[Congressional Record Volume 142, Number 38 (Tuesday, March 19, 1996)]
[Senate]
[Pages S2264-S2267]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  BALANCED BUDGET DOWNPAYMENT ACT, II

  The Senate continued with the consideration of the bill.


                    Amendment No. 3513, As Modified

  Mr. COATS. Mr. President, earlier this morning I proposed a 
unanimous-consent request to modify the amendment which I had offered 
last week, on Thursday, to the legislation that the Senate is currently 
considering. We have had some discussion with the Senator from 
California and others regarding this. I believe we have resolved 
concerns relative to this modification, at least regarding offering the 
unanimous-consent request.
  So I now repeat my unanimous-consent request to modify the pending 
amendment to H.R. 3019.
  The PRESIDING OFFICER. Is there objection? Without objection, it is 
so ordered.
  The amendment (No. 3513), as modified, is as follows:
       At the appropriate place, insert the following:

     SEC.   . ESTABLISHMENT OF PROHIBITION AGAINST ABORTION-
                   RELATED DISCRIMINATION IN TRAINING AND 
                   LICENSING OF PHYSICIANS.

       Part B of title II of the Public Health Service Act (42 
     U.S.C. 238 et seq.) is amended by adding at the end the 
     following section:


``abortion-related discrimination in governmental activities regarding 
                  training and licensing of physicians

       ``Sec. 245. (a) In General.--The Federal Government, and 
     any State or local government that receives Federal financial 
     assistance, may not subject any health care entity to 
     discrimination on the basis that--
       ``(1) the entity refuses to undergo training in the 
     performance of induced abortions, to require or provide such 
     training, to perform such abortions, or to provide referrals 
     for such training or such abortions;
       ``(2) the entity refuses to make arrangements for any of 
     the activities specified in paragraph (1); or
       ``(3) the entity attends (or attended) a post-graduate 
     physician training program, or any other program of training 
     in the health professions, that does not (or did not) perform 
     induced abortions or require, provide or refer for training 
     in the performance of induced abortions, or make arrangements 
     for the provision of such training.
       ``(b) Accreditation of Postgraduatie Physician Training 
     Programs.--
       ``(1) In general.--In determining whether to grant a legal 
     status to a health care entity (including a license or 
     certificate), or to provide such entity with financial 
     assistance, services or other benefits, the Federal 
     Government, or any State or local government that receives 
     Federal financial assistance, shall deem accredited any 
     postgraduate physician training program that would be 
     accredited but for the accrediting agency's reliance upon an 
     acceditation standard that requires an entity to perform an 
     induced abortion or require, provide, or refer for training 
     in the performance of induced abortions, or make arrangements 
     for such training, regardless of whether such standard 
     provides exceptions or exemptions. The government involved 
     shall formulate such regulations or other mechanisms, or 
     enter into such agreements with accrediting agencies, as are 
     necessary to comply with this subsection.
       ``(2) Rules of construction.--
       ``(A) In general.--With respect to subclauses (I) and (II) 
     of section 705(a)(2)(B)(i) (relating to a program of insured 
     loans for training in the health professions), the 
     requirements in such subclauses regarding accredited 
     internship or residency programs are subject to paragraph (1) 
     of this subsection.
       ``(B) Exceptions.--This section shall not--
       ``(i) prevent any health care entity from voluntarily 
     electing to be trained, to train, or to arrange for training 
     in the performance of, to perform, or to make referrals for 
     induced abortions; or
       ``(ii) prevent an accrediting agency or a Federal, State or 
     local government from establishing standards of medical 
     competency applicable only to those individuals who have 
     voluntarily elected to perform abortions.
       ``(c) Definitions.--For purposes of this section:
       ``(1) The term `financial assistance', with respect to a 
     government program, includes governmental payments provided 
     as reimbursement for carrying out health-related activities.
       ``(2) The term `health care entity' includes an individual 
     physician, a postgraduate physician training program, and a 
     participant in a program of training in the health 
     professions.
       ``(3) The term `postgraduate physician training program' 
     includes a residency training program.''.

  Mr. COATS. Mr. President, let me just state, during our discussion 
last Thursday on this amendment, which I will describe in a moment, 
questions were raised by the Senator from Maine relative to some 
language and the interpretation of that language as it affected a 
portion of the bill providing for an exemption to the accreditation 
standards based on a conscience or moral clause relative to performing 
abortion.
  We have discussed that question over the weekend and made some 
clarifications in that language, which is the purpose of the 
modification. The Senator from Maine spoke this morning and the Senator 
from Tennessee spoke, relative to the procedures of the Accrediting 
Council for Graduate Medical Education, its involvement in accrediting 
medical providers and medical training programs, and support for the 
Coats amendment to this particular bill.
  Let me describe that very briefly. The problem that we had here is 
that, prior to 1996, the ACGME, which is the American Council on 
Graduate Medical Education, did not require hospitals or ob/gyn 
residency programs to perform induced abortions or train to perform 
induced abortions. That was done on a voluntary basis. Until 1996, 
hospitals were only required to train residents to manage medical and 
surgical complications of pregnancy, that is those situations where 
treatment of life-threatening conditions to the mother or complications 
of a spontaneous abortion, miscarriage, or stillbirth, was part of the 
medical training.
  At the same time, 43 States have had in place statutes, as well as 
the Federal Government, to protect individual residents in hospitals 
from having to perform on a mandatory basis, or having to train on a 
mandatory basis, for the performance of induced abortions or abortion 
on demand. These procedures generally apply regardless of the reason to 
refuse to perform an abortion.

  Then in 1996, the Accrediting Council on Graduate Medical Education 
changed its standards, indicating that failure to provide training for 
induced abortions could lead to loss of accreditation for these 
hospitals and for these training programs.
  The reason this is important is that a great deal of Federal funding 
is tied to this accreditation. The Medicare reimbursement is tied to 
accreditation, loan deferral provisions are tied to accreditation, and 
a number of other federally provided support for hospital providers and 
for training programs for ob/gyn and others are tied to the 
accreditation. So, if the accreditation is removed, these institutions 
could lose their Federal funds.
  So the language that I offered in the bill that we offered to the 
Senate basically said that, one, we do not think it is right that the 
Federal Government could discriminate against hospitals or ob/gyn 
residents simply because they choose, on a voluntary basis, not to 
perform abortions or receive abortion training, for whatever reason. 
For some it would be religious reasons; for some it would be moral 
reasons; for some it could be practical reasons; for some hospitals it 
could be economic reasons. There are a whole range of reasons why a 
provider may choose not to engage in this mandatory practice.
  But at the same time, we did not feel that it was proper for us to 
mandate to a private, although somewhat quasi-

[[Page S2265]]

public, accrediting agency how they determine their accrediting 
standards. We do not want to prevent ACGME from changing its standards. 
It has every right, even though I do not agree with all of its 
requirements, to set its own standards.
  Second, we do not want to prevent those who voluntarily elect to 
perform abortions from doing so. Nobody is prevented in this 
legislation from voluntarily receiving abortion training or from 
voluntarily offering that training in their hospital, nor do we prevent 
the Government from relying on those accreditation standards. I think 
you can make a case that the Government, by relying on a quasi-public 
entity for accreditation, may be too narrowly restricting in scope in 
terms of determination on Federal reimbursement, but we are not 
addressing that issue.
  So this legislation does not prevent the Government from relying on 
the ACGME for accreditation. We do not prevent the Government from 
requiring training of those who voluntarily elect to perform abortions.
  What we do do is attempt to protect the civil rights of those who 
feel that they do not want to participate in mandatory abortion 
training or performance of abortions. That is a civil right that I 
think deserves to be provided and is provided in this legislation.
  It is a fundamental civil right, as a matter of conscience, as a 
matter of moral determination, as a matter of any other determination, 
as to whether or not this procedure, which is controversial to say the 
least, ought to be mandated and whether that is a proper procedure for 
those who then are forced to participate in programs in order to 
receive reimbursement from the Federal Government for various forms of 
support. We do not believe that it is.
  There was some question about the so-called conscience and morals 
clause that was included in the accrediting standards, but we had 
testimony before our committee from a number of individuals who felt 
that that exception language was unnecessarily restrictive for those 
who felt, because they were a secular hospital or because they were 
residents in a training program at a secular hospital, that conscience-
clause exception would not protect them from the loss of accreditation 
or protect their basic civil rights.
  I have just some examples of that. The University of Texas Medical 
Branch at Galveston wrote to us essentially saying, and I quote:

       Those involved in resident education at the University of 
     Texas Medical Branch made a decision in the mid 1970's not to 
     teach elective abortion as part of our curriculum. This 
     decision was based, originally, on concerns other than moral 
     issues. We encountered two significant problems with our 
     Pregnancy Interruption Clinic, or PIC as it was known at the 
     time. First, the PIC was a money loser. Since there was no 
     reimbursement for elective abortions from either State funds 
     or Medicaid a great deal of expense of the PIC was 
     underwritten by faculty professional income. Faculty income 
     was used without regard to the moral concerns of individual 
     faculty members who generated the income. A second problem 
     was more significant and involved faculty, resident, and 
     staff morale. Individuals morally opposed to performing 
     elective abortions were not required to participate. This led 
     to a perception, by trainees performing abortions, that they 
     were carrying a heavier clinical load than trainees not 
     performing abortions. As fewer and fewer residents choose to 
     become involved in the PIC, this perceived maldistribution of 
     work became a significant morale issue. Morale problems also 
     spilled over to nursing and clerical personnel with strong 
     feelings about the PIC. It is a gross understatement to say 
     that elective abortion is intensely polarizing. Because of 
     bad feelings engendered by a program that was a financial 
     drain, the PIC was closed.

  So here is a respected hospital, the University of Texas at 
Galveston, which basically said the moral, conscience reasons were not 
basically the reasons why this particular hospital chose not to 
participate in the program.
  They followed that up with a letter, which I will quote again. They 
said:

       Because we are a secular institution, and a state supported 
     university, we would have no recourse under the new ACGME 
     ``conscious clause,'' except to provide such instruction to 
     our trainees. The ACGME ``conscious clause,'' providing an 
     opportunity to invoke a moral exemption to teaching elective 
     abortion, is restricted to institutions with moral or 
     religious prohibitions on abortion. It does nothing to 
     protect the faculty at State-run universities.

  I have a similar letter from Mt. Sinai Hospital:

       Your amendment is desperately needed to protect the rights 
     of faculty; students and residents who have no desire to 
     participate in abortion training but who do not work in 
     religious or public hospitals.
       Since our institution would not, therefore, ``qualify" as 
     one with a moral or legal objection--

  Therefore, the moral and conscience clause would not protect them.
  Albany Medical Center in New York offers the same, and the list could 
go on and on.
  So, essentially, what we are saying here is that the amendment that I 
am offering is clearly one which is designed to protect the basic civil 
rights of providers and medical students in training who elect, for 
whatever reason, whether it is a moral or conscience reason or whether 
it is an economic, social or other reason, not to perform abortions.
  We do not believe that it is proper for the Federal Government to 
deny funds on the basis of lack of accreditation if that lack of 
accreditation is based on the decision of a provider or a program that 
they do not want to participate in a mandatory training procedure for 
induced abortions.
  I am pleased we were able to work out language with the Senator from 
Maine, which addressed her concerns to make sure that we did not 
prohibit ACGME from accrediting or not accrediting, because there are 
other reasons why facilities might not deserve accreditation. Federal 
funds certainly should not flow to those hospitals and to those 
programs that do not meet up to basic medical standards that the 
Government requires for its reimbursement.
  By the same token, we do not think that injecting a forced or 
mandatory induced abortion procedure on these institutions, for 
whatever reason, is appropriate. That is the basis of the amendment. 
The amendment has now been offered. It has the support of the Senator 
from Maine.
  The Senator from Tennessee, Dr. Frist, spoke this morning. He 
certainly knows more about these procedures and more about the medical 
concerns than this Senator from Indiana. He has looked this bill over 
very, very carefully and believes that the language incorporated in the 
Coats amendment is most appropriate, and he is supportive of that. I 
think that is a solid endorsement from someone who clearly understands 
the issue in great depth and understands the accrediting process, 
supports that process, but believes there ought to be this exemption.
  Mr. President, I have not yet asked for the yeas and nays on this. My 
understanding is that the vote will be ordered, along with other votes, 
after 2 p.m. So I will now ask for the yeas and nays for this 
amendment.
  The PRESIDING OFFICER (Mr. Smith). Is there a sufficient second? 
There appears to be a sufficient second. There is a sufficient second.
  The yeas and nays were ordered.
  Mr. COATS. Mr. President, I yield the floor.
  The PRESIDING OFFICER. The time of the Senator from Indiana has 
expired.
  Mrs. BOXER addressed the Chair.
  The PRESIDING OFFICER. The Senator from California is recognized for 
15 minutes.
  Mrs. BOXER. I wanted to clarify that. I know we lost some time here. 
So I have 15 minutes remaining to discuss both amendments, is that 
correct, Mr. President?
  The PRESIDING OFFICER. The Senator is correct.
  Mrs. BOXER. Thank you very much, Mr. President.
  I want to explain why it was that it took the Senate extra time to 
get to this point of debating these amendments. The modified amendment 
came to the attention of my staff, in its final form, late last night. 
I was on a plane coming back from California, where I had a full 
schedule. When I returned at midnight, clearly, it was too late to 
contact my colleagues, and, therefore, I needed some time to really 
read the amendment and understand its implications, because the 
amendment, as modified, is of grave concern to me.
  The longer I have to look at this amendment, the more concerned I am 
about it. I would like to explain to my colleagues why. Before I do 
that, I want to explain also that those in this

[[Page S2266]]

community who support a woman's right to choose strongly oppose the 
Coats amendment. Those groups--who oppose this amendment are the 
Women's Legal Defense Fund, the National Abortion Federation; the 
American Association of University Women; the National Women's Law 
Center; Planned Parenthood, and the National Abortion Reproductive 
Rights Action League.
  I think it is very, very clear why. It is because if you look at what 
could happen as a result of the Coats amendment, you quickly come to 
the conclusion, Mr. President, that theoretically --and we hope it 
would not happen--but it is possible under this amendment that every 
single medical school in this country could stop teaching their 
residents how to perform safe, legal abortions and still get Federal 
funding.
  I really do feel that is the intent because I know there are those in 
this Senate, and I have great respect for them, who would like to 
outlaw a woman's right to choose. They cannot do it up front, so they 
try to do it in every which way they can. This is just one more example 
like they said, if the woman is in the military she cannot get a safe 
abortion in a military hospital. This is the kind of theory that you 
see being practiced on the floor. I say to my friends, they have every 
right to do this. I respect their right to do it. But I strongly 
disagree.
  Under current circumstances, for a medical school with an ob/gyn 
Residency training program to get Federal funds they must teach their 
residents how to perform safe, legal abortions unless the institution 
has a religious or moral objection, called a conscience clause. I fully 
support that conscience clause. I do not believe that any institution 
that has a religious or moral problem should have to teach their 
residents how to perform safe, legal abortions. However, under this 
modified amendment by Senator Coats, any institution can stop teaching 
abortion and still get the Federal funds even if they have no religious 
or moral objection.
  For example, let us suppose the anti-choice community targets a 
particular hospital or medical school and day after day stands outside 
there protesting and demanding that they stop, and finally the 
institution throws up its hands and says, ``You know, it isn't worth 
it. We will still get our Federal funds. We'll just stop teaching how 
to perform safe, legal abortions.''
  What does that mean? It seems to me that as long as abortion is legal 
in this country--and it is legal under Roe versus Wade, and it has been 
upheld to be legal by the Court--what we are doing here is very 
dangerous to women's lives, because if we do not have physicians who 
know how to perform these safe abortions, we are going to go back to 
the days of the back alley.
  My friends, I have lived through those years, and no matter how many 
people think you can outlaw a woman's right to choose, in essence, even 
when abortions were illegal in this country, they happened. They 
happened in back alleys. They happened with hangers. Women bled to 
death and women died. We need doctors to know how to perform safe, 
legal abortions. It is very, very important.
  What if a woman is raped? What if she is a victim of incest, and she 
is in an emergency circumstance, and they cannot find a doctor who 
knows how to do a safe, legal abortion? That is the ultimate result of 
this. That is why so many organizations who care about women, in my 
opinion, are opposing this amendment.
  We need trained and competent people to take care of the women of 
this country. If they have a religious or moral problem, I strongly 
support their right not to have to learn how to perform such an 
abortion. But if they have no conscience problem, if the institution 
has no conscience problem, it is in the best interests of all of us 
that we have doctors who are trained, competently, to perform surgical 
abortions until there is another way for a woman to exercise her right 
to choose that is safe.
  I ask the Chair, how much time do I have remaining?
  The PRESIDING OFFICER. The Senator has 9 minutes, 45 seconds 
remaining.
  Mrs. BOXER. I ask that the President advise me when I have 5 minutes 
remaining. I will retain those 5 minutes.


                           Amendment No. 3508

  Mrs. BOXER. Mr. President, I have an amendment that I ask for the 
yeas and nays on right now, if I might, dealing with the District of 
Columbia. I ask for the yeas and nays on that amendment.
  The PRESIDING OFFICER. Is there a sufficient second? There appears to 
be a sufficient second. There is a sufficient second.
  The yeas and nays were ordered.
  (Mr. Coats assumed the chair.)
  Mrs. Boxer. I want to thank my colleague for allowing me to have an 
up-or-down vote. It is quite simple. Mr. President, in this country 
called America, there are 3,049 counties and 19,100 cities. It seems to 
me extraordinary that in this bill that is before us, there is only one 
entity that is singled out and only one entity that is told that it 
cannot use its locally raised funds to help a poor woman obtain an 
abortion.
  We already have strict control on the use of Federal funds. No 
Federal Medicaid funds may be used by any city, county, State or entity 
for abortion. But we have no stricture on what a local government can 
do, except in this bill where we tell Washington, DC, they cannot use 
their own property taxes to help such a poor woman, they cannot use 
fines they collected to help such a poor woman. I think it is a rather 
sad situation.
  I know my colleagues will get up here and say, ``We think we can tell 
Washington, DC, to do whatever we want it to do.'' If we want to do 
that with Federal funds, that certainly is an argument, but not with 
their own locally raised funds.
  So, Mr. President, what I simply do by my amendment, by adding the 
word ``Federal'' my amendment clarifies a point. My amendment 
guarantees that Washington, DC, will be treated as every other city and 
every other county in this country. They may not use Federal funds--
although, by the way, I object to that, but I know I do not have the 
votes to overturn that situation--but I am hoping that we can get the 
votes to stand up and say that local people can decide these matters on 
their own.
  What always interests me in this Republican Congress is, we hear 
speech after speech about ``Let the local people decide, let the States 
decide. Why should Big Brother come into cities and localities and 
States and decide for them?'' Yet, when it comes to this issue, somehow 
this philosophy goes flying out the window and we are going to tell a 
local elected body how they should treat the poor women in their 
community.
  Now, a woman's right to choose is the law of the land. But if she is 
destitute and she is in trouble, it is very hard for her to exercise 
that legal right. And if the locality of Washington, DC, wants to help 
her, I do not think we should stop them.
  Thank you, very much. I reserve the remainder of my time.
  Mrs. MURRAY. Mr. President, I rise in strong support of the amendment 
offered by my colleague from California, Senator Boxer. I am proud to 
be a cosponsor of this measure and I urge all of my colleagues to do 
the right thing and vote for our amendment.
  Since 1980, Congress has prohibited the use of Federal funds 
appropriated to the District of Columbia for abortion services for low-
income women, with the exception for cases of rape, incest, and life 
endangerment.
  From 1988 to 1993 Congress also prohibited the District from using 
its own locally raised revenues to provide abortion services to its 
residents. I am pleased that for fiscal year 1994 and 1995 Congress 
voted to lift the unfair restriction on the use of locally raised 
revenues, and allow the District to decide how to spend its own locally 
raised moneys.
  There is language in this bill that would coerce the District into 
returning to the pre-1994 restrictions. This bill is a step backward, 
and we shouldn't allow it to pass. Congress does not restrict the use 
of dollars raised by the State of Washington or by New York, Texas, 
California or any other State--because Congress does not appropriate 
those funds.
  Why should our Nation's capital be the solitary exception? It 
shouldn't be the exception, Mr. President, and our amendment ensures 
the District of Columbia will have the same rights as

[[Page S2267]]

every locality--every county and city--to determine how to spend 
locally-raised revenue.
  I know why the District is being targeted in this way. And so does 
every woman, and so should every American. This is just another of the 
many attempts by some Members of Congress to chip away and take away a 
woman's right to choose.
  It sure is ironic. That in this Congress, where the mantra has been 
``States know best'' month after month, the majority party now wants to 
micro manage DC's financial decisions.
  Mr. President, restricting the ability of the District to determine 
how it is going to spend its locally raised revenue is the ``Congress 
knows best'' approach at its worst. I find it so very hypocritical that 
virtually every debate over the past year has touted local flexibility 
and vilified Washington, DC's presence in policy making.
  We should allow the District the same right as all other localities--
to choose how to use their locally raised revenue. We should not single 
out our Nation's capital. We should pass the Boxer amendment.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The Chair informs the Senator the time will be 
charged to the Senator unless she asks unanimous consent that her 
remaining time be reserved.
  Mrs. BOXER. I make a unanimous-consent request that my remaining time 
be reserved.
  The PRESIDING OFFICER. The Senator has 6 minutes 6 seconds remaining, 
and that time will be reserved.
  The quorum call will be charged to no one at this particular point.
  The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. SPECTER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SPECTER. Mr. President, I have sought recognition for a few 
moments this morning to speak in morning business for a period not to 
exceed 5 minutes. I ask unanimous consent that I may be permitted to do 
that.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator is recognized to speak up to 5 minutes.
  Mr. SPECTER. I thank the Chair.
  (The remarks of Mr. Specter pertaining to the introduction of 
legislation are located in today's Record under ``Statements on 
Introduced Bills and Joint Resolutions.'')
  Mr. SPECTER. Mr. President, before yielding the floor, I have been 
asked to take a limited leadership role here.

                          ____________________