The shutdown-averting $38.5 billion budget agreement reached on Friday does not include the GOP’s demand to end federal funding for Planned Parenthood, but it would prohibit the District of Columbia from using local funds to pay for abortions. As a result, DC Medicaid ended its coverage of abortions last night, leaving 28 women who were scheduled to have the procedure without a means to pay for it. DC Abortion Fund sent out this alert:

Tonight we received an urgent call from a partner clinic to notify us that DC Medicaid is ending it’s coverage of abortions at MIDNIGHT TONIGHT.

The clinic had to call 28 women who are scheduled tomorrow and bringing their DC Medicaid as payment that they need to fundraise for the total cost of their procedure by their appointment tomorrow because Medicaid will no longer cover the cost of their abortion.

These women are devastated. We need your support NOW.

The clinic has asked if the DC Abortion Fund could pay for a percentage of the cost of all 28 abortions scheduled tomorrow slated to be covered by DC Medicaid, all of which cost several hundreds of dollars.

“We’ve raised over $3,965 so far in the last 12 hours,” DC Abortion Fund’s Tiffany Reed told DCist. “We’re still working to fundraise for the women who are scheduled today and then we have women scheduled Friday and Saturday who are just now being notified they can’t use their Medicaid.”

Abortions cost approximately $400 if performed during the first trimester and the price increases greatly later in the gestation period.

Republicans were quick to criticize President Barack Obama’s proposal to expand the cost-cutting authority of the Independent Payment Advisory Board (IPAB) — a commission created by the Affordable Care Act to help reduce health care costs in Medicare. Without knowing the name of the group or anything about its composition, the GOP took to the airwaves to blast the president for introducing something that would “ration” health care or even kill seniors:

- SEN. TOM COBURN (R-OK): “His plan for changing Medicare is to increase the authority and the ability for price controls from the Individual Payment Advisory Board, which is nothing but say we are going to ration care. [Fox News, 4/13/2011]

- REP. PAUL RYAN (R-WI): “He wants to delegate more power to this IPAB, it’s like 12 people who can’t be controlled by Congress who can just unilaterally ration and price control health care through Medicare. [CNBC, 4/13/2011]

- FRMR. NY LT GOV BETSY MCCAUGHEY: “He warned that he is going to make further cuts with this unelected cost cutting board called IPAB. So for seniors it’s [death].” [Fox Business, 4/13/2010]

Watch it:

Actually, the board — similar to the Federal Aviation Administration (FAA) which establishes flight rules — consists of 15 members from the provider, academic, and consumer communities who are appointed by the President and confirmed by the Senate. The group is tasked with delivering a comprehensive proposal to reduce excess cost growth in Medicare, which Congress must then consider. If it fails to adopt the plan, the Department of Health and Human Services must implement the board’s proposal.

The GOP has introduced legislation to repeal the board and even argued that it would “death panel” seniors, but in actuality, the board is statutory prohibited from “rationing” services. As Section 3403 (page 409) of the Affordable Care Act stipulates, the proposal cannot “include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums…increase Medicare beneficiary cost- sharing (including deductibles, coinsurance, and co- payments), or otherwise restrict benefits or modify eligibility criteria.”

The irony in the attacks is that by the GOP’s standards, the Ryan budget would have a far more significant impact on denying seniors access to care than anything in Obama’s proposal. According to the Congressional Budget Office (CBO) analysis of Ryan’s plan, seniors would have to pay significantly more for the same coverage they receive today, while states would likely have to “reduce the size of their Medicaid programs by cutting payment rates for doctors, hospitals, or nursing homes; reducing the scope of benefits covered; or limiting eligibility.” [I]f states lowered payment rates even further, providers might be less willing to treat Medicaid enrollees. As a result, Medicaid enrollees could face more limited access to care,” the report concluded.

Our guest blogger is Jessica Arons, Director of the Women’s Health and Rights Program at the Center for American Progress Action Fund.

Last week, House Republicans held up the budget and threatened a government shutdown over federal funding for Planned Parenthood. Thankfully a deal was reached that restored funding for this critical safety net provider, but the bargain included an agreement that the Senate hold an independent vote — scheduled for this afternoon — on whether to defund the organization.

Conservatives claim that they object to funding Planned Parenthood because it provides abortion services, even though they know that Planned Parenthood is barred from spending any federal money on abortion by a provision known as the Hyde Amendment, as well as numerous other laws. The truth is that they want to cut off funding for family planning services because they oppose contraception as much as they do abortion.

Nevertheless, they assert that funding should be cut because taxpayers are “subsidizing” abortion. Their argument is that money is “fungible,” meaning that every dollar the government gives Planned Parenthood for family planning services, STI and HIV prevention and treatment, and cancer screening “frees up” money for it to spend on abortion care. According to them, mechanisms to segregate public from private funds are mere “accounting gimmicks” and “funding schemes.”

This is not the first time they’ve tried to play the fungibility card. Some may recall that former Rep. Bart Stupak (D-MI) made the exact same argument when he tried to prevent private insurance companies receiving premium subsidies from offering coverage of abortion in their health plans during the health reform debate. And more recently, Rep. Chris Smith (R-NJ) has tried to expand the Hyde Amendment policy well beyond its current scope, including by reaching into the tax code to restrict abortion access for the first time ever.

However, when it comes to their pet projects, like granting government money to faith-based organizations, they suddenly have every confidence in a recipient’s ability to keep pots of money separate and only use government money for approved uses. For instance, there was no parallel attempt (nor should there have been) during health reform to prevent Catholic-affiliated hospitals and health plans from receiving money under the Affordable Care Act on the theory that it would subsidize their religious activities and violate the Establishment Clause. Ironically, the U.S. Conference of Catholic Bishops was one of the leading proponents of the fungibility argument in the abortion context.

And just last week, the conservative majority of the Supreme Court found that while a direct grant to religious schools would give taxpayers the right to sue for a violation of the Establishment Clause, an Arizona law that gave citizens dollar-for-dollar tax credits for donating to those same schools did not violate taxpayer rights. According to the Court, dissenters’ rights are violated when their money is “extracted and spent” by the government. But the charitable contributions yielding the tax credits at issue passed “directly from taxpayers to private organizations” and resulted from the “decisions of private taxpayers regarding their own funds.” Thus, the dissenters’ injury could not be traced to the government.

As I pointed out last year during the debate over the Stupak Amendment:

Our society recognizes the distinction between direct and indirect funding all the time. Indeed, if we did not, our government probably could not function. Religious organizations receive tax money to provide direct social services but are strictly prohibited from using that money for sectarian purposes. Nonprofit organizations obtain government grants that can be used for charitable activities but not for electioneering….No transaction in our modern society is completely free of government involvement.

Ultimately, the debate over direct and indirect funding is a distraction. People on both sides of the ideological divide recognize accounting firewalls when they approve of underlying policies and object when they do not.

Don’t believe for a second that this fight is about government funding of abortion, because it’s not. In reality, social conservatives are attacking Planned Parenthood funding because they oppose contraception but don’t want to admit it. So they use fungibility arguments to turn it into an abortion debate. But as soon as you look at their position on fungibility in other contexts, you can see that it’s all smoke and mirrors.