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Bob Burnett

Bob Burnett

Posted: September 25, 2009 09:12 AM

Healthcare Reform's Abortion Dilemma

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There's no doubt the Obama Administration's healthcare reform plan represents a historic step forward for women. At long last, the vast majority of females will have access to affordable care that protects their maternity and reproductive health. But this progress may exact a dreadful price, as many women could lose insurance coverage for abortions.

The current healthcare system is completely broken. Whereas one in six Americans under the age of 65 lack insurance coverage, one in five women of child-bearing age are uninsured. And female-headed households file over half of all medical-related bankruptcies. Moreover, in the current healthcare morass, women who are insured encounter a patchwork system of benefits and typically are charged more because of their gender.

From a feminine perspective, the system proposed by Democrats should fix most of the problems. The pending healthcare legislation will provide all women, who are legal residents of the U.S., with a full-range of care at an equitable cost. In addition, females will not be denied coverage because of a pre-existing medical condition, including breast cancer, pregnancy, or evidence of "uninsurability" such as being a victim of domestic violence. Furthermore, the pending legislation would put a cap on out-of-pocket costs so families don't go broke. For the first time, all women will be guaranteed access to maternity and reproductive health care, as well as to preventive tests, like mammograms and pap smears.

These improvements aren't controversial as there is wide public support for expanding healthcare services for women. A recent poll for the National Women's Law Center indicated that most Americans support healthcare reform and 71 percent feel that insurance companies should cover women's reproductive health services including contraception, Pap tests, breast cancer treatments and sexually transmitted infection testing and treatment.

While there is broad agreement that women must be provided with a seamless, lifelong continuum of care, the use of public funds for abortion threatens to either derail the pending legislation or penalize females for taking a step forward.

The stumbling block is the Hyde Amendment, which since 1976 has prohibited the use of federal funds for abortion, except in cases of rape or incest, or when the life of the mother is at risk.

Conservatives believe the pending legislation would undermine the Hyde Amendment. To appease them President Obama has repeatedly denied that Democratic healthcare reform would provide government funding of abortion.

Nonetheless, the House bill can be viewed as skirting the Hyde amendment. Here's where it gets technical. The Democratic proposal divides payment for healthcare services into two accounts: one public and the other private. Women would be eligible for either a public healthcare option, mostly paid for by federal funds, or a variety of private healthcare plans - payment for some part of which might be provided by federal funds depending upon the income of the recipient. Whichever plan females chose, a portion could be paid by public funds and the remainder by private. There's specific language in the pending legislation that prohibits use of public account funds to pay for an abortion.

Conservatives aren't satisfied with the two-account solution. The United States Conference of Catholic Bishops said the House proposal maintains an "illusion" that public funds could be segregated from private funds in a government-run plan or in private plans that accept federal subsidies. "Funds paid into these plans are fungible, and federal taxpayer funds will subsidize the operating budget and provider networks that expand access to abortion." Blue-dog Democratic Representative Bart Stupak has demanded more restrictive language in the House bill.

There are three problems with the conservative push for more restrictive language. First, it would further delay passage of healthcare reform. The National Women's Law Center poll indicated that 66 percent of Americans want healthcare legislation to move forward without being derailed by the issue of abortion. However, since almost no Republicans will vote for the Democratic legislation, Obama needs some votes from Blue-dog Democrats such as Stupak and may be forced to compromise with them.

The second problem is that restrictive language would continue to limit access to abortion to the group who needs it the most, low-income females. Over the last thirty years, the consequence of the Hyde Amendment has been to drastically restrict the availability of publicly funded abortion services - those most accessible to poor women.

The third and potentially most serious problem is that disabling the two accounts system could reduce the coverage afforded to women who already have health insurance. The fear is that some private plans that currently cover abortion would no longer do so if there was restrictive language in the healthcare reform legislation. There's also concern that hospitals and physicians might reduce coverage for the same reason.

American women have waited a long time for equitable healthcare. It would be a savage irony if the price is a drastic curtailment of abortion services.