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This chapter uses four legislative battles (the Freedom of Choice Act, Freedom of Access to Clinic Entrances bill, Medicaid funding of abortion, and abortion provisions in the Federal Employees’ Health Benefit Act) as case studies for understanding the contested issues and complexity belying gender difference and women’s impact. While women members were seen as united around reproductive rights, institutional dynamics in this partisan environment and extra-institutional pressures encouraged the increasingly diverse group of women to give voice to diversity, defined (and re-defined) women’s priorities and their understandings of their roles and responsibilities as representatives of women, and influenced their prospects for political success within an institution whose agenda they did not control. While the case studies suggest the need to bring more women into office, they remind us that the potential of presence is limited without positional power, and that mobilized women voters who pose a gender gap threat can provide legitimacy for difference within institutions steeped in masculine values.

This chapter deconstructs gender differences to explore the contested issues surrounding gender difference, when the politics of presence converged with partisan politics in the struggle over health care reform during the Democratic-controlled 103rd Congress. The impact of the institutional environment on women’s agenda and actions, along with differences in environmental pressures across parties and committees, are explored. The analysis attempts to move beyond the simple question of whether women make a difference to an understanding of how political environments, structured by partisanship and steeped in masculinist values, affect and can be affected by the feminale. The case study suggests that one cannot truly understand gender differences in an institutional vacuum, even as it forces us to confront the relationship between gender difference and substantive representation of women, and to consider the value of the concept of feminist protest in understanding partisan differences in gender difference and women’s impact.

When the 1994 elections gave control of Congress to a conservative, Christian Coalition-dominated, Republican majority, what some had over-optimistically touted as a critical mass of women became a token group, notwithstanding a slight increase in numbers. Nowhere was that more evident than in the ability of that new Republican majority to re-define the agenda, raising new issues (Partial Birth Abortion Ban) and challenging seemingly non-controversial, bipartisan, well-established programs (funding for the Title X Family Planning program and international family planning programs). The continued evidence of the gender gap in prochoice support, along with the critical role played by the shrinking cohort of prochoice Republican women in challenging their leadership’s anti-reproductive rights agenda, reinforce the importance of increasing descriptive representation. Nevertheless, the gendered roles assumed by a growing vocal cohort of female Republican reproductive rights opponents, reluctance by some ostensibly prochoice Republican women to challenge their leadership, a shrinking gender gap in prochoice support within Congress, and the frustrations of those who attempted to fight these often futile battles, all highlight the critical role that institutional environments, increased ideological diversity among women, and extra-institutional forces play in shaping the probabilistic relationship between descriptive and substantive representation, in strengthening or weakening perceptions of legitimacy surrounding gender difference, and in defining and redefining the meaning of substantive representation of women and realizing the potential for difference. These case studies explore gender differences in perspectives of reproductive rights opponents, provide insight into the value of bipartisan support for reproductive rights policy agendas (despite Republicans being less prochoice than Democrats), and point to the important role of women voters in maintaining bipartisan support and political resolve.

Women’s health did not suffer the same endless litany of political defeats as other policy areas in the Republican-controlled 104th. While the case studies of women’s health research funding, breast cancer screening, and women veterans’ health suggest that women’s presence within the institution is important for ensuring substantive representation of women, they also suggest that other factors play a critical role in giving meaning to women’s presence. These include the political environment of Congress, the ideological perspective of those who hold positional power, and the extra-institutional pressure generated from the gender gap in the mass public, which gives legitimacy to action on behalf of women’s health among male members concerned about the next election.

Women’s health policy united women across party lines in the 103rd and yielded numerous victories. These successes continued a trend established in earlier Congresses and, relatively speaking, would not come under attack in the 104th when almost every other political gain previously made by women was vulnerable. As such, juxtaposition of women’s health case studies with the reproductive rights case studies allows us to go once again beyond the simple question of ‘Do women make a difference?’ to explore not only how the confluence of individual, institutional, and cultural factors gives meaning to gender and shapes the probabilistic relationship between descriptive and substantive representation of women over time and across policy areas, but also to suggest strategies for advancing substantive representation regardless of women’s proportional presence. The results illustrate the value of diversity and suggest strategies that can sustain unity amid diversity. They suggest that in addition to increasing women’s presence, substantive representation of women will be facilitated by raising the gender consciousness of women in the mass public, by reinforcing awareness (and fear) of the gender gap, and by women’s advancement within the institutional hierarchy. In short, even with a ‘mom and apple pie’ issue, making a difference requires efforts by women inside the Congress to put matters on the agenda and the mobilization of women outside the institution to give legitimacy and political teeth to demands that challenge masculinist values.

The story of health insurance reform in the 104th brings to life many of the contested issues surrounding gender difference in impact. It illustrates the importance of going beyond quantitative evidence of gender difference to look carefully at the substance of those differences that emerge, to understand their relationship to the broader political context, and to explicitly consider the motivations belying difference. That those who were seen as advocates for women in the health care reform battles of the 103rd played little role in health insurance reform, while some of the more visible vocal women critics of the Clinton plan led the effort some saw as ‘radical’, that the prime [female] motivator and facilitator of the effort was not seen as driven by gendered forces or even connected with women’s organizations, and that Republican women who had supported women’s health also supported a measure likely to have reversed state mandates protecting women’s health benefits all make health insurance reform a unique laboratory for addressing the contested issues that surround difference. The conclusions suggest a growing gap between gender difference and the standards of third wave feminism, the need for an active engaged women’s movement to counter the threat posed by essentialist assumptions that grant legitimacy to any pronouncement women make on behalf of women, the contribution differences in the masculinist cultures of parties may make toward partisan differences in the manifestation of feminist protest, and they caution against the gendered consequences of ostensibly gender-neutral institutional procedures.

The analysis of women’s self-described roles as representatives of women finds both convincing evidence of consensus among women members over time and across parties as well as an abundance of complexity, pointing once again to the importance of going beyond what women say to other factors that give practical meaning to their words: perceptions of women as a group, resentment of perceived gender-related problems facing women, commitment to advancing women, and differences in the relative priority of working on behalf of women. Deconstructing ‘women’ and ‘women’s issues’ reveals differences in meanings that may contribute to different actions on different issues, benefiting different women. A closer look at partisan differences in the institutional and extra-institutional environments reveals challenges and opportunities for surrogate representation of women, which contribute to disunity among women in practice and perhaps diversity in the way feminist protest is manifested.