A truly alarming storm is brewing in the ongoing health care reform saga. Bipartisan Congressional opponents of abortion are explicitly threatening to vote no on any health care bill that does not explicitly prohibit abortion coverage.
Such a prohibition, if put into effect, would actually have the shocking consequence of regulating abortion in the private insurance market as well. Since 1976, there has been a Congressional prohibition (commonly known as the Hyde Amendment) which prohibits Medicaid from using any federal monies to pay for abortions. What some antiabortion foes in Congress are now proposing is to go farther than the Hyde Amendment. Specifically, under 3 versions of Congressional bills in the House, lower income Americans would be eligible for subsidies to aid them in purchasing health insurance. However, if antiabortion legislators succeed, the subsidies could not be used to purchase a policy that in any way offers abortion coverage. This would have the effect of essentially legislating abortion coverage in the private insurance market and taking away from women a right that they currently have with their private insurance. When almost 90% of private policies currently cover abortion services according to a 2002 study by the Guttmacher Institute, this change would be seismic.
Currently, the versions of the health care legislation in the House are silent on the issue of abortion. Earlier this year,19 pro-life House Democrats sent a letter to Speaker Pelosi intoning that they "cannot support any health care reform proposal unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan." With House Republicans indicating that they will not support the current health care legislation, the potential defection of a bloc of House Democrats (now estimated to be as high as 40 Democrats) is catastrophic.
Speaker Pelosi needs to respond to these Democrats with some hard facts. Most importantly, abortion is a constitutionally protected right and for the government to legislate over what can be in a women's private policy cannot stand. Second, it is important to note that one third of all American women will have an abortion in their lifetime. When insurance coverage is not provided, many women, particularly young women and lower income women, may resort to substandard care in subpar clinics. When women already often pay more for health care premiums than men, when a C-section can be viewed as a pre-existing condition, and when insurers can routinely deny a woman who has had a prior C-section from health care coverage entirely, additional restrictions on women's health care are absolutely wrong.
This debate reminds me of the House Republicans' successful efforts to derail the Medicaid Family Planning State Option from the Stimulus bill in February, which would have provided basic reproductive health care to lower income women as part of the stimulus bill. House Republicans, created a frenzied hysteria over the provision, and President Obama and Speaker Pelosi quickly agreed to take the provision out, despite the fact that the provision would have provided contraception and reproductive care to 2.3 million low income women.
Unfortunately, it is now a group of Congressional Democrats that are raising their hackles at the issue of abortion coverage. To me, they are akin to Joe Lieberman and his efforts to block health care reform by threatening to vote no on one of the most important issues our society faces--providing universal health care. Many may not realize that in Congress today there are more anti-choice votes, than pro-choice votes and thus the threat that the issue of abortion coverage provides is indeed a real one. The analogy though to the debate over reproductive care in the stimulus bill is important. At the time of the debate over this proposal, the Congressional Budget Office estimated that, if adopted, the Medicaid Family Planning State Option would have saved the government over $700 million in reduced costs. Similar savings could be realized if proper health coverage, including coverage for abortions, were given to women.
In short, we are now at a critical crossroads in the health care debate. Now is not the time to compromise or cave on comprehensive health care. True health care reform means finally providing women with equal access to health care--and health care that is truly comprehensive in its nature-which de facto must include abortion coverage.