Tuesday, August 4, 2009

The purse strings are so close, yet so far: Abortion coverage and DC sovereignty

Yellow = no lifesaving needle-exchange programs. White = go for it!

I used to live and work in Washington, DC, a place where you'd think people are powerful and have the ability to make important decisions. But the city of the District of Columbia is not the same as what people call "Washington" when they are thinking of Congress and the White House and the Supreme Court and, you know, the halls of power.

Not everyone knows that the residents of DC do not have a single vote in Congress. (They have one non-voting delegate in the House of Representatives, Eleanor Holmes Norton.) Also, not everyone knows that until 1973, DC did not even have an elected mayor or city council, but was directly administered by federally-appointed commissioners -- and Congress can take away that privilege at any time. Congress also has the power to decide how the District can and cannot spend its own income, i.e. money raised from city taxes. Of course, if DC were a state, this would all be very unconstitutional, but the Constitution dictates that the District of Columbia be governed in this way.

It might seem very arcane or very trivial -- why would senators and House reps from other parts of the country care to get involved in someone else's city budget issues, and if they did would their decisions really be so bad for residents anyway? Unfortunately, the residents of DC do indeed feel the repercussions of this lack of sovereignty, repercussions which often hit the poorest among us the hardest.

Every year, Congress writes and passes a new federal budget. And every year, members of Congress use DC as a place to make cheap political statements about where they "stand" on "issues." A timely example: since the late 1990s, DC was prohibited from using its own money to pay for needle exchange programs to combat the spread of HIV, while several of the "real" states were supporting such programs using not just their own funds but federally-allocated funds as well! Basically, conservatives scored political points with their constituents back home using citizens who are politically impotent and thus expendable; meanwhile, the Washington Post reports that "At least 3 percent of District residents have HIV or AIDS, a total that far surpasses the 1 percent threshold that constitutes a 'generalized and severe' epidemic".

In 2007, Congress finally reversed that ban, but now the House is considering a bill with an amendment that restricts where DC can locate needle exchange sites: they cannot be "within 1,000 feet of a public or private day care center, elementary school, vocational school, secondary school, college, junior college, university, public swimming pool, park, playground, video arcade or youth center." The image you see at the top of this post is a map [pdf] 0f what those restrictions would look like: in the white parts it's OK to provide clean needles in exchange for used ones, but not in the yellow parts. (And, um, the blue is water.) How many people can that possibly reach?

OK, so what does this have to do with abortioneering?? As you might guess by now, abortion is another favorite controversy to take out on the residents of DC. Until 1988, the District was using some of its own funds to include abortion coverage as a Medicaid benefit. Since that year (with a brief break 1994-96), Congress has prohibited the District from spending any of its own revenue to pay for abortions, despite the fact that its residents and city council clearly appear to favor it. Again, conservatives scored political points with their constituents back home using citizens who are politically impotent and thus expendable. This year it appears that the Democratic majority in Congress may finally reverse that position and allow DC the choice to resume covering some abortions, and the city probably will choose to do so.

When I worked in DC, most of my clients were on Medicaid, and the vast majority of those were not from jurisdictions that allocated funds for abortion care. They were on Medicaid because their government acknowledged they were too poor to afford health care, but they were going to have to afford an abortion all on their own. Yet abortion care is a part of health care, and we don't suddenly get richer when we have an unwanted pregnancy! It broke and still breaks my heart to know that so many of my neighbors are getting screwed over by people who go to work just a couple blocks or a couple miles away from them.

Living in the nation's capital, you constantly pass monuments, walk right by the White House, and see other stuff that should make you feel like huge decisions are being made in your backyard; yet all that proximity never gets you any closer to meeting those decisionmakers or participating in those decisions. In fact, aside from the euphoria of Election Day and Inauguration, I doubt any of my clients ever thought about the federal government. So maybe it's no wonder that Congresspersons are making terrible decisions about the drug addicts, pregnant women, gay couples and cancer patients of DC as though the latter lived in some tiny shit village thousands of miles away that no one expected Congresspersons to care about in the first place: they don't feel any closer to the residents of their host city than their hosts do to them.

Yes, Congress legally can do all these things. But it still feels like your landlord showed up at your door, set up camp in your nicest bedroom, then went around to all the other rooms and shat on the carpets. Don't forget rent is due on the first.

EDIT: Also, don't you love it when the House minority leader posts a "Statement of Republican Policy" on the party's more-or-less official site for Congressional workings (hosted at a .gov address) and it's got typos and bad logic and unflattering cut-n-paste aesthetics and everything?!

1 comment:

  1. And don't get me started on the poor Medicaid-eligible women who are pregnant AND drug-addicted! (By which I mean, that is worthy of a whole other post and I sorta got started on it already then copy/pasted it to save for another day.) I need my sleep after all.


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