By Dave Andrusko
Medicare and Medicaid Administrator Donald Berwick.
Faced with thinly veiled threats from the Obama Administration to cut off billions in Medicaid funds, the state of Indiana received some welcomed news in the form of a letter of support released yesterday from 28 Republican senators sent to the head of the Centers for Medicare and Medicaid Services (CMMS)
In the letter to Dr. Donald Berwick, the senators roundly rejected Berwick’s conclusion that Indiana’s new law denying state-directed funding for businesses and organizations performing abortions, except for hospitals or ambulatory surgical centers, is in violation of federal law (the Social Security Act).
In fact, they argued, “Indiana’s proposal should not only be approved, we believe it serves as an important model for every state.”
In a letter dated June 1, Berwick wrote Patricia Cassanova, the director of Indiana’s office of Medicaid Policy and Planning, that the CMS would not approve changes to Indiana’s Medicaid plan because “Medicaid programs may not exclude qualified health care providers from providing services that are funded under the program because of a provider’s scope of practice.” He added, “Such a restriction would have a particular effect on beneficiaries’ ability to access family planning providers.”
In the second sentence of the letter, the senators flatly disagreed with Berwick’s “narrow interpretation of Title XIX of the Social Security Act and believe this represents a significant departure from Medicaid’s longstanding practice of having the states – not the federal government – set reasonable standards for qualified providers”—and in the third sentence put the CMMS’ action in context-“Unfortunately, your decision is simply the latest example of this Administration’s alarming pattern of usurping states’ authority to manage their Medicaid programs in ways that best meet the needs of their citizens.”
The Obama administration is broadly hinting that noncompliance could threaten the loss of billions in Medicaid money provided by the federal government and that other states could face the same fate. “We’ve sent out a bulletin to all of the states notifying them of the finding in Indiana,” Berwick said. “And I expect that states will comply.” Berwick wrote that the state had sixty days to appeal CMS’s decision.
The letter defended Indiana’s decision on several grounds, including (1) a section of the Social Security Act that states, “This provision is not intended to preclude a State from establishing, under State law, any other bases for excluding individuals or entities from its Medicaid program” and (2) a decision by the First Circuit that “permit[s] a state to exclude an entity from its Medicaid program for any reason established by state law.”
”We fully support the intent of HEA 1210 [the new Indiana law] to prevent taxpayer dollars from subsidizing the operational costs of abortions,” the senators wrote, “and more broadly, we support the right of states to administer their Medicaid programs in a manner consistent with the values and needs of their citizens.”
On Monday U.S. District Judge Tanya Walton Pratt of the Southern District of Indiana heard arguments on a suit filed by Planned Parenthood of Indiana for a preliminary injunction to block implementation of the law until Pratt rules on its merits, expected on July 1. Judge Pratt gave Indiana Solicitor General Thomas Fischer and Ken Falk of the American Civil Liberties Union, which is representing Planned Parenthood, ten days to file additional written arguments in the case.
Planned Parenthood is the recipient of an enormous amount of state and federal money. According to Planned Parenthood Federation of America’s annual report for 2008-2009, which reported over $1 billion in revenues, the amount it received in “Government Grants & Contracts” has grown from $165 million in 1998 to $363.3 million in the organization’s fiscal year ending June 30, 2009.
During the same time, and at roughly the same rate, abortions have more than doubled at Planned Parenthood, from 165,509 in 1998 to 332,278 in 2009. With just over 1.2 million abortions performed annually nationwide, abortions done in Planned Parenthood clinics account for more than 25% of the national total.
“Using the average estimates for the cost of a first-trimester abortion ($451), Planned Parenthood clinics derived more than one-third ($149.9 million) of their reported $404.9 million in income from abortions in 2008-2009,” National Right to Life President Carol Tobias has noted.
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