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Abortion and Health Care Reform: A Common Ground Solution?

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Before leaving for August recess, the House Energy and Commerce Committee adopted an amendment to proposed health care reform legislation that raises hopes of a detente in ongoing tensions over abortion funding. The amendment, put forth by California Democrat Lois Capps, clearly states that federal funds cannot be used to pay for so-called "elective" abortions, ensures that private plans participating in a proposed regional health care exchange system will neither be prohibited from nor required to pay for abortion services, prohibits the preemption of state abortion laws (such as those requiring parental notification and consent), and extends existing conscience protections to health care providers participating in the exchange. It also attempts to chart a common ground course by requiring at least one plan in each regional exchange to include, and one not to include, abortion coverage.

The Energy and Commerce Committee's decision came as both sides of the abortion debate voiced support for "abortion neutral" health care reform -- that is, in order to reach consensus on the larger issues, reform ought to preserve policies that are currently in effect regarding federal support for abortion services. While the Capps Amendment does make significant progress toward common ground, some important questions still remain. For instance, does abortion neutrality really serve as an adequate standard to gauge common ground in the health care debate? Does the Capps Amendment really constitute abortion neutrality? And how do we define abortion neutrality in areas where federal precedent does not exist?

Indeed, new showdowns are brewing over these very concerns, with groups like the Family Research Council and the Catholic League spearheading a misinformation campaign to cast the legislation as a thinly veiled attempt to force taxpayers to fund others' abortions, and ignoring the progress that has been made toward a health care package that can find broad public support.

More reasonable voices have expressed legitimate concerns over some of the amendment's provisions. These questions, as Steven Waldman points out, stem from the fact that health care reform exposes issues for which there is no federal precedent. The U.S. has never before created a government-managed health insurance plan to compete with private options, and thus there are no standards to uphold regarding abortion coverage in such a plan. Each side in the abortion debate has a strong case for what, if any, role abortion should play in a public option. By putting the decision in the hands of the Secretary of Health and Human Services, the Energy and Commerce Committee has effectively passed the buck either to federal regulators or the drafters of the final legislation, while still ensuring that federal funds won't pay for elective abortions.

Were groups like the Family Research Council and the Catholic League serious about abortion common ground, they would champion the Capps Amendment's positive points instead of issuing categorical condemnations of its intent. For months, antiabortion extremists have warned of a government-funded takeover of health care, which would supposedly mandate abortion coverage as part of an essential benefits package and force Catholic hospitals to provide services to which they morally object. The passage of the Capps Amendment indicates that these fears are completely unfounded.

These radical voices should also take note of the status of the Hyde Amendment -- which stipulates that federal Medicaid funds cannot be used to pay for elective abortions -- under the proposed legislation. Abortion rights opponents have long argued that Hyde protections should apply to health care reform, and the Capps Amendment effectively accomplishes this in two ways. First, it explicitly derives the health care bill's definition of abortion services for which federal funding is not allowed from the definition contained in the Hyde Amendment. Second, it duplicates Hyde's limitations on the use of those funds.

The Capps Amendment does not prohibit private health care plans that cover abortion services from receiving federal subsidies, something that has proven to be a sticking point for some abortion opponents. These observers should note that this provision is, in fact, entirely consistent with current federal policy. State Medicaid programs are presently allowed to pay for abortions, provided they fund these services using non-federal monies. And the federal government currently subsidizes private insurance through programs like COBRA and the Health Coverage Tax Credit, without excluding those private plans that provide abortion coverage.

As Congress moves into the August recess, the Capps Amendment may be touted as significant progress toward common ground in the abortion debate. Unfortunately, it is not the end of the story. Both supporters and opponents of abortion rights should continue to engage in constructive dialogue to establish shared parameters for what constitutes abortion neutrality, and propose ways to achieve abortion-neutral results.

This post originally appeared on OnCommonGround, a forum dedicated to the search for common ground in the abortion conflict.