Republicans in the House of Representatives succeeded in combining the two major crusades they have relentlessly pursued since assuming the majority in that chamber following the 2010 elections— assailing both reproductive rights and the recently passed health care reform legislation, the Patient Protection and Affordable Care Act(P.L. 111-148). Following the defeat in the Senate of the House-passed bill to repeal health care reform, House Republicans set out to dismantle it. They introduced a package of five bills, H.R. 1213–1217, et seq., attacking various elements of health care reform, including the Personal Responsibility Education Program, the Prevention and Public Health Fund, and funding to establish state health insurance exchanges and for the construction of school-based health centers. H.R. 1216 would “convert funding for graduate medical education in qualified teaching health centers [THCs]” from mandatory to discretionary, giving “Congress control over spending for a program to encourage health centers to provide training to medical residents.”[1]

An amendment to H.R. 1216, offered by Representative Virginia Foxx (R-NC) while the bill was being considered on the House floor, would bar THCs from using any graduate medical education funding they do receive for providing training in surgical abortion procedures; it was approved 234–182. The amendment also specifies that none of the funds can be used to provide abortion services and that funded THCs cannot discriminate against medical students who do not wish to know how to perform an abortion. The latter two provisions are duplicative of existing laws and procedures. The executive order that President Barack Obama issued to placate anti-choice legislators who threatened to block passage of the health care reform legislation affirms that the legislation “maintains current Hyde Amendment restrictions governing abortion policy”—in other words, it bars the use of federal funds to subsidize abortion services except in cases of rape or incest, or to preserve the life of the pregnant woman.[2] The same executive order also prohibits discrimination against health care providers who decline to provide abortion care.

In addition, the standards of the Accreditation Council for Graduate Medical Education (ACGME), the organization responsible for accrediting the nation’s medical residency programs, fully address the issue of abortion training. ACGME standards mandate that no institution or provider will be required to provide abortion training and that no resident may be discriminated against if he or she chooses not to receive abortion training.[3] The amendment’s prohibition on THCs using the federal funding they receive also defies the ACGME’s standards, which affirm that “access to experience with induced abortion must be part of residency education” and “[e]xperience with management of complications of abortion must be provided to all residents” training in obstetrics and gynecology.[4]

In her opposition to the amendment, which she characterized as “mean-spirited” and “an extreme and direct attack on women’s health,” Representative Diana DeGette (D-CO) noted that inhibiting medical residents’ access to essential training in how to provide a surgical abortion will “jeopardize both education and women’s health care by obliterating funding for a necessary full range of medical training by health care professionals.”[5] Access to safe abortion services already is extremely limited—87% of counties in the United States do not have an abortion provider, according to the Guttmacher Institute.[6] In addition, many women who experience a miscarriage may require a surgical abortion to remove the remaining fetal and placental tissue or else risk developing a potentially life-threatening infection. Finally, as Representative DeGette observed in her comments on the House floor, “an abortion is a life-saving procedure” for numerous complications of pregnancy, including “preeclampsia, hemorrhage, and severe pulmonary hypertension, or bleeding placenta previa, which can be fatal if left untreated.”[7]

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