**[MEMORANDUM]{.underline}**

DATE: September 18, 2008

FROM: Jonathan Imbody

Vice President for Government Relations

Christian Medical Association - Washington Bureau

21798 Jarvis Sq. • Ashburn, VA 20147

TO: Secretary Mike Leavitt

RE: Provider Conscience Regulation

I write in strong support of the regulation and in specific reference to
the request for *\"information with regard to general knowledge or lack
thereof of the protections established by these nondiscrimination
provisions, including any facts, surveys, audits, reports, or any other
evidence of knowledge or lack of knowledge on these matters in the
general public...\"*

To answer this question, the polling company, inc. on September 11-14,
2008 conducted a nationwide survey, commissioned by the Christian
Medical Association. Full results of this survey are included in this
memorandum, below.

This scientific, objective poll found that only 38 percent of Americans
realize that physicians may not legally be coerced into violating
standards of medical ethics and their own conscientiously held moral
convictions by requiring them to perform abortions or refer patients for
abortions.

This widespread ignorance of civil rights protections helps explain why
over 40 percent of our members report being pressured to violate their
moral and ethical convictions in healthcare. It also underscores the
urgent need for the HHS regulation and to educate the public and medical
community concerning civil rights in healthcare.

Protecting the civil rights of healthcare professionals allows their
adherence to time-tested ethical standards that protect patients,
including the Hippocratic Oath. It\'s ironic and alarming that many
today would actually disregard civil rights and forbid physicians from
following the Hippocratic Oath and other ethical standards that respect
early human life.

If physicians lose the freedom to follow conscience and ethical
standards, patients lose the protections of those standards. Patients
also will ultimately lose access to those physicians, who will be forced
to choose other careers rather than violate ethical standards.

*Thank you* very much for your consideration of these views and the poll
data, which follows.

**the polling company TM, inc./WomanTrend\
*for\
*Christian Medical Association**

To: Jonathan Imbody, Vice President for Government Relations

From: Kellyanne Conway, President and CEO

Date: September 16, 2008

Re: Analysis of Findings: *Nationwide Survey of American Adults*

#### Introduction and Methodology

**the polling company TM, inc**. is pleased to present to **Christian
Medical Association\
(CMA)** the results of a recent nationwide telephone survey of 1,000
adults (aged 18+).

The survey was fielded September 11-14, 2008 at a Computer Assisted
Telephone Interviewing (CATI) phone facility using live callers. The
sample was drawn utilizing a Random Digit Dial (RDD), where phone
numbers were generated by a computer to ensure that every household in
the nation with a landline telephone had an equal chance to be surveyed.

Sampling controls were used to ensure that a proportional and
representative number of adults were interviewed from such demographic
groups as age, gender, race and ethnicity, and geographic region^1^
according to the latest figures available from the United States Census.

One close-ended question that probed Americans' knowledge about federal
law and the obligations of doctors when patients request abortions was
added to a national omnibus survey. The addition of this question was
prompted by a request from the U.S. Department of Health and Human
Services for information regarding the public's knowledge (or lack
thereof) about this topic. The final question wording was approved by an
authorized representative of CMA prior to fielding.

The margin of error is calculated at +/- 3.1% at the 95% confidence
level, meaning that in 19 out of 20 cases, the results obtained would
differ by no more than three point one percentage points in either
direction if other groups of 1,000 adults were surveyed using the same
random sampling plan. Margins of error for subgroups are higher.

^1^ Northeast includes CT, ME, MA, NH, RI, VT, NJ, NY, PA; North Central
includes IL, IN, MI, OH, WI, IA, KS, MN, MO, NE, ND, SD; South includes
DC, DE, FL, GA, MD, NC, SC, VA, WV, AL, KY, MS, TN, AR, LA, OK, TX; West
includes AZ, CO, ID, MT, NV, NM, UT, WY, AK, CA, HI, OR, WA.

#### Most Americans Don't Know the Law Regarding Doctors and Abortion.

*\"I am now going to ask you a question about healthcare and the law.\
\"If a patient in the United States wants a doctor to perform an
abortion or to refer her to another doctor who will perform an abortion,
which of the following BEST describes what the doctor is required to do
by federal law?\"*

\[Read entire list before recording one answer\]

  ------ ----------------------------------------------------------------
  4%     \"The doctor must perform the abortion.\"

  38%    \"The doctor does not have to perform the abortion, but must
         refer the patient to another doctor who will.\"

  38%    \"The doctor does not have to perform the abortion, nor does he
         or she have to refer the patient to another doctor who will.\"

  5%     \"It depends\" (volunteered).

  11%    Don't know (volunteered).

  4%     Refused (volunteered).
  ------ ----------------------------------------------------------------

**W**hen read three possible descriptions regarding the legal
obligations of a doctor when a patient requests an abortion, the clear
majority of Americans surveyed revealed they did not have a firm grasp
on the law.

As the results box demonstrates, just 38% of those surveyed selected the
description that is actually in line with current federal law: that a
doctor has the right to refuse to provide both the procedure and the
referral.

By comparison, 42% of these adults believed the doctor did have some
obligation under federal law: either to perform the abortion (a paltry
4%) or at least refer the patient to someone who would (38%). Another
11% admitted they weren't sure and 5% allowed for situational variances,
saying "it depends."

An examination of the crosstabular data revealed the following:

>  [**The lack of knowledge of federal law on this topic was widespread
> as no more than 47% of any demographic subgroup selected the correct
> description of the doctor's obligations**.]{.underline} Those more
> likely than most to know the doctors was not required to perform an
> abortion or provide a referral included 45-64 year olds, residents of
> the North Central region, and those earning between \$25,000 and
> \$50,000 per year.

 Young adults (those aged 18-24) stood out as especially likely to
believe the\
doctor was legally required to perform an abortion (10% vs. 4% overall).

>  Groups more likely than most to believe a physician in this
> situation was legally bound to give a referral to an abortion provider
> included 18-24 year olds, residents of the North East, and Hispanics.
>
>  Americans more apt than average to admit they simply did not know
> included 25- 34 year olds, seniors (65+), and those earning less than
> \$25,000 per year.
>
>  There was no appreciable difference between the answers of men and
> women, nor was there a statistically significant pattern based on
> education.

#### In Conclusion\...

*These data make clear that most Americans aren't sure what the rights
and obligations of doctors are regarding abortion. While very few
believe doctors are compelled by federal law to perform the procedure, a
substantial number think they are required to provide a referral. To
fully comprehend their rights and options as patients, it is important
for Americans to understand the laws governing the practice of medicine
by doctors.*

*Overall, it seems apparent that additional information is required to
ensure both doctors and patients know both their rights and their
obligations.*

#### TOPLINE DATA 

**Nationwide Telephone Survey of 1,000 Adults**

Field Dates: September 11-14, 2008 Margin of Error: +/- 4.4%

1\. I am now going to ask you a question about healthcare and the law.
If a patient in the United States wants a doctor to perform an abortion
or to refer her to another doctor who will perform an abortion, which of
the following BEST describes what the doctor is required to do by
federal law?

\[Read entire list before recording one answer\]

  ------ ----------------------------------------------------------------
  4%     \"The doctor must perform the abortion.\"

  38%    \"The doctor does not have to perform the abortion, but must
         refer the patient to another doctor who will.\"

  38%    \"The doctor does not have to perform the abortion, nor does he
         or she have to refer the patient to another doctor who will.\"

  5%     \"It depends\" (volunteered).

  11%    Don't know (volunteered).

  4%     Refused (volunteered).
  ------ ----------------------------------------------------------------

**[DEMOGRAPHICS]{.underline}**

2.  What is your age?

> 13% 18-24
>
> 17% 25-34
>
> 19% 35-44
>
> 19% 45-54
>
> 14% 55-64
>
> 16% 65+
>
> 2% REFUSED (VOLUNTEERED)

3.  Are you Spanish, Hispanic, or Latino?

> 13% YES
>
> 86% NO
>
> 1% REFUSED (VOLUNTEERED)

4.  Which of the following describe your race? You can select as many as
    apply.

> 75% WHITE/CAUCASIAN
>
> 11% BLACK/AFRICAN-AMERICAN
>
> 2% ASIAN/ASIAN-AMERICAN
>
> 12% SOME OTHER RACE
>
> 2% REFUSED (VOLUNTEERED)

5.  What is your household's total income before taxes?

> 14% UNDER \$25,000
>
> 9% \$25,000- \$34,999
>
> 17% \$35,000- \$49,999
>
> 17% \$50,000- \$74,999
>
> 26% \$75,000 OR MORE
>
> 17% DON'T KNOW/REFUSED (VOLUNTEERED)

6.  Are there any children under the age of 18 living in your household?

> 40% YES
>
> 59% NO
>
> 1% REFUSED (VOLUNTEERED)

7.  What was the last grade in school you completed?

> 7% LESS THAN HIGH SCHOOL
>
> 32% HIGH SCHOOL GRADUATE
>
> 28% SOME COLLEGE/ ASSOCIATES DEGREE
>
> 19% COLLEGE GRADUATE
>
> 13% POST GRADUATE
>
> 1% REFUSED (VOLUNTEERED)

7.  Gender

> 48% MALE
>
> 52% FEMALE

8.  Region^1^

> 19% NORTHEAST
>
> 22% NORTH CENTRAL
>
> 37% SOUTH
>
> 23% WEST