Bush Rule Makes Fetuses Eligible for Health Benefits

By ROBERT PEAR

ASHINGTON, Sept. 27 — The Bush administration issued final rules today allowing states to define a fetus as a child eligible for government-subsidized health care under the Children's Health Insurance Program.

" `Child' means an individual under the age of 19, including the period from conception to birth," the regulation says.

Tommy G. Thompson, the secretary of health and human services, said the rule would increase the number of low-income women who receive prenatal care. "What better way to allow kids to have the best start in life, a healthy start?" Mr. Thompson asked.

But critics said the change was a backdoor effort to advance the administration's anti-abortion agenda and to establish a legal precedent for recognizing the fetus as a person.

Under the rule, states can use federal money to provide prenatal care to low-income pregnant women, even those who are illegal immigrants and would otherwise be ineligible.

"It does not make sense to try to impute an immigration status to an unborn child based on the status of the mother," the administration said. Under the Constitution, a person born in this country is a United States citizen, even if the mother is an illegal immigrant. So the child may qualify for coverage at birth.

The administration said the rule would increase insurance coverage for prenatal care and delivery. "This is compassionate conservatism at its best," Mr. Thompson said.

But Senator Jon Corzine, Democrat of New Jersey, said the administration was making "an outrageous attempt to politicize prenatal care, something that should be dealt with in a simple, straightforward way."

Laurie Rubiner, vice president of the National Partnership for Women and Families, an advocacy group that supports abortion rights, said the rule was "a cynical move by the administration to court Latinos and anti-abortion groups at the same time." The administration, Ms. Rubiner said, has opposed Congressional efforts to restore health benefits to tens of thousands of low-income immigrants who have not become citizens and lost coverage as a result of the 1996 welfare law.

Gloria Feldt, president of the Planned Parenthood Federation of America, said: "This regulation is ridiculous. It elevates the status of the fetus above that of the woman. It does not provide prenatal care to the woman in whose body the fetus resides. It makes the fetus eligible for prenatal care, but treats the woman as a mere vessel, an incubator."

The Bush administration said federal money from the Children's Health Insurance Program could not be used to provide postpartum services or follow-up care to a woman after delivery, unless the woman herself was younger than 19.

The National Right to Life Committee praised the new rule. "Many unborn children, and their mothers as well, are now eligible to receive proper prenatal care as part of the children's health program," said Douglas D. Johnson, legislative director of the committee.

Mr. Thompson insisted that he was not trying to placate opponents of abortion. "This, to me, is not an abortion issue," Mr. Thompson said. "It's strictly a health issue. Our goal is simply to promote the health of that unborn baby. That's my motivation."

The administration estimated that the new rule would increase federal spending by $330 million over five years. For the purpose of calculating costs, it predicted that 13 states would choose to cover "unborn children" and that 30,000 fetuses would gain coverage as a result.

"The health status of children will improve to the extent that their mothers receive prenatal care," it said.

Critics said the administration was trying to create a precedent for viewing a fetus as a separate physical and legal entity, with its own rights. By enhancing the status of the fetus, they said, the administration undercuts a woman's right to control her life and to obtain an abortion.

But the administration said the rule would not set up "an adversarial relationship between the mother and her unborn child." Moreover, it said, "there is no conflict, as the services to be provided benefit both mother and child."

When the Supreme Court recognized a right to abortion in Roe v. Wade, in 1973, it said that the word "person," as used in the 14th Amendment to the Constitution, "does not include the unborn." The Bush administration said it saw no contradiction between that ruling and the new rule, which gives states "maximum flexibility" to include a fetus among those eligible for the child health program.