A series of sting videos targeting Planned Parenthood is raising questions about the field of fetal tissue research. Companies who buy and sell such tissue defend their work.

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A federal judge in California has temporarily banned the release of anymore videos featuring members of an abortion-provider group. The National Abortion Federation had sued, saying a series of sting videos by anti-abortion activists had placed its members in danger. The anti-abortion group Center for Medical Progress has used the videos to accuse Planned Parenthood of illegally selling fetal tissue. The U.S. Senate plans to vote next week on a bill to cut off funds for Planned Parenthood which denies it did anything illegal. This has all created a new focus on fetal tissue research. NPR’s Jennifer Ludden reports.

JENNIFER LUDDEN, BYLINE: The anti-abortion activists who made the videos pose as insiders. In this clip, one pretends to be a broker looking to buy fetal tissue from Planned Parenthood and then sell it to researchers.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED WOMAN: So I don’t want to sound like a salesman here, but I’m going to. So we return a portion of our fees to the clinics.

LUDDEN: The highly edited videos give an impression of cutthroat competition over big-time profit.

LINDA TRACY: I cringe every time I hear the words sell or buy when it comes to human tissue of any kind.

LUDDEN: Linda Tracy is a real insider. She heads Advanced Bioscience Resources, a nonprofit in Northern California. In 2013, public records show the organization had net income of just over a million dollars.

TRACY: I began ABR as an altruistic endeavor because I believe in the research. And I have striven to keep the cost to the researchers as low as possible and still maintain my business.

LUDDEN: She says ABR procures fetal tissue from hospitals and clinics that perform abortions, paying $30 to $100 a specimen. By law, that amount is meant to only cover costs. ABR isolate cells for researchers who are working on everything from HIV and AIDS to cancer, diabetes and more. She says researchers then typically pay between $340 and $550 for the material. Again, Tracy says her fees only cover costs which can be considerable.

TRACY: Any processing required, preservation, quality control, supplies, equipment.

LUDDEN: But not all middlemen are nonprofit. A sting video released this week features a former employee of the company Stem Express. Holly O’Donnell disparages her ex-boss.

O’DONNELL: The owner, Cate Dyer – she used to be a procurement tech, and then she went and started her own business. And now she’s making a lot of money.

LUDDEN: Dyer declined to speak. A crisis communications consultant hired by the company says Stem Express nets about $2.2 million a year, but with 37 employees, he says, you do the math. The federal law regulating fetal tissue research dates to 1993. It’s not clear how much research today is still bound by it.

ALTA CHARO: Technically, this only applies to research that’s been financed by NIH.

LUDDEN: Alta Charo teaches law and bioethics at the University of Wisconsin. She says the National Institutes of Health funds about $70 million a year in such research, but there’s much more than that.

CHARO: For example, there are some states that finance research. There are private foundations and patient groups that finance research. And technically, they are not required to follow these rules, but in practice, they do.

LUDDEN: Including, she says, Planned Parenthood when it provides companies with tissue from aborted fetuses. The organizations we spoke with – ABR and Stem Express – also say they’re monitored by the FDA, outside review boards and auditors. Still, some question how much oversight there is. Robert Klitzman of Columbia University thinks it’s good that Congress is looking into the field.

ROBERT KLITZMAN: As science has advanced, up come all these opportunities for making money, and people are quick to step in. And it’s important to think about what the ethical issues are.

LUDDEN: Planned Parenthood itself is calling for a blue-ribbon commission on fetal tissue research. It would not be the first. Legal scholar Charo says a series of commissions starting in the 1970s have weighed the ethical concerns of fetal tissue research. All, she says, have found the potential benefits are worth it. Jennifer Ludden, NPR News.

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The law creating a national health insurance program for older Americans was signed in 1965 after a long political battle. Renee Montagne talks to Edith Mitchell of the National Medical Association.

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Medicare turns 50 years old today. The law creating a national health insurance program for older Americans was signed in 1965 after a long political battle. One big opponent was the American Medical Association. The AMA famously signed up then-actor Ronald Reagan to campaign against Medicare.

(SOUNDBITE OF AMERICAN MEDICAL ASSOCIATION AD)

RONALD REAGAN: Write those letters now. Call your friends, and tell them to write. If you don’t, this program, I promise you, will pass just as surely as the sun will come up tomorrow. And behind it will come other federal programs that will invade very area of freedom as we have known it in this country. Until, one day, as Norman Thomas said, we will awake to find that we have socialism. And if you don’t do this and if I don’t do it, one of these days, you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.

MONTAGNE: Well, of course, that ad did not stop the bill from being passed. And when he signed it into law, President Lyndon Johnson made a point of not inviting the AMA to the ceremony. He did invite the National Medical Association. That was the organization for black doctors. They’d long supported the bill. They saw the potential for Medicare to help desegregate health care for patients and professionals.

EDITH MITCHELL: I think that Medicare actually contributed to a new day.

MONTAGNE: Edith Mitchell is the president-elect of the National Medical Association.

MITCHELL: They had access to health care in a way that it had not been provided before. And no longer did individuals have to go through the door that said colored only.

MONTAGNE: Medicare became a force for civil rights because the Civil Rights Act was signed just a year before, and it now barred federal funding for institutions that discriminated on the basis of race. For hospitals, the fear of losing federal funds became a powerful motivator.

DAVID BARTON SMITH: The money and the holding of the dollars to hospitals really created a rather dramatic and amazing transformation in a very short period of time.

MONTAGNE: Temple University professor David Barton Smith is writing a book on Medicare and the Civil Rights Movement. But he says it wasn’t just how the law was written, it was how it was enforced. After the signing, a tiny understaffed team of official inspectors was bolstered by hundreds of volunteers.

SMITH: Most of them had already been involved in civil rights activities. They were all very passionately committed people. Early on, they were making sure that all of the white and colored signs were removed. But then, they would go back and insist that hospital employees and patients not self-segregate in the waiting rooms. They were pretty fierce about it. And they had an invisible army in the sense of local civil rights groups that would guide them in their inspections, including a lot of black health workers that helped in providing the eyes and ears for making sure that the hospitals were not just trying to cover everything up.

MONTAGNE: Within a few months, Smith says 2,000 hospitals had desegregated. Dr. Edith Mitchell is from the South. And soon after Medicare was implemented, her grandmother went to the hospital for the first time.

MITCHELL: My grandmother was in the first group of individuals to receive a Medicare card. And it was the first time that my grandmother had ever been admitted to a hospital, although she had given birth to five children. She had a chronic condition, and she was in a hospital room with a Caucasian patient, who we knew, who my grandmother knew. And just to be able to lay in the bed in a room where another Caucasian patient was in the room was something that never happened before.

MONTAGNE: That’s National Medical Association President-elect Edith Mitchell. We spoke to her for this 50th anniversary of Medicare.

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Insurers are supposed to cover mental health treatment as they cover other illnesses but they don’t always comply. They are improving, but the U.S. does not appear to actively enforce the federal law.

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The federal mental health parity law was supposed to protect patients from discrimination by insurance companies. But in the seven years since it was passed, the U.S. government has not taken a single public enforcement action against an insurer or employer for violating the law. And some patients still find it difficult to get the mental health treatment they need. Jenny Gold has this story of a father who is suing his insurance company over the treatment given to his son.

JENNY GOLD, BYLINE: Michael Kamins remembers when he first opened the letter from his insurer in 2012.

MICHAEL KAMINS: When I got that letter, there was steam coming out of my ears. This is my kid’s life. This is my kid’s well-being.

GOLD: According to his lawsuit, his 20-year-old son had attempted suicide a year before as a freshman at an Ivy League college. Since then, he’d been diagnosed with bipolar disorder and hospitalized twice; most recently just a few months before. He thought his son was getting better, but now, his suit alleges, the insurer was cutting his son’s visits with the psychiatrist to just twice a month.

KAMINS: I’m seeing progress and what do they tell me? Oh, no, you can’t have 13 sessions. You can only have two.

GOLD: Kamins and the psychiatrist filed several appeals to the insurer Optum, which is a subsidiary of United Health Group, but they were denied. Eight months later, his son was back in a psychiatric ward, according to the lawsuit.

KAMINS: I’ll make the analogy of somebody drowning who finally gets to the surface of a lake. His head comes out, he gasps for air, and what does Optum do? They shove him down again.

GOLD: Kamins, who’s a professor in New York, decided to sue. The federal parity law is supposed to guarantee people with mental illnesses the same access to treatment as patients with diseases like cancer or diabetes. And most insurers have dropped the higher copayments and separate deductibles they used to charge for mental health. But Kamins’s lawyer, Meiram Bendat, says some insurers have continued to limit treatment in subtle ways.

MEIRAM BENDAT: Insurers have become much more crafty at finding protocols that are not expresed numerically that are more difficult to spot.

GOLD: For example, the lawsuit alleges that Optum required Kamins’s son to get prior authorization to see his psychiatrist, something not required for other kinds of illnesses. And the insurer claimed his visits weren’t medically necessary, despite the psychiatrist’s orders, according to the complaint. The federal law doesn’t allow people with insurance plans like Kamins’s to bring private lawsuits to enforce it. So instead, he had to sue under New York state law. Optum would not comment on the specifics of the case and has asked that the suit be dismissed. But Bendat says the real problem is that state and federal governments aren’t doing enough.

BENDAT: The implementation and enforcement of parity has been rather lacking across the board.

GOLD: But Clare Krusing disagrees. She’s a spokeswoman for America’s Health Insurance Plans – the industry’s main trade group.

CLARE KRUSING: The idea that there is limited enforcement of mental health parity is a misperception.

GOLD: Krusing says insurers are working behind the scenes with federal and state agencies to make sure they’re providing proper mental health coverage. But that isn’t easy.

KRUSING: It’s not a math formula. A treatment plan for diabetes or a chronic heart disease is very different from a treatment plan for a patient that’s seeking care for depression or another mental illness.

GOLD: Especially when insurers are also trying to hold down costs by preventing unnecessary care, she says. Former Congressman Patrick Kennedy helped write the parity legislation. He describes the government’s enforcement record as slow and sparse, and he says the timing of the Affordable Care Act is partly to blame.

PATRICK KENNEDY: The parity law kind of got kicked down the tracks until the Obama administration could get the ACA on track.

GOLD: And he says enforcing the laws against insurance companies has been delicate politically.

KENNEDY: Insurance companies were part of the coalition that helped bring the ACA to life. And so the administration feels an enormous debt of gratitude to insurers. So it’s a challenge politically to then step on the toes of those that brought them to the dance.

GOLD: Since 2010, the Department of Labor, which is the main federal agency in charge of parity, has found 140 instances in which a patient’s parity rights were violated. A spokesman for the department says all those issues were resolved voluntarily, but no insurer has been fined, and none of the results are public. Carol McDaid, of the Parity Implementation Coalition, says that’s made it difficult for advocates like her to help other consumers.

CAROL MCDAID: Our problem with that that these investigations are all kept secret. They’re not putting it on a website. They’re not releasing it to us.

GOLD: She says few patients even know they have legal protection. Michael Kamins is one of just a handful of consumers to bring a lawsuit, a costly and time-consuming endeavor. He says he owes it to his son.

KAMINS: I’m his dad. I do love him. He’s a wonderful kid. He’s a wonderful kid and I’m going to give him every opportunity to achieve everything that he can achieve, you know? And I think any father would do the same.

GOLD: His lawsuit is still pending. Meanwhile, the family has a new insurance company, which, so far, has given his son more access to treatment. Now 23, he’s doing better and is scheduled to graduate from college next year. For NPR News, I’m Jenny Gold.

CORNISH: Jenny Gold is with our partner, Kaiser Health News, a nonprofit news service.

Copyright © 2015 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.