Posts Tagged ‘Nelson’

Abortion and Health Care Reform: Wading Through the Complexity

March 6, 2010

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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“It Had All Come Down to Abortion”

December 20, 2009

Sadly, so many important and complex ethical issues today seem to be seen through the lens of the abortion wars (yet another reason it is so important to have discourse on this topic far, far differently than we currently do), and health care reform is another one of them.  It was not just a central issue, but THE issue down the stretch.  Indeed, as Politico reports, “It had all come down to abortion”:

After a break for lunch, Reid turned to abortion.  Nelson and Chief of Staff Tim Becker, who had flown in from Nebraska, set up shop in one room of Reid’s suite. Sen. Barbara Boxer (D-Calif.) and her aides settled into another wing with Sen. Patty Murray (D-Wash.), the two senators there to represent Democrats who favor abortion rights.  The opposing senators never spoke with each other or sat at the same table. They negotiated through Reid and Schumer.

Through the afternoon and early evening, they appeared deadlocked. Both sides, in consultation with advocacy groups, rejected various offers.  They couldn’t get beyond differences between the so-called Stupak amendment in the House bill, which would require women who receive federal subsidies for insurance to seek out a separate abortion rider, and a proposal by Sen. Bob Casey (D-Pa.) requiring policyholders to opt-out of abortion coverage. “I don’t know if we can do this,” Nelson said he told Reid at one point. “I’m running out of ideas.”

As he spent the day munching on almonds, peanuts and potato chips, Nelson said he eventually had what he described as a breakthrough. He turned over a piece of paper, and drew a line down the center.  “Why don’t we have two policies?” Nelson asked. “One with and one without.”  Nelson proposed that every state insurance exchange offer at least one plan that does not cover abortion, and policyholders could choose a plan with or without abortion coverage, unless states choose to ban it. Also, people who receive federal subsidies would need to write two separate checks as a way to ensure that none of the federal dollars went toward the abortion premium.

But this was not a new idea, and the pro-life groups who had supported Nelson (and had previously rejected similar ideas) were aghast.  As National Right to Life pointed out, “This seems to envision a system under which the OPM director would administer multi-state plans that cover elective abortions, and perhaps even possess authority to require such plans to cover elective abortions, as long as the director also ensured that there was one plan that did not cover abortions (except types of abortions also funded by the federal Medicaid program).”  The idea that the federal government would subsidize and manage (and perhaps require) health insurance companies that cover abortions is unprecedented, and Senator Nelson looks like a small time legislative sell out for this 11th hour move.

But with the senate vote likely to pass tonight, this sets up a huge and dramatic conference committee process between the House and Senate in the next couple weeks.  Pro-Life Democratic Representative Bark Stupak has already said that his pro-life democrat cohort will not support the Nelson compromise which means, if they are serious, the Senate bill cannot pass the House.  I know I’ve beat a dead horse on this blog already about this issue, but it is worth repeating again and again: the political winds have shifted; being liberal no longer means supporting abortion rights…and it certainly doesn’t mean supporting federal funding and managing of abortion.  Democrats now appear to have a huge choice to make: either pass a bill that will cover 30+ million of our most vulnerable citizens, end refusal of coverage based on preexisting conditions, and save billions of dollars in the long run–or reject the call of history and of their president and cave into the pro-abortion rights extremists of their party…leaving the bill to suffer a humiliating and unnecessary defeat.  If they choose the latter, they sacrifice not only those vulnerable uninsured counting on them to succeed, but also their political future and that of their president. If they choose the former, they get on the right side of history and score a huge victory for authentic reform.

Oh, and they go a long way to ending the horrifically destructive practice of viewing virtually every issue through the lens of the abortion wars.

Letter from the US Bishops on Health Care Reform

December 16, 2009

The US Catholic Bishops, major providers of health care in the United Sates, (and supporters of the ‘liberal’ bill proposals in Congress) have sent a letter to the Senate showing the hypocrisy of voting against amendments like Stupak/Nelson (sorry this is a bit long, but worth it):

The central argument against the Nelson amendment, voiced during floor debate by many
Senators, was that this amendment goes too far by barring federal subsidies to entire
health plans that include abortion coverage. The three-decades-long precedent of the
Hyde amendment and similar provisions governing all other federal health programs, it
was claimed, is this: Federal funds may not be used “directly” for an elective abortion,
but non-Federal funds such as private premium dollars may be used in the same health
plan for such abortions.1 The underlying health care reform bill was said to respect this
tradition by “segregating” funds with plans to allow “private” funding of abortion. It was
chiefly on the basis of this argument that the Nelson amendment was tabled

However, yesterday’s overwhelming vote to approve the Consolidated Appropriations
Act creates a new situation. In that vote, almost all Democrats, including almost
every Senator who claimed the Nelson amendment’s policy goes too far, voted in
favor of that exact policy. For these Senators voted to retain the actual current
language of the Hyde amendment, and of the parallel provision governing abortion in the
Federal Employees Health Benefits Program – and that language clearly requires a policy
in all other federal health programs that is identical to that of the Nelson amendment.
Here is the language of the Nelson amendment that Senators claimed was new and
unprecedented:

1 No abortion provision at issue forbids funding abortions (or plans including abortion) when the mother’s life is endangered or in cases of rape or incest; these exceptions are not at issue and will not be included in quotes from the provisions. Abortions not covered by these exceptions are here called “elective” abortions.
2 No funds authorized or appropriated by this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion.

Here is the Hyde amendment, governing all current programs funded by the Labor/HHS
appropriations bill, which the Senate just voted to reaffirm:

None of the funds appropriated in this Act, and none of the funds in any trust
fund to which funds are appropriated in this Act, shall be expended for any
abortion…. None of the funds appropriated in this Act, and none of the funds in
any trust fund to which funds are appropriated in this Act, shall be expended for
health benefits coverage that includes coverage of abortion…. The term “health
benefits coverage” means the package of services covered by a managed care
provider or organization pursuant to a contract or other arrangement.
(H.R. 3288 as approved by the Senate on December 13, Division D, sec. 508;
emphasis added)

The Hyde amendment states further that it does not prevent use of state, local or private
funds for abortions, as long as these are separate from the state matching funds that
combine with federal funds to purchase a benefits package. In other words, not only
federal funds, but other funds used to purchase the same package, may not pay for
elective abortions.

Here is the parallel provision governing the Federal Employees Health Benefits Program,
which the Senate also approved yesterday:

No funds appropriated by this Act shall be available to pay for an abortion, or
the administrative expenses in connection with any health plan under the
Federal employees health benefits program which provides any benefits or
coverage for abortions.
(H.R. 3288 as approved by the Senate on December 13, Division C, sec. 613;
emphasis added)

Neither of these longstanding provisions says anything about “segregating” private and
federal funds within a health plan or benefits package. Attempts to achieve such
segregation are irrelevant to current policy, which bars federal funds from being used for
any part of a package that covers elective abortions.

Literally the only substantive difference between these noncontroversial and widely
supported provisions and the Nelson amendment is that the latter explains at length that
(a) it does not prevent purchasers who do not receive federal subsidies from buying a
health plan including elective abortions, even on the Exchange created by the health care
reform bill, and (b) it does not prevent purchasers receiving federal subsidies from buying
separate supplemental abortion coverage with their own funds.

What this means substantively is that the democratic opposition to Stupak/Nelson-like amendments is a disingenuous political ploy.  They really don’t have principled opposition, but rather this is the kind of public face they have to put forward to keep NARAL and Planned Parenthood happy.  While frustrating, the fact that they really ultimately don’t care about the principle might make a ‘manager’s amendment’ which brought back this kind of language that much more likely to get through.  Again, whether or not this happens–especially if Senators Nelson and Casey steel their spines and insist on it–will be a major turning point in the self-definition of the democratic party.

And it might be the basis of the only remaining problematic opposition to the bill as both the public option and medicare buy-in appear to be dead.  More drama to  come.