Are poor women suffering because of stiff restrictions governing when state Medicaid funds can be used to pay for abortions?
Answering that question will be a priority of the Health Systems Agency (HSA) of Northern Virginia, in spite of objections from some of the agency's board members and the public.
Meeting this week to adopt five-year and one-year plans, the board rejected a resolution that called for striking the controversial abortion question from sections titled "family planning." In effect, that would have eliminated the question, since it is dealt with only in those sections.
At an earlier public hearing, representatives of the Prince William County Citizens for LIFE and Alexandria Right to Life groups objected to including abortion in the definition of family planning, and their comments were echoed by some board members at the meeting Monday night.
"By including abortion in the definition of family planning we are promulgating a very dangerous and expensive form of birth control," said ASA board member William Rich, a Fairfax opthamologist.
Board member James Cantwell called it "incongruous" to place abortion under the heading because, he said, ending an unplanned pregnancy cannot be considered family planning.
The General Assembly's 1978 action to stop state payments for abortion, except when the mother's health is endangered, reduced to nine the number of Medicaid abortions during the first three months of 1979 -- less than 1 percent of the number during the same period a year earlier, Rich noted.
"That indicates that 99 percent of abortions before were not medically necessary," he said.
Other board members said it was confusion over the meaning of the General Assembly's action that caused the decline in Medicaid abortions.
Kelly likened the issue to obesity, saying a litte fate might cause social problems for some persons, while not immdiately threatening their health. "We're spending half our section on family planning on something that is not necessarily a health problem," he said.
Betty Adelman, chairman of the agency's planning committee, said she did not see the parallel, and a majority of the board members voted their agreement.
The vote elevated the issue to one of several priorities that will command the agency's attention during the one year plan, which begins May 1, 1980.
Called the Annual Implementation Plan, it earmarks $1,700 worth of staff time for efforts to remove any obstacles to the establishment of halfway houses for the mentally ill and retarded.
Zoning practices make it difficult to establish community residences for the mentally ill in Virginia, the plan says. It recommends reviewing zoning ordinances, then contracting public officials and community groups to work toward whatever changes are necessary.
Another priority is working with dental societies and health departments to see that the 169,000 Northern Virginians who do not receive fluoridated water learn about the benefits of fluoride and how they can be obtained through dietary supplements and toothpastes.
The document also addresses the problem of health-care costs in a variety of ways. One goal is to see that Medicaid and Medicare payments are used for day-care programs for the elderly -- not just more costly nursing homes. The plan also proposes setting up a technical advisory group to study ways of holding down hospital costs.
Evaluating health education and nutrition in the schools is another goal, as is coordinating planning with other jurisdictions in the Washington area to avoid the kind of duplication that now exists with cardiac care units. Three of the six adult, open-heart surgery programs in nonfederal hospitals operated at less than 25 percent capacity in 1978, an HSA task force found.
Revised each year, the annual plan sets up short-term priorities to be addressed in reaching the objectives of the five-year Health Systems Plan, also revised and newly adopted Monday night.
"It serves as a guideline or foundation," Adelman said. "In the absence of a market system, the concept of planning has developed so health services won't be poorly distributed geographically."
The plan will serve as the basis for denying or approving any new medical facilities in an area with excess hospital beds, Adelman said.
"When there are too many cans of green peas on a shelf, they just sit there. When there are too many hospital beds, we have to pay for them and that raises the rates for everybody," she said. "That's where hospitals are different. Nobody pays for the peas until they buy them."
In keeping with federal law, Northern Virginia's Health Systems Agency is governed by a 30-member board of directors, representing nine jurisdictions, from Arlington and Alexandria to Prince William and Loudoun counties.
Following board approval Monday, the two new plans will be submitted to federal and state officials for approval, Adelman said.