Female lawmakers approve of plan but fear retreat on abortion coverage CLINTON'S HEALTH PLAN

September 15, 1993|By Karen Hosler | Karen Hosler,Washington Bureau

WASHINGTON -- Lawmakers seeking health care equity for women said yesterday that President Clinton's reform proposal represents a step forward but worry that his failure to make a clear commitment to abortion coverage may lead to a retreat on that key issue.

The president's plan would give many women coverage for Pap smears, mammograms, prenatal services, routine exams and other preventive services for the first time, though some advocates complain the coverage would still fall short of what most doctors recommend.

"It's not enough. . . . It's just the first step we're taking toward catching up," said Rep. Louise M. Slaughter, a New York Democrat who chairs the congressional women's Health Care Caucus. "We're not expecting this to be the perfect health care program, but it is a step in the right direction."

Administration officials said yesterday that abortion coverage would be provided as part of the standard benefit package, although there is no mention of the procedure in the 239-page draft of the Clinton proposal now circulating on Capitol Hill.

pTC Several female legislators said they fear that, because a battle over the abortion issue could doom the entire health care reform effort, Mr. Clinton will accept whatever terms a highly charged congressional debate on the subject produces.

"Women's health must not be negotiated away during the legislative process," said Rep. Nita M. Lowey, a New York Democrat who has been a leader on the abortion-rights issue. "We expect the president to unequivocally endorse the retention of pregnancy-related services, including abortion."

Abortion opponents have no such qualms about Mr. Clinton's position.

They believe the president is trying to use health care reform to force all Americans to pay premiums into a system that will finance abortions and greatly expand coverage for the procedure, according to Douglas Johnson, legislative director for the National Right to Life Committee.

The Clinton proposal is generally being warmly welcomed by advocates for women because it puts a new emphasis on preventive gynecological and prenatal care and increases access for many women.

Universal coverage would be available for the first time to the working poor and the unemployed and expanded services for the elderly.

All three of these groups are predominantly women.

In addition, greater assistance would be available to the family members -- most of them female -- who wind up as caregivers in the home for disabled relatives.

"This would be a huge improvement for a lot of women who don't have any kind of health care at all," said Linda Tarr-Whelan, an health care analyst with the Center for Policy Alternatives.

But female lawmakers active on health issues and health policy analysts outside the government raised questions yesterday about the limits that the Clinton plan sets on preventive screenings to detect cervical and breast cancer.

For example, women of child-bearing age could get coverage for a Pap smear only once every three years if they get a negative result on three previous annual tests. The American College of Obstetricians and Gynecologists recommends a Pap smear every year for women.

Similarly, the Clinton plan allows for routine mammogram screenings only for women 50 and over and then only once every two years.

The value of regular mammograms for women under 50 has been challenged recently by doctors who say breast tissue in younger women is too dense for meaningful results. But most medical authorities agree that after 50 years of age, mammograms should be annual.

The Clinton plan makes no provision for preventive screening for osteoporosis, which Maryland Sen. Barbara A. Mikulski had strongly advocated to help women take steps to avoid costly treatment later for shrunken spines and broken bones.

An administration official who refused to be identified said the provision for preventive screenings, which would be covered without any co-payment, was based on the latest scientific data.

Such screenings would also be covered as part of a diagnostic benefit if a doctor determined there was reason to suspect a problem, the official said.

"We're going to have to do a lot of negotiating" before female members of Congress, who now represent about one-ninth of the total 535, will broadly support the plan, said Rep. Patricia A. Schroeder, a Colorado Democrat. "We don't want women to have to use their private funds to pay for their private parts, when men can get all they need through the public sector."

Other features of the Clinton plan that may be particularly beneficial to women include coverage for mental health services, including depression, and prescription drug benefits.

But for women seeking treatment for infertility, the Clinton plan draws the line at in vitro fertilization, singling out the costly procedure as one not eligible for coverage under any version of that plan. That would be a step backward in Maryland, where, as in some other states, in vitro coverage was mandated by the General Assembly.

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