ABORTION CLOUDS HEALTH BILL DEBATE

Legislation aimed at improving access to health care for 600,000 Missourians enters the final week of the 1993 legislative session with a good chance of passage but clouded by the abortion issue.

House Bill 564 was approved by the House of Representatives on April 7, but only after supporters convinced enough lawmakers that a school nurse section of the bill would not promote abortions.

The bill, sponsored by House Speaker Bob Griffin, is scheduled for debate in the Senate, where concerns over the abortion issue are likely to dominate the discussion.

Under provisions of the bill, physicians could enter into collaborative practice agreements with registered professional nurses to provide health care. In addition, advanced practice nurses would receive permission to write basic prescriptions under a physician's supervision.

The bill also gives schools the option of becoming Medicaid providers so they could offer such primary care services as immunizations and diagnostic treatments for disadvantaged children.

The program provides incentives for hiring nurses in every school, and could be tapped by parochial and private schools as well as public schools.

Among those concerned about the bill is Pamela Riehn of Jackson, who is the Southeast Missouri regional public relations coordinator for Missouri Right to Life.

Riehn has a number of concerns about the ultimate impact of Griffin's bill, concerns based not only on current law but on what the impact of future laws will be.

She points out that the RU-486 abortion pill is likely to be approved eventually by the Food and Drug Administration, and the nurse practitioners will be able to dispense drugs that include that one. Riehn noted that Planned Parenthood uses nurse practitioners to do routine examinations.

Another concern expressed by Missouri Right to Life is that if the Freedom of Choice Act passes Congress, then nurse practitioners would be able to perform abortions and other restrictions would be lifted.

"We fear the Freedom of Choice Act would lift state regulations that state if someone is under 18 they need parental consent for an abortion," said Riehn.

Further adding to the group's worries is that unwanted pregnancy eventually may be considered a disease. In that case, "then doctors would be entitled to do immunizations for that disease," she said.

Another concern with the bill is a "grandfather clause" that would allow schools that are currently counseling or referring for abortions to continue doing so.

Added Riehn: "The wording in the bill does not say school nurses or personnel will be prohibited from performing or referring abortions. We want stricter, more explicit language in the bill."

But Rep. Larry Thomason, D-Kennett, contends there is no basis for the concerns of anti-abortion forces.

Said Thomason: "That bill has absolutely nothing to do with the pro-life/pro-choice issue. What it has to do with is health care for Missourians. No other issue we face today in the mind of the public is more important to them than affordable health care."

The regard to abortion, Thomason said, "Anyone who reads that issue into this bill is out of touch with reality, or looking for an issue to press their point."

Thomason said it is unfortunate that many people are trying to turn the legislation into a fight over abortion.

"There is a lot of concern about what school nurses will and won't be able to do, and some of the right-wing fundamentalist people are opposing it because it does not have in their mind enough restrictions to keep a school nurse from being involved, even obliquely, in the abortion issue," said Thomason.

"But I think it has tremendous safeguards; you cannot do anything remotely related to abortion."

Thomason said it is important to weigh the bill's costs against its accomplishments. When that is done, he believes, most reasonable people will support the plan.

"Some people care more about principle than they do about the welfare of children," said Thomason.

"There are some folks out here, when it comes to this issue, who have no reason. They don't care about the good the measure accomplishes. They don't care that safeguards are in there. All they know is someone told them the bill is not perfect, and consequently they are opposed to all the good because it does not adamantly support their fringe position."

Sen. Peter Kinder, R-Cape Girardeau, said he will support restrictive abortion amendments that Sen. John Schneider, D-Florissant, plans to propose for the bill.

"If those things are resolved, I hope I will be able to support the bill because there is some good stuff in there," said Kinder. "I do have some concerns about school-based health clinics. I want to make sure we have a situation that is elective for local school districts to choose."

Rep. David Schwab, R-Jackson, said he too is concerned about some of the bill's language and its impact on the abortion issue. He fears the bill could allow school nurses to make abortion referrals.

Schwab voted against the bill the first time, but it has since been amended to reduce the fiscal note to $28 million. The money would come from a tax on tobacco products.

"I want to see it when it comes back to the House and may consider voting for it," said Schwab.

Rep. Mark Richardson, R-Poplar Bluff, said he too may re-consider his "no" vote if the bill comes back to the House with some modifications.

"I want to see some tightening down on the school nurse issue for abortion, but it has an awful lot of good in it. But I fear, with forthcoming changes in the federal health care system the next 12-24 months, many provisions in this bill will become moot."

Rep. Mary Kasten, R-Cape Girardeau, voted for the bill the first time and may do so again after studying Senate changes.

"I voted for it, but with a lot of apprehension," said Kasten. "It has a lot of good parts and provides some health care for people that are not going to have it ... the bill is worth taking a look at."

Rep. Marilyn Williams, D-Dudley, said she supports the bill and believes it is important to get more nurses in the schools. "I feel like that is very important, and many schools have had to cut out nurses in budget cuts," said Williams.

"I have a child with asthma and have a friend with a child who has diabetes, and these are both cases where a school nurse needs to be around. This bill makes health care more convenient and accessible, and provides more health screening, which is very important."

But Riehn maintains there simply are not enough safeguards in the bill to keep it from increasing access or counseling for abortions.

The bill calls for the formation of a permanent joint committee of legislators to oversee the program, but Riehn points out the appointments would be made by Griffin and Senate President Jim Mathewson, who she said are both pro-abortion.

Riehn is also concerned that one of the proponents of the bill is Judith Widdicombe, president of the Health Policy Institute. She was a founder of Reproductive Health Services in St. Louis. Riehn says the agency is "the largest abortion mill in the state."

Widdicombe is no longer associated with the agency.

Other parts of HB-564 establish a legal defense fund to offer malpractice insurance to professionals who donate primary and preventive care to charity patients; set up medical loans for students that could be forgiven and other incentives for doctors to practice in areas where there are shortages of doctors; would allow for the establishment of individual medical accounts; provide community substance abuse grants; expand Medicaid coverage; and require the Department of Social Services to make greater efforts to inform uninsured and under-insured people about state- and federally-funded programs they might be eligible for.