Of all the odd twists and turns in the health care reform debate that climaxes this week, the oddest may be the possibility that a dozen House Democrats will kill the Senate health bill because of fears that it is pro-abortion.
In fact, a straightforward reading of the Senate health bill section on abortion, which was written mainly by pro-life Democrat Ben Nelson (D-NE), finds legislators doing all kinds of gymnastics to stigmatize abortion and prevent any American from even indirectly paying for it who does not want to do so. I am not aware of any other medical procedure that is treated this way in the massive health care bill.
The Senate bill, which will apparently be the subject of the first vote in the House late this week, has a strikingly large number of anti-abortion provisions. (I am indebted to Washington and Lee law professor Timothy Stoltzfus Jost for much of this analysis.) In layman's terms, these provisions include:
- A prohibition preventing insurance companies from using federal funds, including tax credits or cost-sharing assistance, to pay for abortion services that go beyond the longstanding Hyde Amendment restrictions long enshrined in Medicaid (threat to the life of the mother, rape, and incest);
- A prohibition preventing the Secretary of Health and Human Services from requiring the coverage of any abortion services as part of the "essential health benefits" for any qualified health plan in a state insurance exchange;
- A mandate that if an insurance company offers a plan in a state exchange that has abortion coverage that goes beyond the Hyde abortion restrictions, that company is required to collect a separate second premium payment from each enrollee who wants that abortion coverage--they actually have to write what I would call an "abortion check";
- A further mandate that said insurance company would then be required to deposit these separate abortion checks into what could equally well be called an "abortion account" consisting solely of these payments and used exclusively to pay for these services;
- A mandate that state insurance commissioners ensure that health plans comply with these abortion segregation requirements in accordance with generally acceptable accounting principles on fund management as specified by the Office of Management and Budget;
- A permission (going far beyond the current House bill) allowing states to pass laws prohibiting the inclusion of abortion coverage in plans offered in a state health insurance exchange, even if those plans do not receive a public subsidy;
- A reaffirmation of federal conscience protection clauses banning qualified health plans from discriminating against any health care provider or facility because of its unwillingness to provide, pay for, provide coverage of, or even refer for, abortions;
And then there are two deeply pro-life measures in the bill that some of us have been advocating for quite some time:
- Establishment and funding of programs to support vulnerable pregnant women and thus prevent abortion from the demand side;
- Increase of the adoption tax credit and a provision to make it refundable so that lower income families can access the tax credit.
Is this a pro-choice bill? Not in the view of Planned Parenthood, which decries the legislation by saying: "The current Senate language...would result in the most significant restriction in access to abortion coverage in the nearly 35 years since the U.S. Congress first adopted the Hyde Amendment...it is anticipated that most private health insurers would no longer offer coverage for abortion."
Stepping back from the details, what is most clear to me is that the Senate bill actually stigmatizes abortion in a way that must be deeply distressing for those who have spent the last several decades trying to mainstream abortion as a basic medical service. The deeply entrenched Hyde Amendment had already stigmatized abortion by narrowing the grounds for abortion that would be seen as legitimate enough for tax dollars to pay for it. If the Senate abortion language passes it will further mark off abortion as a morally dubious medical practice that no American should have to be implicated in who does not choose to be.
Note that it is not the pro-choice side that is threatening to sink health care reform over this language. It is the pro-life side. Led by Rep. Bart Stupak (D-MI), this group has not been persuaded that this language is anti-abortion enough for their preferences. I do not question their motives, but I wonder whether at this point we are talking more about having gotten out on a limb with a position that is now very difficult to walk back from, than it is about the actual substance of the matter.
Personally, I am an evangelical Christian who seeks to live by a consistent pro-life ethic. I deeply desire to see thirty million of my uninsured neighbors in this country to be able to visit a doctor when they are sick and avoid 45,000 preventable deaths a year. I also deeply desire to see a country that turns away from abortion as a routine social practice.
Whatever else might be said about health care reform, in the bill that will be voted on this week both goals are front and center--health care for tens of millions, and stark limits on abortion. I think that pro-life legislators should accept the victory they have won while they can get it.