Abortion and Health Care Reform: Wading Through the Complexity

Like most conflicts that have very smart people on multiple sides of the argument, the debate over abortion and health care reform is complicated.  But here is one thing we now know: the final act of the health care debate will come down to how this argument plays out.  Indeed, Politico reported yesterday that Nancy Pelosi has invited several woman’s groups to a strategy meeting to figure out how to approach the very real final problem they face: overcoming the twelve+ pro-life democrats who, though they voted for the House bill, are not expected to vote for the Senate bill.

But those who wish to see the strongest language possible prohibiting our money from going to subsidize abortions need to be honest about something.  Many of the premiums we pay into our own private health care insurance company go to pay for others’ abortions.  Many of the taxes we pay go to state medicaid programs which cover abortions.  Indeed the Roman Catholic Church, which considers abortion even in the case of rape to be an intrinsic evil, strongly supports the House health care reform bill–a bill which uses taxpayer money to subsidize abortion in the case of rape.  What we need to be honest about, then, is that this is not some ultra-principled, never-say-die, fight.  This is an important political calculation.  The U.S. Bishops, along with many of those who are rightly object to our tax dollars going to fund abortion and yet support the House bill, are apparently willing to make the calculation that the good of health care reform outweighs the evil of having some abortions federally subsidized.

But many believe that such a calculation nevertheless involves making absolutely clear that no abortions done for reasons of mere birth control should be covered in a federally managed and subsidized health care insurance exchange.  That’s their line in sand.  They therefore support the House bill which explicitly mandates this over the Senate bill which does not.   Nevertheless, many like Timothy Noah over at Slate assure them that ‘the Senate bill doesn’t fund abortions’ and:

What really rankles Stupak (and the bishops) isn’t that the Senate bill commits taxpayer dollars to funding abortion. Rather, it’s that the Senate bill commits taxpayer dollars to people who buy private insurance policies that happen to cover abortion at nominal cost to the purchaser (even the poorest of the poor can spare $1 a month) and no cost at all to the insurer. Stupak and the bishops don’t have a beef with government spending. They have a beef with market economics.

But this just is government funding of abortion.  If I buy a health insurance policy with the expressed desire to have abortion as part of my coverage, and the government says, “Sure, go ahead…we’ll even help you with your payments in such a policy…but we’ll require you to send a separate check to fund your abortion coverage,” is this really anything more than an accounting trick?   Indeed, it seems that even pro-choice leaders have described it as such:

In January, Senator Barbara Boxer (D-Ca.), a pro-abortion leader in the Senate, assured McClatchy News Service that the abortion surcharge requirement is only an “accounting procedure,” and DHHS Secretary Kathleen Sebelius also assured pro-abortion listeners that the Nelson language was of no consequence.  Yet today, in an effort to entice pro-life Democrats in the House to vote for the bill, the White House and Democratic leaders are working on “convincing as many as a dozen antiabortion Democrats in the House that abortion language in the Senate bill is more stringent than initially portrayed,” according to a report in the March 5 Washington Post.

The bottom line is that if the Senate bill is passed, for the first time ever we will have (multiple)  federal government managed and subsidized insurance companies offering birth control abortions.  This is what those who want the House bill don’t want to see.  But even even if they are wrong about that (and I think that good people can disagree) the Senate bill funds abortion in multiple other ways that the House bill does not.  Here are just two examples:

The Senate bill would reauthorize all federal Indian health programs, without including language to prohibit funding of elective abortion, even though such an amendment (the Vitter Amendment, similar to the Stupak Amendment) was approved by the Senate when it last considered Indian health legislation on February 26, 2008.   There is a clause in the Senate health bill [Sec. 10221, pp. 2175-2176] that has been misrepresented as an abortion restriction, but it actually contains no policy standard on abortion funding — it merely “punts” the question to the annual appropriations process, an unacceptable approachA vote for the Senate bill is a vote to open the door to future federal funding of abortion on demand through all Indian health programs.

The Senate bill, due to a last-minute amendment, provides $7 billion for the nation’s 1,250 Community Health Centers (CHCs), without any restriction whatever on the use of these federal funds to pay directly for abortion on demand.  (These funds are both authorized and appropriated by the bill, and thus would be untouched by the “Hyde Amendment” that currently covers Medicaid funds that flow through the annual Health and Human Services appropriations bill.)  Two pro-abortion groups, the Reproductive Health Access Project and the Abortion Access Project, are already actively campaigning for Community Health Centers to perform elective abortions.  In short, the Senate bill would allow direct federal funding of abortion on demand through Community Health Centers.

But those who want the House bill  instead of this (and, in my view, rightly so) have a major problem.  The way that health care reform will be passed, if at all, is by the House passing the Senate bill–and then using budget reconciliation to pass amendments that will appease a simple majority of House members.  Unfortunately, though this isn’t totally clear (and the we are learning just how much power the parliamentarian of the House and Senate has in this process in determining this), Stupak’s abortion amendment to the House bill  appears not to fall under the budgetary procedure that would make it open to being inserted into the final bill via reconciliation.  If so, and Pelosi cannot get 12+ new votes for the bill to balance the democrat pro-lifers who want Stupak language (an unlikely prospect to be sure), then the only way to do this would be to have the Senate pass the House bill and then do reconciliation (an even more unlikely prospect).

But I think I’ve actually changed my mind about this.

I’m glad Stupak and company are doing what they are doing, and I think they should continue to try to force the issue to get what is clearly the better abortion language, but if it comes down to passing health care reform or not I think the duty we have to the dozens of millions without health insurance trumps the abortion coverage difference between the two bills.  Remember, we are already simply playing for political points here and not standing by principle: every single supporter of the House bill is willing to support subsidized abortion in some form already.  Would the Senate bill be that much worse?  I think that the ‘separate check’ strategy, though clearly not stopping federal support of abortion, sends a wonderfully symbolic message that we as a country do not put birth control abortions in the same category as the rest of medicine.  Everyone who takes the time to write a separate check to get birth control abortion coverage will get this message.   Indeed, this is a message which upsets all the right pro-abortion rights groups.

Public policy is a teacher…and this is about as important as a lesson gets.


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4 Responses to “Abortion and Health Care Reform: Wading Through the Complexity”

  1. Kristina Says:

    This is disappointing.

    I agree that the whole “separate check” method sends a message that we “do not put birth control abortions in the same category as the rest of medicine” when it comes to health care. As for your question, “Would the Senate bill be that much worse?” I think you answer it pretty well yourself above—“if the Senate bill is passed, for the first time ever we will have (multiple) federal government managed and subsidized insurance companies offering birth control abortions.”

    The Stupak Amendment to the House Bill prohibits federal funding of abortions or any health plan that includes abortion except in cases of rape, incest, or (undefined) danger to the life of the mother. So, while you are correct that the House bill does allow for some funding of abortions, it seems to be more restrictive than the Senate proposal.

    So, would the Senate bill be that much worse? Yes, it sounds that way.

    Stupak and friends do not need to, nor should they, back down. You know far more about all this than I, but, I didn’t think there was “trumping” involved when we talk about having consistent ethic of life. Isn’t trumping contradictory to consistent? Please, help me understand this better. We have a duty to uphold the dignity or all human life; I understand that much. It is possible to pass health care reform that appeases a large majority of the pro-life camp and provides coverage to those dozens of millions on the margins, uncovered for whatever reason. The House showed us that in November.

    Just last week you wrote: “The decision they [pro-choice democrats] reach will impact not only health care reform (a monstrous issue in itself), but also the very identity of their party. Will they retreat toward being the party of Planned Parenthood and NARAL, or will they continue to move in the direction of Bob Casey and Bart Stupak? That is, in the direction of those that want to protect both the very young and those without health insurance? That is, in the direction of a consistent ethic of life.”

    Why the change of heart/mind now? We’ve seen that compromise is possible in this debate (re: passage of House bill with Stupak language). The US Bishops’ support of that Bill (which allows for federal funding of some abortions) speaks volumes to the willingness of the pro-life constituency to seek and find common ground and compromise to get this job done. We don’t have to back down from this issue, and in fact, if we desire to move in the direction of a consistent ethic of life, we cannot back down from this issue.

  2. nohiddenmagenta Says:

    I think Stupak should fight like hell for his language. I’m just going to say that if he cannot get it for whatever reason (can’t use reconciliation to get it in, doesn’t have the votes, etc.) that he and others should be able to vote for the Senate bill.

    If we have the duty to stand up for ALL life, and never make a prudential political judgment, then how can you support the House bill which allowed federal funding of SOME abortions? (It also allows participants in the exchange to purchase a separate ‘rider’ to their plan to cover abortion…which isn’t that far off from the ‘two check’ system of the House bill.)

  3. Kristina Says:

    “If we have the duty to stand up for ALL life, and never make a prudential political judgment, then how can you support the House bill which allowed federal funding of SOME abortions?” Good question. I support the House Bill, with full knowledge and pretty good understanding of what it does in fact allow in regards to abortion (all of which is contradictory to my opinion on abortion), for its attempt to compromise, to find some sort of middle ground.

    If we know this type of compromise is possible, we shouldn’t settle for less. If that means a “no” vote until we get what we KNOW we can get (which, yes, is not everything we want or everything that is right and good– but is moving in the right direction), then I say no. In the meantime, yes, unfortunately, millions of uninsured Americans remain uninsured. This makes me indirectly responsible for millions of my American brothers and sisters going uninsured, untreated, and quite likely dying and dead. The alternative makes me indirectly responsible for the deaths of millions of my tiniest brothers and sisters, and negative health effects to their mothers and fathers, family and friends. There’s no win here. I don’t know what to do with that, except continue to support Catholic Health and my nearest neighborhood clinic and others who serve the un (and under) insured until there’s compromise I can stand behind. I don’t think we should be afraid of saying no in this case, even if no results in further delay of this reform.

  4. nohiddenmagenta Says:

    Then we agree: I support Stupak until it can be shown that it can’t/won’t pass at which point I’ll support the Senate bill.

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