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Coughing Up Stupak's "Morning-After" Poison Pill

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Bart Stupak (D-MI), the conservative Michigan back-bencher who has suddenly injected abortion rights into the health care debate, may have been acting on a sincere religio-moral impulse: after all, both he and his amendment's co-author, Joe Pitts (R-PA) belong to the secretive, conservative religious family called "The Family," and Stupak lodges at The Family's infamous C Street house when he's in D.C. (More here.) But Pitts hates health care reform itself -- he even spoke at Michelle Bachmann's "Teabagger" gathering last week -- and The Family, like many conservative religious organizations, exists largely to manipulate religious sentiment for political and economic gain. So, whether Stupak intended it or is merely a stooge, he has handed political conservatives -- not religious conservatives, again, but purely political ones -- a tremendous gift:

A poison pill that could cause the miscarriage of health care reform.

Stupak's amendment to HR 3962, which passed the House by just three votes late Saturday, wasn't necessary to prevent taxpayer dollars from being spent on abortions. The bill already contained such a provision. But conservative Democrats like Sen. Ben Nelson (D-NE), whose vote is indispensable to defeat a Republican filibuster, already are saying they will not support any reform without Stupak's additional provisions. Meanwhile, liberals are up in arms, and 41 House Democrats have signed a letter swearing not to vote for any health care reform that contains the abortion restrictions.

When both the Right and the Left are opposed to an already-precarious bill, that bill probably is doomed. Some will say that's not a bad thing: already, health care reform is so tentative in its vision, and has been so diluted by concessions to trade groups, that its value is questionable. However, the bills in both houses contain the so-called "public option," a federally-run, citizen-owned, nonprofit health insurance carrier that -- if well-run and well-liked -- could grow into a larger, broadly accessible, cost-effective competitor to private carriers and perhaps even into the single-payer system that many progressives want to see. If nothing else, the public option should be a good political science experiment: a test to see whether the government can run a decent health care system (validating liberals and boosting hopes for an eventual single payer system) or will fail miserably as conservatives predict (effectively taking single payer off the table for a generation). Both sides should welcome the small-scale experiment contained in the current proposals -- and both proposals are worth fighting for, for that reason if no other.

But Stupak's poison pill will kill the public option -- unless progressives react intelligently rather than emotionally, in which case they can actually turn Stupak to their advantage.

If progressives boycott the House bill over Stupak, health care won't pass. But if they are willing to accept Stupak's amendment -- grudgingly, reluctantly, hatefully give in -- they may be able to trade that concession for the support of conservaDems like Ben Nelson (D-NE) and Mary Landrieu (D-LA) and Dem-caucusing (for now) Joe Lieberman (I-CT) on the Republican filibuster of health care reform itself. That would stop the cackling of the Cigna and Wellpoint executives who are having a very good day today, because they, and their minions in Congress, don't really care about abortion; they only care about stopping effective competition.

Does that sell women down the river? Yes -- if Democrats stop there. But if the White House and Congressional Democrats are willing, for a change, to be tough and savvy, they could save both healthcare reform and abortion rights by using the budget reconciliation process to reinstate the abortion protections Stupak's amendment removed.

Budget reconciliation isn't subject to the filibuster: only a bare majority in each house is needed to pass a reconciled bill. And while reconciliation can only be used to effect budgetary changes, not to change details of federally-administered insurance coverage, that's actually a plus, because it would allow liberals to pass a poison pill of their own: revocation of the Hyde Amendment and full federal funding of all abortions.

Few people actually want the federal government to go that far -- but, in reconciliation, it could be done; and once a provision that odious was made law, conservatives would have no choice but to make concessions to dial things back to a reasonable compromise -- concessions like removing the odious Stupak amendment in 2011, two full years before most reforms are even scheduled to go into effect.

Right now, liberals face a choice between health care reform that unacceptably restricts women's reproductive rights, or no health care at all. In essence, they're being asked to choose between mammograms for millions of women who currently can't get them, or insurance coverage of abortion. For advocates of women's health, that's a hellish choice. But by passing the reform bill now, and boldly forcing through abortion funding in the next budget, liberals could shift the painful choice to conservatives: outright use of your tax dollars to pay for millions of abortions each year, or statutory language allowing federally-administered insurance policies to contain the same reproductive health services that 90% of employer-provided policies do right now?

My guess is that, given the choice, conservatives would bow and the Stupak Amendment can be dead within a year -- again, long before health care reform even goes into effect. But to get there, Democrats need to be both savvy now, and gutsy later -- qualities that have been in short supply in both the White House and Senate. The question is whether they have the courage, discipline, and outside-the-box vision to do so.

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