The MacNeil/Lehrer Report; Abortion

JIM LEHRER: Good evening. Robert MacNeil is off, and so is the Congress of the United States, having recessed Friday for three weeks. They went away without resolving the real sweat issue of the session, abortion -- specifically, whether federal money can be used to fund abortions for the poor through Medicaid.

The House passed the Hyde Amendment, which forbids such payments, but the Senate rejected it, opting for a more liberal version. And for the last four months, off and on, back and forth, fight and scramble, House and Senate conferees have been trying to reach a compromise, with no luck. Because the amendment is to an appropriations bill, emergency funding had to be voted three times just to keep several government agencies functioning. Late Friday, just before adjournment, it did look like a breakthrough agreement had been reached, but that fell through the legislative cracks at the last minute, the House refusing to budge a final step for the Senate, and vice versa.

Tonight, a look at the Congressional politics of this non-compromise and at the practical effect it`s having outside Washington. One of those non- budgers on the House side is Congressman Robert Bauman, Republican of Maryland. Congressman, the Hyde Amendment would forbid Medicaid payments for abortion except when the woman`s life is in danger. Is that your nocompromise position?

Rep. ROBERT BAUMAN: Well, I don`t think it`s a no-compromise position; it certainly is my position, but it`s also the position that was upheld by a majority of the House of Representatives and two Congresses on nine occasions upheld by the Senate of the United States last year prior to the Supreme Court`s decision, and upheld by the Supreme Court of the United States. So I would hardly say that it`s a no-compromise position; it`s one that is written into current law and is in effect today in federal statute.

LEHRER: All right, but no-compromise from the standpoint of working out an agreement in this particular case that we`re talking about between the House and Senate.

BAUMAN: That`s the very minimum that I would concede personally, yes.

LEHRER: All right. As I understand it now the Senate was willing to go along with language that would forbid abortion funding except in cases of rape or incest or when a woman would suffer "severe or long lasting physical health damage." You will not accept that.

BAUMAN: Severe and long-lasting.

LEHRER: There`s some dispute about whether an "and" or an "or" got in there.

BAUMAN: No, because the basic premise on which I view this is the preservation of life, the life of the child and the life of the mother. And any exception which expands the number of babies that will be killed by abortion to me is repugnant and I don`t support it.

LEHRER: What about the rape/incest part to it?

BAUMAN: Well, the House had offered language regarding rape and incest which required prompt reporting of the incident so that some determination could have been made whether or not the pregnancy had actually occurred, and it did not rule out the possibility of a medical procedure at that point. But the problem you face with rape or incest is that several months later anyone can claim that they have been a victim of this type of attack and it would be almost impossible for anyone to prove that. And as we read this, it could be interpreted to allow an abortion and a death.

LEHRER: There was a loophole, in other words, in the prohibition. Does that same objection apply to the words "severe and long-lasting physical health damage"?

BAUMAN: I think you have to view that in the context of the way it would be administered, because severe and long-lasting can be any number of conditions which would not in any way affect the birth of the child. There are many things related directly that would affect the mother, would be severe and long-lasting, but still a child could be born and could live; and so I think that too is a rather broad praise, and as Chairman Flood of our conference committee said, we have no idea to what extent this would be broadened by individual doctors administrating the law or the bureaucrats who write the regulations.

LEHRER: Congressman, I know you`re a fiscal conservative. Is your objection to this based on money things or is it a moral question as far as abortion generally is concerned?

BAUMAN: No, it`s a moral question, and certainly money does not enter into my argument for the right to life. I definitely feel that abortion is murder; just as surely as if I were to draw a pistol from my coat and shoot you, a baby is being killed when abortion occurs. Therefore, I don`t think that the federal taxpayers have any reason to have to spend their tax money to promote murder on a massive scale --300,000 deaths a year.

LEHRER: But what would you say to those who point out that abortion as a procedure is fully legal in the United States, so why should this legal procedure be denied to the poor?

BAUMAN: The Supreme Court said in 1973 that abortion was now a right that a woman had, but the court didn`t say and subsequently rule, there was no requirement of the taxpayers to finance abortions in the United States. There are many things that are rights in the United States but which the government is not compelled or required to pay for.

LEHRER: All right, Congressman, thank you. One of the Senators saying the Senate can and should budge no further to reach an agreement is Senator Robert Packwood of Oregon, also a Republican. Senator, abortions for rape and incest and if the woman would suffer severe and/or long-lasting physical health damage: anything more restrictive than that would be too much for you, is that correct?

Sen. BOB PACKWOOD: As a matter of fact, I voted against that language in the Senate because I thought it was too severe.

LEHRER: The first go round?

PACKWOOD: The first go round. I voted against it when it said "or" rather than changing it to "and" and the Senate only changed that expression to "and" because we`d been given a signal that Speaker O`Neill and some other House leaders would help get through that compromise, and the Senate wanted to get it behind us. So the Senate made that compromise reluctantly, and I voted against it because I didn`t think it was a compromise that was acceptable to me anyway. But then the House turned it down, and I don`t think the Senate is going to budge any more from that position.

LEHRER: Are you going to budge any more from your own position?

PACKWOOD: No, this goes much farther. I think that a woman`s entitled to an abortion, and if she cannot afford to have one on her own that the federal government should help pay for it. I didn`t like the compromise; I haven`t liked any of the compromises that we`ve had to make to go along this far, and so I don`t plan to vote for this compromise.

LEHRER: Why is the Hyde Amendment language that`s supported by the majority of the House and Congressman Bauman included, which makes death of the woman the only exception, why is that not acceptable to you?

PACKWOOD: Well, if ,I had to,, I could accept that. But I would not accept that. What I am saying is that any woman is entitled to an abortion if she wants an abortion. It`s not your business, not my business, least of all is it the federal government`s business; that`s a private decision between a woman and her physician, and we should not be involved in putting ourselves - Congress -- between that physician and that woman.

LEHRER: All right. You`ve heard what Congressman Bauman says, that if rape and incest were in there, or even this severe and long-lasting physical damage, that that would --it`s ambiguous, that it`s a loophole. How do you respond to that?

PACKWOOD: The rape and incest is not much of a loophole because the number of pregnancies that result from rape or incest are relatively slight. I know what the Congressman is afraid of, it`s that expression "physical health," because an argument could be made -- and I think validly, perhaps -- that how your mental health is can affect your physical health. And therefore the Congressman I think is afraid that if a number of doctors were to say, "Yes, this woman needs an abortion because it`s going to mentally upset her and that will affect her physical health," that they could fit it within this very narrow exception. I don`t think many physicians would be willing to do that. No physician in his right mind is going to run the risk of deliberately violating the law. But the fear is there.

LEHRER: What about his other objection that he raises, that a woman could come to a doctor, say, four months or three months after having conceived and say, "Look, I was raped," and without a procedure to check, I mean, that could provide a loophole.

PACKWOOD: At one time there was a requirement -- I can`t remember if we left it in there -- that the rape had to be reported to legal authorities. You literally cannot even be raped in private unless you`re prepared to go and tell the police about it; you couldn`t even get any help. So I think if-a woman came three or four months later and you had a provision in the law that she was supposed to report the rape to the law officials, and she said, "Oh, well, I didn`t think about reporting it for three or four months," she`d have a pretty tough case to fit within this exception.

LEHRER: Gentlemen, let me ask you both. I have listened attentively to each one of you lay out your positions, and I know what the positions of the House and Senate are, and each one of you represents basically the majority view in each one of your bodies. Where is there room for compromise, Congressman?

BAUMAN: Politicians have a tendency to get tired over a period of time, particularly when an emotional issue is put on their back and they have to face it over and over because the pressure has become very great.

And I think we decided on it last Friday night when the House only preserved the Hyde Amendment by about a twenty-vote margin with some number of absences. The leadership in the Democratic Party sold us out, in my opinion; they didn`t try to help us at all, although they supposedly -at least, the Speaker, is supposed to be in support of the Hyde Amendment. And I think that what we`re going to find is that on November 29 when the House and Senate come back the pressures for compromise will be even greater. And all of the payrolls that the federal employees want passed will also be a pressure, and something somewhere between the language rejected the other night that the Senate has offered and the original Hyde Amendment will probably be adopted by both houses. I suspect it can be worked out.

LEHRER: Do you agree, Senator?

PACKWOOD: I think the Congressman is probably right, although I don`t expect the Senate to budge any further from the position that they last submitted because they feel that they had maybe been doubly dealt. They thought they had a promise from the House leadership, or at least a covert indication from the House leadership, that if the Senate receded from its last position and adopted the language that went to the House, the House would adopt it. For whatever reason, it turns out the leadership could not deliver.

BAUMAN: Well, they can`t speak for us in the House, Senator.

(General laughter.)

LEHRER: Senator, you have said several times that abortion is one of those single issues that could destroy a representative or senator`s political career. Why is that?

PACKWOOD: It`s because it`s the kind of issue that people will especially those who are against abortion, very zealously against it they will vote against a candidate on that issue alone. Whereas on the other side, normally people who are for something are not so single-minded, and they`ll weigh a candidate`s record; and they might like him on abortion but not like him on gun registration, or like him on a SALT agreement with Russia but not like him on his Middle East stand, or whatever it might be. But if you`re in a close district, a district that might be won or lost by fifty- two/forty-eight, or fifty-three/forty-seven, and there are three or four percent of the people that will vote against you that would otherwise vote for you but for your stand in favor of abortion, they can defeat you. And that`s why it`s such a volatile issue, and it doesn`t take fifty-one percent, it just takes a zealous small band who say, "This is the issue, if you cross us on this issue it doesn`t matter what else you stand for, we`ll vote against you."

LEHRER: Do you agree with that, Congressman?

BAUMAN: Yes, and I think the reason is that the issue is so fundamental that it has stirred the emotions in a great many people regardless of their political affiliations. Some of my most active friends who work in Right to Life are liberal Democrats who agree with me as a conservative Republican on nothing else, but they feel the preservation of life -- and the direction that in indicates this country is taking if we accept the murder of children -- is so fundamental to the existence of this nation that they do react.

PACKWOOD: I have a comment. Several times the Congressman has referred to the "murder of children." Now the Supreme Court in 1973 said that every woman as a matter of right is entitled to an abortion, and the Supreme Court is not endorsing murder. And anybody who says this is the murder of children has got to conclude that the Supreme Court is supporting murder. The American...

BAUMAN: ... it is, Senator, I would say...

PACKWOOD: The American...

LEHRER: We could be here all night arguing on that particular issue. Gentlemen, we`ll be right back. The effect this Congressional stalemate thus far is having out in the states which must administer Medicaid funds is complicated and, as we`ve seen, very controversial. But to sort it out first in its simplest terms, the U.S. Supreme Court ruled last summer that states are not required to use Medicaid funds for abortions; in other words, it`s up to them. So until Congress passes a bill restricting the practice the option to fund or not fund lies with the states. Currently thirteen states and the District of Columbia still pay for Medicaid abortions. Idaho, New York and Pennsylvania will pay only for those considered medically necessary. And the remaining thirty-four have discontinued paying for them except to save a woman`s life, the Hyde Amendment approach, in other words. Virginia becomes the thirty-fifth on November 30.

North Carolina, for instance, cut off abortion Medicaid funding on August 4. Dr. Takey Crist has some definite views on what the practical effect has been. He`s director of the Crist Clinic for Women in Jacksonville, North Carolina. He came to our attention through a letter he wrote to Senator Jesse Helms, Republican of North Carolina. Dr. Crist, what was the situation you described in your letter to Senator Helms?

Dr. TAKEY CRIST: I described to Senator Helms a patient that I`d become involved in who was on welfare. She was a forty-one-year-old black, married and had eleven children, husband disabled. And she was in my office with her seventeen-year-old daughter who was mentally retarded, who was pregnant, requesting a therapeutic abortion. And long before I could ever give her the answer I knew what the answer would be, because in our state funds had been cut off. And I wanted to share with him and ask him a few questions. He may be comfortable sitting here in Washington making decisions that reflect other people`s lives, particularly women, but how about the physician or how about this patient? What am I going to tell her?

LEHRER: What did you tell her?

CRIST: Well, for Rosalie right now we`re trying to get some funds, and as I satin my office I thought about the number of Rosalies that must be across the State of North Carolina and in the United States that have this same problem. Since August 4 we`ve not only seen cases like Rosalie, but thirteen-year-old girls who`ve been impregnated by their fathers on welfare, many teenagers from lower socioeconomic life that have gotten involved in the situation. What do you do with them?

LEHRER: I ask you, what do you do with them?

CRIST: It`s a very difficult decision to make, particularly when you have nowhere to go. And we have social workers and public health nurses and county officials asking you to help them and help take care of the patients. It`s a very frustrating situation.

LEHRER: Doctor, in the Rosalie case and other Rosalie cases that you`ve had since August 4, have you done any follow-up? For instance, have there been women who came to you that before the funding was cut off you would have performed a therapeutic abortion on them, did not, and you followed it up to see what they did after they left your office -- did they get an illegal abortion, did they go to another state, or did they have the child, or what?

CRIST: As best as we know at the present time on those patients that have come to us since August 4, which has been over three hundred patients that we`ve had to turn away...

LEHRER: Three hundred you`ve turned away?

CRIST: That`s correct, because we are a referral center for over fifty counties. Now, we do not know of any illegal abortions that have been done at this time. They may have been done, not reported, the patient has gotten along fine. They may have been done, the patient could be in a hospital somewhere in North Carolina with a fever, have had already a hysterectomy and it wasn`t reported. What woman is going to go to a physician after having an illegal abortion and had complications and tell the physician that she`s had an illegal abortion?

LEHRER: Have there been fewer women just coming to your clinic asking for abortions since August 4?

CRIST: There have been fewer from the Medicaid Title 20 and so-called "welfare type" patients, but there still has been the number of women from private, middle class and those who can afford it.

LEHRER: And you tell them -- what do you tell them? You perform them.

CRIST: We perform the abortions.

LEHRER: All right. Thank you, Doctor. To broaden this effect question a bit now, Dr. Ann Kimball is a medical officer with the Abortion Surveillance Branch of the U.S. Center for Disease Control in Atlanta. Her agency has been monitoring the fallout from the funding cutoff nationwide. Dr. Kimball, let me ask you: the situation that we just heard Dr. Crist report, is that nationwide, or is that general thing happening elsewhere in the country?

Dr. ANN KIMBALL: That would be very difficult for us to say, because we do get anecdotal reports from people in Dr. Crist`s situation. Of course people that aren`t seeing the problem wouldn`t call us. We have set up a surveillance system to see if this is in fact going to be the case nationwide, but the data from that, although we`ve collected it, is still being analyzed. We rely on statistically significant events to make statements from our branch.

LEHRER: Can you tell us anything thus far since August, a general trend, a kind of semi-general trend, or whatever?

KIMBALL: I think it would be really too premature to say that at this point.

LEHRER: All right. You can tell us about some specifics. For instance, your agency investigated the incident in Texas where five welfare women could not get abortions and they went to Mexico, as I understand it; as a result one of them died, the other four were hospitalized. What are the circumstances there?

KIMBALL: Well, actually, to begin with all five weren`t welfare recipients. We received a call in the Abortion Surveillance Branch from a private physician in Texas, who called to tell us that he had four cases of septic abortion related...

LEHRER: Septic abortion?

KIMBALL: That means with a massive infection. And one of the women had died. The abortions were illegal. Since 1971 we`ve investigated seven such similar requests. We contacted the State of Texas; they asked us for our aid, which is the usual way that the Center for Disease Control becomes involved in these investigations. The situation when we arrived was that there were four cases documented of overwhelming infection in women who had gone to Mexico for illegal abortions. One of those women had died. Reviewing the records, we found another case. Of these five women, three of the women were Medicaid-eligible. The woman who died was aware that Medicaid would not pay for her abortion, and according to sources in her family and according to her private physician, whom we also interviewed, financial constraints were one of the major reasons she went to Mexico to get an illegal abortion.

LEHRER: In other words, she couldn`t afford to go through the regular procedure in Texas. Is abortion legal in Texas now?

KIMBALL: Yes, abortion is legal.

LEHRER: So if she`d had the money she could have gone to, say, a Dr. Crist- type clinic. And you`re saying she didn`t have the money to do it that way, and it was cheaper to go to Mexico, is that it?

KIMBALL: Yes. The price differential was forty dollars in Mexico and two hundred dollars in Texas.

LEHRER: Did she actually go to a clinic like Dr. Crist`s and say, need an abortion," and was turned down?

KIMBALL: No, she did not. The context of her discussion with her private physician-wag,-she mentioned to him in the course of a visit for another complaint that she had missed some of her periods, felt she may have been pregnant. He informed her. at that point that Medicaid would no longer pay for abortions.

LEHRER: Have there been other cases reported to you since August like the Texas case, that you-all have investigated in other parts of the country?

KIMBALL: No, there haven`t.

LEHRER: That is the most aggravated. Is there any way for you at this point, just based on the experience thus far, to project what the overall effect might be, say in the course of a year or two, if the funds continue to be cut off, or if an unamended Hyde Amendment should be passed?

KIMBALL: Yes. There was a paper that was published through our branch that was written by Diana Pettiti and Ward Cates, who are both medical doctors who work with our branch. They made projections based on that premise. They projected that between five and ninety excess maternal deaths would occur...

LEHRER: Between five and ninety.

KIMBALL: Between five and ninety, dependent on the choice that the Medicaid woman makes once she becomes pregnant. One hypothesis, of course, would be that nothing would happen. That wasn`t included in their paper, but it`s possible that Medicaid women will no longer get pregnant at the same rate that they were previously. The other possibilities are that they would continue the pregnancy to term, in which case statistically we would expect to see forty-four additional maternal deaths; or they would delay for two weeks looking for funding, in which case we would expect to see five excess deaths; or they would all seek illegal abortions, in which case we would see ninety excess deaths in the nation; or seventy percent of them would seek illegal abortions and thirty percent may go on to term -- that was the only other possibility that was dealt with, and that was seventy-seven excess maternal deaths.

LEHRER: You`ve given me a lot of figures there. Can you add them up in any way and tell me what all that means?

KIMBALL: The range, depending on the choices that the Medicaid women make once they become pregnant, will result in between five and ninety excess maternal deaths in the country, according to the projections in that paper.

LEHRER: All right. Let`s go first back to you, Congressman. Does this -- Dr. Crist`s experience and what Dr. Kimball has just reported -does that concern you from your standpoint?

BAUMAN: Yes, of course it concerns me. The death of five people or ninety people concerns me a great deal. But the death of 300,000 children concerns me as well, and that`s why I feel that the Hyde Amendment as originally written, which allows the life of the mother to be elevated above that of the child, and an abortion to be performed if the mother`s life is threatened by the continuation of the pregnancy, I think that`s a reasonable approach. But to mourn the death of five or ninety is one thing, when 300,000 deaths on the average are being financed by federal funding, seems to me somewhat disproportionate. A death is just as tragic whether it`s a mother or a child, in my view.

LEHRER: Senator, what`s your reaction to the effect part of this question?

PACKWOOD: I`m surprised her figures are as low as they are in terms of her estimates. If we, year after year, cut off all Medicaid funding for abortions -- it`s interesting that we`ll give it for anything else, any other medical treatment but not abortion -- I would be surprised if the death figure is that low.

LEHRER: Dr. Crist, let me come back to you. Dr. Kimball`s two biggest bosses, President Carter and HEW Secretary Joseph Califano, favor the Hyde Amendment approach, but they couple that with the additional thing that there should be additional programs for prenatal and postnatal care, welfare costs, et cetera. What has been the experience in North Carolina? Since the funds have been cut off, have there been expanded services for...

CRIST: There is an attempt to expand the services, certainly; always. But I think there are some other points that we need to bring out in the question that you`ve asked, and I`d like to address one of my questions to the Congressman, if you would allow me at this time.

LEHRER: All right.

CRIST: When he was asked whether this is really a moral issue on his part, I`d like to ask the Congressman, where is the morality in the one million teenagers that were pregnant last year? Where is the morality in the number of child abuse cases that we have? Where is the morality in the epidemic of venereal disease that we have? Where is the morality in a nation that chooses to deny a segment of its population -- poor people -- a benefit and a right that another segment of population is allowed to have that can afford it?

LEHRER: Congressman?

BAUMAN: Well, you see, I happen to have the quaint notion that poor people have as much right to live, Doctor, as rich ones do, and I lament the fact that the rich people in this country can murder their children at will if they have the money to do it. But I still think I have an obligation to try to save as many lives as I can. And if you`re really concerned about child abuse you ought to consider the ultimate abuse of a child, and that is murdering it.

CRIST: Yes, Congressman, you`re very articulate, and you have a knack with playing with words in the language. But you lead us all to believe and equate murder with abortion, but that`s not a fact, that`s your opinion. And as your opinion you can state it as you want and I respect your opinion. But I don`t thins; it`s fair and I don`t think it`s moral to put your opinion on the millions of poor women in this country, and that`s our difference, sir.

BAUMAN: Well, I...

CRIST: You sit here and you equate...

LEHRER: Let`s let the Congressman respond, Doctor.

CRIST: Excuse me.

BAUMAN: I don`t think there`s been many fundamental questions ever debated in this country, whether it`s been slavery or the morality of the Vietnam War, that haven`t involved moral judgments. I`m forced to make those as a legislator; obviously you don`t share my moral judgment. But I do think we have an obligation to balance the moral aspects of this issue. And murder is still illegal in this country, and abortion is ...

CRIST:I just don`t think we can legislate morality.

LEHRER: Yes, Senator?

PACKWOOD: This is about the fourth time he has said "murder," and I come back again, the Supreme Court has said abortion is permissible, and they`re not going to go around legalizing murder. The Presbyterian Church, the Lutheran Church, the Episcopalian Church have all endorsed legalized abortion. Is the Congressman going to sit here and say that these churches are endorsing murder? The American Medical Association, the American Bar Association, organizations concerned with life and concerned with law support legalized abortion.

LEHRER: Congressman, you have ten seconds.

BAUMAN: Yes, they are all endorsing murder, and that`s why the issue is so fundamental and has to be addressed by you and I as members of the Congress.

LEHRER: And I think we have proved tonight why you two members of Congress and all other members of Congress are having problems reaching an agreement. We`ll see what happens in November 30. My thanks to both of you. Dr. Crist, Dr. Kimball, I appreciate you-all coming tonight too. Robert MacNeil and I will be back tomorrow night. I`m Jim Lehrer. Thank you and good night.