[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-
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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
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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
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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.
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