The MacNeil/Lehrer Report; Abortion

Funding for this program has been provided by this station and other public television stations and by grants from Exxon Corporation, Allied Chemical Corporation and the Corporation for Public Broadcasting. (opening music) Jim Lehrer: Good evening, Robert McNeil 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 abortions, 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 Baumann, 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 no compromise position? Congressman Robert Baumann: 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 in 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. Jim 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. Congressman Robert Baumann: Well, that's the very minimum that I would concede personally, yes. Jim 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, quote, severe or long lasting physical health damage. You will not accept that. Speaking over each other: The severe end long lasting. And long lasting. Or long one or the other. Jim Lehrer: Yeah, there were some dispute about whether an and or an or got in there. Congressman Robert Baumann: 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. Jim Lehrer: What about the rape incest part? Congressman Robert Baumann: Well, the House had offered language regarding rape and incest which required prompted 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 in a death. Jim Lehrer: Always a loophole in other words, in the prohibition. Does that same thing apply, same objection applied to the words severe and long lasting physical health damage? Congressman Robert Baumann: 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 phrase and as Chairman Flood of our conference committee said, we have no idea to what extent this would be broadened by individual doctors administering the law

or the bureaucrats who write the regulations. Jim Lehrer: Congressman, is your basic objection to this based on, I know you're a fiscal conservative..... Is it based on money things or is it a moral question as far as abortion generally? Congressman Robert Baumann: No, it's a moral question and certainly money does not enter into my argument again for the right to life. I definitely feel that abortion is murder. Just as surely as if I were to draw a pistol for my coat and shoot you, a baby is being killed and abortion occurs and 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. Jim Lehrer: But what would you say to those who say who would point out that abortion as a procedure is completely legal, fully legal in the United States? So why should this procedure, legal procedure be denied to the poor? Congressman Robert Baumann: Well, the Supreme Court said in 1973 that abortion was now a right that a woman had but she didn't, the court didn't say and subsequently ruled that there was no requirement of the taxpayers to finance abortions in the United States.

So there are many things that are rights in the United States but which the government is not compelled or required to pay for. Jim Lehrer: All right. Congressman, thank you. All right. 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 if and if the woman would suffer severe and or long lasting physical health damage, is there anything more restrictive than that would be too much for you is that correct? Senator Robert Packwood: Well, as a matter of fact, I voted against that language in the Senate because I thought it was too severe. Jim Lehrer: The first go round. Senator Robert 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've 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 as 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. Jim Lehrer: Are you going to budge any more in your own position? Senator Robert Packwood: No, this goes much farther. I think that a woman's entitled to an abortion and if she cannot afford to have one under her own that the federal government should help pay for it, I didn't like the compromise. I haven't liked any of the Senate compromises that we've had to make to go along this far and so I don't plan to vote for this compromise. Jim Lehrer: Why is the Hyde amendment language that's supported by the majority of the House and Congressman Baumann included which makes death of the woman the only exception? Why is that not acceptable to you? Senator Robert Packwood: Oh, I could, if I had to, I could accept that. But I mean, 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 that the federal government's in 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. Jim Lehrer: All right. Now, you've heard what Congressman Baumann says that if rape and incest were in there or

even this severe and long-lasting physical damage, that that would, it's ambiguous, it's a loophole. How do you respond to that? Senator Robert Packwood: There's a, 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, it's that expression 'physical health' because an argument can be made, and I think validly perhaps, that how your mental health is can affect your physical health. And therefore, and 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 what about his fears there? Jim Lehrer: What about his other objection that he raises that a woman could come to a doctor, say four months after, three months after having conceived and say, look, I was raped and without a

opportunity to check, I mean, that could provide a loophole. Senator Robert Packwood: Well, at one time there is a requirement, I can't remember if we left it in there, that the rape had to be reported to legal authorities. I mean, you can't even, 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. Jim Lehrer: Gentlemen, let me ask you both. I have listened attentively to each one of you lay out your positions and I know that the positions of the House and Senate are in each one of you represent, basically, the majority view in each one of your bodies. Where is their room for compromise, Congressmen? Congressman Robert Baumann: 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 pressures become very great. And I think we saw that last Friday night when the House only preserved the Hyde

Amendment by about a 20-vote margin with some number of absences, the leadership and 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 29th, when the House and the 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't be worked out. Jim Lehrer: You agree, Senator? Senator Robert 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 were 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. Well, for whatever reason

it turns out the leadership could not deliver it. Congressman Robert Baumann: Well, I can't speak for us in the House, senator. Jim 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? Senator Robert Packwood: 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 assault agreement with Russia, but not like him on his Middle East standard, whatever it might be. But if you're in a close district, a district that might be won or lost by 5248 or 5347, 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 51 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. Jim Lehrer: Do you agree with that, congressman? Congressman Robert Baumann: Yes, and I think the reason is that the issue is so fundamental that it has stirred the emotions. And a great many people, regardless of their political affiliation, 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 it 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 very..... Senator Robert Packwood: 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. (talking over each other) The American ........., I would say.

The American......? Jim Lehrer: All right. We'll be here all night, we're arguing on that particular issue, gentlemen, we'll be right back. All right, 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, 13 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 34 have discontinued paying for them except to save a woman's life, the high-demand approach, in other words. Virginia becomes the 35th on November 30th. North Carolina, for instance, cut off abortion Medicaid funding on August 4th. 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. Crist: Well I described to Senator Helms the patient that I had become involved in who was on welfare. She was a 41-year-old black, married, who had 11 children, husband's disabled. And she was in my office with her 17-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? Jim Lehrer: What did you tell her? Dr. Crist: Well, for Rosalie right now, we're trying to get some funds. And as I sat in my office, I thought about the number of Rosalie's that must be across the state of North Carolina and in the United States that have this same problem. Since August 4th, we've not only seen cases like Rosalie, but 13-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? Jim Lehrer: I ask you, what do you do with them? Dr. Crist: It's a very difficult decision to make, particularly when you have nowhere to go, and you 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. Well, Dr. in these, and the Rosalie case and other Rosalie cases that you had since August 4th. 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. Have you followed up to see what they did as, 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? Dr. Crist: As best as we know at the present time on those patients that have come to us since August 4th, which have been over 300 patients that we've had to turn away. Jim Lerher: 300 you've turned away? Dr. Crist: That's correct, because we are a referral center for over 50 counties. We do not know of any illegal abortions that have been done at this time. Now, 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 right now in North Carolina with a fever, have had already a historectomy, and it wasn't reported. I mean, what woman is going to go to a physician after having an illegal abortion and has, have a complication tell the physician that she's had a illegal abortion?

Jim Lehrer: Have there been fewer women just coming to your clinic asking for abortion since August 4th? Dr. 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 campus, private, middle class, and those that can afford it. Jim Lehrer: And here you tell them, what do you tell them? Do you perform them? Dr. Crist: Well, we perform the abortions. Jim Lehrer: Yeah. All right. Thank you, doctor. All right. To broaden this effect question a bit now, Dr. Ann Kimble 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. Kimble, let me ask you, is the situation that we just heard Dr. Crist report? Is that general nationwide or is that happening, general thing happening elsewhere in the country? Dr. Kimble: 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. Jim Lehrer: Can you tell us anything thus far since August that a general trend, a kind of semi-general trend or whatever? Dr. Kimble: I think it would be really too premature to say that. Jim Lehrer: You can tell us about some specific, for instance, your agency investigated the incident in Texas where five women, welfare women could not get abortions, they went to Mexico as I understand it, one as a result, one of them died, four, the other four were hospitalized. You looked in, what are the circumstances there? Dr. Kimble: 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 abortions. Jim Lehrer: septic abortions. Dr. Kimble: related....

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 infections 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.

Jim Lehrer: In other words, she couldn't afford to go through the regular procedure in Texas. Is abortion legal in Texas now under.... Dr. Kimble: yes abortion is legal, Jim Lehrer: 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, but it was cheaper to go to Mexico. Is that what you're saying? Dr. Kimble: The price differential was $40 in Mexico, and $200 in Texas. Jim Lehrer: Did she actually go to a clinic like Dr. Crist and say, I need an abortion and was turned down? Dr. Kimble: No, she did not. The context of her discussion with her private physician was she mentioned to him in the course of a visit for another complaint that she admits some of her periods felt she may have been pregnant. He informed her at that point that Medicaid would no longer pay for abortions. Jim Lehrer: There have been other cases reported to you since August like the Texas case that you all have investigated in other parts of the country. Dr. Kimble: No, there haven't. Jim Lehrer: That is the most aggravated. Is there any way for you at this point to 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 to say if an amended, unamended, Hyde amendment should be passed? Dr. Kimble: There was a paper that was published through our branch that was written by Diana Petitian Ward Cates, who were both medical doctors who worked with our branch. They made projections based on that premise. They projected that between 5 and 90 excess maternal deaths would occur in time Jim Lehrer: between 5 and 90. Between 5 and 90 depended on the choice that the Medicaid woman makes once she becomes pregnant. One hypothesis, of course, would be that nothing would happen, okay? 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 their pregnancy to term, in which case statistically we would expect to see 44 additional maternal deaths, or they would delay for two weeks looking for funding, in which case we would expect to see 5 excess deaths, or they would all seek illegal abortions, in which case we would see 90 excess deaths in the nation,

or they would 70% of them would seek illegal abortions, and 30% may go on to term. That was the only other possibility to dealt with, and that was 77 excess maternal deaths. Jim Lehrer: You give me a lot of figures there, can you add them up in any way and tell me what all that means? Dr. Kimble: The range, depending on the choices that the Medicaid women make once they become pregnant, will result in between 5 and 90 excess maternal deaths in the country, according to the projections in that paper. Jim Lehrer: All right. Let's go first back to you, Congressman. Does this Dr. Crist experience, and what Dr. Kimball has just reported? Does that concern you from your advantage, of course? Congressman Robert Baumann: Of course it concerns me, the death of five people, or 90 people, concerns me a great deal, but the death of 300,000 children concerns me as well. 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 90 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. Jim Lehrer: Senator, want your reaction to the effect part of this question? Senator Robert 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, and 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. Jim Lehrer: Dr. Crist, let me come back to you. Dr. Kimbles, two biggest bosses, President Carter and H.E.W. 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, etc.

What has been the experience of North Carolina? Since the funds have been cut off, have there been expanded services for health? Dr 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. I'd like to address one of my questions to the congressman if you would allow me at this time. 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 1 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 veneral 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? Jim Lehrer: Congressman. Congressman Robert Baumann: 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. Dr Crist: Yes, Congressman, you're very articulate, and you have a knack with playing with words in the language, but you make us all and you lead us all to believe and equate murder with abortion, but that's not a fact, that's your opinion. And as as your opinion, you can state it as you want, and I respect your opinion, but I don't think 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. Well, you sit here, and you- Jim Lehrer: Let's let the Congressman respond, Dr. Dr Crist: Excuse me. Congressman Robert Baumann: 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. And I'm forced to make those as a legislator, obviously you don't share my moral judgment, and I do think we have an obligation to balance the moral aspects of this issue. Dr Crist: I just don't think ....(talking over) murder is still illegal in this country, but abortion is- Dr. Crist: I just don't think we can legislate morality. Jim Lehrer: Yes, Senator Senator Robert 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. So 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. Jim Lehrer: Congressman, to have ten seconds. Congressman Robert Baumann: 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. Jim Lehrer: And I think we have proved tonight why the you two members of Congress and all other members

of Congress are having problems reaching an agreement and we'll see what happens on November 30th. My thanks to both of you. Dr. Chris, Dr. Kimble, appreciate you all coming tonight too. McNeil and I'll be back tomorrow night. I'm Jim Lehrer. Thank you and good night. (music) For a transcript send $1 to the McNeil Lehrer report, Box 345, New York, New York, 10019. (music) The McNeil Lehrer Report was produced by WNET and WETA. They are solely responsible for its content. Funding for this program has been provided by this station and other public television stations and by grants from the Exxon Corporation, Allied Chemical Corporation and the Corporation

for Public Broadcasting. (music) Thank you.