound public policy to ensure delivery of comprehensive preconception and prenatal care for maternal and fetal patients in order to reduce maternal and fetal morbidity and mortality. The U.S. Centers for Disease Control states, “Comprehensive preconception and prenatal care includes encouraging women to stop smoking, refrain from using alcohol and other drugs, eat a healthy diet, take folic acid supplements, maintain a healthy weight, control high blood pressure and diabetes, and reduce exposure to workplace and environmental hazards. In addition, screening and providing services to prevent intimate partner violence and infections (e.g., HIV, STI and viral hepatitis) help to improve the health of the mother and the baby.”
Again, delivery of these critical services is best accomplished through a single point-of-service provider such as a primary care provider, and directed by a primary care clinician who has knowledge of the patient’s medical history and personal, familial and environmental health factors. The utilization of public funding to maximize effective delivery of holistic prenatal and maternal health care conflicts with medical intervention models that emphasize the provision of services to discrete patient sub-populations, e.g., women of child-bearing age, to address discrete patient conditions or provide particular therapies.
H.B. 2800 directs funds in a four-tiered order of priority. It begins with “health care facilities that are owned and operated” by the state of Arizona or any political subdivision of the state. Second are hospitals and federally qualified health centers. Hospitals offer an array of services that vary but nonetheless typically exceed the limited services available at ad hoc family planning agencies, whether or not they offer abortion onsite. Federally qualified health centers (FQHCs), on the other hand, are required under federal law to provide a wide range of services to the public. Third in priority under the proposed legislation are rural health clinics, which are guided by a provision of federal law related to FQHCs but are required to offer an intermediate array of services. Finally, H.B. 2800 prioritizes funding to any health care providers whose “area of practice is the provision of primary health services” as enumerated in federal law.
It should be noted that many advocates for passage of the most targeted federal legislation covered by this bill, Title X of the Public Health Service Act, insisted that expenditures under it should be directed toward the comprehensive forms of care providers identified in the bill under consideration today. These advocates included the man who became the 41st president of the United States and the then-president of Planned Parenthood-World Population. George H.W. Bush, a cosponsor of original bill authorizing Title X, told the House of Representatives that he believed Title X funds could and should be available for general health services:
“Let us not allow the programers (sic) to be so carried away with birth control that other services are neglected. Let us be sure that family planning services include at a minimum complete yearly physical examinations for all members of the family. Where other health care money is lacking or where other medical services are inadequate to handle patient referrals as in many of our rural areas, let us leave no doubt that these services can be financed through this legislation where the Secretary of Health, Education and Welfare feels it beneficial to the health and welfare of the recipients.”
In addition, during testimony in support of the legislation, Dr. Alan F. Guttmacher offered similar support for the broad distribution of funds under the law and even offered the view that the organization he led, Planned Parenthood, would receive very little of the funds it made available. He told a House subcommittee:
“This money will not only be given to voluntary agencies, perhaps only a very small proportion of it will. Most will probably go to county health departments and to your great hospitals which should and can do the job if properly financed. So that my organization, Planned Parenthood World Population, is not backing this bill because we see in it a chance of accumulating large funds to work with because actually, this will not be the case. In the second place, the bill provides formula grants to State agencies annual amounts increasing from $10 to $30 million. This will secure more vigorous activity on the part of State health departments in furnishing family planning services.”
H.B. 2800 can clearly be said to harmonize with the original purposes of this legislation and of other federal laws that continue to envision the integration of health services in a holistic way that improves care and reduces cost.
Harmonization with Federal and State Law Distinguishing Family Planning and Abortion
Just as important as the prioritization policy H.B. 2800 represents is its provision Section 1(B) that neither Arizona nor any of its political subdivisions may “enter into a contract with or make a grant to any person that performs nonfederally qualified abortions” or to any person who “maintains or operates a facility where nonfederally qualified abortions are performed for the provision of family planning services.” This provision is a vital part of H.B. 2800 as it carries out the intentions long-stated in federal law to distinguish family planning, which prevents pregnancy, from abortion, which ends the life of a developing child after it has begun.
Sec. 1008 of the Family Planning and Reproductive Health Services Act of 1970 (Title X of the Public Health Service Act) stipulated that “None of the funds appropriated under this title shall be used in programs where abortion is a method of family planning.” While the meaning of the word “program” was not explicitly stated in the law, its intent was made clear by Rep. John Dingell (D-Mich.) a prominent member of the committee of jurisdiction in his statement on the floor of the U.S. House of Representatives on November 16, 1970:
“[T]he committee members clearly intend that abortion is not to be encouraged or promoted in any way through this legislation. Programs which include abortion as a method of family planning are not eligible for funds allocated through this act.”
Rep. Dingell, who later chaired this committee, continued:
“There is a fundamental difference between the prevention of conception and the destruction of developing human life. Responsible parenthood requires different attitudes toward human life once conceived than toward the employment of preventive contraceptive devices or methods. What is unplanned contraceptively does not necessarily become unwanted humanly.”
Rep. Dingell concluded that the failure to achieve program separation, that is, to ensure that “abortion is not to be encouraged or promoted in any way,” would be unwise because “there is evidence that the prevalence of abortion as a substitute or a back-up for contraceptive methods can reduce the effectiveness of family planning services.”
H.B. 2800 is in keeping with both the letter and the spirit of longtime federal policy regarding both the financing of abortion and government involvement in encouraging and promoting a practice that is contra-distinct from family planning.
H.B. 2800 is good and necessary legislation because it focuses existing federal-state funding streams on family planning services so they are provided in the context of holistic health care for women and their families. It does not reduce current family planning spending levels by a single penny but it does ensure that these tax dollars are prioritized to agencies that can best serve the needs of Arizona women. Moreover, H.B. 2800 harmonizes with the longstanding goals of federal and Arizona law with respect to preventing the use of public money to encourage or promote abortion as a method of family planning. It favors childbirth over abortion, consistent with the rulings of the U.S. Supreme Court, as the appropriate outcome when unexpected pregnancies do occur. Similar laws have been passed in four states – Kansas, Tennessee, Texas, and Wisconsin – and similar bills are pending in at least five others.
A footnoted copy of this testimony is available on request from the Lozier Institute – contact us at firstname.lastname@example.org.