Health concerns

Kansas Gov. Kathleen Sebelius is a Roman Catholic. She says that abortion is morally unacceptable. And in April 2007, she hosted a reception for notorious late-term abortionist George Tiller of Wichita at her official residence.

This disconnect took on national significance on March 2, when President Barack Obama nominated Sebelius to head the Department of Health and Human Services. If confirmed by the Senate, Sebelius will direct a massive federal agency that employs nearly 65,000 workers and oversaw more than $700 billion in spending last year. While tasked with implementing statutory law, she will also be able to put her stamp on the president's agenda through the department's regulatory powers.

What approach she may bring to the job is illuminated by her record back home.

In socially conservative Kansas the nation's abortion wars have spilled across the political terrain, and Sebelius has been intensely involved. Throughout her lengthy political career, she has steadfastly supported legal abortion.

As governor, she vetoed numerous pieces of pro-life legislation during six years in office. The most significant may have been last year's Comprehensive Abortion Reform Act, or CARA. Passed by large bipartisan majorities in both legislative chambers, the package would have strengthened the state's informed consent law, safeguarded against coerced abortions, and strengthened enforcement of existing late-term abortion restrictions. She also blocked abortion clinic licensing standards, late-term abortion reporting requirements, and a state matching grant program designed to assist pregnancy resource and adoption centers.

Sebelius launched her public career as a state representative (before winning two terms as the state's insurance commissioner). Over the course of four terms in the Kansas House, she opposed basic limitations on abortion by voting against parental consent and notification requirements, patient waiting periods, restrictions on post-viability abortions, and reporting requirements on the same. On at least one occasion, she voted in favor of state funding for abortion services.

The governor's relationship with Tiller and her efforts to protect other practitioners from legal scrutiny is another controversial hallmark of her time in office. By derailing requirements to report case information on late-term abortions, she made it more difficult for law enforcement officials to prosecute alleged violations of existing restrictions on the practice. Her court appointees have influenced the legal process toward a pro-abortion bias, and she even helped recruit political challengers to pro-life officials like former Attorney General Phill Kline. (After five years of legal wrangling, Tiller will finally face criminal trial later this month on 19 charges related to late-term abortion, about the same time confirmation hearings may commence for Sebelius.)

To observers like Michael Schuttloffel of the Kansas Catholic Conference, the governor's festive reception for Tiller says a lot about her personal feelings on abortion: "The back slapping and grinning between Sebelius and abortionists does not seem to indicate someone who is personally troubled by abortion." As a result of her actions on abortion, the local archbishop has instructed Sebelius not to present herself to receive communion.

Liberal groups like Catholics United have endorsed her confirmation and suggested that Sebelius is a moderate who has actually reduced the abortion rate in Kansas. As part of a larger crime package, the governor did sign a law criminalizing harm to an unborn child, and she once approved the state matching grant program for pregnancy resource centers-a program she had previously opposed and reversed her decision on the next year. Pro-lifers point to other political factors, like a veto-proof majority, that they say compelled her to support pro-life laws in a few isolated instances. "She has signed some pro-life bills, but only under the gun," says Mary Kay Culp of Kansans for Life. The organization notes that abortion rates were on the decline in Kansas preceding her tenure in office, and lowered nationally during the same period in question.

On other health-care issues, Sebelius eschewed reforms integrating consumer choice, market competition, and individual responsibility in favor of a larger role for the state government in directly providing care and coverage to Kansans. Her vision of increasing access to health care included expanding eligibility guidelines for the state children's health insurance program, or S-CHIP, up to 250 percent of the poverty level. Some analysts believe such changes expand the entitlement program into the middle class, establishing the government over parents as providers for their children and crowding out private insurance in the process. One lawmaker bristled at the expansion, pointing out that his own family would qualify for public benefits under the plan.

Sebelius signed programs into law providing dental coverage and anti-smoking counseling to poor pregnant women, but she failed in her attempt to impose a statewide indoor smoking ban. As insurance commissioner, she blocked a large insurance company merger, a move hailed by some consumer groups at the time and lauded by President Obama in his nomination announcement. She has stressed a link between education and health care, leveraging the widely accepted government obligation of providing education as a rationale for an expanded government role in providing health care. "Those children are better-prepared to learn as students when they enter a classroom," Sebelius said of S-CHIP enrollees in a blog entry for the Huffington Post website.

Administration supporters have cited the nominee's resumé of red state success as an indication of her bipartisan bona fides, and even the fact that her father was a Democratic governor and father-in-law was a Republican congressman. More difficult to establish are examples of substantial, principled compromise in the nominee's history. Her record is that of a strongly ideological liberal rather than a moderate who sought to develop consensus.

Once installed at HHS, Sebelius would have no shortage of opportunity to exercise her belief in an activist, liberal government. Decisions regarding federal funding of abortion are essentially under the control of Congress and the states, which manage Medicaid. However, one of Sebelius' first tasks might be to re-write the right-of-conscience regulations enacted by the outgoing Bush administration (see sidebar). President Obama has already signaled his intention to overturn the policy allowing doctors, nurses, and other medical personnel to avoid participating in procedures they deem morally objectionable, including abortion and perhaps some forms of artificial insemination and contraception. It will be up to the department to determine how broadly to apply the new rule and how aggressively to enforce it. Hospitals could be forced to fire such employees or risk losing critical federal funding streams.

Introducing Sebelius to the nation, Obama declared that his administration will be led by those "who push politics aside in favor of proven science, who eschew stale ideology for sound ideas and a focus on what works." It was the type of rhetoric used by Democrats in the past to dismiss moral concerns over issues like embryonic stem-cell research, various forms of fertility treatment, comprehensive sexual education programs, and provision of sexual health services to minors. With authority over a network of 11 sub-agencies and 300 programs across every manner of health research and service operation, Sebelius will be able to have an impact on every one of these areas.

Confirmation doesn't appear to be a problem for Sebelius. Her HHS bid immediately gained the support of at least two Republicans: home-state Senators Sam Brownback and Pat Roberts. The two senators released a statement congratulating Sebelius on the nomination, but Brownback declined requests for further comment. Pro-life groups were dismayed by the move, with the Family Research Council pulling out of Brownback's weekly "Values Action Team" meeting on Capitol Hill.

Concerned Women for America President Wendy Wright said she was "disappointed" in Brownback's endorsement but that conservatives' focus should remain on Sebelius. "I don't want this to be a Rush Limbaugh-Michael Steele," she said. "We are focused more on infighting and our opponents slip right by."

-with reporting by Emily Belz in Washington; Brian T. Johnson is a writer in Overland Park, Kan.

Your conscience or your job?

James Madison, the father of the Constitution, once wrote that "conscience is the most sacred of all property."

No one understands this better today than Texas primary care physician Michele Phillips, who was at a crossroads last summer: her conscience or her job.

Forced by officials at to prescribe medicine that Phillips morally objected to because of her religious beliefs, Phillips battled administrators for six months. She said providing birth control pills to unwed patients was outside of her comfort zone:

"Why should I be made to prescribe a medicine that I did not feel was appropriate? It is our basic right as physicians to practice medicine based on our religious and moral beliefs."

When the hospital denied Phillips' offer to refer the patients to other physicians and insisted that she had to prescribe the pills herself, Phillips, 46, finally resigned.

Phillips refused to disclose the name of the university hospital where she worked because she does not want her motives for leaving widely known: "If you have that on your record as a physician you have to explain that everywhere you go."

That is why Phillips was heartened when the outgoing Bush administration announced a new federal regulation to protect medical professionals who decline participation in health procedures they find ethically, morally, or religiously objectionable. The rule, which took effect the day Obama was inaugurated, required medical facilities to respond in writing that they are in compliance or risk losing federal funding. The victory was hailed by pro-life organizations around the country as protecting civil rights.

But this month the Department of Health and Human Services signaled its intention to rescind the regulation. The notice kicks off a 30-day public comment period that will surely see both sides of the debate pulling out all the stops in a battle that could have far-reaching consequences for the place of beliefs in medicine.

"Essentially you are stripping away the First Amendment rights of medical professionals," says David Stevens, head of the Christian Medical Association (CMA) with more than 15,000 members. "We don't think a health-care professional should be ethically neutered."

A new organization-Freedom2Care Coalition-also will fight the repeal.

Laws have been on the books for more than 30 years protecting the moral choices of health-care professionals. But some pro-life doctors felt increasing pressure to be complicit in providing medical services that went against their beliefs. A recent CMA survey found that 40 percent of its members have been pressured to violate their ethical standards, with nearly a quarter of those polled claiming they lost a position, promotion, or compensation as a result of their moral stances.

Sandy Christiansen, an obstetrician from Maryland, recalls 20 years ago as a medical resident being publicly reprimanded for refusing to participate in a late-term abortion of a baby who had been diagnosed with Down syndrome. "Not just my professionalism was called into question but my very character. If there is no moral compass, then how are decisions made? It's popular opinion and societal pressure."

Without protection, Christiansen fears pro-life medical students may be driven from careers in obstetrics: "When a country loses its moral compass, it is not a prescription for success."

But the Obama administration has argued that the new regulation goes too far. A White House statement reported by the Associated Press stresses that Obama "believes this issue requires a balance between the rights of providers and the health of women and their families, a balance that the last-minute Bush rule appears to upset."

If pro-life groups are able to overcome the rescission move, they still face legal challenges brought on by Planned Parenthood, the American Civil Liberties Union, and several states.