Conservatives have argued that abortion has no place in a health care bill—I couldn’t agree more (although for completely different reasons…). In fact, I think individual insurers should be the ones to decide whether or not it makes sense for them to offer the benefit to women. We are wasting far too much time and political capital on an issue that has little to do with the overall goals of reform.
Socially-conservative members of Congress, led by Bart Stupak (D-MI), are focusing attention on abortion once again and threatening to block passage of the House bill (The Affordable Health Care for America Act (H. R. 3962) if a full ban on coverage for the procedure isn’t included in the legislation. By doing this, these Congressmen are sacrificing the far more important goals of reform—making health coverage affordable, covering the uninsured and reducing skyrocketing health care costs—for an ideological battle that should be fought elsewhere.
The fact of the matter is that the House bill contains more than two dozen references to abortion and virtually all of them describe how insurers can restrict or deny coverage for the procedure. For example, abortion is not included in the essential benefit package for insurance plans (both private and public) that want to participate in the exchanges. The bill also makes permanent the Hyde Amendment’s ban on the use of federal funding for abortion except in the cases of rape, incest, or to ensure the life of the mother. Specifically, the bill prohibits the use of federal affordability subsidies to pay for abortions—requiring private insurers to tap funds derived from policyholder premiums if they choose to provide coverage for the procedure.
The bill goes even further in trying to placate opponents like Stupak and the other 39 Democrats who reportedly share his views. Timothy Jost, a law professor at Washington and Lee University School of Law (and one of the few people who has actually done a close reading of the bill) offers more details of the restrictions on the Health Affairs blog; “The federal and state governments may not discriminate against providers or plans for refusing to cover, provide, or refer for abortions (although the government is not prohibited from discriminating against those that do). Exchanges may not discriminate against plans that cover or refuse to cover abortions, but apparently are not obligated to offer at least one plan that does cover abortion, as the Senate bill requires. Federal and state abortion and conscience protection laws are expressly not preempted.”
This idea that the insurance exchanges are not obligated to offer at least one plan that does cover abortion is an important change in the legislation. At my request, Jost went back and restudied the bill and reiterated this finding. The compromise on abortion that is known as the Capps Amendment (which I wrote about here) would have required the exchanges to include at least one plan that covers abortion and one that does not. The Senate Finance bill also has that provision.
Meanwhile, the other aspects of the Capps Amendment—inclusion of at least one plan in the Exchanges that does not cover abortion, and the ban on insurers using federal funds in the form of affordability subsidies to pay for abortion—made it into the House bill.
Still, this isn’t enough for the tenacious abortion foes. Stupak and the other socially-conservative House Democrats have threatened to block the bill from coming to the floor if it doesn’t include an amendment that specifically bans abortion coverage from all plans that want to participate in the exchanges or in a public plan. But how likely is this to happen?
Reports coming out of Washington indicate that Nancy Pelosi is unlikely to consider a vote on any amendments to the health reform bill before it heads to the floor vote.
According to the Washington Post, Majority leader Steny H. Hoyer is involved in ongoing negotiations with Democratic hold-outs and might be working on other concessions (like the one that omitted the requirement for inclusion of a plan that offers abortion coverage on the Exchanges…) to win their support for the bill. A full abortion ban does not seem likely—even with Stupak’s threat of 40 votes against the bill.
There are signs that Stupak—who says he still supports comprehensive reform—might yet cut a deal with Pelosi and vote for the bill if he can make a strong argument that he did all he could to get the ban enacted. (Maybe this last burst of righteous opposition is just for show?) Suzy Khimm, writing on The American Prospect group blog, refers to this quote from Stupak at an October 24 town hall meeting as one indication that he might be open to an agreement that lets him save face:
“If everything I want [is] in the final bill, I like everything in the bill except you have public funding for abortion, and we had a chance to run our amendment and we lost. OK, I voted my conscience, stayed true to my principles, stayed true to the beliefs of this district, could I vote for healthcare? Yes I still could.”
The Democrats will have to work harder to get the message across to the public that neither the House nor the Senate Finance bills provide increased “public funding for abortion.” Obama, who has been wishy-washy about the issue, has to join in to make the point. Because, despite the hyperbole coming from the right-to-life crowd, this bill absolutely does not provide the “massive federal support” for abortion they claim. In fact, it stands to make permanent the federal abortion ban and to extend its reach to millions more Americans who will be covered under government programs.
The real losers here are those who support choice and comprehensive reproductive benefits for women. There is nothing in this bill that advances that cause—the federal ban on abortion funding is made permanent and the procedure is not included as part of essential benefits for plans participating in exchanges.
Already, according to the Guttmacher Institute, some 74% of abortions are paid for out-of-pocket. Only 13% are covered by Medicaid (primarily through state funds) and another 13% are paid for by private insurers. This legislation will not change those figures in any meaningful way and women already burdened with having to pay for abortions—those who are poor, nonwhite and unmarried, and already have one or more children—will continue to disproportionately suffer the consequences.